Evolve: GI

A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care? 1 Empty feeding bag stays attached to the tubing. 2 Tube is flushed with air after medication is given. 3 Replacement of the tube is done on a weekly basis. 4 Head of the bed remains elevated after the feeding.

4 Head of the bed remains elevated after the feeding.

Ranitidine (Zantac) has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by: 1 Lowering the gastric pH 2 Promoting the release of gastrin 3 Regenerating the gastric mucosa 4 Inhibiting the histamine H2 receptors

4 Inhibiting the histamine H2 receptors Ranitidine inhibits histamine at H2 receptor sites in parietal cells, which limits gastric secretion. Lowering the gastric pH is not the direct action of this drug; it eventually will raise the pH. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the drug prevents its erosion by gastric secretions.

A client is admitted with a diagnosis of cancer of the colon. What information about malignant tumors of the colon should the nurse consider when caring for this client? 1 They are detected easily. 2 They usually are localized. 3 Women are more at risk than men. 4 Intestinal obstructions usually are malignant

4 Intestinal obstructions usually are malignant Mechanical obstruction most often is caused by obliteration of the lumen of the intestine by malignant cells. In the early stages, symptoms of cancer of the colon are vague or absent. Localized tumors usually are benign. Cancer of the lower bowel is more common in men than in women; however, the incidence is increasing in women.

A nurse is assisting a health care provider to perform a sigmoidoscopy. In which position should the nurse place the client for this procedure? 1 Sims 2 Prone 3 Lithotomy 4 Knee-chest

4 Knee-chest Knee-chest position maximally exposes the rectal area and facilitates entry of the sigmoidoscope . The Sims position does not expose the rectal area to the same extent as does the knee-chest position; it can be used for a sigmoidoscopy if a client is unable to maintain the knee-chest position. Although prone refers to a facedown position, the rectal area is not exposed. The lithotomy position is appropriate for gynecological examinations.

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium (Colace) daily. Before discharge, the nurse teaches the client that an intermittent side effect of this medication may be: 1 Rectal bleeding 2 Fecal impaction 3 Nausea and vomiting 4 Mild abdominal cramping

4 Mild abdominal cramping

A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome? 1 Constipation 2 Clay-colored stools 3 Sensations of hunger 4 Reactive hypoglycemia

4 Reactive hypoglycemia

A client is admitted to the hospital with a diagnosis of intestinal obstruction. The health care provider prescribes intestinal suction via a nasoenteric decompression tube. The loss of which constituents associated with intestinal suctioning is most important to consider when caring for this client? 1 Protein enzymes 2 Energy carbohydrates 3 Vitamins and minerals 4 Water and electrolytes

4 Water and electrolytes

A client had an abdominal cholecystectomy. Postoperatively, the client refuses to deep breathe and cough, saying, "It's too painful." The nurse should: 1 Give pain medication regularly as soon as possible 2 Obtain a prescription to increase the client's pain medication 3 Medicate the client for pain before coughing and deep breathing 4 Substitute incentive spirometry for coughing and deep breathing

Correct3 Medicate the client for pain before coughing and deep breathing

A nurse is assessing a client who has possible appendicitis. The nurse assesses the client for rebound tenderness. Mark where the client is expected to report pain.

McBurney's point is located in the right lower quadrant of the abdomen over the appendix. This point is one third of the distance from the anterior iliac spine to the umbilicus; rebound tenderness in this area may indicate appendicitis.

The nurse teaches the client with gastroesophageal reflux disease that after meals the client should: 1 Drink 8 ounces of water 2 Take a walk for 30 minutes 3 Lie down for at least 20 minutes 4 Rest in a sitting position for one hour

Rest in a sitting position for one hour

A client who is receiving a 2-gram sodium diet asks for juice. How should the nurse respond? 1 "I suggest you have either apple juice or pear nectar." 2 "I suggest you have tomato juice." 3 "Juice is not permitted on a low-sodium diet." 4 "Juice between meals is not calculated into your diet."

1 "I suggest you have either apple juice or pear nectar."

A client with a parotid tumor expresses anxiety about the surgery to remove the tumor. The client states that perhaps surgery should be performed soon, even if the preoperative radiotherapy is not completed. The best response by the nurse is: 1 "You are concerned about the delay of surgery?" 2 "You are anxious about the effects of radiotherapy?" 3 "I think you do not have confidence in your health care provider's decisions." 4 "I can understand your anxiety concerning the delay of your surgery."

1 "You are concerned about the delay of surgery?"

A self-help group of clients with irritable bowel syndrome have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to minimize in the diet to decrease gastrointestinal (GI) irritability? 1 Cola drinks 2 Amino acids 3 Rice products 4 Sugar products

1 Cola drinks

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care? 1 Encouraging expression of concerns 2 Administering antibiotics as prescribed 3 Teaching the importance of getting rest 4 Explaining that everything will be all right

1 Encouraging expression of concerns

A client with cholecystitis is placed on a low fat, high protein diet. What nutrient should the nurse teach the client is included with this diet? 1 Skim milk 2 Boiled beef 3 Poached eggs 4 Steamed broccoli

1 Skim milk During acute cholecystitis, low-fat liquids are permitted; skim milk is low in fat and contains protein, which eventually will promote healing. Beef, even if it is lean, contains fat. Egg yolks contain fat. Although low in fat, broccoli does not contain protein; in addition, it is a gas-producing vegetable that should be avoided at this time.

A client on a low-residue diet asks the nurse about foods that must be avoided. Which foods should the nurse instruct the client to avoid? (Select all that apply.) 1 1. Fresh fruit 2 Broiled fish 3 Poached eggs 4 Buttered white rice 5 Whole wheat bread

1 1. Fresh fruit 5 Whole wheat bread Fresh fruit contains fiber and should be avoided on a low-residue diet. Whole wheat bread contains fiber and should be avoided on a low-residue diet. Broiled fish, poached eggs, and buttered white rice are permitted on a low-residue diet

A nurse is assessing a client with the diagnosis of hemorrhoids. Which factors in the client's history probably played a role in the development of the client's hemorrhoids? (Select all that apply.) 1 Constipation 2 Hypertension 3 Eating spicy foods 4 Bowel incontinence 5 Numerous pregnancies

1 Constipation 5 Numerous pregnancies

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? (Select all that apply.) 1 Ecchymosis 2 Yellow sclera 3 Dark brown stool 4 Straw-colored urine 5 Pain in right upper quadrant

1 Ecchymosis 2 Yellow sclera 5 Pain in right upper quadrant

A client develops peritonitis and sepsis after the surgical repair of a ruptured diverticulum. What signs should the nurse expect when assessing the client? (Select all that apply.) 1 Fever 2 Tachypnea 3 Hypertension 4 Abdominal rigidity 5 Increased bowel sounds

1 Fever 2 Tachypnea 4 Abdominal rigidity The metabolic rate will be increased and the temperature-regulating center in the hypothalamus resets to a higher than usual body temperature because of the influence of pyrogenic substances related to the peritonitis. Tachypnea results as the metabolic rate increases and the body attempts to meet cellular oxygen needs. With increased intraabdominal pressure, the abdominal wall will become rigid and tender. Hypovolemia and therefore hypotension, not hypertension, results because of a loss of fluid, electrolytes, and protein into the peritoneal cavity. Peristalsis and associated bowel sounds will decrease or be absent in the presence of increased intraabdominal pressure.

A nurse advises a client receiving furosemide (Lasix) to increase potassium intake. Which fruit should the nurse encourage the client to eat? (Select all that apply.) 1 Prune 2 Apple 3 Banana 4 Pineapple 5 Tangerine

1 Prune 3 Banana

The mother of a large family asks the home health nurse for inexpensive sources of B vitamins. What suggestion should the nurse make? 1 "Eat more red meat." 2 "Bake with whole-wheat flour." 3 "Include more eggs in the diet." 4 "Sprinkle wheat germ on casseroles.

2 "Bake with whole-wheat flour." Whole grains are the least expensive sources of B vitamins. Red meat is a source of B vitamins, but it is expensive. Eggs contain limited quantities of B vitamins. Wheat germ is a source of B vitamins, but it is expensive.

A client with a diagnosis of incarcerated hernia asks the nurse for an explanation of the diagnosis. The nurse explains that an incarcerated hernia means that the: 1 Bowel has twisted on itself 2 A piece of the intestine gets stuck in a hole in the abdominal wall 3 Intestinal blood supply has been cut off 4 Involved intestine has developed an erosion

2 A piece of the intestine gets stuck in a hole in the abdominal wall When the intestine cannot be returned manually to the body cavity, the hernia is considered incarcerated. A twisted bowel is called a volvulus. When blood supply is cut off to the intestine, it is called a strangulated hernia. Erosion of intestinal tissue may be caused by a variety of conditions; one condition that can cause erosion of the bowel is a strangulated hernia, not an incarcerated hernia.

A client has surgery for an incarcerated hernia. The health care provider returns the incarcerated tissue to the abdominal cavity and uses a mesh to reinforce the muscle wall. What specific instructions should be included in the discharge instructions? 1 Reduce dietary roughage. 2 Avoid lifting heavy items. 3 Increase dietary potassium intake. 4 Keep the head of the bed elevated.

2 Avoid lifting heavy items.

A health care provider prescribes psyllium (Metamucil) 3.5 g twice a day for constipation. What is most important for the nurse to teach this client? 1 Urine may be discolored. 2 Each dose should be taken with a full glass of water. 3 Use only when necessary because it can cause dependence. 4 Daily use may inhibit the absorption of some fat-soluble vitamins.

2 Each dose should be taken with a full glass of water.

When assessing a client's abdomen, the nurse palpates the area directly above the umbilicus. This area is known as the: 1 Iliac area 2 Epigastric area 3 Hypogastric area 4 Suprasternal area

2 Epigastric area

A client is returned to the surgical unit after an abdominal cholecystectomy. What is the main reason why the nurse should assess for clinical indicators of respiratory complications? 1 Length of time required for surgery is prolonged. 2 Incision is in close proximity to the client's diaphragm. 3 Client's resistance is lowered because of bile in the blood. 4 Bloodstream is invaded by microorganisms from the biliary tract.

2 Incision is in close proximity to the client's diaphragm.

On the third postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action? 1 Assist the client to ambulate. 2 Obtain the client's vital signs. 3 Administer the prescribed analgesic. 4 Encourage using the incentive spirometer.

2 Obtain the client's vital signs.

A client with severe Crohn's disease develops a small bowel obstruction. Which clinical finding should the nurse expect the client to report? 1 Bloody vomitus 2 Projectile vomiting 3 Bleeding with defecation 4 Pain in the left lower quadrant

2 Projectile vomiting Nausea and vomiting, accompanied by diffuse abdominal pain, commonly occur in clients with small bowel obstruction; the vomiting may be projectile and may contain bile or fecal material. Hematemesis is associated more closely with peptic ulcer disease. Bleeding with defecation is associated with hemorrhoids and anal fissures. Pain in the left lower quadrant is associated with diverticulitis. Pain associated with a small bowel obstruction usually is more diffuse.

A client who is suspected of having salmonellosis asks the nurse how the diagnosis is confirmed. The nurse responds that the medical diagnosis is established by a: 1 Urinalysis 2 Stool culture 3 Febrile agglutinin test 4 Complete blood count

2 Stool culture

Discharge instructions for the client diagnosed with cirrhosis with varices should include information about the importance of: (Select all that apply.) 1 Adhering to a low carbohydrate diet 2 Avoiding aspirin and aspirin containing products 3 Limiting alcohol consumption to two drinks weekly 4 Avoiding acetaminophen and products containing acetaminophen 5 Avoiding coughing, sneezing, and straining to have a bowel movement

2 Avoiding aspirin and aspirin containing products 4 Avoiding acetaminophen and products containing acetaminophen 5 Avoiding coughing, sneezing, and straining to have a bowel movement

A nurse is obtaining a history and performing a physical assessment of a client who has cancer of the tongue. Which clinical findings should the nurse expect to identify? (Select all that apply.) 1 Halitosis 2 Leukoplakia 3 Bleeding gums 4 Substernal pain 5 Alterations in taste 6 Enlarged cervical lymph nodes

2 Leukoplakia 5 Alterations in taste 6 Enlarged cervical lymph nodes Leukoplakia are white, thickened patches that tend to fissure and become malignant; ulcerations in the mouth or on the tongue may indicate cancer. Taste buds in the tongue may be impaired, resulting in alterations in taste. Regional lymph nodes enlarge as cancer cells begin to metastasize. Halitosis is not an early sign of or specific to cancer of the mouth. Bleeding gums occur in gingival diseases. Pain associated with cancer of the tongue does not radiate to the substernal area.

