Endocrine and GI Prep U
Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas? Biliary cirrhosis Postnecrotic cirrhosis Compensated cirrhosis Alcoholic cirrhosis
Alcoholic cirrhosis
What is a major concern for the nurse when caring for a patient with chronic pancreatitis? Pain Weight loss Nausea Mental status changes
Weight loss
Which nursing action is most appropriate for a client hospitalized with acute pancreatitis? Withholding all oral intake, as ordered, to decrease pancreatic secretions Administering meperedine, as ordered, to relieve severe pain Limiting I.V. fluids, as ordered, to decrease cardiac workload Keeping the client supine to increase comfort
Withholding all oral intake, as ordered, to decrease pancreatic secretions
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: an ectopic corticotropin-secreting tumor. adrenal carcinoma. a corticotropin-secreting pituitary adenoma. an inborn error of metabolism.
a corticotropin-secreting pituitary adenoma
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. The nurse understands that a likely cause of her symptoms is ________. Pancreatitis hepatitis A acute cholecystitis hepatitis B
acute cholecystitis
A client admitted for treatment of a gastric ulcer is being prepared for discharge on antacid therapy. Discharge teaching should include which instruction? "Continue to take antacids even if your symptoms subside." "You may take antacids with other medications." "Avoid taking antacids containing magnesium if you develop a heart problem." "Be sure to take antacids with meals."
"Continue to take antacids even if your symptoms subside." Rationale: Antacids decrease gastric acidity and should be continued even if the client's symptoms subside.
A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching? "I'll increase my intake of protein during exacerbations.". "I should increase my intake of fresh fruits and vegetables during remissions." "I'll incorporate foods rich in omega-3 fatty acids into my diet." "I'll snack on nuts, olives, and popcorn during flare-ups."
"I should increase my intake of fresh fruits and vegetables during remissions."
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? "I'm going to visit my pastor weekly for a while." "I will have to take vitamin B12 shots up to 1 year after surgery." "I will call my physician if I begin to have abdominal pain." "I will weight myself each day and record the weight."
"I will have to take vitamin B12 shots up to 1 year after surgery." Rationale: They are life long
A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns? "When your thyroid levels are stable, we won't have to draw your blood as often." "It's only a little stick. It'll be over before you know it." "The physician has ordered this test so you can get better sooner." "I'll stay here with you while the technician draws your blood."
"I'll stay here with you while the technician draws your blood."
A client with a peptic ulcer is diagnosed with Heliobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole (Flagyl), omeprazole (Prilosec), and clarithromycin (Biaxin). Which statement by the client indicates the best understanding of the medication regimen? "My ulcer will heal because these medications will kill the bacteria." "I should take these medications only when I have pain from my ulcer." "The medications will kill the bacteria and stop the acid production." "These medications will coat the ulcer and decrease the acid producation in my stomach."
"The medications will kill the bacteria and stop the acid production."
Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? 0.45% of NS D10W D5W 0.9% NS
0.9% NS
The nurse is assisting a patient to drain his continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve? 5 in 6 in 2 in 3 in
2 in
The severity of pancreatitis is directly proportional to the number of indicators present. A patient with five to six signs indicative of pancreatitis would have a __________% chance of mortality. 20% 40% 60% 80%
40%
A nurse is responsible for monitoring the diet of a patient with hepatic encephalopathy. The nurse knows that the 185-pound male should have a daily protein intake between __________ 34 and 100 grams 25 and 75 grams 17 and 50 grams 42 and 126 grams
42 and 126 grams
Which of the following clients is at highest risk for peptic ulcer disease? A 19-year-old female college student A 52-year-old male accountant A 31-year-old pregnant woman A 72-year-old grandfather of four
A 52-year-old male accountant Rationale: Peptic ulcer disease occurs with the greatest frequency in people 40 and 60 years old. It is uncommon in women of child bearing years
A nursing instructor is lecturing to a class about chronic pancreatitis. Which of the following does the instructor list as major causes? Malnutrition and acute pancreatitis Alcohol consumption and smoking Alcohol consumption and acute pancreatitis Acute pancreatitis and alcohol consumption
Alcohol consumption and smoking
After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? Abdominal surgery Volvulus Tumor intussusception
Abdominal surgery
After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: Mild. High-pitched. Hyperactive. Absent.
