Alterations in Bowel

When assessing a patient's abdomen, it would be most appropriate to A) Auscultate the abdomen before palpation. B) Palpate the abdomen before auscultation. C) Percuss the abdomen before auscultation. D) Perform deep palpation before light palpation.

a (During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.)

2. A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain? (select all that apply) a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

a, b, c, d, e (Rationale: All these conditions could cause acute abdominal pain.)

Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis? A) Administration of antibiotics B) Monitor for complications C) Preparation for lithotripsy D) Preparation for surgery

b (The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.)

An 80-year-old patient who is hospitalized with peptic ulcer diseaseevelops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? a. Sucralfate (Carafate) b. Aluminum hydroxide c. Omeprazole (Prilosec) d. Metoclopramide (Reglan)

d (Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids.)

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

a (A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat.)

When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? a. Blood glucose test b. Cardiac enzyme tests c. Postural blood pressures d. Resting electrocardiogram

a (A fasting blood glucose result greater than 100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome, but they may be used to check for cardiovascular complications of the disorder.)

Which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care? a. Administer IV fluids. b. Prepare for colonoscopy. c. Encourage a high-fiber diet. d. Give stool softeners and enemas.

a (A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.)

Which patient would the nurse assess first after receiving change-of-shift report? a. A patient with esophageal varices who has a rapid heart rate b. A patient with a history of gastrointestinal bleeding who has melena c. A patient with nausea who has a dose of metoclopramide (Reglan) due d. A patient who is crying after receiving a diagnosis of esophageal cancer

a (A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients require interventions, but their findings do not indicate acutely life-threatening complications.)

Which patient statement would indicate to the nurse that teaching after a laparoscopic cholecystectomy was effective? a. "I can take a shower and walk around the house tomorrow." b. "I need to limit my activities and not return to work for 4 weeks." c. "I can expect yellowish drainage from the incision for a few days." d. "I will follow a low-fat diet for life because I do not have a gallbladder."

a (After a laparoscopic cholecystectomy, patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.)

A patient with a new ileostomy asks how much it will drain after the bowel has adapted in a few months. How many cups of drainage per day would the nurse tell the patient to expect? a. 2 b. 3 c. 4 d. 5

a (After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.)

The client asks the nurse to recommend bulk-forming foods that may be included in the diet. Which of the following should be recommended by the nurse? A) Whole grains B) Fruit juice C) Rare meats D) Milk products

a (Bulk-forming foods, such as grains, fruits, and vegetables, absorb fluids and increase stool mass. Fruit juice is not a bulk-forming food. Rare meats are not bulk-forming foods. Milk products are not bulk-forming foods.)

Which diagnostic test would the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis? a. Endoscopy b. Angiography c. Barium studies d. Gastric analysis

a (Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.)

Which of the following dietary measures would be useful in preventing esophageal reflux? A) Eating small, frequent meals B) Increasing fluid intake C) Avoiding air swallowing with meals D) Adding a bedtime snack to the dietary plan

a (Esophageal reflux worsens when the stomach is over-distended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.)

The nurse is coaching a community group for persons who are overweight. Which participant behavior is an example of the best exercise plan for weight loss? a. Walking for 40 minutes 6 or 7 days/week b. Playing soccer for an hour on the weekend c. Running for 10 to 15 minutes 3 times/week d. Lifting weights for 2 hours with friends 1 time/week

a (Exercise should be at least 150 minutes of moderate-intensity aerobic activity (i.e., brisk walking) every week. Muscle-strengthening activities on 2 or more days a week is recommended. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but patients should start with an exercise that is less stressful and can be done for a longer period.)

The nurse is caring for a client following a BillrothII procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify? A) Irrigating the nasogastric tube B) Coughing a deep breathing exercises C) Leg exercises D) Early ambulation

a (In a Billroth II procedure the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.)

The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? A) Rovsing sign B) Referred pain C) Chvostek's sign D) Rebound tenderness

a (In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.)

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation? A) Maintain a high intake of fluid and fiber in the diet. B) Reduce intake of medications causing constipation. C) Eat several small meals per day to maintain bowel motility. D) Sit upright during meals to increase bowel motility by gravity.

a (Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility.)