A nurse is caring for a client with hepatic cirrhosis. Which elements are important to include in this client's diet? (Select all that apply.) 1 High fat 2 Low protein 3 Low sodium 4 High vitamins 5 Low carbohydrates

2 Low protein 3 Low sodium 4 High vitamins A low protein diet reduces formation of ammonia, which must be degraded by the liver. A low sodium intake controls fluid retention, blood pressure, and, consequently, edema. Vitamins help to repair long-standing nutritional deficits associated with cirrhosis of the liver. High fat intake is avoided because of related cardiovascular risks and the demand for bile that the liver may not be capable of meeting. High, not low, carbohydrate intake is necessary to meet energy requirements for tissue regeneration.

A client with a diagnosis of cancer of the stomach expresses a lack of interest in food and eats only small amounts. What should the nurse provide? 1 Nourishment between meals 2 Small portions more frequently 3 Supplementary vitamins to stimulate the client's appetite 4 Only foods the client likes in small portions at mealtimes

2 Small portions more frequently

Which statement by an older adult most strongly supports the nurse's conclusion that the client is impacted with stool? 1 "I have a lot of gas pains." 2 "I don't have much of an appetite." 3 "I feel like I have to go and just can't." 4 "I haven't had a bowel movement for several days."

3 "I feel like I have to go and just can't."

A nurse is caring for a client who had a gastroscopy. What response indicates a major concern associated with this surgery? 1 Projectile vomiting 2 Increased gastrointestinal (GI) motility 3 Abdominal distention 4 Difficulty swallowing

3 Abdominal distention Abdominal distention, which may be associated with pain, may indicate perforation, a complication that can lead to peritonitis. Projectile vomiting usually does not occur. Increased GI motility, together with cramping, is considered an expected response. A local inflammatory response to insertion of the fiberoptic tube may result in a sore throat and dysphagia once the anesthetic wears off, but the client will be able to swallow.

Following surgery, a client asks the nurse if he or she can help measure intake and output. What is the best nursing response? 1 Determine the client's willingness to really help 2 Identify the client's reason for wanting to do this task 3 Assess the client's ability to measure the intake and output 4 Explain that measuring intake and output is the responsibility of the nurse

3 Assess the client's ability to measure the intake and output

A client with a recent colostomy expresses concern about the inability to control the passage of gas. The nurse should teach the client to: 1 Eliminate foods high in cellulose 2 Decrease fluid intake at mealtimes 3 Avoid foods that in the past caused flatus 4 Adhere to a bland diet before social events

3 Avoid foods that in the past caused flatus

A client is instructed to avoid straining on defecation postoperatively. The nurse evaluates that the related teaching is understood when the client states, "I must increase my intake of: 1 Ripe bananas." 2 Milk products." 3 Green vegetables." 4 Creamed potatoes."

3 Green vegetables."

A client has been diagnosed with cholelithiasis. Which fact about cholelithiasis should the nurse recall when assessing this client for risk factors? 1 Men are more likely to be affected than women. 2 Young people are affected more frequently than older people. 3 Individuals who are obese are more prone to this condition than those who are thin. 4 People who are physically active are more apt to develop this condition than those who are sedentary.

3 Individuals who are obese are more prone to this condition than those who are thin.

A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client? 1 Prone 2 Supine 3 Left Sims 4 Right side-lying

3 Left Sims Retained carbon dioxide can irritate the phrenic nerve. Placing the client in the left Sims position helps to move the gas pocket away from the diaphragm. Deep breathing and ambulation should be encouraged. Prone position will not help to alleviate the problem. Supine position will not help to alleviate the problem. Right side-lying position will not help to alleviate the problem.

A client with cancer of the pancreas has a pancreaticoduodenectomy (Whipple procedure). The nurse expects that the client will have which tube after surgery? 1 Chest 2 Intestinal 3 Nasogastric 4 Gastrostomy

3 Nasogastric Nasogastric surgery involves the stomach, duodenum, pancreas, and common bile duct; a nasogastric tube removes gastric secretions and prevents distention of the gastrointestinal tract. A chest tube is used to remove air or blood from the chest cavity; the chest is not entered in the Whipple procedure. Intestinal tubes are used for small bowel obstructions; except for the duodenum, the small bowel is not included in the Whipple procedure. A gastrostomy tube is used to deliver nutrients into the stomach of a client who cannot ingest food via the oral route.

A client complains of pain four hours after a liver biopsy. The nurse identifies that there is a leakage of a large amount of bile on the dressing over the biopsy site. What should the nurse do first? 1 Tell the client to remain flat on the back. 2 Medicate the client for pain as prescribed. 3 Notify the client's health care provider immediately. 4 Monitor the client's vital signs every 10 minutes.

3 Notify the client's health care provider immediately.

The diet prescribed for a client with diverticulosis includes 30 grams of fiber a day. What breakfast items should the nurse encourage the client to select? 1 Cream of wheat, milk, and cranberry juice 2 Unstrained orange juice, pancakes, and bacon 3 Oatmeal, sliced bananas, whole-wheat toast, and milk 4 Poached eggs on whole-wheat toast, tomato juice, and tea

3 Oatmeal, sliced bananas, whole-wheat toast, and milk

When caring for a client who is recovering from a gastrectomy, a nurse is concerned about the potential development of pernicious anemia. What should the nurse conclude may be the cause of this complication? 1 Vitamin B12 is just absorbed in the stomach. 2 Hemopoietic factor is secreted in the stomach. 3 Parietal cells of the stomach secrete the intrinsic factor. 4 Chief cells in the stomach promote the secretion of the extrinsic factor.

3 Parietal cells of the stomach secrete the intrinsic factor. Pernicious anemia is caused by a lack of vitamin B12 . Intrinsic factor, produced by the parietal cells of the gastric mucosa, is necessary for B12 absorption. B12 is absorbed in the ileum. The hemopoietic factor is the combination of B12 and intrinsic factor. The intrinsic factor is secreted by the stomach, and food is the source of vitamin B12 . Chief cells secrete the enzymes of the gastric juice.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery. The nurse concludes that the client understands teaching about the purpose of TPN when the client states, "TPN: 1 Provides short-term nutrition after surgery. 2 Assists in providing supplemental nutrition. 3 Provides total nutrition when gastrointestinal (GI) function is questionable. 4 Assists people who are unable to eat but have active GI function.

3 Provides total nutrition when gastrointestinal (GI) function is questionable.

A client says, "I take baking soda in water when I get heartburn." The nurse suggests an antacid containing aluminum and magnesium hydroxide instead of baking soda. What is the advantage these antacids have over baking soda? 1 They contain little, if any, sodium. 2 Absorption by the stomach mucosa is markedly enhanced. 3 There is no direct effect on the systemic acid-base balance when taken as directed. 4 Fewer side effects, such as diarrhea or constipation, are experienced when they are used properly.

3 There is no direct effect on the systemic acid-base balance when taken as directed. Nonsystemic antacids are not readily absorbed, so they do not alter acid-base balance. Sodium bicarbonate is absorbed and can alter acid-base balance. These preparations do contain sodium. Nonsystemic antacids are insoluble and not readily absorbed. Diarrhea and constipation are side effects of nonsystemic antacids.

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole (Flagyl). The nurse explains, "Antibiotics are prescribed to: 1 Augment the immune response." 2 Potentiate the effect of antacids." 3 Treat Helicobacter pylori infection." 4 Reduce hydrochloric acid secretion."

3 Treat Helicobacter pylori infection."

A nurse is caring for a client who is positive for hepatitis A. Which precautions should the nurse take? 1 Wear a gown when entering the client's room. 2 Use caution when bringing in the client's food. 3 Use gloves when removing the client's bedpan. 4 Wear a protective mask when entering the client's room.

3 Use gloves when removing the client's bedpan.

The nurse is caring for a client with a 25-year history of excessive alcohol use. The nurse expects that assessment findings will indicate: 1 Signs of liver infection 2 A low blood ammonia level 3 A small liver with a rough surface 4 An elevated temperature and a generalized rash

3 A small liver with a rough surface Scar tissue that forms as cirrhosis progresses causes the liver tissue to contract, making the liver small with a rough surface; little lumps are formed as scar tissue pulls the liver at certain points.

The nurse teaches the client about foods to help prevent constipation after pelvic surgery. Which foods selected by the client indicate that the teaching is understood? (Select all that apply.) 1 Ripe bananas 2 Milk products 3 Green vegetables 4 Creamed potatoes 5 Whole grain bread

3 Green vegetables 5 Whole grain bread

A client is admitted with a lesion in the descending colon. Which factor in the client's history is unrelated to a predisposition to cancer? 1 Colitis 2 Constipation 3 Hemorrhoids 4 Diverticulitis

3 Hemorrhoids

A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse? 1 "Sedatives can be given to help you relax." 2 "We can give you immune serum globulin." 3 "Vitamin supplements are frequently helpful and hasten recovery." 4 "There are medications to help reduce viral load and liver inflammation."

4 "There are medications to help reduce viral load and liver inflammation."

A client has a colostomy after surgery for cancer of the colon. What postoperative nursing intervention maximizes skin integrity? 1 Empty the colostomy bag when it is three fourths full 2 Allow one half inch between the stoma and the appliance 3 Help the client to remove the appliance on the first postoperative day 4 Apply stoma adhesive around the stoma and then attach the appliance

4 Apply stoma adhesive around the stoma and then attach the appliance

A client was diagnosed with cancer of the head of the pancreas two months ago. The client is admitted to the hospital with weight loss, severe epigastric pain, and jaundice. When performing the client's assessment, the nurse expects the client's stool to be what color? 1 Green 2 Brown 3 Red-tinged 4 Clay-colored

4 Clay-colored -Tumors of the head of the pancreas usually obstruct the common bile duct where it passes through the head of the pancreas to join the pancreatic duct and empty at the ampulla of Vater into the duodenum. The feces will be clay-colored when bile is prevented from entering the duodenum. Green stools may occur with prolonged diarrhea associated with gastrointestinal inflammation. The feces are brown when there is unobstructed bile flow into the duodenum. Inflammation or ulceration of the lower intestinal mucosa results in blood-tinged stools.

Which client statement indicates to the nurse that a client who is receiving cyanocobalamin (vitamin B12) therapy for an intrinsic factor deficiency understands the treatment? 1 "I should have a vitamin B12 injection every month." 2 "I'll take my B12 vitamin every morning with my breakfast." 3 "I'll have a salad every day because Vitamin B12 is in green vegetables." 4 "I should feel better because my vitamin B12 treatments will improve my aplastic anemia."

1 "I should have a vitamin B12 injection every month." Vitamin B12 is administered via injection on a weekly or monthly basis. Vitamin B12 is destroyed by stomach acid and therefore cannot be taken in pill form. Green vegetables are not an important source of vitamin B12. Vitamin B12 is found primarily in meat, fish, poultry, and eggs. Vitamin B12 is prescribed for pernicious, not aplastic, anemia.

A female client who had a colostomy recently is asking questions about how normal her life will be now that she has a colostomy. The statement by the client that indicates a need for further teaching is: 1 "I wanted another child, and now pregnancy is not an option for me." 2 "I must allow extra time for irrigating my colostomy when traveling." 3 "It is good to know that I can swim every day after my incision heals." 4 "I'm glad I won't have to have special clothing and I can wear what I have."

1 "I wanted another child, and now pregnancy is not an option for me."

A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. With this evidence of impending hepatic coma, which diet can the nurse expect will be prescribed for this client? 1 20 g of protein, 2000 calories 2 70 g of protein, 1200 calories 3 80 g of protein, 2500 calories 4 100 g of protein, 1500 calories

1 20 g of protein, 2000 calories Because the liver is unable to detoxify ammonia to urea, protein intake should be further restricted when coma is inevitable. 70 g of protein, 1200 calories, 80 g of protein, 2500 calories, and 100 g of protein, 1500 calories are relatively high intakes of protein that will increase blood ammonia levels.

A client with gastroesophageal reflux disease (GERD) is being treated with dietary management. The client states, "I like to have a glass of juice every day." The nurse teaches the client that the most appropriate type of juice to select is: 1 Apple 2 Orange 3 Tomato 4 Grapefruit

1 Apple

Three days after admission to the hospital for a brain attack (cerebrovascular accident [CVA]), a client has a nasogastric tube inserted and is receiving continuous tube feedings. What should the nurse do to best evaluate whether the feeding is being absorbed? 1 Aspirate for a residual volume. 2 Evaluate the intake in relation to the output. 3 Instill air into the client's stomach while auscultating. 4 Compare the client's body weight with the baseline data.

1 Aspirate for a residual volume.

A primary health care provider prescribes three stool specimens for occult blood for a client who complains of blood-streaked stools and a 10-pound weight loss in one month. To ensure valid test results, the nurse should instruct the client to: 1 Avoid eating red meat before testing 2 Test the specimen while it is still warm 3 Discard the day's first stool and use the next three stools 4 Take three specimens from different sections of the fecal sample

1 Avoid eating red meat before testing Red meat can react with reagents used in the test to cause false-positive results. Testing the specimen while it is still warm may apply for testing for ova and parasites, not for occult blood. If the correct procedure is followed, discarding the first specimen is unnecessary. Random stool testing can be done but must be on three different bowel movements during the screening period.