Absent
A patient tells the nurse that it feels like food is "sticking" in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate? Achalasia Diffuse spasm Gastroesophageal reflex disease Hiatal hernia
Achalasia Rationale:Achalasia is absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing. -not on test but other options are, know that they aren't correct
Following a thyroidectomy, a patient develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which of the following actions by the nurse is appropriate? Administer the sedative ordered. Administer the IV calcium gluconate ordered. Start administration of oxygen at 2 L/min per cannula. Administer the oral calcium supplement ordered.
Administer the IV calcium gluconate ordered.
An 87-year-old client is in the ICU where you practice nursing. He was admitted for critical care due to his esophageal varices and his precarious physical condition. Which of the following could result in causing his varices to hemorrhage? Little protective tissue to protect fragile veins Rough food Chemical irritation All options are correct.
All options are correct.
Clinical manifestations of common bile duct obstruction include all of the following except: Amber-colored urine Clay-colored feces Pruritus Jaundice
Amber-colored urine
A 50-year-old woman is brought into the ED with symptoms suggestive of peritonitis. Nursing management would include all of the following, except? Analgesics are limited to avoid the formation of paralytic ileus. Accurate recording of input and output Insertion of nasogastric tube Insertion of urinary retention catheter
Analgesics are limited to avoid the formation of paralytic ileus.
When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? Depression Mental confusion Angina Hypoglycemia
Angina
A patient presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate the area: Between the umbilicus and the left iliac crest. Between the umbilicus and the anterior superior iliac spine. In the left periumbilical area. In the upper right quadrant slightly below the diaphragm.
Between the umbilicus and the anterior superior iliac spine.
A patient who had developed jaundice 2 months previous is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this patient to have? Hypertension Bile-stained vomiting Warm, dry skin Weight loss
Bile-stained vomiting
A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? Blood supply to the stoma has been interrupted. An intestinal obstruction has occurred. This is a normal finding 1 day after surgery. The ostomy bag should be adjusted.
Blood supply to the stoma has been interrupted.
During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring? Infection Bowel perforation Colonic polyp Rectal fissure
Bowel perforation Rationale: Immediately after the test, the patient is monitored for signs and symptoms of bowel perforation (e.g., rectal bleeding, abdominal pain or distention, fever, focal peritoneal signs).
A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. A peanut butter sandwich and fruit cup Salami on whole grain bread and V-8 juice Broiled chicken with low-fiber pasta A fruit salad with yogurt
Broiled chicken with low-fiber pasta
When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following? Caput medusae Palmar erythema Cutaneous spider angiomata gynecomastia
Caput medusae
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. Sodium Calcium Potassium Magnesium
Calcium
When caring for a patient with advanced cirrhosis and hepatic encephalopathy, which of the following assessment findings should the nurse report immediately? Change in the patient's handwriting and or cognitive performance Weight loss of 2 pounds in 3 days Anorexia for more than 3 days Constipation for more than 2 days
Change in the patient's handwriting and or cognitive performance
Which foods should be avoided following acute gallbladder inflammation? Cooked fruits Cheese Coffee Mashed potatoes
Cheese
A client with gastric cancer is having a resection. What is the nursing management priority for this client? Discharge planning Correcting nutritional deficits Preventing deep vein thrombosis (DVT) Teaching about radiation treatment
Correcting nutritional deficits Rationale: Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority.
A nurse caring for a patient in a burn treatment center knows to assess for the presence of which of the following types of ulcer about 72 hours post injury? Peptic Cushing's Gastric Curling's
Curling's
A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? Instillation Gavage Lavage Decompression
Decompression
A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily. Discuss meals that include low-fat high-carbohydrate content. Discuss the importance of eliminating caffeine in the diet. Discuss meals that have a high-fiber, high-protein content.
Discuss meals that include low-fat high-carbohydrate content.