Which information would the nurse teach patients about self-management after gastric bypass surgery? a. Drink fluids between meals but not with meals. b. Choose high-fat foods for at least 30% of intake. c. Developing flabby skin can be prevented by exercise. d. Choose foods high in fiber to promote bowel function.

a (Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.)

Which action would the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? a. Obtain a stool specimen for culture. b. Administer antidiarrheal medication. c. Provide teaching about antibiotic therapy. d. Teach the adverse effects of acetaminophen (Tylenol).

a (Patients with bloody diarrhea should have a stool culture for Escherichia coli O157:H7. Antidiarrheal medications are usually avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications. Acetaminophen does not cause bloody diarrhea.)

7. The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stools." c. "I may not need to wear a drainage pouch if I irrigate it daily." d. "Limiting my fluid intake should decrease the amount of output."

a (Rationale: Because ileostomy drainage is a liquid to thin paste, the patient will always need to wear a drainage bag . The patient should use an open-ended drainable pouch. It is worn for 4 to 7 days. Output from a sigmoid colostomy resembles normally formed stool. Some patients can regulate emptying time so they do not need to wear an ostomy pouch.)

4. Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."

a (Rationale: Patients who use an as-needed antacid should do so 1 to 3 hours after eating. Teach patients that the increased saliva production associated with chewing gum will help with GERD symptoms. The patient should not eat meals within 3 hours of bedtime. Some foods, such as red wine, decrease lower esophageal sphincter pressure and worsen symptoms. Milk increases gastric acid secretion. There is no need for the patient to limit protein intake.)

The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate? A) "The tube will help to drain the stomach contents and prevent further vomiting." B) "The tube will push past the area that is blocked, and thus help to stop the vomiting." C) "The tube is just a standard procedure before many types of surgery to the abdomen." D) "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."

a (The nasogastric tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting.)

A 40-yr-old woman who is obese reports that she wants to lose weight. Which question would the nurse ask first? a. "What factors led to your weight gain?" b. "Which types of food do you like best?" c. "How long have you been overweight?" d. "What physical activities do you enjoy?"

a (The nurse should obtain information about the patient's perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patient's beliefs are considered in planning.)

Which patient would the nurse assess first after receiving change-of-shift report? a. A 40-yr-old patient who has a distended abdomen and tachycardia b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours c. A 30-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

a (The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients would be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.)

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

a (There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort.)

5. The nurse performs an abdominal assessment of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.

a, b (Rationale: With lower intestinal obstructions, abdominal distention is markedly increased, and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually obstipation, not diarrhea.)

Which criteria must be met for a diagnosis of metabolic syndrome? (select all that apply) a. Hypertension b. High triglycerides c. Elevated plasma glucose d. Increased waist circumference e. Decreased low-density lipoproteins

a, b, c, d (Rationale: Three of the following 5 criteria must be met for a diagnosis of metabolic syndrome: • Waist circumference of 40 inches or more in men and 35 inches or more in women • Triglyceride levels higher than 150 mg/dL or need for drug treatment for high triglyceride levels • High-density lipoprotein (HDL) cholesterol levels lower than 40 mg/dL in men and lower than 50 mg/dL in women or need for drug treatment for reduced HDL cholesterol levels • Blood pressure: 130 mm Hg or higher systolic or 85 mm Hg or higher diastolic, or need for drug treatment for hypertension • Fasting blood glucose level of 100 mg/dL or higher, or need for drug treatment for elevated glucose levels)

A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain? (select all that apply) a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

a, b, c, d, e (Rationale: All these conditions could cause acute abdominal pain.)

3. Assessment findings suggestive of peritonitis include (select all that apply) a. abdominal pain. b. rebound tenderness. c. a soft, distended abdomen. d. shallow respirations with bradypnea. e. observing that the patient is lying still.

a, b, e (Rationale: With peritoneal irritation, the abdomen is hard, and the patient has severe continuous abdominal pain that is worse with any sudden movement. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness. The patient lies very still and takes shallow breaths. Abdominal distention, tachypnea, fever, and tachycardia may occur.)