A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease? 1 Esophageal pain may imitate the symptoms of a heart attack. 2 GERD may predispose to heart disease. 3 Strenuous exercise may exacerbate both cardiac and reflux problems. 4 Similar changes in laboratory studies may occur in both cardiac and reflux problems.

1 Esophageal pain may imitate the symptoms of a heart attack. Symptoms associated with myocardial infarction may be interpreted by a client as esophageal reflux and therefore ignored. GERD does not predispose to heart disease. Exercise tends to aggravate cardiovascular problems to a much greater extent than esophageal problems. Laboratory workups help differentiate these two diagnoses. Tests, such as cardiac enzymes, can help to reveal a myocardial infarction, thereby facilitating differentiation between these problems.

A client is admitted to the hospital with a diagnosis of liver disease, and a liver biopsy is prescribed. After the liver biopsy, the nurse should take the client's vital signs every: 1 Every 15 minutes for two hours 2 Every 30 minutes for four hours 3 Every hour for 8 hours 4 Every 2 hours for 12 hours

1 Every 15 minutes for two hours Every 15 minutes for two hours is an appropriate frequency to take the vital signs after a liver biopsy. The risk of internal bleeding is highest immediately after the biopsy; diseases of the liver result in impaired blood-clotting mechanisms. Every 30 minutes after a liver biopsy is too infrequent; two hours after the procedure the vital signs can be taken every 30 minutes instead of every 15 minutes if they are stable. Every hour for eight hours is too infrequent and unsafe if hemorrhage is to be detected before shock occurs. Every 2 hours for 12 hours is too infrequent and unsafe if hemorrhage is to be detected before shock occurs.

A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for possible situations in which exposure may have occurred. Which event does the nurse determine is the most likely source of this infection? 1 Had a small tattoo on the arm three months ago 2 Assisted in the emergency birth of a baby two weeks ago 3 Worked for a month in an undeveloped area in Mexico four months ago 4 Attended an ecologic conference in a large urban center two months ago

1 Had a small tattoo on the arm three months ago

A female client with the diagnosis of Crohn's disease tells the nurse that her boyfriend dates other women. She believes that this behavior causes an increase in her symptoms. What should the nurse do first when counseling this client? 1 Help the client explore attitudes about herself. 2 Educate the client's boyfriend about her illness. 3 Suggest the client should not see her boyfriend for a while. 4 Schedule the client and her boyfriend for a counseling session.

1 Help the client explore attitudes about herself.

A nurse is caring for a client who just had a liver biopsy. After the procedure, the nurse should monitor for which common complication associated with the biopsy? 1 Hemorrhage 2 Gastroparesis 3 Pulmonary embolism 4 Tension pneumothorax

1 Hemorrhage

A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. The nurse concludes that the most likely cause of this client's ascites is: 1 Impaired portal venous return 2 Impaired thoracic lymph channels 3 Excess production of serum albumin 4 Enhanced hepatic deactivation of aldosterone secretion

1 Impaired portal venous return

A nurse is caring for a client who is admitted to the hospital with ascites and a diagnosis of cirrhosis of the liver. The nurse concludes that the probable cause of ascites is: 1 Impaired portal venous return 2 Inadequate secretion of bile salts 3 Excess production of serum albumin 4 Decreased interstitial osmotic pressure

1 Impaired portal venous return An enlarged liver impairs venous return, leading to an increased portal vein hydrostatic pressure and a fluid shift into the abdominal cavity. Bile plays an important role in digestion of fats, but it is not a major factor in fluid balance. Increased serum albumin causes hypervolemia, not ascites. Ascites is not associated with the interstitial fluid compartment.

A client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. A nursing priority is to: 1 Institute fall prevention/safety measures 2 Monitor respiratory status 3 Measure abdominal girth daily 4 Test stool specimens for blood

1 Institute fall prevention/safety measures

A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the client's discomfort? 1 Lactase 2 Sucrase 3 Maltase 4 Amylase

1 Lactase

A client is scheduled for a colonoscopy, and the health care provider prescribes a tap water enema. In which position should the nurse place the client during the enema? 1 Left Sims 2 Back lying 3 Knee chest 4 Mid-Fowler

1 Left Sims

A client with a 20-year history of excessive alcohol use is admitted to the hospital with jaundice and ascites. A priority nursing action during the first 48 hours after the client's admission is to: 1 Monitor the client's vital signs 2 Increase the client's fluid intake 3 Improve the client's nutritional status 4 Determine the client's reasons for drinking

1 Monitor the client's vital signs

Thiamine (vitamin B1) and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan? 1 Neuronal activity 2 Bowel elimination 3 Efficient circulation 4 Prothrombin development

1 Neuronal activity Thiamine and niacin help convert glucose for energy, and therefore influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacture of prothrombin.

A client who recently has had an abdominoperineal resection and colostomy accuses the nurse of being uncomfortable during a dressing change because the "wound looks terrible." The nurse identifies that the client is using the defense mechanism known as: 1 Projection 2 Sublimation 3 Compensation 4 Intellectualization

1 Projection

A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of: 1 Pruritus 2 Diarrhea 3 Blurred vision 4 Bleeding gums

1 Pruritus Itching associated with jaundice is believed to be caused by accumulating bile salts in the skin. Diarrhea, blurred vision, and bleeding gums are not related to jaundice.

A client is admitted to the ambulatory surgery unit for a liver biopsy. The nurse recalls that which assessment finding will be a cause for the biopsy to be postponed? 1 Signs of bruising 2 Visible hyperactivity 3 Lethargy on the morning of the test 4 Foods high in vitamin K consumed on the day before the test

1 Signs of bruising If the client has numerous bruises and petechiae, they may indicate deficient thrombocytes or prolonged clotting; both are contraindications for a percutaneous liver biopsy. The client may need support and the health care provider may need assistance, but the test can be done. The client's activity level is unrelated to contraindications for performing a liver biopsy. The amount of foods high in vitamin K consumed the day before the test is unrelated to contraindications for performing a liver biopsy. Although vitamin K is needed for the production of prothrombin, the ingestion of foods high in vitamin K does not guarantee adequate clotting activity.

The nurse is caring for a client with ascites who is scheduled for a paracentesis. The client teaching will include: 1 The need to empty the bladder immediately before the procedure 2 The importance of a low fat diet after the procedure to aid in healing 3 The importance of staying in a supine position throughout the procedure 4 The need to consume only liquids for 24 hours after the procedure

1 The need to empty the bladder immediately before the procedure

What should transmission-based precautions for a client with salmonellosis include? 1 Wearing a gown if soiling is likely. 2 Providing isolation in a private room. 3 Wearing a mask when emptying the bedpan. 4 Limiting visiting hours during the acute phase

1 Wearing a gown if soiling is likely. Wearing a gown if soiling is likely, in addition to gloves, reduces the possibility that the organisms may be transmitted to others. Providing isolation in a private room is not necessary as long as fecally contaminated articles are handled and disposed of appropriately. The organism is not transmitted via the airborne route. The type of exposure, not the length of exposure, increases the risk for transmission; visitors are allowed as long as appropriate precautions are implemented.

Which clinical indicators identified by the nurse support the probable presence of a fecal impaction in a client? (Select all that apply.) 1 Abdominal cramps 2 Fecal liquid seepage 3 Hyperactive bowel sounds 4 Bright red blood in the stool 5 Decreased number of bowel movements

1 Abdominal cramps 2 Fecal liquid seepage 3 Hyperactive bowel sounds Peristalsis increases in an attempt to evacuate the hardened feces; spasms of the intestine may occur. When the bowel is impacted with hardened feces, there often is seepage of liquid feces around the obstruction and thus uncontrolled diarrhea. Intestinal gas builds up behind the obstruction; peristaltic waves initiate movement of intestinal contents that cause gurgling sounds in the intestine (borborygmi). Bright red blood in the stool is indicative of lower gastrointestinal (GI) bleeding. There are often frequent liquid bowel movements in the presence of an impaction.

Which medications are associated commonly with upper gastrointestinal (GI) bleeding? (Select all that apply.) 1 Acetylsalicylic acid (Aspirin) 2 Methylprednisolone (Solu-Medrol) 3 Acetaminophen (Tylenol) 4 Ibuprofen (Advil) 5 Ciprofloxacin (Cipro)

1 Acetylsalicylic acid (Aspirin) 2 Methylprednisolone (Solu-Medrol) 4 Ibuprofen (Advil) Nonsteroidal anti-inflammatory agents (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone, are known causes of drug-induced gastrointestinal bleeding by causing irritation and erosion of the gastric mucosal barrier. Acetaminophen is a safe alternative to NSAIDS to reduce the risk of GI bleeding. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding.

A nurse is caring for a client with Addison disease. What should the nurse teach the client to do regarding an appropriate diet? 1 Add extra salt to food 2 Limit intake to 1200 calories 3 Omit protein foods at each meal 4 Restrict the daily intake of fluids to 1 L

1 Add extra salt to food Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to develop hyponatremia. Therefore, the addition of salt to the diet is advised.

A nurse is providing discharge instructions for a client with a diagnosis of gastroesophageal reflux disease (GERD). What should the nurse advise the client to do to limit symptoms of GERD? (Select all that apply.) 1 Avoid heavy lifting. 2 Lie down after eating. 3 Avoid drinking alcohol. 4 Eat small, frequent meals. 5 Increase fluid intake with meals. 6 Wear an abdominal binder or girdle

1 Avoid heavy lifting. 3 Avoid drinking alcohol. 4 Eat small, frequent meals. Heavy lifting increases intraabdominal pressure, allowing gastric contents to move up through the lower esophageal sphincter (regurgitation), causing heartburn (pyrosis). Alcohol, in addition to peppermints, caffeine, and chocolate, decreases lower esophageal sphincter (LES) pressure, which permits gastric contents to move from the stomach into the esophagus. Eating small, frequent meals limits the amount of food in the stomach, which limits gastroesophageal reflux. Lying down after eating promotes reflux and should be avoided. Increasing fluids with meals increases gastric volume, causing distention and reflux. Constrictive garments, such as belts, binders, and girdles, increase intraabdominal pressure and may lead to reflux.

A nurse is caring for a client who is having difficulty digesting fatty foods. To what deficiency does the nurse attribute this difficulty? 1 Bile 2 Lipase 3 Amylase 4 Cholesterol

1 Bile Fatty acids are insoluble and must combine with bile to form water-soluble substances. Lipase is a pancreatic enzyme. Amylase, which digests starch, is found in saliva and pancreatic juice. Although cholesterol is produced in the liver and stored in the gallbladder, it is not the component of bile that emulsifies fats.

A nurse is providing education about excellent food sources of vitamin A for a client who is deficient in this vitamin. Which foods should the nurse include in the teaching? (Select all that apply.) 1 Carrots 2 Oranges 3 Tomatoes 4 Skim milk 5 Leafy greens

1 Carrots 5 Leafy greens Yellow/orange vegetables contain large quantities of the pigments alpha-, beta-, and gamma-carotene; beta-carotene is the major chemical precursor of vitamin A in human nutrition. Cantaloupe, sweet potatoes, and apricots also are high in vitamin A. Dark green leafy vegetables contain large quantities of the pigments alpha-, beta-, and gamma-carotene; beta-carotene is the major chemical precursor of vitamin A in human nutrition. Broccoli, cabbage, spinach, and collards also are high in vitamin A. Oranges are considered a good source of both vitamin C and potassium. Tomatoes are a good source of vitamin C. Levels of vitamin A are higher in whole milk than in skim milk.

To help prevent long-term complications associated with gastric bypass surgery, the nurse needs to educate the client. Identify the factors that should be included in the nurse's teaching plan for this client. (Select all that apply.) 1 Eat foods rich in calcium. 2 Ingest three small feedings daily. 3 Limit fluids to 1500 mL daily. 4 Consume a diet high in protein. 5 Receive vitamin B12 injections routinely.

1 Eat foods rich in calcium. 4 Consume a diet high in protein. 5 Receive vitamin B12 injections routinely. Calcium deficiency is a late complication of bariatric surgery because of inadequate absorption, even with an intake of calcium-rich foods; calcium supplementation may be necessary. Foods high in protein exit the stomach more slowly than foods high in carbohydrates, which minimize the dumping syndrome. Vitamin B12 deficiency is a late complication of bariatric surgery because of a lack of intrinsic factor; gastric secretion is necessary for the absorption of vitamin B12 . Lifelong supplementation may be necessary. Three small feedings daily will not provide adequate calories and nutrients; six small feedings with a total of 600 to 800 calories a day is routine once the client is eating. Clients need to increase, not limit, fluid intake; the dumping syndrome contributes to diarrhea, which can cause dehydration and electrolyte imbalance.

