Exam 3 MED SURG GI

Ascites occurs because the liver is unable to synthesize which of the following? A. Albumin B. Glucose C. Bile D. Carbohydrates

A. Albumin

A male client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. When obtaining this client's history, the nurse should give priority to the client's statement that: A) His stools have a tarry appearance B) He recently joined alcoholics anonymous C) He experiences nausea frequently D) His pain is increased after meals

A) His stools have a tarry appearance

The most therapeutic diet for a client with hepatic failure would be: A) low protein diet b) low calorie diet C) high fat diet D) high sodium diet

A) low protein diet

A nurse is assigned to four clients who have been diagnosed with gastric ulcers. Which one of these clients should the nurse conclude is most as risk to develop GI bleed? A. A 70 yr old client who takes 81 mg of ASA a day to prevent CAD B. A 45yr old client who drinks 4 ounces of alcohol a day C. A 40 yr old client who is positive for H pylori D. A 30 yr olf pregnant client who uses Tylenol as needed for headaches

A. A 70 yr old client who takes 81 mg of ASA a day to prevent CAD

A client with end-stage cirrhosis develops severe vomiting. The client is at risk for what complication? A. Bleeding esophageal varices B. Decreased excretion of bilirubin C. The accumulation of plasma within the peritoneal cavity D. Intrahepatic bile stasis

A. Bleeding esophageal varices

What statement will be included in the nurse's teaching about oral care for the client with stomatitis? A. "Clean your mouth three times a day with a gentle foam sponge." B. "Rinse you mouth out twice a day with mouthwash." C. "Suck on ice cubes to minimize the discomfort." D. "Use lemon-glycerin swabs to clean your mouth after meals and at bedtime."

A. Clean your mouth three times a day with a gentle foam sponge

The nurse is caring for a client who has just had abdominal surgery. When auscultating the client's abdomen, the nurse does not hear any bowel sounds. Which is the nurse's best action? A. Document the finding B. Notifying the physician C. Inserting a nasogastric tube D. Percussing the abdomen

A. Document the finding

The nurse is caring for a client with a peptic ulcer disease. The client vomits a large amount of undigested food after breakfast. Which intervention will the nurse prepare to do for the client? A. Insert a nasogastric (NG) tube to low intermittent suction B. Administer a soap suds cleansing enema C. Administer prochlorperazine (Compazine) 10 mg IM D. Change the client's diet to clear liquids only

A. Insert a nasogastric (NG) tube to low intermittent suction

The nurse is caring for a client with a gastric ulcer who suddenly develops sharp mid-epigastric pain. The nurse notes that the client's abdomen is hard and very tender to light palpation. Which is the priority action of the nurse? A. Prepare the client for emergency surgery B. Administering morphine 2 mg IV as ordered by the physician C. Inserting a nasogastric tube to low intermittent suction D. Placing the client in a knee-chest position

A. Prepare the client for emergency surgery

The patient develops an active upper GI bleed. Which actions does the nurse take in caring for this patient. (Select all that apply). A. Prepare to infuse 0.9% normal saline B. Start 1 or 2 large-bore IV lines C. Prepare patient for colonoscopy D. Provide oxygen

A. Prepare to infuse 0.9% normal saline B. Start 1 or 2 large-bore IV lines D. Provide oxygen

Which of the following menus would be most appropriate for a client with cholelithiasis? A. Roast chicken, baked potato, skim milk B. Baked fish, steamed broccoli, and tea C. Two eggs, two slices of toast with margarine, and whole milk D. Grilled cheese sandwich, steamed vegetables with butter, and coffee

A. Roast chicken, baked potato, skim milk

The nurse is caring for a client who has a new small-bore nasoduodenal tube for feedings. Which intervention will most effectively prevent clogging of the tube? A. Using a 60-mL syringe to irrigate the tube with warm water before and after administration of medications B. Diluting tube feedings to half-strength with cold water before infusion into the feeding tube C. Administering medications that have been thoroughly crushed and dissolved in cold water D. Flushing the feeding tube with 60mL of cranberry juice or carbonated beverage four times daily

A. Using a 60-mL syringe to irrigate the tube with warm water before and after administration of medications

An 18 year old is admitted with an acute onset of right lower quadrant pain. Appendicitis is suspected. To determine the etiology of the pain, the client should be assessed for: A. rebound tenderness B. urinary retention C. increased lower bowel motility D. gastric hyperacidity

A. rebound tenderness

The physician orders contact precautions for a client with hepatitis A. In addition to standard precautions, the isolation procedures that must be followed are: A) A private room is required, and the door must be kept closed B) A gown and gloves must be worn when handling articles possibly contaminated by urine or feces C) Gown and gloves must be worn only when handling the client's soiled linen, dishes, or utensils D) Persons entering the room must wear a gown, a mask, and gloves

B) A gown and gloves must be worn when handling articles possibly contaminated by urine or feces

The nurse plans care for the client with hepatitis A with the understanding that the causative virus will be excreted from the client's body primarily through the A) Urine B) Feces C) Blood D) Skin

B) Feces

The serum ammonia level of a client with cirrhosis is elevated. As a priority, a nurse should plan to: A) Measure the urine specific gravity B) Observe for increasing confusion C) Restrict the client's oral fluid intake D) Monitor the client's temperature every 4 hours

B) Observe for increasing confusion

. A client is admitted with a history of GI bleeding. His hemoglobin is 9.6 g/dL, and the hematocrit is 30%. A nasogastric tube has been inserted and connected to low suction. Which orders would the nurse question? A. Type and cross-match for 2 units of PRBSs (packed red blood cells) B. Clear liquid diet as tolerated C. Bed rest with bathroom privileges D. Vital signs q 2 hr