Health risks associated with obesity include (select all that apply) a. colorectal cancer. b. rheumatoid arthritis. c. polycystic ovary syndrome. d. nonalcoholic steatohepatitis. e. systemic lupus erythematosus.

a, c, d (Rationale: Health risks associated with obesity include cardiovascular disease, hypertension, sleep apnea, type 2 diabetes, osteoarthritis, gout, gastroesophageal reflux disease, gallstones, nonalcoholic steatohepatitis, fatty liver and cirrhosis, and breast, endometrial, kidney, colorectal, pancreas, esophagus, and gallbladder cancers.)

A 61-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 4:00 am. The nurse shares in the morning report that the day shift staff should check the tube for patency at which of the following times? A) 7:00 am, 10:00 am, and 1:00 pm B) 8:00 am and 12:00 pm C) 9:00 am and 3:00 pm D) 9:00 am, 12:00 pm, and 3:00 pm

b (A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 am, it would be due to be checked at 8:00 am and 12:00 pm.)

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to assistive personnel (AP)? a. Auscultating for bowel sounds b. Brushing the teeth and tongue c. Assessing the nares for irritation d. Irrigating the nasogastric (NG) tube

b (AP education and scope of practice include patient hygiene such as oral care. The other actions require education and scope of practice appropriate to the RN.)

The nurse is admitting a patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you drink?" b. "Have you had a recent weight loss?" c. "What time of day do your bowels move?" d. "Do you eat meat or other animal products?"

b (Although all the questions provide useful information, it is most important to determine if the patient has an imbalance in nutrition because of the steatorrhea.)

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which action would the nurse take? a. Administer morphine sulfate. b. Encourage the patient to ambulate. c. Offer the prescribed promethazine. d. Instill a mineral oil retention enema.

b (Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention.)

Which of the following tests is most commonly used to diagnose cholecystitis? A) Abdominal CT scan B) Abdominal ultrasound C) Barium swallow D) Endoscopy

b (An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn't necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.)

Which screening test would the nurse plan to teach a 45-yr-old male about during an annual wellness exam? a. Endoscopy b. Colonoscopy c. Computerized tomography d. Carcinoembryonic antigen (CEA)

b (At age 45 years, persons with an average risk for colorectal cancer (CRC) would begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 45 years.)

A 32 year old client is admitted to the hospital with a BMI of 24.7. The nurse interprets this to mean the client: A) Is undernourished B) Has an optimal amount of body fat C) Is 10% overweight D) Is morbidly obese

b (BMI is an estimation of total body fat in relation to height and weight. An optimal BMI is 20-25.)

Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider? a. The patient has frequent liquid stools. b. The patient is pale and has many bruises. c. The patient feels very bloated after meals. d. The patient is having a weight loss plateau.

b (Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are expected during weight reduction.)

Which action would the nurse take when coaching adults who are obese in a behavior therapy program? a. Having the adults write down the caloric intake of each meal b. Asking the adults about situations that tend to increase appetite c. Suggesting that the adults plan rewards such as sugarless candy for achieving their goals d. Encouraging the adults to eat small amounts frequently rather than having

b (Behavior therapy programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior therapy.)

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? A) Ineffective coping related to fear of diagnosis of chronic illness B) Deficient knowledge related to unfamiliarity with significant signs and symptoms C) Constipation related to decreased gastric motility D) Imbalanced nutrition: Less than body requirements due to gastric bleeding

b (Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their physician.)

Which information will the nurse prioritize in planning preoperative education for a patient undergoing a Roux-en-Y gastric bypass? a. Explaining the nasogastric (NG) tube to the patient b. Teaching the patient coughing and breathing techniques c. Discussing necessary postoperative modifications in lifestyle d. Demonstrating passive range-of-motion exercises for the legs

b (Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.)

Which assessment action would help the nurse determine if an obese patient has metabolic syndrome? a. Take the patient's apical pulse. b. Check the patient's blood pressure. c. Ask the patient about dietary intake. d. Dipstick the patient's urine for protein.

b (Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information will not assist with the diagnosis of metabolic syndrome.)

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a. "Peppermint tea may reduce your symptoms." b. "Keep the head of your bed elevated on blocks." c. "Avoid eating between meals to reduce acid secretion." d. "Vigorous exercise may increase the incidence of reflux."

b (Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.)

Which nursing action would be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? a. Reposition the NG tube if drainage stops. b. Elevate the head of the bed to at least 30 degrees. c. Start oral fluids when the patient has active bowel sounds. d. Notify the doctor for any bloody nasogastric (NG) drainage.

b (Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube would not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.)