A client with advanced bone cancer is experiencing cachexia. The nurse discusses the nutritional aspect of palliative care with the family. Why is it important to explain these nutritional interventions to the family? 1 Enhance the quality of the client's life 2 Reduce the likelihood of a respiratory infection 3 Prevent the malabsorption syndrome from occurring 4 Decrease the consequences of impaired glucose metabolism

1 Enhance the quality of the client's life Nutritional interventions to decrease cachexia will not necessarily contribute to survival, but they may enhance the client's quality of life. They may promote enjoyment of eating and may limit nausea and fatigue.

A paracentesis is prescribed for a client recently admitted to a medical unit. The nurse recalls that the procedure is performed for what reasons? (Select all that apply.) 1 Extract peritoneal fluid 2 Improve respiratory status 3 Decrease intrapleural fluid 4 Increase intraabdominal tension 5 Obtain peritoneal fluid for culture

1 Extract peritoneal fluid 2 Improve respiratory status 5 Obtain peritoneal fluid for culture

An active adolescent is admitted to the hospital for surgery for an ileostomy. When planning a teaching session about self-care, the nurse includes sports that should be avoided by a client with an ileostomy. Which should be included on the list of sports to be avoided? (Select all that apply.) 1 Football 2 Swimming 3 Ice hockey 4 Track events 5 Cross-country skiing

1 Football 3 Ice hockey Trauma to the abdominal wall and to the stoma should be avoided; contact sports, such as football and ice hockey, are contraindicated . Trauma to the abdominal wall is a minimal risk when swimming. Track events are not associated with trauma to the abdominal wall. Cross-country skiing is not associated with trauma to the abdominal wall.

Which food selections by a client with malabsorption syndrome indicate that the nurse's dietary teaching was successful? (Select all that apply.) 1 Green beans 2 Baked potato 3 Noodle pudding 4 Turkey sandwich 5 Whole wheat cereal

1 Green beans 2 Baked potato Green beans are a vegetable; fresh fruits and vegetables are permitted on a gluten-free diet. A baked potato is permitted on a gluten-free diet. Noodles are made of flour high in gluten and should be avoided. Bread is made with flour high in gluten and should be avoided. Whole wheat cereal is high in gluten and should be avoided.

A nurse is assessing a client for dehydration, The client has had diarrhea and vomiting for 48 hours. What are indicators of dehydration? (Select all that apply.) 1 Headache 2 Protruding eyeballs 3 The client reporting drinking an average of two glasses of water daily 4 The skin on the client's forehead remains tented after being pinched 5 Within four days, the client lost two pounds of weight

1 Headache 4 The skin on the client's forehead remains tented after being pinched Headache is an indicator of dehydration. To determine dehydration in the adult the nurse should test for decreased skin turgor . To assess for dehydration, pinch the skin over a bone with little or no underlying fat, such as the sternum, forehead, or pelvis. If the skin remains tented after it is released, the client is dehydrated. The eyeballs may be sunken, not protruding, in the presence of dehydration. Asking the client how many glasses of fluid are ingested daily does not evaluate the client's physical status in relation to dehydration. A weight loss of two pounds does not indicate dehydration.

A client has cholelithiasis with possible obstruction of the common bile duct. What should be determined about the client's nutritional status before surgery is scheduled? 1 Is the client deficient in vitamins A, D, and K? 2 Does the client eat adequate amounts of dietary fiber? 3 Does the client consume excessive amounts of protein? 4 Are the client's levels of potassium and folic acid increased?

1 Is the client deficient in vitamins A, D, and K? Bile promotes the absorption of fat-soluble vitamins; an obstruction of the common bile duct limits the flow of bile to the duodenum. Knowing if the client eats adequate amounts of dietary fiber is not relevant to the situation. Knowing if the client consumes excessive amounts of protein is unnecessary; however, protein is desirable for wound healing. An increase in potassium and folic acid are not expected.

A client has a low hemoglobin level that is attributed to a nutritional deficiency. Which foods should the nurse teach the client to increase in the diet? (Select all that apply.) 1 Liver 2 Apples 3 Carrots 4 Raisins 5 Spinach

1 Liver 4 Raisins 5 Spinach

A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist? (Select all that apply.) 1 Nizatidine (Axid) 2 Ranitidine (Zantac) 3 Famotidine (Pepcid) 4 Lansoprazole (Prevacid) 5 Metoclopramide (Reglan)

1 Nizatidine (Axid) 2 Ranitidine (Zantac) 3 Famotidine (Pepcid) Nizatidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Ranitidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Famotidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

A client is diagnosed with gastric cancer, and a subtotal gastrectomy is performed. After surgery the client begins to hemorrhage. What clinical findings support the nurse's conclusion that the client is experiencing hypovolemic shock? (Select all that apply.) 1 Oliguria 2 Bradypnea 3 Diaphoresis 4 Tachycardia 5 Hypertension

1 Oliguria 3 Diaphoresis 4 Tachycardia Decreased blood volume leads to decreased glomerular filtration; compensatory antidiuretic hormone (ADH) and aldosterone secretion cause sodium and water retention, thereby decreasing urinary output . Diaphoresis and tachycardia occur because of the sympathetic nervous system-mediated response. Respirations become rapid and shallow, not slow, because of the sympathetic nervous system-mediated response. Hypotension, not hypertension, is the response to a decrease in circulating blood volume.

A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply. 1 Oliguria 2 Lethargy 3 Irritability 4 Hypotension 5 Slurred speech

1 Oliguria 3 Irritability 4 Hypotension Restlessness, not lethargy, usually occurs because of decreased cerebral blood flow. Irritability, along with restlessness and anxiety, occurs because of a decrease in oxygen to the brain. Hypotension and a narrowing of the pulse pressure occur because of declining blood volume. Decreased blood flow to the kidneys leads to oliguria or anuria. There are various changes in sensorium, but slurred speech is not a manifestation of shock.

When assessing a client who had abdominal surgery, the nurse determines that peristalsis has returned when the client: 1 Passes flatus 2 Has a large formed bowel movement 3 Tolerates clear liquids 4 Has a bowel movement of any size and consistency

1 Passes flatus Passing flatus is the first sign of peristaltic activity, reflecting that intestinal contents are being propelled through the alimentary tract, causing characteristic sounds. Liquids should not be given until bowel sounds have returned. Passing flatus indicates peristaltic movement, not the formation of bowel movements.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse should monitor the client for which complications? (Select all that apply.) 1 Phlebitis 2 Infection 3 Hepatitis 4 Anorexia 5 Dysrhythmias

1 Phlebitis 2 Infection Phlebitis may occur because the hypertonic nature of the infusion is irritating to the vein. The concentration of glucose in the solution is a culture medium that supports the growth of microorganisms. Hepatitis usually is not associated with total parenteral nutrition. Anorexia often is present before the medical decision is made to begin total parenteral nutrition. Dysrhythmias are not related to total parenteral nutrition but may be a sign of hyperkalemia or hypokalemia.

A client who recently had an abdominoperineal resection and colostomy accuses the nurse of being uncomfortable during a dressing change because the "wound looks terrible." Which defense mechanism does the nurse conclude the client is using as a form of self-protection? 1 Projection 2 Sublimation 3 Intellectualization 4 Reaction formation

1 Projection Projection is the attribution of unacceptable feelings and emotions to others. Sublimation is the substitution of socially acceptable feelings or instincts that, if expressed, will be threatening to the self. Intellectualization is the use of mental reasoning processes to deny facing emotions and feelings involved in a situation. Reaction formation is the unconscious reversal of feelings or behavior unacceptable to the self-image and the assumption of opposite feelings or behavior.

A client is admitted with dehydration. Which findings should the nurse expect the client to exhibit? (Select all that apply.) 1 Rapid, thready pulse 2 Increased skin turgor 3 Decreased hematocrit 4 Elevated specific gravity 5 Adventitious breath sounds

1 Rapid, thready pulse 4 Elevated specific gravity The pulse is rapid and thready because of the decreased blood volume associated with dehydration. The specific gravity of urine increases as the body reabsorbs water to correct the fluid deficit; as a result, the urine is concentrated. Skin turgor is decreased with evidence of tenting. The hematocrit is increased because of hemoconcentration. Adventitious breath sounds, such as crackles, occur with fluid volume excess, not with deficit.

A client is admitted to the hospital for surgery for recto-sigmoid colon cancer, and the nurse is obtaining a health history as part of the admission process. What clinical findings associated with recto-sigmoid colon cancer does the nurse expect the client to report? (Select all that apply.) 1 Rectal bleeding 2 Inability to digest fat 3 Change in the shape of stools 4 Feeling of abdominal bloating

1 Rectal bleeding 3 Change in the shape of stools 4 Feeling of abdominal bloating Passage of red blood (hematochezia) is one of the cardinal signs of recto-sigmoid colon cancer; ulceration of the tumor and straining to pass stool precipitate this clinical finding. A cancerous mass can grow into the lumen of the sigmoid colon, altering the shape of stool; stools may be ribbon-like or pencil thin. Tumors in the recto-sigmoid colon cause partial and eventually complete obstruction of the intestinal lumen. Stool in the descending and sigmoid colon is more formed and thus straining to pass stools, gas pains, cramping, and incomplete evacuation commonly occur. An inability to digest fat is not specific to recto-sigmoid colon cancer.

A client reports pain as a result of a gastric ulcer. What clinical findings is the nurse most likely to identify during an assessment of the client's pain? (Select all that apply.) 1 Vomiting relieves pain. 2 Eating food prevents pain. 3 Pain described as gnawing. 4 Flatulence accompanies pain. 5 Pain occurs a half hour after meals.

1 Vomiting relieves pain. 3 Pain described as gnawing. 5 Pain occurs a half hour after meals. Vomiting removes gastric hydrochloric acid (HCl), which irritates the ulcer and causes pain. Typically, gastric ulcer pain is described as burning or gnawing. Eating causes the secretion of HCl, which increases pain. Eating causes the secretion of HCl, which increases, not relieves, pain. Flatulence is not related to a gastric ulcer.

A client is to be discharged after a laparoscopic cholecystectomy. What statement indicates to the nurse that the client understands the discharge instructions? 1 "The bandages must be changed every day." 2 "I may have mild shoulder pain for about a week." 3 "The surgical sites should not be bathed for a week." 4 "I will remain on a full liquid diet for two more days."

2 "I may have mild shoulder pain for about a week." Mild shoulder pain is common up to 1 week after surgery because of diaphragmatic irritation secondary to abdominal stretching or residual carbon dioxide that was used to inflate the abdominal cavity during surgery. The response "The bandages must be changed every day" is not necessary; the bandages are removed on the second postoperative day. The response "The surgical sites should not be bathed for a week" is not necessary; the client may bathe and shower as usual. The response "I will remain on a full liquid diet for two more days" is not necessary; clients generally tolerate food after 24 to 48 hours.

A client newly diagnosed with cancer of the pancreas is scheduled for surgery. The client says to the nurse, "Wouldn't I be better off with some other treatment instead of surgery?" The nurse's best response is: 1 "If I were you, I would explore other acceptable treatments for your cancer." 2 "Surgery is the recommended approach. Why don't you discuss this further with the health care provider?" 3 "Maybe you will be more confident with a second opinion. I think you need a referral to another health care provider." 4 "With your disease your prognosis will improve if you follow the suggestion to have the recommended surgery."

2 "Surgery is the recommended approach. Why don't you discuss this further with the health care provider?"

Which statement made by a client after attending a class on nutrition indicates an understanding of the importance of essential amino acids? 1 "Amino acids can be made by the body because they are essential to life." 2 "They come from the diet because they cannot be synthesized in the body." 3 "They are used in key processes essential for growth once they are synthesized by the body." 4 "Essential amino acids are required for metabolism, whereas the other amino acids are not."

2 "They come from the diet because they cannot be synthesized in the body." The body does not synthesize these amino acids ; they must be ingested in the diet. The essential amino acids cannot be made by the body. All amino acids are needed for metabolism; however, arginine and histidine are necessary for growth, but not during adulthood.

A nurse is reviewing a newly admitted client's medication administration record (MAR). The nurse identifies that it is incomplete when the record is lacking information regarding the client's: 1 Height 2 Allergies 3 Body weight 4 Medical diagnosis

2 Allergies

A nurse provides a list of suggested food choices to a client who has peptic ulcer disease. What foods should be included on the list? 1 Orange juice, fried eggs, and sausage 2 Applesauce, cream of wheat, and milk 3 Tomato juice, raisin bran cereal, and tea 4 Sliced oranges, pancakes with syrup, and coffee

2 Applesauce, cream of wheat, and milk

A nurse is caring for a postoperative client who had a gastrectomy. What early client response indicates that peristalsis has returned? 1 Passage of stool occurs 2 Borborygmi are auscultated 3 Nausea and vomiting cease 4 Absence of a rigid and tender abdomen

2 Borborygmi are auscultated The presence of borborygmi indicates the return of peristalsis. The nurse should auscultate the abdomen and listen for bowel sounds, which signify the passage of flatus. The first bowel movement occurs after peristalsis returns and usually after food is ingested. Nausea may be present even though peristalsis has begun. Peristalsis should return before the tenderness of the abdomen subsides.

