Evolve: GI

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 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 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 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 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 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 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

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 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 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 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 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.

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 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 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

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?"

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 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 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 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 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 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.

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

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 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 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.

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

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 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

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 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 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 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

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.

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 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

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

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 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 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 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 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

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

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 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.

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 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 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 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.

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 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."

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."

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

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 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 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 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.

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.

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 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.

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 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 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

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 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."

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