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." Which action would the nurse take? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Postpone any teaching until the patient adjusts to the ileostomy. d. Develop a detailed written list of ostomy care tasks for the patient.

b (Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching could be postponed, the nurse should begin to offer teaching about some aspects of living with an ostomy.)

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of famotidine (Pepcid)? a. "Famotidine absorbs the excess gastric acid." b. "Famotidine decreases gastric acid secretion." c. "Famotidine constricts the blood vessels near the ulcer." d. "Famotidine covers the ulcer with a protective material."

b (Famotidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. Famotidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer.)

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks about the purpose of receiving famotidine (Pepcid). Which information would the nurse explain about the action of the medication? a. "It decreases nausea and vomiting." b. "It inhibits development of stress ulcers." c. "It lowers the risk for H. pylori infection" d. "It prevents aspiration of gastric contents"

b (Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.)

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 ml of green-brown drainage. Which nursing intervention is most appropriate? A) Notify the physician B) Document the findings C) Irrigate the T-tube D) Clamp the T-tube

b (Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to green-brown. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 ml per day. The nurse would document the output.)

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD? a. "I quit smoking years ago, but I chew gum." b. "I eat small meals and have a bedtime snack." c. "I take antacids between meals and at bedtime each night." d. "I sleep with the head of the bed elevated on 4-inch blocks."

b (GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of the bed are appropriate actions to control symptoms of GERD.)

A client is to receive gavage feeding through a nasogastric (NG) tube. Which of the following actions should be instituted to prevent complications? A) Flush with 20mL of air B) Place client in high Fowler's position C) Advance tube 1 cm D) Plug the air vent during feeding

b (Keeping the client in a high Fowler's position minimizes the risk of aspiration.)

Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet? a. "It will be necessary to change lifestyle habits permanently to maintain weight loss." b. "You are likely to notice changes in how you feel after a few weeks of diet and exercise." c. "You will decrease your risk for future health problems such as diabetes by losing weight now." d. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat."

b (Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. Future health problems are unlikely to motivate a 22-yr-old patient. Telling a patient that the initial weight loss is water would be discouraging, although this may be correct. Changing lifestyle habits permanently is recommended, but this process occurs over time, and discussing this is not likely to motivate the patient.)

After change-of-shift report, which patient would the nurse assess first? a. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea b. A 30-yr-old female patient hernia who has abdominal pain and vomiting c. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown d. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer

b (Pain and vomiting with a femoral hernia suggest strangulation, which will require emergency surgery. All the other patients require assessment or care but have less urgent problems.)

A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A) Cancer of the stomach B) Peptic ulcer disease C) Chronic gastritis D) Pylorospasm

b (Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer would not evidence pain or vomiting unless the pylorus was obstructed.)

Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease? A) Neutralize acid B) Reduce acid secretions C) Stimulate gastrin release D) Protect the mucosal barrier

b (Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.)

8. In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. usually develops peritonitis. d. has localized cramping pain.

b (Rationale: Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.)

A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patients oral temperature. d. Obtain information about the accident.

b (Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.)

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis? a. The patient's urine is bright yellow. b. The patient's stools are tan colored. c. The patient reports chronic heartburn d. The patient has increased pain after eating.

b (Tan or gray stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, and would be reported but do not require urgent intervention.)

Which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD)? a. "You will need to remain on a bland diet." b. "Avoid foods that cause pain after you eat them." c. "High-protein foods are least likely to cause pain." d. "You should avoid eating raw fruits and vegetables."

b (The best information is that each person should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients tolerate these healthy foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their ongoing use.)

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? a. The bowel sounds are hyperactive in all four quadrants. b. The patient's lungs have crackles audible to the midchest. c. The nasogastric (NG) suction is returning coffee-ground material. d. The patient's blood pressure (BP) has increased to 142/84 mm Hg.

b (The patient's lung sounds indicate that pulmonary edema may be developing because of the rapid infusion of IV fluid and that the fluid infusion rate would be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding.)

A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action would the nurse take? a. Irrigate the NG tube. b. Check the vital signs. c. Give the ordered antacid. d. Elevate the foot of the bed.

b (The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.)