A nurse is caring for a client who had major abdominal surgery one day ago. What factor increases the risk of this client developing a wound dehiscence? 1 Placement of a T-tube 2 Client being overweight 3 Presence of excessive flatus 4 Client receiving prophylactic antibiotics

2 Client being overweight

A nurse is caring for a client with a history of gastrointestinal (GI) irritability. What should the nurse advise the client to avoid to limit GI irritability? 1 Iodized salt 2 Cola drinks 3 Amino acids 4 Rice products

2 Cola drinks

A low-residue diet is recommended for a client. Which food should the nurse encourage the client to select from a menu? 1 Steamed broccoli 2 Creamed potatoes 3 Raw spinach salad 4 Baked sweet potato

2 Creamed potatoes Creamed potatoes are the only vegetable listed that is included in a low-residue diet; this vegetable is low in fiber. Steamed broccoli, raw spinach salad, and baked sweet potato contain more fiber than creamed potatoes.

An 85-year-old client has a three-day history of nausea, vomiting, and diarrhea. The client develops weakness and confusion and is admitted to the hospital. To best monitor the client's rehydration status, the nurse should assess the client's: 1 Skin turgor 2 Daily weight 3 Urinary output 4 Mucous membranes

2 Daily weight A continuous increase in serial weight determinations indicates a movement toward correction in the dehydration; 1 L of fluid weighs 2.2 pounds. The skin in older adults has less fluid and subcutaneous fat than younger adults, which results in a subjective and inaccurate assessment of rehydration. In older adults there can be a 50% decrease in renal blood flow and tubular function; therefore, urinary output does not provide an accurate assessment of rehydration therapy. The mucous membranes in older adults are drier than in younger adults because of the decrease in salivary secretions and therefore do not provide an accurate assessment of rehydration therapy.

A health care provider prescribes dietary and medication therapy for a client with the diagnosis of gastroesophageal reflux disease (GERD). What is most appropriate for the nurse to teach the client about meal management? 1 Ingest foods while they are hot. 2 Divide food into four to six meals a day. 3 Eat the last of three daily meals by 8 pm. 4 Suck a peppermint candy after each meal.

2 Divide food into four to six meals a day.

A nurse is educating a client with a colostomy of the ascending colon about using a colostomy appliance. Which instruction should the nurse provide to help prevent leakage of stool from the appliance? 1 Irrigate the colostomy to establish an expected pattern of elimination. 2 Empty the appliance when it is approximately one half full with feces. 3 Use an antiseptic to clean the peristomal skin before applying the appliance. 4 Select an appliance with a pouch opening of at least 5 cm larger than the stoma.

2 Empty the appliance when it is approximately one half full with feces.

A client is scheduled for gastrointestinal surgery. What is the most important nursing action that should be implemented the evening before surgery? 1 Describing the specific surgical procedure 2 Ensuring the bowel preparation is initiated 3 Encouraging the client to socialize with other clients 4 Providing the client's food preferences for the evening meal

2 Ensuring the bowel preparation is initiated

A client has a paracentesis during which 1500 mL of fluid is removed. The nurse should monitor the client carefully for: 1 Hypertensive crisis 2 Hypovolemic shock 3 Abdominal distention 4 Tenting of the integument

2 Hypovolemic shock

A client with jaundice associated with hepatitis expresses concern over the change in skin color. The nurse explains that this color change is a result of: 1 Stimulation of the liver to produce an excess quantity of bile pigments 2 Inability of the liver to remove normal amounts of bilirubin from the blood 3 Increased destruction of red blood cells during the acute phase of the disease 4 Decreased prothrombin levels, leading to multiple sites of intradermal bleeding

2 Inability of the liver to remove normal amounts of bilirubin from the blood

A client has had a total gastrectomy. What should the nurse include in the discharge teaching? 1 Daily use of a stool softener. 2 Injections of vitamin B12 for life. 3 Monthly injections of iron dextran. 4 Replacement of pancreatic enzymes.

2 Injections of vitamin B12 for life. Intrinsic factor is lost with removal of the stomach, and vitamin B12 is needed to maintain the hemoglobin level and prevent pernicious anemia. Adequate diet, fluid intake, and exercise should prevent constipation. Iron deficiency anemia is not expected. Secretion of pancreatic enzymes should not be affected because this surgery does not alter this function.

A day after surgery to create an ileostomy, a 68-year-old male client remarks to the nurse, "It will be difficult for my wife to care for a helpless old man." Which conflict of Erikson's developmental stages is reflected by this comment? 1 Trust versus mistrust 2 Integrity versus despair 3 Industry versus inferiority 4 Generativity versus stagnation

2 Integrity versus despair

A client is admitted to the hospital for the surgical repair of an incarcerated indirect inguinal hernia. What is the primary preoperative nursing intervention for this client? 1 Placing the client in the supine position 2 Observing the client's bowel movements 3 Monitoring the client's serum enzyme levels 4 Teaching the client about the need to cough postoperatively

2 Observing the client's bowel movements A possible complication of a hernia is intestinal obstruction; if an obstruction occurs, there is no passage of flatus or regular bowel movements. The supine position has no effect on an incarcerated hernia. Monitoring serum enzyme levels is done for all clients; it is not specific for a client with a hernia. Coughing is contraindicated because it places stress on the operative site.

A client follows a vegetarian diet and must compensate for the lack of vitamin B12 found in food of animal origin. Which food should the nurse encourage the client to consume each day? 1 One orange 2 One glass of soy milk 3 Two handfuls of nuts 4 Two servings of green vegetables

2 One glass of soy milk One glass of soy milk provides the recommended daily amount of vitamin B12. Soy protein is the only complete plant protein. One orange does not provide vitamin B12. Two handfuls of nuts does not provide vitamin B12. Two servings of green vegetables does not provide vitamin B12.

A client with Crohn's disease is admitted to the hospital with a history of chronic, bloody diarrhea, weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level, and signs of negative nitrogen balance. The nurse concludes that the client's health status is related to a major deficiency of: 1 Iron 2 Protein 3 Vitamin C 4 Linoleic acid

2 Protein

A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, the nurse expects: 1 Melena 2 Steatorrhea 3 Hard, dry stool 4 Ribbon-shaped stool

2 Steatorrhea Decreased secretion of lipase from the pancreas limits fat breakdown in the small intestine, resulting in increased fat content in feces; steatorrhea is soft, frothy, foul-smelling feces. Melena refers to black, tarry stool containing digested blood; melena is caused by upper gastrointestinal bleeding. Hard, dry stool reflects constipation; stools associated with pancreatitis are soft and frothy. Ribbon-shaped stool is associated with obstruction of the descending or sigmoid colon.

Three months after beginning chemotherapy, a client develops severe anorexia, stomatitis, and episodes of diarrhea. The nursing plan includes increasing fluid and caloric intake and measures to relieve discomfort caused by stomatitis. To address the plan, the nurse should recommend that the client: 1 Drink water frequently 2 Suck on an ice pop every two hours 3 Swallow warm tea throughout the day 4 Rinse the mouth with the prescribed nystatin after meals

2 Suck on an ice pop every two hours Ice pops provide calories and fluid, and the cold relieves discomfort associated with the stomatitis. Water does not provide calories, only fluid. Tea has no calories, and warm drinks will increase, not decrease, the discomfort associated with the stomatitis. Although rinsing the mouth with nystatin after meals may prevent infection, it does not provide calories or fluid, or relieve discomfort associated with the stomatitis.

When planning discharge teaching for a client who had an ileostomy, the nurse places primary emphasis on: 1 Informing the client about the ileostomy association 2 Telling the client whom to contact if assistance is needed 3 Encouraging the client to return to the workplace as soon as possible 4 Teaching the client the importance of irrigations to regulate bowel movements

2 Telling the client whom to contact if assistance is needed The client should know there is help available, even though direct supervision is no longer provided. Informing the client about the ileostomy association and encouraging the client to return to the workplace are not the priorities at this time. Ileostomies are not irrigated because stool is liquid.

Megadoses of vitamin A are taken by a client. Why should the nurse question this practice? 1 Vitamin A is highly toxic, even in small amounts. 2 The liver has a great storage capacity for vitamin A, even to toxic amounts. 3 Vitamin A cannot be stored; therefore excess amounts will saturate the general body tissues. 4 Although the body's requirement for vitamin A is great, the cells can synthesize more as needed.

2 The liver has a great storage capacity for vitamin A, even to toxic amounts.

A client is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver. The nurse suspects what type of toxicity? 1 Thiamine 2 Vitamin A 3 Vitamin C 4 Pyridoxine

2 Vitamin A These adaptations, as well as anemia, irritability, pruritus, and an enlarged spleen, occur with vitamin A toxicity. Excess thiamine is excreted in the urine and rarely, if ever, causes toxicity; an excessive dose may elicit an allergic reaction in some individuals. Excess vitamin C (ascorbic acid) does not cause these adaptations or toxicity; however, vitamin C may cause diarrhea or renal calculi. Pyridoxine (vitamin B6) is relatively nontoxic, and excess amounts are excreted in the urine.

The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase (Viokase). The nurse evaluates that teaching is understood when the client states, "I will take them: 1 At bedtime." 2 With meals." 3 One hour before meals." 4 On arising each morning."

2 With meals." The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum; at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase one hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? (Select all that apply.) 1 Provide a low fat diet. 2 Administer analgesics. 3 Teach relaxation exercises. 4 Encourage walking in the hall. 5 Monitor cardiac rate and rhythm. 6 Observe for signs of hypercalcemia

2 Administer analgesics. 3 Teach relaxation exercises. 5 Monitor cardiac rate and rhythm.

A client has a diagnosis of hemorrhoids. Which signs and symptoms does the nurse expect the client to report? (Select all that apply.) 1 Flatulence 2 Anal itching 3 Blood in stool 4 Rectal pressure 5 Pain when defecating

2 Anal itching 3 Blood in stool 4 Rectal pressure 5 Pain when defecating Pruritus occurs as varicosities enlarge and become inflamed. Blood and mucus in the stool occur as varicosities enlarge and become inflamed. Rectal pressure occurs as portal venous pressure increases and varicosities enlarge. Pain occurs when varicosities enlarge and thromboses occur; pain increases on defecation. Flatulence is unrelated to hemorrhoids.

Which interventions should the nurse anticipate will be prescribed initially for a client who had a hemorrhoidectomy? (Select all that apply.) 1 Giving an enema 2 Applying moist heat 3 Administering stool softeners 4 Encouraging showers as needed 5 Providing occlusive dressings to the area

2 Applying moist heat 3 Administering stool softeners Moist heat dilates the blood vessels, thereby increasing circulation to the area; this is soothing and promotes healing. Stool softeners are prescribed to avoid straining on defecation and constipation. Enemas may be prescribed several days after surgery if the client has not had a bowel movement. Baths, especially sitz baths, are advised to promote healing and cleaning of the area. Occlusive dressings are not used. Light applications of witch hazel may be used to promote drainage and healing.

A client had a laproscopic cholecystectomy. Postoperatively the client experiences nausea and vomiting and is admitted overnight for observation and hydration. What should the nurse include in the teaching plan when preparing this client for discharge? (Select all that apply.) 1 Wash the puncture sites with strong soap and hot water daily. 2 Call the health care provider if you have a fever of 100o F or more for two days. 3 Remove the tape-strips over the puncture sites one week after surgery. 4 Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage. 5 Ease the discomfort from the gas used to insufflate the abdomen during surgery by applying a heating pad to the left shoulder.

2 Call the health care provider if you have a fever of 100o F or more for two days. 4 Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage.

A client is diagnosed as having colitis. Which clinical findings should the nurse expect the client to report? (Select all that apply.) 1 Fever 2 Diarrhea 3 Gain in weight 4 Spitting up blood 5 Abdominal cramps

2 Diarrhea 5 Abdominal cramps The inflammatory process tends to increase peristalsis , causing diarrhea. As ulceration occurs, loss of blood leads to anemia. The inflammatory process tends to increase peristalsis, causing spasms of the intestines. Fever may or may not be a sign. The client will lose weight because of anorexia and malabsorption. Hemoptysis (coughing up blood from the respiratory tract) is not a related sign.

Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? (Select all that apply.) 1 Irritability 2 Dysrhythmias 3 Muscle weakness 4 Abdominal cramps 5 Tingling of the fingertips

2 Dysrhythmias 3 Muscle weakness Dysrhythmias are a sign of potassium depletion in cardiac muscle. Other cardiovascular effects include irregular, rapid, weak pulse, decreased blood pressure, flattened and inverted T waves, prominent U waves, depressed ST segments, peaked P waves, and prolonged QT intervals. Muscle weakness is a symptom of potassium depletion in skeletal muscles; potassium facilitates the conduction of nerve impulses and muscle activity. Irritability, as a result of heightened neuromuscular activity, is a sign of hyperkalemia. Abdominal cramps, as a result of heightened neuromuscular activity, are symptoms of hyperkalemia. Tingling of the fingertips, as a result of a lowered threshold of excitation of peripheral sensory nerve fibers, is a symptom of hypocalcemia.