Clients with Type O blood are at higher risk for which of the following GI disorders? Gastric cancer Duodenal ulcers Esophageal varices Diverticulitis
Duodenal ulcers
The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? Duodenum Esophagus Pylorus Stomach
Duodenum
A patient receiving vasopressin for the management of active bleeding due to esophageal varices should be assessed for evidence of the drug's most serious complication. Therefore, the nurse should frequently check the patient's: Urinary output. Electrocardiogram. Electrolytes. Liver enzymes.
Electrocardiogram. Rationale: Vasopressin is administered during an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose patients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the patient for evidence of chest pain, ECG changes, and vital sign changes.
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? Colonoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Cholecystectomy Abdominal x-ray
Endoscopic retrograde cholangiopancreatography (ERCP)
A physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test
Endoscopy Rationale: Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained.
A patient with an ileostomy should avoid which of the following? Wax matrix coated products. Nonlayered tablets Enteric-coated products Antacids and antibiotics
Enteric-coated products
A patient underwent a continent ileostomy. Within which timeframe should the patient expect to empty the reservoir? At least once a day At least once every 2 days Three or four times daily Every 4 to 6 hours
Every 4 to 6 hours
The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery? High Fowler's Prone Supine with head of bed elevated 15 degrees Sims' left lateral
High Fowler's
A patient diagnosed with IBS is advised to eat a diet that is: Sodium-restricted. High in fiber. Low in residue. Restricted to 1,200 calories/day.
High in fiber. Rationale: A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.
A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? Increase respiratory effectiveness. Eliminate the need for nasogastric intubation. Improve nutritional status during recovery. Decrease the amount of postoperative analgesia needed.
Increase respiratory effectiveness.
A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? Fatigue Excess fluid volume Ineffective breathing pattern Imbalanced nutrition: Less than body requirements
Ineffective breathing pattern Rationale: Due to pressure in thoracic cavity
The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? (SATA) Decreased deep tendon reflexes Insomnia Agitation Alterations in mood Complaints of headache
Insomnia Agitation Alterations in mood
The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? Thyrotropin Iodine Thyroxine Calcitonin
Iodine
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. Jaundice Petechiae Ecchymoses Cyanosis of the lips Aphthous stomatitis
Jaundice Petechiae Ecchymoses
Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? (SATA) Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium) Famotidine (Pepcid) Nizatidine (Axid)
Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium) Rationale: PPI end in "azole"
A positive Rovsing's sign is indicative of appendicitis. A nurse knows to assess for this indicator by palpating the: Left lower quadrant Right lower quadrant Right upper quadrant Left upper quadrant
Left lower quadrant
Which of the following is the recommended dietary treatment for a client with chronic cholecystitis? High-fiber diet Low-protein diet Low-fat diet Low-residue diet
Low-fat diet
A nurse is planning care for a patient with acute pancreatitis. Which of the following patient outcomes does the nurse assign as the highest priority? Developing no acute complications from the pancreatitis Maintenance of normal respiratory function Maintaining satisfactory pain control Adequate fluid and electrolyte balance
Maintenance of normal respiratory function
A nurse is providing care to a client with primary hyperparathyroidism. Which of the following interventions would be included in the client's care plan? (SATA) Monitor gait, balance, and fatigue level with ambulation. Monitor for fluid overload. Monitor for signs and symptoms of diarrhea. Encourage intake of dairy products, seafood, nuts, broccoli, and spinach.
Monitor gait, balance, and fatigue level with ambulation. Monitor for fluid overload.
The nurse in the ED admits a patient with suspected gastric outlet obstruction. The patient's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which of the following orders? Pelvic x-ray Stool specimen Nasogastric (NG) tube insertion Oral contrast
Nasogastric (NG) tube insertion Rationale: The nurse anticipates an order for NG tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.
Which of the following is the most common symptom of gastrointestinal (GI) problems in general? Nausea Vomiting Dysphagia Odynophagia
Nausea
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? Normal activities may be resumed the day after surgery. Normal activities may be resumed in 1 week. Normal activities may be resumed in 2 weeks. Normal activities may be resumed in 1 month
Normal activities may be resumed in 1 week.