Which of the following assessments is essential for the nurse to make when caring for a client who has just had an esophagogastroduodenoscopy (EGD)? A) Auscultate bowel sounds B) Check gag reflex C) Monitor gastric pH D) Measure abdominal girth

b (The posterior pharynx is anesthetized for the easy passage of the endoscope into the esophagus. The return of the gag reflex indicates that normal function is returning and that your patient is able to swallow.)

Which adult would the nurse plan to teach about risks associated with obesity? a. Man who has a BMI of 18 kg/m2 b. Man with a 42 inch waist and 44 inch hips c. Woman who has a body mass index (BMI) of 24 kg/m2 d. Woman with a waist circumference of 34 inches (86 cm)

b (The waist-to-hip ratio for this patient with a 42 inch waist and 44 inch hips is 0.95, which exceeds the recommended level of less than 0.80. A patient with a BMI of 18 kg/m2 is considered underweight. A BMI of 24 kg/m2 is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm).)

After the nurse teaches about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the patient understands the diet instructions? a. 3 oz of lean beef, 2 oz of low-fat cheese, and a sliced tomato b. 3 oz of roasted pork, a cup of broccoli, and a cup of carrot sticks c. Cup of tossed salad and nonfat dressing topped with a chicken breast d. Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery

b (This selection is most consistent with the recommendations to limit foods from animal sources and increase plant source foods. The other choices all have higher ratios of animal origin foods to plant source foods than would be recommended.)

After bariatric surgery, a patient who is being discharged tells the nurse, "I prefer to be independent. I am not interested in any support groups." Which initial response would the nurse provide? a. "I hope you change your mind so that I can suggest a group for you." b. "Tell me what types of resources you think you might use after this surgery." c. "Support groups have been found to lead to more successful weight loss after surgery." d. "Because there are many lifestyle changes after surgery, we recommend support groups."

b (This statement allows the nurse to assess the individual patient's potential needs and preferences. The other statements offer the patient more information about the benefits of support groups but do not acknowledge the patient's preferences.)

Which information in this male patient's electronic health record as shown in the accompanying figure will the nurse use to confirm that the patient has metabolic syndrome? (Select all that apply.) a. Weight b. Waist size c. Blood glucose d. Blood pressure e. Triglyceride level f. Total cholesterol level

b, c (The patient's waist circumference, high-density lipoprotein level, and fasting blood glucose level indicate that he has metabolic syndrome. The other data are not used in making a metabolic syndrome diagnosis or do not meet the criteria for this diagnosis.)

A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

c (A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms.)

After change-of-shift report, which patient would the nurse assess first? a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy

c (A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.)

A patient is being admitted for bariatric surgery. Which nursing action can the nurse delegate to assistive personnel (AP)? a. Demonstrate use of the incentive spirometer. b. Plan methods for turning the patient after surgery. c. Assist with IV insertion by holding adipose tissue out of the way. d. Develop strategies to provide privacy and decrease embarrassment.

c (AP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require registered nurse (RN)-level education and scope of practice.)

When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A) Assisting in inserting a Miller-Abbott tube B) Assisting in inserting an arterial pressure line C) Inserting a nasogastric tube D) Inserting an I.V.

c (An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (A) is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line (B) is not appropriate at this time and an IV (D) is optional.)

A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine? a. Apical pulse b. Bowel sounds c. Breath sounds d. Abdominal girth

c (Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.)

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Send the patient for a CT scan. b. Insert a urinary catheter to drainage. c. Infuse metronidazole (Flagyl) 500 mg IV. d. Place a nasogastric tube to intermittent low suction.

c (Because peritonitis can be fatal if treatment is delayed, the initial action would be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated.)

To evaluate an obese patient for adverse effects of Plenity, which action will the nurse take? a. Measure the apical pulse. b. Check sclera for jaundice. c. Ask about bowel movements. d. Assess for agitation or restlessness.

c (Constipation is a common side effect of Plenity, a gel substance taken to increase the volume of stomach and small intestine contents and induce satiety. The other assessments would be appropriate for other weight-loss medications.)

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? a. The patient reports 7/10 (0 to 10 scale) abdominal pain. b. The patient is experiencing intermittent waves of nausea. c. The patient has no breath sounds in the left anterior chest. d. The patient has hypoactive bowel sounds in all four quadrants.

c (Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The nausea and abdominal pain would be addressed, but they are not as high priority as the patient's respiratory status. Decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.)