A client is admitted with anorexia, weight loss, abdominal distention, and abnormal stools. A diagnosis of malabsorption syndrome is made. What nursing action should the nurse implement to best meet this client's needs? 1 Allow the client to eat food preferences. 2 Encourage the consumption of high-protein foods. 3 Institute intravenous (IV) therapy to improve the client's hydration. 4 Maintain nothing by mouth status because food precipitates diarrhea.

2 Encourage the consumption of high-protein foods. The diet should be high in protein and calories, low in fat, and gluten-free for individuals with malabsorption syndrome . Protein is needed for tissue rebuilding. The client may prefer foods high in gluten, which will potentiate malabsorption. IV therapy is a dependent function and does not provide all the necessary nutrients. Diarrhea is caused by malabsorption, which accounts for the depressed nutritional status; once the diarrhea is corrected, it is essential to compensate by providing a nutritious diet.

A nurse teaches a client that it is not recommended to take bicarbonate of soda regularly. What effect of bicarbonate of soda is the nurse trying to prevent? 1 Gastric distention 2 Metabolic alkalosis 3 Chronic constipation 4 Cardiac dysrhythmias

2 Metabolic alkalosis Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water.

A nurse teaches a client with gastrointestinal (GI) irritability to minimize the intake of dietary irritants. Which products did the nurse teach the client to avoid? (Select all that apply.) 1 Rice 2 Milk 3 Cheese 4 Table salt 5 Chocolate candy

2 Milk 3 Cheese 5 Chocolate candy

A client has a nasogastric feeding tube inserted, and the health care provider prescribes the feeding to be instituted immediately. What should the nurse do first? 1 Instill normal saline into the tube to maintain patency. 2 Obtain an x-ray to verify that the tube is in the stomach. 3 Auscultate the epigastric area while instilling 15 mL of air. 4 Withdraw 30 mL of stomach contents to verify tube placement.

2 Obtain an x-ray to verify that the tube is in the stomach X-ray verification of tube placement is required before anything is instilled into the nasogastric tube. Administering a feeding through a misplaced tube can cause the formula to enter the client's lungs. Instilling normal saline into the tube to maintain patency is unsafe. The normal saline will enter the client's lungs if the tube is in the wrong place. Auscultating the epigastric area while instilling 15 mL of air and withdrawing 30 mL of stomach contents to verify tube placement are not definitive ways to ensure correct placement of the nasogastric tube. Once placement is verified by an x-ray, these methods may be used before initiating a feeding.

A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? (Select all that apply.) 1 Preventing constipation 2 Screening of blood donors 3 Avoiding shellfish in the diet 4 Limiting hepatotoxic drug therapy 5 Maintaining a monogamous sexual relationship

2 Screening of blood donors 5 Maintaining a monogamous sexual relationship Contracting hepatitis B through blood transfusions can be prevented by screening donors and testing the blood. Hepatitis B can be transmitted via contaminated body fluids such as semen, saliva, and urine. Multiple sexual partners increase the risk. A monogamous sexual relationship with an infection-free individual eliminates the risk. Preventing constipation is not related to limiting the risk for contracting hepatitis B. Avoiding shellfish in the diet limits the risk for contracting hepatitis A. Limiting hepatotoxic drug therapy does not prevent transmission of hepatitis B.

A client has a fractured mandible that is immobilized with wires. For which life-threatening postoperative problem should the nurse monitor this client? 1 Infection 2 Vomiting 3 Osteomyelitis 4 Bronchospasm

2 Vomiting Vomiting may result in aspiration of vomitus, because it cannot be expelled; this may cause pneumonia or asphyxia. Infection, osteomyelitis, and bronchospasm generally are not life-threatening problems.

A nurse is reviewing preoperative instructions with a client who is scheduled for orthopedic surgery at 8 AM the next day. The nurse advises the client to: 1 "Have your dinner completed by 6 PM tonight and then no food or fluids after that." 2 "Drink whatever liquids you want tonight and then only clear liquids tomorrow morning." 3 "Consume a light evening meal tonight and then no food or fluids after midnight." 4 "Eat lunch today and then do not drink or eat anything until after your surgery."

3 "Consume a light evening meal tonight and then no food or fluids after midnight.

A client is diagnosed with chronic pancreatitis. When providing dietary teaching it is most important that the nurse instruct the client to: 1 Eat a low fat, low protein diet 2 Avoid foods high in carbohydrates 3 Avoid ingesting alcoholic beverages 4 Eat a bland diet of six small meals a day

3 Avoid ingesting alcoholic beverages

A nurse is teaching a group of adults about the signs and symptoms of colorectal cancer. What is the most common clinical manifestation that the nurse should include in the teaching program? 1 Rectal bleeding 2 Abdominal pain 3 Change in bowel habits 4 Alteration in caliber of stools

3 Change in bowel habits

Immediately after a liver biopsy, a client is placed onto the right side. The nurse explains that the rationale for this positioning is to: 1 Decrease pain to provide comfort 2 Support erythropoiesis to increase red blood cell production 3 Compress blood vessels to prevent bleeding 4 Expel fluid trapped in the biliary ducts to promote drainage

3 Compress blood vessels to prevent bleeding

Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is bright red. What should the nurse do first? 1 Notify the health care provider. 2 Clamp the nasogastric tube for one hour. 3 Determine that this is an expected finding. 4 Irrigate the nasogastric tube with iced saline.

3 Determine that this is an expected finding. Nasogastric drainage is expected to be bright red during the first 12 hours after surgery; bleeding lessens gradually during the 12 hours after surgery in response to hemostasis in the surgical area. Notifying the health care provider is unnecessary; bloody drainage is expected this soon after surgery. Nasogastric suction must be working, and the tube must remain patent to prevent stress on the suture line. The nasogastric tube is only irrigated if the health care provider prescribes it because of the danger of injury to the suture line; generally saline at room temperature is prescribed.

A client with hepatic cirrhosis develops hepatic encephalopathy. Neomycin sulfate (Mycifradin) is prescribed. The nurse concludes that the purpose of neomycin is to: 1 Decrease intestinal edema 2 Reduce abdominal distention 3 Diminish the blood ammonia level 4 Limit development of systemic infections

3 Diminish the blood ammonia level Neomycin sulfate reduces bacterial activity on blood and wastes in the gastrointestinal (GI) tract, thereby reducing the level of blood ammonia, a byproduct of protein metabolism; hepatic encephalopathy is a result of elevated ammonia levels in the blood. Neomycin sulfate interferes with bacterial protein synthesis but has little or no effect on intestinal edema. Neomycin sulfate reduces bacterial action in the GI tract but does not reduce abdominal distention. Neomycin sulfate does not limit the development of a systemic infection when it is ingested because it is not absorbed systemically.

A client undergoes an abdominal cholecystectomy with common duct exploration. In the immediate postoperative period the priority nursing action is: 1 Irrigating the T-tube every hour 2 Changing the dressing every two hours 3 Encouraging coughing and deep breathing 4 Promoting an adequate fluid and food intake

3 Encouraging coughing and deep breathing

A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn's disease. Which expected outcome is most important for this client? 1 Does skin care 2 Takes oral fluids 3 Gains a half pound per week 4 Experiences less abdominal cramping

3 Gains a half pound per week Weight loss usually is severe with Crohn's disease ; therefore, weight gain is a priority; this goal is specific, realistic, measurable, and has a time frame. Although skin care, taking oral fluids, and experiencing less abdominal cramping are important, they are not as high a priority as weight gain.

During a client's paracentesis, 1500 mL of fluid is removed. The nurse monitors the client for which sign of a potentially severe response? 1 Abdominal girth decrease 2 Mucous membranes becoming drier 3 Heart rate increases from 80 to 135 4 Blood pressure rises from 130/70 to 190/80

3 Heart rate increases from 80 to 135 Fluid may shift from the intravascular space to the abdomen as fluid is removed, leading to hypovolemic shock and compensatory tachycardia. A paracentesis should decrease the degree of distention. Mucous membranes becoming drier is a sign dehydration may occur, but it is not as vital or immediate as signs of shock. A fluid shift may cause hypovolemia with resulting hypotension, not hypertension.

A client is to have gastric lavage following an overdose of acetaminophen (Tylenol). In which position should the nurse place the client when the nasogastric tube is being inserted? 1 Supine 2 Mid-Fowler 3 High-Fowler 4 Trendelenburg

3 High-Fowler -The high-Fowler position promotes optimal entry into the esophagus aided by gravity. Supine position does not take full advantage of the effect of gravity. Mid-Fowler and Trendelenburg positions will contribute to aspiration. The head of the bed should be raised, not lowered.

A client has circumgastric banding, a bariatric surgical procedure. The nurse provides discharge teaching about signs and symptoms of dumping syndrome and includes what physiological response? 1 Fever 2 Vomiting 3 Palpitations 4 Constipation

3 Palpitations Dumping syndrome is caused by a rapid emptying of gastric contents into the small intestine, resulting in a constellation of vasomotor responses, including tachycardia, vertigo, syncope, diaphoresis, and pallor. Fever is a sign of infection, not dumping syndrome. Vomiting is not a sign of dumping syndrome; excessive food intake may result in nausea and vomiting. Diarrhea and abdominal cramping occur, not constipation.

A nurse is planning care for a client admitted to the hospital with abdominal spasms and pain associated with severe diarrhea. What primary serum blood level should the nurse monitor? 1 Urea 2 Chloride 3 Potassium 4 Creatinine

3 Potassium

A client in a debilitated state is admitted for palliative treatment of cancer of the liver. Which objective information collected by the nurse is most helpful for future monitoring of the client's condition? 1 Diet history 2 Bowel sounds 3 Present weight 4 Pain description

3 Present weight

An 18-year-old is admitted with an acute onset of right lower quadrant pain at McBurney's point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis? 1 Urinary retention 2 Gastric hyperacidity 3 Rebound tenderness 4 Increased lower bowel motility

3 Rebound tenderness -Rebound tenderness is a classic subjective sign of appendicitis .

An older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the health care provider will most likely prescribe? 1 Increase intake of dietary roughage slowly. 2 Avoid oral feedings for a prolonged period. 3 Resume small, easily digested feedings gradually. 4 Limit intake to self-selection of personally preferred foods.

3 Resume small, easily digested feedings gradually.

A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles associated with this diagnosis? 1 Turkey salad, French fries, sherbet 2 Cottage cheese, mixed fruit salad, milkshake 3 Salad, sliced chicken sandwich, gelatin dessert 4 Cheeseburger, tortilla chips, chocolate pudding

3 Salad, sliced chicken sandwich, gelatin dessert

A client's serum albumin value is 2.8 g/dL. Which food selected by the client indicates that the nurse's dietary teaching is successful? 1 Beef broth 2 Fruit salad 3 Sliced turkey 4 Spinach salad

3 Sliced turkey This client's serum albumin value indicates severe depletion of visceral protein stores; the expected range for serum albumin is 3.5 to 5.5 g/dL. White meat turkey (two slices 4 × 2 × 1/4 inch) contains approximately 28 g of protein. A 4 oz serving of beef broth contains approximately 2.4 g of protein. A 6 oz serving of mixed fruit contains approximately 0.5 g of protein. A 3 oz serving of spinach salad contains approximately 9 g of protein

A nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which diet should the nurse teach the client to maintain because it will help minimize clinical manifestations of dumping syndrome? 1 Low-residue, bland diet 2 Fluid intake below 500 mL 3 Small, frequent feeding schedule 4 Low protein, high carbohydrate diet

3 Small, frequent feeding schedule

A client develops acute appendicitis. Prior to arrival to the hospital, the client attempted self-care at home. Which self-care measures could potentially lead to rupture of the appendix? 1 Refusing food and liquids 2 Applying an ice pack to the abdomen 3 Taking a small volume enema 4 Taking acetaminophen (Tylenol) for pain

3 Taking a small volume enema Enemas can increase pressure in the intestines and cause rupture of an inflamed appendix. Fasting from food or applying an ice pack will not lead to rupture of the appendix. Taking acetaminophen will not increase the risk of rupture of the appendix.

A client with gastroesophageal reflux disease (GERD) should make diet and lifestyle changes. What instructions should the nurse include in the client's discharge teaching? (Select all that apply.) 1 Add milk to coffee. 2 Elevate the foot of the bed. 3 Avoid caffeine-containing products. 4 Eat three evenly spaced meals daily. 5 Chew thoroughly while eating slowly.