A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? Vitamin K Octreotide (Sandostatin) Vasopressin (Pitressin) Epinephrine
Octreotide (Sandostatin)
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? Methimazole PTU Potassium iodide SSKI
PTU
Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis? Shock Pancreatic necrosis MODS Tetany
Pancreatic necrosis
Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis? Shock Pancreatic necrosis Multiple organ dysfunction syndrome (MODS) Tetany
Pancreatic necrosis
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? Appendicitis Pancreatitis Cholecystitis Gastric ulcer
Pancreatitis
In actively bleeding patients with esophageal varices, the initial drug of therapy is usually: Sandostatin Inderal Pitressin Corgard
Pitressin
A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The doctor has ordered the "triple therapy" regimen. Which of the following is the correct representation of "triple therapy" refers? H2-receptor antagonist and two antibiotics H2-receptor antagonist, proton-pump inhibitor, and an antibiotic Proton-pump inhibitor, an antibiotic, and Pepto-Bismol Proton-pump inhibitor and two antibiotics
Proton-pump inhibitor and two antibiotics Rationale: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori bacteria -answer and rationale dont match but thats what it is on prep U
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? Related to bone demineralization resulting in pathologic fractures Related to exhaustion secondary to an accelerated metabolic rate Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces Related to tetany secondary to a decreased serum calcium level
Related to bone demineralization resulting in pathologic fractures
A nurse is teaching a patient about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the patient correctly identifies which of the following conditions as a cause of acute pancreatitis? Fibrosis and atrophy of the pancreatic gland Calcification of the pancreatic duct leading to its blockage Self-digestion of the pancreas by its own proteolytic enzymes Use of loop diuretics to increase the incidence of pancreatitis
Self-digestion of the pancreas by its own proteolytic enzymes
A patient comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out possible acute pancreatitis. The nurse would expect the diagnosis to be confirmed with which of the following elevated laboratory tests? Serum calcium Serum bilirubin Serum amylase Serum potassium
Serum amylase
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: Serum calcium Serum lipase Serum bilirubin Serum amylase
Serum lipase
A patient has been diagnosed with Zenker's diverticulum. What treatment does the nurse anticipate educating the patient about? A low-residue diet Chemotherapeutic agents Radiation therapy Surgical removal of the diverticulum
Surgical removal of the diverticulum Rationale: Because Zenker's diverticulum is progressive, the only means of cure is surgical removal of the diverticulum.
Which of the following diagnostic studies definitely confirms the presence of ascites? Ultrasound of liver and abdomen Abdominal x-ray Colonoscopy Computed tomography of abdomen
Ultrasound of liver and abdomen
The nurse is completing a morning assessment on a patient with cirrhosis. Which datum obtained by the nurse will be of most concern? The patient's skin on the abdomen has multiple spider-shaped blood vessels. The patient has gained 2 kg from the previous day. The patient complains of nausea and anorexia. The patient's hands flap back and forth when the arms are extended.
The patient's hands flap back and forth when the arms are extended. Rationale: This indicates hepatic encephalopathy
Total parental nutrition (TPN) should be used cautiously in patients with pancreatitis due to which of the following? They are at risk for gallbladder contraction. They are at risk for hepatic encephalopathy. They can digest high-fat foods. They cannot tolerate high-glucose concentration.
They cannot tolerate high-glucose concentration.
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication? Thyrotoxic crisis Myxedema coma Diabetes insipidus Syndrome of inappropriate antidiuretic hormone secretion
Thyrotoxic crisis
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? Indwelling urinary catheter kit Tracheostomy set Cardiac monitor Humidifier
Tracheostomy set
A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for? Transjugular intrahepatic portosystemic shunting (TIPS) Vasopressin (Pitressin) Sclerotherapy Balloon tamponade
Transjugular intrahepatic portosystemic shunting (TIPS)
The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy? Prone Supine Left-lateral Sims' Upright
Upright
A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? Monitor pulse oximetry every hour. Withhold analgesics unless necessary. Instruct the client to cough only when necessary. Use incentive spirometry every hour.