39. Which activity in the care of a patient with a new colostomy could the nurse delegate to assistive personnel (AP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown.

c (Draining and measuring the output from the ostomy is included in AP education and scope of practice. The other actions should be implemented by LPNs or RNs.)

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a. Chocolate pudding b. Glass of low-fat milk c. Cherry gelatin with fruit d. Peanut butter and jelly sandwich

c (Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.)

A patient had an incisional cholecystectomy 6 hours ago. Which action would the nurse identify as the highest priority for the patient to accomplish? a. Perform leg exercises hourly while awake. b. Ambulate the evening of the operative day. c. Turn, cough, and deep breathe every 2 hours. d. Choose preferred low-fat foods from the menu.

c (Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions are also important to implement but are not as high a priority as ensuring adequate ventilation.)

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? A) Before meals B) With meals C) At bedtime D) When pain occurs

c (Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.)

A patient with extreme obesity has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse expects that the patient a. may have severe diarrhea early in the postoperative period. b. will not be allowed to ambulate for 1 to 2 days postoperatively. c. will have small amounts of oral liquids within the first 24 hours. d. will require nasogastric suction until the drainage is pale yellow.

c (Rationale: A low-sugar, clear-liquid diet is usually started within 24 hours after surgery. Begin with 15-mL increments every 10 to 15 minutes. If the patient does not have any nausea or other problems, gradually increase intake to a goal of 90 mL every 30 minutes.)

7. Which finding can indicate gallstones and gallbladder obstruction? a. Dark colored stools b. Pain in the left lower abdomen c. Referred pain to the right shoulder d. Improved symptoms with high-fat meals

c (Rationale: Patients with gallstones and gallbladder obstruction may experience referred pain to the right shoulder and scapula. Clay-colored stools, pain in the right upper quadrant, and exacerbation of pain after consuming high fat foods may also be seen.)

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. Which action would the nurse take first? a. Auscultate for hypotonic bowel sounds. b. Notify the patients health care provider. c. Check for tube placement and reposition it d. Remove the tube and replace it with a new one.

c (Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded.)

A patient has peptic ulcer disease associated with Helicobacter pylori. Which medications will the nurse plan to teach the patient? a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) b. Metoclopramide (Reglan), bethanechol, and promethazine c. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole

c (The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.)

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. Which action would the nurse take during the initial assessment of the patient? a. Remove the knife and assess the wound. b. Determine the presence of Rovsing sign. c. Check for circulation and tissue perfusion. d. Insert a urinary catheter and assess for hematuria.

c (The initial assessment is focused on determining whether the patient has hypovolemic shock. The knife should not be removed until the patient is in surgery, where bleeding can be controlled. Rovsing sign is assessed in the patient with suspected appendicitis. Assessment for bladder trauma is not part of the initial assessment)

After successfully losing a pound per week for several months, a patient at the clinic has not lost any weight for the past month. Which action should the nurse take first? a. Review the diet and exercise guidelines with the patient. b. Instruct the patient to weigh and record weights weekly. c. Ask the patient whether there have been any changes in exercise or diet patterns. d. Discuss the possibility that the patient has reached a temporary weight loss plateau.

c (The initial nursing action should be assessment of reasons for weight stability. The other actions may be needed, but further assessment is required before any interventions are planned or implemented.)

Which action would the nurse in the emergency department take first for a patient who arrives vomiting blood? a. Insert a large-gauge IV catheter. b. Draw blood for coagulation studies. c. Check blood pressure and heart rate. d. Place the patient in the supine position.

c (The nurse's first action would be to determine the patient's hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter are also appropriate. However, the vital signs may indicate the need for more urgent actions. Because aspiration is a concern for this patient, the nurse will need to assess the patient's vital signs and neurologic status before placing the patient in a supine position.)

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action would the nurse take? a. Assist the patient to cough and deep breathe. b. Palpate the abdomen for rebound tenderness. c. Suggest the patient lie on the side, flexing the right leg. d. Encourage the patient to sip clear, noncarbonated liquids.

c (The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.)

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102F (38.3C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention would the nurse implement first? a. Administer IV ketorolac 15 mg for pain relief. b. Send a blood sample for a complete blood count (CBC). c. Infuse a liter of lactated Ringer's solution over 30 minutes. d. Send the patient for an abdominal computed tomography (CT) scan.

c (The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.)