3 Avoid caffeine-containing products. 5 Chew thoroughly while eating slowly.

When a client develops steatorrhea, the nurse documents this stool as: 1 Dry and rock-hard 2 Clay colored and pasty 3 Bulky and foul smelling 4 Black and blood-streaked

3 Bulky and foul smelling Bulky and foul smelling characteristics describe steatorrhea, which results from impaired fat digestion

A client who is about to have a blood transfusion asks the nurse, "Which type of hepatitis is most frequently transmitted by transfusions?" The nurse should respond, "Although the risk is minimal, the type of hepatitis associated with blood transfusions is hepatitis: 1 A." 2 B." 3 C." 4 D."

3 C." Hepatitis C is caused by an RNA virus that is transmitted parenterally. More effective blood screening for hepatitis C was introduced in June 1992; this brought about a dramatic decrease in hepatitis C infection caused by blood transfusions. Recent studies document that the risk of contracting hepatitis C from a blood transfusion is 1 in 103,000 transfusions. The incubation period is 5 to 10 weeks. Hepatitis A, also known as infectious hepatitis, is caused by an RNA virus that is transmitted via the fecal-oral route. The incubation period is 2 to 6 weeks. Hepatitis B is transmitted parenterally, sexually, and by direct contact with infected body secretions. The incubation period is 1 to 6 months. It is not the major cause of posttransfusion hepatitis. Hepatitis D is a complication of hepatitis B.

A nurse is caring for a client who just had a gastrectomy. What should the nurse emphasize when teaching the client how to avoid dumping syndrome? 1 Increase activity after eating 2 Drink at least two to three glasses of fluid with each meal 3 Eat small meals with low carbohydrate and moderate fat content 4 Sit in a high-Fowler position for 30 minutes after eating

3 Eat small meals with low carbohydrate and moderate fat content Small meals with low carbohydrate, moderate fat, and high protein are recommended; these are digested more readily and prevent rapid stomach emptying. Rest, not activity, after meals assists in limiting dumping syndrome. Fluid intake with meals should be in moderation. Fluids with meals cause rapid emptying of the food from the stomach into the jejunum before it is adequately subjected to the digestive process; the hyperosmolar mixture causes a fluid shift to the jejunum. A high-Fowler position will not reduce the risk of dumping syndrome.

For which classic clinical finding should the nurse assess the stool of clients with malabsorption syndrome? 1 Melena 2 Frank blood 3 Fat globules 4 Currant jelly consistency

3 Fat globules Undigested fat in the feces (steatorrhea) is associated with diseases of the intestinal mucosa (e.g., celiac sprue) or pancreatic enzyme deficiency. Darkening of feces by blood pigments (melena) is related to upper gastrointestinal (GI) bleeding. Bright red blood in the stool is related to lower GI bleeding (e.g., hemorrhoids). Stools containing blood and mucus (currant jelly stools) are associated with intussusception.

A nurse reviews the plan of care for a client with less than adequate nutritional intake. The nurse should question which prescription? 1 Have client sit in a chair for meals 2 Provide six small feedings in 24 hours 3 Give one can of diet supplement at 8 am and 4 pm 4 Encourage the client's family members to bring food from home

3 Give one can of diet supplement at 8 am and 4 pm Supplements given before meals will make a client less hungry at mealtimes; supplements should be given after meals.

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone (Aldactone).What should the nurse monitor the client for? 1 Bruising 2 Tachycardia 3 Hyperkalemia 4 Hypoglycemia

3 Hyperkalemia Spironolactone (Aldactone) is a potassium-sparing diuretic that is used to treat clients with ascites; therefore, the nurse should monitor the client for signs and symptoms of hyperkalemia

A nurse provides dietary teaching for a client with an acute exacerbation of colitis, and afterward the client makes a list of foods that can be included on the diet. Which food choices indicate that the teaching was effective? (Select all that apply.) 1 Orange juice 2 Creamed soup 3 Jelly sandwich 4 Lean roast beef 5 Scrambled eggs

3 Jelly sandwich 4 Lean roast beef 5 Scrambled eggs A jelly sandwich is low in residue and therefore is less irritating to the colon than other foods. Lean roast beef is low in residue and therefore is less irritating to the colon than other foods. Eggs are low in residue and therefore are less irritating to the colon than other foods. Orange juice contains cellulose, which is not absorbed and irritates the colon. Milk in creamed soup contains lactose, which is irritating to the colon.

A client with chronic hepatic failure is to be discharged from the hospital. Which diet should the nurse encourage the client to follow based on the health care provider's prescription? 1 High fat 2 Low-calorie 3 Low protein 4 High sodium

3 Low protein With liver failure, the protein intake is limited to 20 g daily to decrease the possibility of hepatic encephalopathy. A high fat diet is avoided because of the related cardiovascular risks and the related demand for bile. Regeneration of tissue requires a high-calorie, high carbohydrate diet. Sodium usually is restricted to decrease the accumulation of fluid and help limit ascites and edema.

The menu for a client with malabsorption syndrome must be limited because of a sensitivity to gluten. Which foods cannot be served to this client? (Select all that apply.) 1 Cheese omelet 2 Creamed spinach 3 Roast beef sandwich 4 Chicken noodle soup 5 Spaghetti and meatballs

3 Roast beef sandwich 4 Chicken noodle soup 5 Spaghetti and meatballs

When discussing a scheduled liver biopsy with a client, the nurse explains that for several hours after the biopsy the client will have to remain in what position? 1 The left side-lying position with the head of the bed elevated 2 A high Fowler position with both arms supported on several pillows 3 The right side-lying position with pillows placed under the costal margin 4 Any comfortable recumbent position as long as the client remains immobile

3 The right side-lying position with pillows placed under the costal margin In the right side-lying position with pillows placed under the costal margin, the liver capsule at the entry site is compressed against the chest wall and escape of blood or bile is impeded. The left side-lying position with the head of the bed elevated, a high Fowler position with both arms supported on several pillows, and any comfortable recumbent position as long as the client remains immobile are unsafe because pressure will not be applied to the puncture site and the client can bleed from the insertion site.

A client was recently diagnosed with a cancerous lesion of the mouth. What should the nurse ask when analyzing the client's need for health education in relation to this health problem? 1 "Are you having difficulty sleeping?" 2 "Do feel like your gums are inflamed?" 3 "How frequently are you seeing the dentist?" 4 "Have you noticed any change in your appetite?"

4 "Have you noticed any change in your appetite?"

A nurse is teaching an older adult client about managing chronic pain with acetaminophen (Tylenol). Which client statement indicates that the teaching is effective? 1 "I need to limit my intake of acetaminophen to 650 mg a day." 2 "I can take oxycodone with the acetaminophen if it is ineffective." 3 "I should take an emetic if I accidentally overdose on the acetaminophen." 4 "I have to be careful about which over-the-counter cold preparations I take when I have a cold."

4 "I have to be careful about which over-the-counter cold preparations I take when I have a cold."

The nurse is teaching a client about the prescribed diet after a Whipple procedure for cancer of the pancreas. Which statement should the nurse include in the dietary teaching? 1 "There are no dietary restrictions because the tumor has been removed." 2 "Your diet should be low in calories to prevent taxing your diseased pancreas." 3 "Meals should be restricted in protein because of your compromised liver function." 4 "Low fat meals should be eaten to prevent interference with your fat digestion mechanism."

4 "Low fat meals should be eaten to prevent interference with your fat digestion mechanism." Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine; interference with fat digestion occurs, causing dyspepsia. Clients require small, frequent meals and should eat a high-calorie, high protein, low fat diet. The response "There are no dietary restrictions because the tumor has been removed" is false assurance. High-calorie meals are needed for energy and to promote the use of protein for tissue repair. High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless metastasis occurs by direct extension.

Prednisone (Meticorten) is prescribed for a client with an exacerbation of colitis. Before administering the first dose, the nurse teaches the client that: 1 Symptoms associated with the colitis will decrease slowly over time 2 The client will be protected from getting an infection 3 Although the medication causes anorexia, weight loss may not occur 4 Although the medication decreases intestinal inflammation, it will not cure the colitis

4 Although the medication decreases intestinal inflammation, it will not cure the colitis

A client with cholelithiasis has a laser laparoscopic cholecystectomy. Postoperatively it is most appropriate for the nurse to: 1 Maintain the client's nothing by moth status for the first 24 hours 2 Monitor the client's abdominal incision for bleeding 3 Offer clear carbonated beverages to the client 4 Ambulate the client when the client is alert and oriented

4 Ambulate the client when the client is alert and oriented

What should the nurse do when caring for a client with an ileostomy? 1 Teach the client to eat foods high in residue. 2 Explain that drainage can be controlled with daily irrigations. 3 Expect the stoma to start draining on the third postoperative day. 4 Anticipate that any emotional stress can increase intestinal peristalsis.

4 Anticipate that any emotional stress can increase intestinal peristalsis. -Emotional stress of any kind can stimulate peristalsis and thereby increase the volume of drainage. The client should be encouraged to eat a regular diet if possible. Ileostomy drainage is liquefied and continuous, so irrigations are not indicated. The stoma will start to drain within the first 24 hours after surgery.

A client had surgery for a ruptured appendix. Postoperatively, the health care provider prescribes an antibiotic to be administered intravenously twice a day. The nurse administers the prescribed antibiotic via a secondary line into the primary infusion of 0.9% sodium chloride. During the administration of the antibiotic, the client becomes restless and flushed, and begins to wheeze. What should the nurse do after stopping the antibiotic infusion? 1 Check the client's temperature 2 Take the client's blood pressure 3 Obtain the client's pulse oximetry 4 Assess the client's respiratory status

4 Assess the client's respiratory status

A client with chronic gastritis is being treated with medication and diet. What should the nurse teach the client when discussing the therapeutic regimen? 1 Lie down after eating when possible 2 Take an antacid preparation with meals 3 Limit high carbohydrate foods in the diet 4 Avoid using analgesics that contain aspirin

4 Avoid using analgesics that contain aspirin Aspirin interferes with the gastric mucosa's natural protection from pepsin and hydrochloric acid, worsening the gastritis. The client should avoid lying down after eating; sitting up for one hour after meals uses gravity to minimize esophageal reflux. Antacids usually are prescribed after meals. Small, frequent, bland feedings are preferred; carbohydrate intake may be increased to provide calories needed during tissue repair.

A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question? 1 Blood clotting 2 Bone formation 3 Muscle contraction 4 Cellular membranes

4 Cellular membranes Cholesterol is an essential structural and functional component of most cellular membranes. That it is associated with atherosclerotic plaques does not detract from its essential functions. Cholesterol is not necessary for blood clotting; calcium and vitamin K are necessary. Cholesterol is not essential for bone formation; calcium, phosphorus, and calciferol are necessary. Cholesterol is not involved in muscle contraction; potassium, sodium, and calcium are necessary.

A nurse is administering an enema to a client who is scheduled for gastrointestinal surgery. What should the nurse do when the client complains of abdominal cramps during the enema? 1 Reduce the rate of flow of the infusion. 2 Discontinue the enema and try again later. 3 Lower the container below the level of the rectum. 4 Close the lumen of the tubing and wait until the discomfort subsides

4 Close the lumen of the tubing and wait until the discomfort subsides Stopping the flow reduces cramping caused by distention of the intestinal lumen. Distention results from the volume of fluid instilled. Reducing the rate of flow of the enema fluid still infuses fluid into the intestine, which will increase the discomfort. There is no need to discontinue the enema. An effective enema must be administered before gastrointestinal surgery. Lowering the container several inches below the anus will result in the fluid flowing back out through the rectal tube into the container; this is the principle used when administering a return-flow enema (also known as Harris flush). The purpose of the preoperative enema is to evacuate the bowel of feces, not just flatus.

A client asks the nurse to review a list of the foods the client has been choosing to combat constipation. Upon review, the nurse identifies that the food item that has the least amount of fiber content is: 1 Stewed prunes 2 Whole-bran cereal 3 Grapefruit sections 4 Cream of wheat cereal

4 Cream of wheat cereal Cream of wheat cereal is highly refined, with reduced fiber content. Prunes are high in bulk and promote intestinal motility. The fiber residue of whole-bran cereal promotes intestinal motility. The fiber residue of grapefruit sections promotes intestinal motility.

The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. What would be appropriate to include in the dietary plan? 1 Soft-textured foods to reduce the digestive burden 2 Low-cholesterol foods to avoid further formation of gallstones 3 Increased protein intake to promote tissue healing and improve energy reserves 4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

A client is scheduled for a pyloroplasty and vagotomy because of strictures caused by ulcers unresponsive to medical therapy. What information about the purpose of a vagotomy should the nurse include when reviewing the health care provider's discussion with the client? 1 Increases the heart rate 2 Hastens gastric emptying 3 Eliminates pain sensations 4 Decreases acid in the stomach

4 Decreases acid in the stomach The vagus nerve stimulates the stomach to secrete hydrochloric acid. When it is severed, this neural pathway is interrupted and stomach acid is decreased. The portion of the vagus nerve that is severed innervates the stomach, not the heart; therefore, the heart rate is not affected. The vagus nerve controls hydrochloric acid secretion, not gastric emptying; emptying is determined by the nature of foods being digested. The vagus nerve is not a sensory nerve.