Use incentive spirometry every hour
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? Vomiting Watery diarrhea Ringing in the ears Asterixis
Watery diarrhea Rationale: Lactulose also works as a laxative
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? Weight loss, increased appetite, and hyperdefecation Weight loss, increased urination, and increased thirst Weight gain, decreased appetite, and constipation Weight gain, increased urination, and purplish-red striae
Weight gain, decreased appetite, and constipation
A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are: cryoprecipitate and fresh frozen plasma. fresh frozen plasma and whole blood. platelets and packed red blood cells. whole blood and albumin.
cryoprecipitate and fresh frozen plasma.
When evaluating a client for complications of acute pancreatitis, the nurse should observe for: increased intracranial pressure. decreased urine output. bradycardia. hypertension.
decreased urine output. Rationale: Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition.
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: wearing an appliance pouch only at bedtime. increasing fluid intake to prevent dehydration. consuming a low-protein, high-fiber diet. taking only enteric-coated medications.
increasing fluid intake to prevent dehydration.
A nurse is caring for a client who underwent a subtotal gastrectomy 24 hours ago. The client has a nasogastric (NG) tube. The nurse should: apply suction to the NG tube every hour. clamp the NG tube if the client complains of nausea. irrigate the NG tube gently with normal saline solution if ordered. reposition the NG tube if pulled out.
irrigate the NG tube gently with normal saline solution if ordered. Rationale: The nurse can gently irrigate the tube if ordered, but must be careful not to reposition it.
A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor: urine output. abdominal girth. stool frequency. level of consciousness (LOC).
level of consciousness (LOC). Rationale:In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function.
When planning care for a client with a small-bowel obstruction, the nurse should consider the primary goal to be: maintaining body weight. reestablishing a normal bowel pattern. reporting pain relief. maintaining fluid balance.
maintaining fluid balance.
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: elevated blood urea nitrogen and creatinine levels and hyperglycemia. subnormal clotting factors and platelet count. subnormal serum glucose and elevated serum ammonia levels. elevated liver enzymes and low serum protein level.
subnormal serum glucose and elevated serum ammonia levels.
Perforation of the appendix generally occurs within which timeframe of the onset of pain if no intervention is done? 24 hours 12 hours 36 hour 48 hours
24 hours
A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? Preparing to insert a nasogastric (NG) tube Administering pain medication Administering I.V. fluids Obtaining a blood sample for laboratory studies
Administering I.V. fluids
A patient complaining of shortness of breath is admitted with the diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? Temperature Albumin Hemoglobin Bilirubin
Albumin Rationale: With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity.
Management of a patient with ascites includes nutritional modifications and diuretic therapy. Which of the following interventions would a nurse expect to be part of patient care? (SATA) Aldactone, an aldosterone-blocking agent would be used. Zaroxolyn would be the thiazide diuretic of choice. A daily weight change of 0.5 pounds would require health care provider notification. Daily salt intake would be restricted to 2 grams or less. The diuretic will be held if the serum sodium level decreases to <134 m Eq/L.
Aldactone, an aldosterone-blocking agent would be used. Daily salt intake would be restricted to 2 grams or less. The diuretic will be held if the serum sodium level decreases to <134 m Eq/L.
Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? (SATA) Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. Avoid beer, especially in the evening. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows.
Avoid beer, especially in the evening. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows. Rationale: Milk should be avoided, as should eating before bed. Advise the patient not to eat or drink 2 hours before bedtime.
When caring for a client with cirrhosis, which of the following symptoms should a nurse report immediately? Select all that apply. Change in mental status Signs of GI bleeding Anorexia and dyspepsia Diarrhea or constipation
Change in mental status Signs of GI bleeding
A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? Discuss meals that include low-fat high-carbohydrate content. Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily. Discuss meals that have a high-fiber, high-protein content. Discuss the importance of eliminating caffeine in the diet.
Discuss meals that include low-fat high-carbohydrate content. Rationale:In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for carbohydrates and other energy sources for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein effectively
A patient receiving vasopressin for the management of active bleeding due to esophageal varices should be assessed for evidence of the drug's most serious complication. Therefore, the nurse should frequently check the patient's: Urinary output Liver enzymes Electrolytes ECG
ECG
As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene? Rejoice with the client. Notify the physician that the client is eager to sign the consent form. Evaluate the client's understanding of the procedure. Ask the client what her plans are after surgery.