Which information will the nurse include in teaching for a 35-yr-old woman who is overweight and starting a weight-loss plan? a. Weigh yourself at the same time every morning and evening. b. Stick to a 600- to 800-calorie diet for the most rapid weight loss. c. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. d. Weighing all foods on a scale is necessary to choose appropriate portion sizes.

c (The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category and need to be closely supervised. Patients should weigh weekly rather than daily.)

The nurse is caring for a patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the provider? a. Bilateral crackles audible at both lung bases b. Redness, irritation, and skin breakdown in skinfolds c. Emesis of bile-colored fluid past the nasogastric (NG) tube d. Use of patient-controlled analgesia (PCA) several times an hour for pain

c (Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the provider to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the provider. Frequent PCA use after bariatric surgery is expected.)

9. The discharge teaching plan for the patient after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) a. limiting alcohol intake to 1 serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.

c, d (Rationale: Before discharge, teach the patient with upper gastrointestinal (GI) bleeding and the caregiver how to avoid future bleeding episodes. Drug and alcohol use can be a source of irritation and interfere with tissue repair. Their use should be eliminated. Help make the patient and caregiver aware of the consequences of nonadherence with drug therapy. Emphasize not to take any drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the HCP. Taking drugs with meals may decrease irritation.)

A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? a. Soak in sitz bath several times each day b. Cough 5 times each hour for the next 48 hours. c. Avoid using acetaminophen (Tylenol) for pain. d. Apply a scrotal support and ice to reduce swelling.

d (A scrotal support and ice are used to reduce edema and pain. Coughing will increase pressure on the incision. Sitz baths will not relieve pain and would not be of use after this surgery. Acetaminophen can be used for postoperative pain.)

Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction? a. Referred back pain b. Metabolic alkalosis c. Projectile vomiting d. Abdominal distention

d (Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.)

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? A) "I should take my antacid before I take my other medications." B) "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." C) "My antacid will be most effective if I take it whenever I experience stomach pains." D) "It is best for me to take my antacid 1 to 3 hours after meals."

d (Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.)

Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn? a. Radionuclide tests b. Barium swallow exam c. Endoscopy procedures d. Proton pump inhibitors

d (Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.)

The client with GERD complains of a chronic cough. The nurse understands that for a client with GERD this symptom may be indicative of which of the following conditions? A) Development of laryngeal cancer B) Irritation of the esophagus C) Esophageal scar tissue formation D) Aspiration of gastric contents

d (Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.)

A client being treated for chronic cholecystitis should be given which of the following instructions? A) Increase rest B) Avoid antacids C) Increase protein in diet D) Use anticholinergics as prescribed

d (Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.)

The nurse is caring for a 68-year-old patient admitted with recent onset of abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? A) Low pitched and rumbling above the area of obstruction B) High pitched and hypoactive below the area of obstruction C) Low pitched and hyperactive below the area of obstruction D) High pitched and hyperactive above the area of obstruction

d (Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.)

A patient who takes a nonsteroidal anti-inflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What would the nurse anticipate teaching the patient? a. Substitution of acetaminophen (Tylenol) for the NSAID b. Use of enteric-coated NSAIDs to reduce gastric irritation c. Reasons for using corticosteroids to treat the rheumatoid arthritis d. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

d (Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis.)

After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action would be included in the postoperative plan of care? a. Offer sips of fruit juices at frequent intervals. b. Irrigate the nasogastric (NG) tube frequently. c. Remind the patient that PCA use may slow the return of bowel function. d. Support the surgical incision during patient coughing and turning in bed.

d (Protecting the incision from strain decreases the risk for wound dehiscence. The patient should be encouraged to use the PCA because pain control will improve the cough effort and patient mobility. NG irrigation may damage the suture line or overfill the stomach pouch. Sugar-free clear liquids are offered during the immediate postoperative time to decrease the risk for dumping syndrome.)

The obesity classification that is most often associated with cardiovascular health problems is a. primary obesity. b. secondary obesity. c. gynoid fat distribution. d. android fat distribution.

d (Rationale: A person with fat primarily in the abdominal area (i.e., whose body is apple shaped) is at greater risk for obesity-related complications (e.g., heart disease) than is a person whose fat is primarily in the upper legs (i.e., whose body is pear shaped). Those whose fat is distributed over the abdomen and upper body (i.e., neck, arms, and shoulders) are classified as having android obesity.)