A health care provider prescribes an upper gastrointestinal (GI) series and a barium enema. The client asks, "Why do I have to have barium for these tests?" The nurse's best response is "Barium: 1 Gives off visible light, illuminating the alimentary tract." 2 Provides fluorescence, thereby lighting up the alimentary tract." 3 Dyes the structures of the alimentary tract, making them more visible." 4 Gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays."

4 Gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays." Barium salts used in a GI series and barium enemas coat the inner lining of the GI tract and then absorb x-rays passing through. Thus, they outline the surface features of the tract on a photographic plate. Barium has no light-emitting properties. Barium does not fluoresce. Barium does not have the properties of a dye.

A client with Parkinson disease complains about a problem with elimination. The nurse should encourage the client to: 1 Eat a banana daily 2 Decrease fluid intake 3 Take cathartics regularly 4 Increase residue in the diet

4 Increase residue in the diet Increasing residue in the diet produces bulk, which stimulates defecation; the muscles used in defecation are weak in clients with Parkinson disease. Bananas are binding and will intensify the problem of constipation. Decreasing fluid intake will intensify the problem; fluids need to be increased. Cathartics are irritating to the intestinal mucosa, and their regular administration promotes dependence.

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? 1 Promotes the formation of calculi in the cystic duct 2 Stimulates the pancreas to secrete more insulin than it can immediately produce 3 Alters the composition of enzymes so they are capable of damaging the pancreas 4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct. The backflow of enzymes into the pancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Although blockage of the bile duct with calculi may precipitate pancreatitis, this is not associated with alcohol. Alcohol does not deplete insulin stores; the demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged.

A nurse is assessing two clients. One client has ulcerative colitis and the other client has Crohn's disease. Which is more likely to be identified in the client with ulcerative colitis than the client with Crohn's disease? 1 Inclusion of transmural involvement of the small bowel wall 2 Correlation with increased malignancy because of malabsorption syndrome 3 Pathology beginning proximally with intermittent plaques found along the colon 4 Involvement starting distally with rectal bleeding that spreads continuously up the colon

4 Involvement starting distally with rectal bleeding that spreads continuously up the colon In ulcerative colitis, pathology usually is in the descending colon; in Crohn's disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. There is no direct correlation of colitis with malignancy of the bowel, although psychological, environmental, genetic, and nutritional factors, as well as preexisting disease, appear to be influential in malignancy. Involvement is in the distal portion of the colon, not the proximal portion.

A client who recently immigrated to the United States has a chronic vitamin A deficiency. What information about vitamin A should the nurse consider when assessing this client for clinical indicators of this deficiency? 1 Vitamin A is an integral part of the retina's pigment called melanin. 2 It is a component of the rods and cones, which control color visualization. 3 Vitamin A is the material in the cornea that prevents the formation of cataracts. 4 It is a necessary element of rhodopsin, which controls responses to light and dark environments.

4 It is a necessary element of rhodopsin, which controls responses to light and dark environments. Vitamin A is used in the formation of retinol, a component of the light-sensitive rhodopsin (visual purple) molecule. Melanin is a pigment of the skin. Vitamin A does not influence color vision, which is centered in the cones. The cornea is a transparent part of the anterior portion of the sclera; a cataract is opacity of the usually transparent crystalline lens. Vitamin A does not prevent cataracts.

A nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. For which risk factor commonly associated with cancer of the tongue should the nurse assess when collecting the client's history? 1 Nail biting 2 Poor dental habits 3 Frequent gum chewing 4 Large consumption of alcohol

4 Large consumption of alcohol A large amount of alcohol ingestion predisposes an individual to the development of oral cancer because it is a mucosal irritant. Nail biting, poor dental habits, and frequent gum chewing have no effect on the development of oral cancer.

A client who recently experienced a brain attack (CVA) and who has limited mobility complains of constipation. What is most important for the nurse to determine when collecting information about the constipation? 1 Presence of distention 2 Extent of weight gained 3 Amount of high-fiber food consumed 4 Length of time this problem has existed

4 Length of time this problem has existed First, the nurse should establish when the client last defecated because the client may have perceived constipation. Abdominal distention may or may not be observed with constipation. Weight gain has no relationship to constipation. Although lack of bulk in the diet can lead to constipation, particularly in clients with limited activity or an inadequate fluid intake, the lack of bulk in the diet is not the most significant information to obtain at this time.

A client with a history of ulcerative colitis has a large portion of the large intestine removed and the creation of an ileostomy. For which potential life-threatening complication should the nurse assess the client after this surgery? 1 Infection caused by the excretion of feces 2 Injury caused by exposed intestinal mucosa 3 Altered bowel elimination caused by the ostomy 4 Limited water reabsorption caused by removal of intestine

4 Limited water reabsorption caused by removal of intestine The continuous excretion of liquid feces may deplete the body of fluid and electrolytes, resulting in a life-threatening fluid deficit and electrolyte imbalance. Although the irritation of the skin by fecal material may result in an infection, this usually is not a life-threatening complication. Although the stoma should be protected from injury, this is not a life-threatening complication. Although altered bowel elimination is a concern, it is not a life-threatening complication.

A client who has been caring for a colostomy on the left side of the abdomen for several years is admitted to the hospital for an unrelated health problem. What type of stool should the nurse expect? 1 Pencil-shaped 2 Mucus-coated 3 Loose and liquid 4 Moist and formed

4 Moist and formed A colostomy on the left side involves the descending colon, leaving most of the colon intact to absorb fluid. Pencil-shaped stool is associated with conditions that narrow the intestinal lumen; this usually is not associated with a colostomy. Stools usually are not covered with mucus; they may be moist but not mucoid. Loose and liquid stools are associated with a colostomy that involves the ascending colon.

A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition? 1 Avoid foods high in vitamin K. 2 Check the pulse several times a day. 3 Drink a glass of milk when taking aspirin. 4 Report signs of bleeding no matter how slight.

4 Report signs of bleeding no matter how slight.

When teaching a client how to prevent constipation, the nurse evaluates that the dietary teaching is understood when the client states that the preferred breakfast cereal is: 1 Froot Loops 2 Corn Flakes 3 Cap'n Crunch 4 Shredded Wheat

4 Shredded Wheat

A nurse is teaching a class about hepatitis, specifically hepatitis A. Which food should the nurse explain most likely will remain contaminated with the hepatitis A virus after being cooked? 1 Canned tuna 2 Broiled shrimp 3 Baked haddock 4 Steamed lobster

4 Steamed lobster The temperature during steaming is never high enough or sustained long enough to kill microorganisms. Processing destroys the virus. Because of the extremely high temperature, broiling sufficiently destroys the virus. Baking will destroy the virus.

A nurse is caring for a client who is cachectic. What information about the function of adipose tissue in fat metabolism is necessary to better address the needs of this client? 1 Releases glucose for energy 2 Regulates cholesterol production 3 Uses lipoproteins for fat transport 4 Stores triglycerides for energy reserves

4 Stores triglycerides for energy reserves A triglyceride is composed of three fatty acids and a glycerol molecule. When energy is required, the fatty acids are mobilized from adipose tissue for fuel. The nurse needs to consider that a client who is cachectic will have limited reserves to meet energy needs. Releasing glucose for energy is not the function of adipose tissue; its main function is storage. Regulating cholesterol production is not a function of adipose tissue; cholesterol is produced in the liver. Using lipoproteins for fat transport is not the function of adipose tissue in fat metabolism.

A nurse caring for a client who has gastroesophageal reflux disease (GERD) should place the client in what position in the illustration? 1 a 2 b 3 c 4 d

4 d The reverse Trendelenburg position uses gravity to help keep gastric contents in the stomach, thereby minimizing reflux of gastric contents into the esophagus. The high-Fowler position promotes lung expansion; it is used when the client eats in bed and when the nurse suctions secretions from the client's respiratory tract. The client can slide down lower in bed while in the semi-Fowler position, which puts undue stress on the stomach, contributing to reflux. The flat position may permit the flow of gastric contents through the cardiac sphincter into the esophagus, contributing to GERD and increasing the risk of aspiration.

The nurse is reviewing the plan of care for a client that is scheduled for a barium swallow. The plan will include: 1 Giving clear fluids on the day of the test 2 Asking the client about allergies to iodine 3 Administering cleansing enemas before the test 4 Administering a laxative after the procedure

4 Administering a laxative after the procedure Barium will harden and may create an impaction; a laxative and increased fluids promote elimination of barium. The client must be kept nothing by mouth. Iodine is not used with barium. Administering cleansing enemas before the test is not part of the preparation; feces in the lower gastrointestinal (GI) tract will not interfere with visualization of the upper GI tract.

A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client? 1 Levin 2 Salem sump 3 Miller-Abbott 4 Blakemore-Sengstaken

4 Blakemore-Sengstaken Blakemore-Sengstaken includes an esophageal balloon that exerts pressure on inflation, which retards hemorrhage. A Levin tube is used for gastric decompression, gavage, or lavage; it has one lumen. A Salem sump tube is used for gastric decompression; it has two lumens, one for decompression and one for an air vent. A Miller-Abbott tube is used for intestinal decompression.

After taking spironolactone (Aldactone), a potassium-sparing diuretic, the client inquires about foods and fluids that are low in potassium. Which juice should the nurse teach the client contains the least amount of potassium? 1 Apple juice 2 Orange juice 3 Tomato juice 4 Cranberry juice

4 Cranberry juice Cranberry juice contains approximately 46 mg of potassium per 8 ounces. Apple juice contains approximately 295 mg of potassium per 8 ounces. Orange juice contains approximately 496 mg of potassium per 8 ounces. Tomato juice contains approximately 535 mg of potassium per 8 ounces.

A client is scheduled for a barium swallow. How should the nurse prepare the client for this test? (Select all that apply.) 1 Ask about allergies to iodine before the test. 2 Administer cleansing enemas before the test. 3 Suggest a light breakfast on the day of the test. 4 Ensure that a laxative is prescribed after the test. 5 Instruct to withhold prescribed opioids for one day before the test.

4 Ensure that a laxative is prescribed after the test. 5 Instruct to withhold prescribed opioids for one day before the test. Barium will harden and may lead to constipation and a possible impaction; a laxative and increased fluids promote elimination of barium. Opioids are withheld for 24 hours before the test to prevent intestinal immobility.

A client appears depressed since the surgical creation of a colostomy five days ago. The nurse determines that there is some movement toward adaptation to the change in body image when the client: 1 Discusses the necessity of the colostomy 2 Requests the nurse to change the dressing 3 Looks at the face of the nurse during care 4 Stares at the stoma during dressing changes

4 Stares at the stoma during dressing changes\ A willingness to view the stoma indicates the beginning of acceptance and integration of the colostomy into the body image. Discussing the necessity of the colostomy is evidence of intellectualization rather than acceptance of the change in body image. Requesting the nurse to change the dressing indicates lack of readiness to participate in the care of the stoma. Watching the face of the nurse during the care indicates that the client is observing the staff's response to and acceptance of the stoma and, by extension, the client as an individual.

A health care provider prescribes bisacodyl (Dulcolax) for a client with cardiac disease. The nurse explains to the client that this drug acts by: 1 Producing bulk 2 Softening feces 3 Lubricating feces 4 Stimulating peristalsis

4 Stimulating peristalsis Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as *psyllium hydrophilic mucilloid (Metamucil)*, form soft, pliant bulk that promotes physiological peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as *docusate sodium*, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as *mineral oil (Kondremul)*, lubricate the feces and decrease absorption of water from the intestinal tract.

A client is experiencing chronic constipation and the nurse discusses how to include more bulk in the diet. The nurse concludes that learning has occurred when the client states, "Bulk in the diet promotes defecation by: 1 Irritating the bowel wall." 2 Stimulating the intestinal mucosa chemically." 3 Acting on the microorganisms in the large intestine." 4 Stretching intestinal smooth muscle, which causes it to contract."

4 Stretching intestinal smooth muscle, which causes it to contract."

A client is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. The nurse is providing discharge teaching about how many days the client should wait to engage in certain activities. Place in order the activities from the first to the last in which the client may engage. 1. Showering 2. Driving a car 3. Performing light exercise 4. Lifting objects of more than 10 lbs 5. Getting out of bed in a chair

5. Getting out of bed in a chair 3. Performing light exercise 1. Showering 2. Driving a car 4. Lifting objects of more than 10 lbs

When advising a college student about dietary choices, the nurse should consider the caloric value of the most commonly ordered fast foods eaten by active young adults. List the following foods in order from the one with the least number of calories to the one with the most number of calories. 1. French fries 2. Garden salad 3. Hamburger with cheese 4. One slice of French toast 5. Six pieces of chicken tenders

A garden salad has 95 calories. One slice of French toast has 126 calories. Six chicken tenders have 236 calories. An order of French fries has 372 calories. A hamburger with cheese has 720 calories.