Evaluate the client's understanding of the procedure. Rationale: The client may not understand that surgery alone isn't a cure for obesity; lifestyle modifications and counseling are also necessary.
A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has what type of potential side effect? Extrapyramidal Peptic ulcer disease Gastric slowing Nausea
Extrapyramidal Rationale: Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.
Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels? Frequent vomiting leading to loss of fluid volume Dry mouth, which makes the patient thirsty Acetone in the urine High glucose levels in the blood
Frequent vomiting leading to loss of fluid volume
A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? Helps the body adjust to stress Maintains blood pressure Slows the body's response to inflammation Regulates metabolism
Helps the body adjust to stress
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: Hemorrhage Intractable ulcer Perforation Pyloric obstruction
Hemorrhage
The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of: Kidney Stones Heart palpitations Bone fractures Gastric esophageal reflex
Kidney Stones
When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? The appendix may develop gangrene and rupture, especially in a middle-aged client. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? Rovsing's sign Referred pain Rebound pain Cremasteric reflex
Rovsing's sign
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? Treat the esophageal varices. Cure the cirrhosis. Reduce fluid accumulation and venous pressure. Promote optimal neurologic function.
Reduce fluid accumulation and venous pressure.
A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________. McBurney's sign; perforation McBurney's sign; acute appendicitis Rovsing's sign; acute appendicitis Rovsing's sign; perforation
Rovsing's sign; acute appendicitis
A patient is prescribed Sandostatin for the treatment of esophageal varices. The nurse knows that the purpose of this cyclic octapeptide is to reduce portal pressure by: Selective vasodilation of the portal system. Using a beta-adrenergic blocking action. Reducing blood pressure in the portal. Constricting the splanchnic arteries.
Selective vasodilation of the portal system.
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see? Serum potassium level of 6.8 mEq/L Blood urea nitrogen (BUN) level of 2.3 mg/dl Serum sodium level of 156 mEq/L Serum glucose level of 236 mg/dl
Serum potassium level of 6.8 mEq/L
The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? Dull pain, points to epigastric area Sharp, stabbing pain in the left lower quadrant of the abdomen Severe midabdominalto upper abdominal pain radiating to both sides and to the back Severe abdominal pain that radiates to the right shoulder
Severe midabdominal to upper abdominal pain radiating to both sides and to the back
The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? Sharp, stabbing pain in the left lower quadrant of the abdomen Severe midabdominal to upper abdominal pain radiating to both sides and to the back Severe abdominal pain that radiates to the right shoulder Dull pain, points to epigastric area
Severe midabdominal to upper abdominal pain radiating to both sides and to the back
Which of the following is the most common complaint(s) of patients with pancreatitis? Tarry-black stools and dark urine Increased and painful urination Increased appetite and weight gain Severe, radiating abdominal pain
Severe, radiating abdominal pain
A patient with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which of the following would be the most appropriate response from the nurse? You can use milk thistle instead of the medications you have been prescribed. Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated. You should not use herbal supplements in conjunction with medical treatment.
Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated.
A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication? Small bowel obstruction Pyelonephritis Megacolon Nephrolithiasis
Small bowel obstruction
A nurse is caring for a client in the emergency department who is complaining of severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value requires immediate intervention? Serum glucose level of 240 mg/dl White blood cell (WBC) count of 18,000 mm3 Troponin of 2.3 mcg/L Calcium level of 7.8 mg/dl
Troponin of 2.3 mcg/L Rationale: An elevated troponin level indicates myocardial damage and needs immediate further investigation.
The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption
Ulcerative colitis
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. The nurse understands that a likely cause of her symptoms is ________. hepatitis A hepatitis B acute cholecystitis pancreatitis
acute cholecystitis Rationale: Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders.