The best nutrition therapy plan for a person who is obese a. is high in animal protein. b. is fat-free and low in carbohydrates. c. restricts intake to under 800 calories per day. d. lowers calories with foods from all the basic groups.

d (Rationale: Lower caloric intake is a cornerstone for any weight loss or maintenance program. A good weight loss plan should include foods from the 4 basic food groups and be nutritionally sound.)

Discharge teaching for the patient who underwent laparoscopic cholecystectomy should include the need to a. abstain from alcohol. b. avoid eating low-fat meals. c. obtain hepatitis A vaccine. d. call if there are changes in stool or urine color.

d (Rationale: Patients should be taught to assess for signs or symptoms of obstruction, which include stool and urine changes.)

7. The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that cause oversecretion of acid, such as excess diet fats, smoking, and alcohol use. d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.

d (Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) is not necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and decaffeinated) is a strong stimulant of gastric acid secretion.)

9. A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is to a. maintain the patient on bedrest. b. allow the patient to stand to void. c. support the incision during coughing. d. apply a scrotal support with an ice bag.

d (Rationale: Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.)

Which statement best describes the cause of obesity? a. Obesity primarily results from a genetic predisposition. b. Psychosocial factors can override the effects of genetics in causing obesity. c. Genetic factors are more important than environmental factors in causing obesity. d. Obesity is the result of complex interactions between genetic and environmental factors.

d (Rationale: The cause of obesity involves significant genetic and biologic susceptibility factors that are highly influenced by environmental and psychosocial factors.)

This bariatric surgical procedure involves creating a gastric pouch that is reversible, and no malabsorption occurs. Which procedure is this? a. Vertical gastric banding b. Biliopancreatic diversion c. Roux-en-Y gastric bypass d. adjustable gastric banding

d (Rationale: With adjustable gastric banding (AGB), the stomach size is limited by an inflatable band placed around the fundus of the stomach. The band is connected to a subcutaneous port and can be inflated or deflated to change the stoma size to meet the patient's needs as weight is lost. The procedure is done laparoscopically and, if needed, can be modified or reversed after the first procedure.)

Four months after bariatric surgery, a patient tells the nurse, "My skin is hanging off me. I think I might want to surgery to remove the skinfolds." Which response would the nurse provide? a. "The important thing now is that you are improving your health." b. "The skinfolds show everyone how much weight you have lost." c. "Perhaps you should talk to a counselor about your body image." d. "Cosmetic surgery may be possible once your weight has stabilized."

d (Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. The responses, "The important thing is that your weight loss is improving your health," and "The skinfolds show everyone how much weight you have lost," ignore the patient's concerns about appearance and implies that the nurse knows what is important. It may be helpful for the patient to talk to a counselor; however, there is no indication given that the concern about skinfolds is dysfunctional.)

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. Which medication schedule would the nurse teach the patient? a. Sucralfate at bedtime and antacids before each meal b. Sucralfate and antacids together 0 minutes before meals c. Antacids 30 minutes before each dose of sucralfate is taken d. Antacids after meals and sucralfate 30 minutes before meals

d (Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.)

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid-epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following? A) An intestinal obstruction has developed B) Additional ulcers have developed C) The esophagus has become inflamed D) The ulcer has perforated

d (The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in board-like muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause mid-epigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid, board-like abdomen.)

Which assessment would the nurse perform first for a patient who just vomited bright red blood? a. Measuring the quantity of emesis b. Palpating the abdomen for distention c. Auscultating the chest for breath sounds d. Taking the blood pressure (BP) and pulse

d (The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.)

How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn? a. "It reduces gastroesophageal reflux by increasing the rate of gastric emptying." b. "It neutralizes stomach acid and provides relief of symptoms in a few minutes." c. "It coats and protects the lining of the stomach and esophagus from gastric acid." d. "It treats gastroesophageal reflux disease by decreasing stomach acid production."

d (The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.)

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. Which action would the nurse take? a. Place ice packs around the stoma. b. Notify the surgeon about the stoma. c. Monitor the stoma every 30 minutes. d. Document stoma assessment findings.

d (The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery. An ice pack is not needed.)