What is the most common cause of small-bowel obstruction? Neoplasms Hernias Volvulus adhesions
adhesions
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? Ammonia Calcium Bicarbonate alcohol
ammonia
The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department for chest pain. The client was diagnosed as having gastroesophageal reflux disease. The nurse notes in the client's record that the client is taking carbidopa/levodopa (Sinemet). The nurse questions the physician's order for a low-fat diet elevation of upper body on pillows pantaprazole metoclopramide
metoclopramide Rationale: The instructions are appropriate for the client experiencing gastroesophageal reflux disease. The client is prescribed carbidopa/levodopa, which is used for Parkinson's disease. Metoclopramide can have extrapyramidal effects, and these effects can be increased in clients with Parkinson's disease.
A nurse is caring for a client with acute pancreatitis. His physical examination reveals that he has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, his lab results indicate that he is hypovolemic. Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity? (SATA) Albumin Sodium Diuretics Dextrose solution
Albumin Diuretics
The nurse caring for a patient with diverticulitis is preparing to administer the patient's medications. The nurse anticipates administration of which category of medications due to the patient's diverticulitis? Anti-inflammatory Anti-anxiety Antiemetic Antispasmodic
Antispasmodic
The nurse is preparing a care plan for a patient with hepatic cirrhosis. Which of the following nursing diagnoses are appropriate? (SATA) Altered nutrition, more than body requirements, related to decreased activity and bed rest Disturbed body image related to changes in appearance, sexual dysfunction, and role function Urinary incontinence related to general debility and muscle wasting Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Risk for injury related to altered clotting mechanisms
Disturbed body image related to changes in appearance, sexual dysfunction, and role function Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Risk for injury related to altered clotting mechanisms
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? Creatinine Urobilinogen Chloride Albumin
Albumin Rationale: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder.
Which of the following interventions should be included in the plan of care for a patient who has undergone a cholecystectomy? Placing the patient on NPO status for 2 days following surgery Clamping the T-tube immediately after surgery Placing the patient in the semi-Fowler's position immediately following surgery Assessing the color of the sclera every shift
Assessing the color of the sclera every shift Rationale: Assess for jaundice
Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? Increased motor activity Asterixis Negative Babinski reflex Irritability
Asterixis
Which dietary modification is utilized for a patient diagnosed with acute pancreatitis? High-protein diet Elimination of coffee Low-carbohydrate diet High-fat diet
Elimination of coffee
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (SATA) Encouraging bed rest to decrease the metabolic rate Assisting the patient into the prone position Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered Administering prophylactic antibiotics
Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered
A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? Insulin Hydrocortisone Potassium Hypotonic saline
Hydrocortisone
The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly? Maintain intermittent or continuous suction at a rate greater than 120 mm Hg. Keep the vent lumen above the patient's waist to prevent gastric content reflux. Irrigate only through the vent lumen. Tape the tube to the head of the bed to avoid dislodgement.
Keep the vent lumen above the patient's waist to prevent gastric content reflux. Rationale: he blue vent lumen should be kept above the patient's waist to prevent reflux of gastric contents through it; otherwise, it acts as a siphon.
A nurse is providing education to a client with GERD. The client asks what measures she can institute on her own to help reduce her symptoms. Which of the following interventions would the nurse recommend? (SATA) Maintaining an upright position following meals Avoiding foods that intensify symptoms Sleeping in a supine position Ensuring intake of food and fluids 2 to 3 hours before bedtime
Maintaining an upright position following meals Avoiding foods that intensify symptoms
The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? (SATA) Melena Polyuria Bradycardia Tachypnea Thirst Mental confusion
Melena Tachypnea Thirst Mental confusion
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? Mental confusion Bradycardia Bradypnea Hypertension
Mental confusion
The nurse identifies a potential collaborative problem of electrolyte imbalance for a patient with severe acute pancreatitis. Which of the following assessment findings would alert the nurse to an electrolyte imbalance associated with acute pancreatitis? Paralytic ileus and abdominal distention Hypotension Muscle twitching and finger numbness Elevated blood glucose levels
Muscle twitching and finger numbness Rationale: Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate
The nurse is caring for a patient who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? Place the patient in a recumbent position with the legs elevated. Prepare a peripheral and central line for intravenous infusion. Assess vital signs. Call the physician.
Place the patient in a recumbent position with the legs elevated. Rationale: Treatment of hemorrhage includes complete rest for the GI tract, placing the client in a recumbent position with the legs elevated, blood transfusions, and gastric lavage with saline solution.
A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? Potassium chloride Normal saline solution Hydrocortisone (Cortef) Fludrocortisone (Florinef)
Potassium chloride
A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? Providing generous servings at mealtime Reserving an antecubital site for a peripherally inserted central catheter (PICC) Providing the client with plenty of P.O. fluids Limiting I.V. fluid intake according to the physician's order
Reserving an antecubital site for a peripherally inserted central catheter (PICC) Rationale: Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition.
Gynecomastia is a common side effect of which of the following diuretics? Spironolactone (Aldactone) Furosemide (Lasix) Vasopressin (Pitressin) Nitroglycerin (IV)
Spironolactone (Aldactone)
A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy? Stage 1 Stage 2 Stage 3 Stage 4
Stage 2
A nurse is doing her initial assessment on a client who had gastric bypass surgery the previous day. Which of the following would she expect to see when observing the client's nasogastric tube drainage? Yellow-green secretions Dark blood Red blood Clear mucous secretions
Yellow-green secretions Rationale: It is normal to observe a small amount of dark blood when the client first returns from the operating room, but then the drainage should promptly return to the yellow green of normal gastric secretions.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: hypotension. thick, coarse skin. deposits of adipose tissue in the trunk and dorsocervical area. weight gain in arms and legs.
deposits of adipose tissue in the trunk and dorsocervical area.
Halitosis and a sour taste in the mouth are clinical manifestations associated most directly with esophageal diverticula. achalasia. gastroesophageal reflux. hiatal hernia.
esophageal diverticula. Rationale: Because the diverticula may retain decomposed food, halitosis and a sour taste in the mouth are frequent complaints.
A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? Colonoscopy Barium enema Flexible sigmoidoscopy CT scan
Colonoscopy
The nurse is planning care for a patient following an incisional cholecystectomy for cholelithiasis. Which of the following interventions is the highest nursing priority for this patient? Assisting the patient to turn, cough, and deep breathe every 2 hours Teaching the patient to choose low-fat foods from the menu Performing range-of-motion (ROM) leg exercises hourly while the patient is awake Assisting the patient to ambulate the evening of the operative day
Assisting the patient to turn, cough, and deep breathe every 2 hours
The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the following measures to manage his disease? Minimize intake of caffeine, beer, milk, and foods containing peppermint and spearmint Avoid eating or drinking 2 hours before bedtime Elevate the foot of the bed on 6- to 8-inch blocks Eat a low carbohydrate diet
Avoid eating or drinking 2 hours before bedtime Rationale:The patient should not recline with a full stomach. The patient should be instructed to avoid the listed foods and food components. The patient should be instructed to elevate the head of the bed on 6- to 8-inch blocks. The patient is instructed to eat a low-fat diet.
A nurse working on a medical-surgical unit is caring for a client with Cushing's syndrome. After receiving repot, the nurse reads through the client's nursing diagnoses and prioritizes her interventions. Which of the following would the nurse not include in her plan of care? Provide a high-sodium diet. Examine extremities for pitting edema. Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. Administer prescribed diuretics.
Provide a high-sodium diet. Rationale: Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone, tight-fitting shoes or rings, the appearance of lines in the skin from stockings, and seams in the shoes or areas where they lace.
Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? Providing intensive insulin therapy Allowing a clear liquid diet during the acute phase Administering oral analgesics around the clock Maintaining a high-Fowler's position
Providing intensive insulin therapy
A patient with gastroesophageal reflux disease (GERD) comes to the physician's office with complaints of a burning sensation in the esophagus. The nurse documents that the patient is experiencing which of the following? Pyrosis Dyspepsia Dysphagia Odynophagia
Pyrosis
A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis? Presence of blood in the client's stool and recent hypertension Recent weight loss and temperature elevation Presence of easy bruising and bradycardia Adventitious breath sounds and hypertension
Recent weight loss and temperature elevation
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? Respiratory assessment related to increased thoracic pressure Urinary output related to increased sodium retention Peripheral vascular assessment related to immobility Skin assessment related to increase in bile salts
Respiratory assessment related to increased thoracic pressure