B. Clear liquid diet as tolerated

A client with peptic ulcer disease vomits undigested food after eating breakfast. The nurse notes abdominal distention. What intervention should the nurse anticipate will be implemented for this client? A. Administration of an oral antimetic B. Insertion of a nasogastric tube C. Administration of H2-receptor antagonists D. Insertion of a jejunostomy tube

B. Insertion of a nasogastric tube

Which nursing intervention would be appropriate for the patient with peptic ulcer disease? (Select all that apply.) A. Monitor peripheral edema B. Monitor O2 sats C. Monitor abdominal pain, bowel sounds, and distention D. Insert NGT

B. Monitor O2 sats C. Monitor abdominal pain, bowel sounds, and distention

The nurse is caring for a client who has been brought to the emergency room with upper GI bleeding. The client is unconscious and requires lavage to stop the bleeding. Which is the nurse's priority action? A. Inserting a 20-gauge IV and starting normal saline IV infusion B. Preparing to intubate the client with an endotracheal tube C. Obtaining a 14 French nasogastric tube and iced normal saline for the procedure D. Setting up the suction unit with collection canister and medium intermittent suction

B. Preparing to intubate the client with an endotracheal tube

During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse: A. prepare the patient for immediate portal shunting surgery B. maintain the patient's airway and prevents aspiration of blood C. perform gastric testing on all stools to detect occult blood D. monitor for the cardiac stimulant effects of IV vasopressin and nitroglycerin

B. maintain the patient's airway and prevents aspiration of blood

The nurse is assessing a client who is being admitted from the ED with a history of vomiting bright red blood for the past 24 hours. What would be a priority nursing assessment? A. Evaluate bowel sounds and palpate abdomen for areas of tenderness B. Determine the quality of bilateral breath sounds C. Monitor the blood pressure and pulse D. Inquire as to how much emesis the client has had in the last 6 hours

C. Monitor the blood pressure and pulse

A nurse who is using a 24-hour recall method for obtaining data about a client's dietary intake would be aware that which of the following is true? A) Client's have a tendency to overestimate intake as the portion size increases B) Virtually all clients provide through and accurate information C) The previous day's intake may not represent the usual intake D) Most clients accurately recall the exact amounts of various foods eaten

C) The previous day's intake may not represent the usual intake

The nurse assesses dullness of the left anterior axillary line. The nurse is concerned about which condition that the client may have? A) cirrhosis b) abdominal aortic aneurysm C) splenomegaly D) bowel obstruction

C) splenomegaly

The nurse is caring for a client who presents with chronic epigastric pain, heartburn, and anorexia. The client asks the nurse how the doctor can best determine if the symptoms are cause by gastric. Which is the nurse's best response? A. "A CT scan of your abdomen will show if there is inflammation present in your stomach" B. "A blood sample will be sent to the laboratory to determine if you have a stomach infection or bleeding" C. "The doctor will take a look inside your stomach using a tube with a light on the end of it." D. "You will be asked to drink a barium solution while x-rays are taken of your stomach."

C. "The doctor will take a look inside your stomach using a tube with a light on the end of it."

A client who underwent liver transplantation 8 days ago reports a temp of 101 degrees F and right flank pain. What would be the nurse's best response? A. "take acetaminophen every 4 hours until you feel better." B. "the immunosuppressive drugs you are taking may make you susceptible to infections." C. "you may be rejecting the transplanted liver and should go to the hospital immediately." D. "You should take a additional dose of cyclosporine today."

C. "you may be rejecting the transplanted liver and should go to the hospital immediately."

What is the priority assessment of a client experiencing regurgitation? A. Culturing the throat for bacterial infection B. Inspecting the oral cavity C. Auscultating lungs for crackles D. Palpating the cervical lymph nodes

C. Auscultating lungs for crackles

The nurse identifies which laboratory value as the usual indication of hepatic encephalopathy? A. Elevated sodium level B. Increased clotting time C. Elevated ammonia level D. Increased BUN

C. Elevated ammonia level

The nurse should assess for which complication in a client with Barrett's esophagus who is complaining of dysphagia? A. Achalasia B. Oropharyngeal dysphagia C. Esophageal stricture D. Paraesophageal hernia

C. Esophageal stricture

Patients with cirrhosis are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver preventing the absorption of which vitamin? A. E B. D C. K D. A

C. K

A client with Crohn's disease has strictures in the colon. Based on this finding, for which of the following complications is the client most at risk? A. Malabsorption B. Fluid imbalance C. Obstruction D. Peritonitis

C. Obstruction

The nurse is caring for a client who is at risk for developing gastritis. Which finding from the client's history leads the nurse to this conclusion? A. The client recently traveled to Mexico and South America B. The client works at least 60 hours per week in a stressful job C. The client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain D. The client is lactose-intolerant and cannot drink milk

C. The client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain

The nurse is caring for an anorexic client who is severely malnourished. A nasogastric feeding tube is inserted and tube feedings are started. Which laboratory finding is the best indication that the client's nutritional status is improving? A. The client's sodium has risen from 130 to 144 mg/dL B. The client's creatinine has dropped from 1.9 to 0.5 mg/dL C. The client's prealbumin level has risen from 9 to 13 mg/dL D. The client's blood urea nitrogen (BUN) level has dropped from 15 to 11 mg/dL

C. The client's prealbumin level has risen from 9 to 13 mg/dL

The nurse should assess the client with cirrhosis for indications of hepatic coma. One classic sign of hepatic coma is: A) elevated cholesterol b) depressed muscle reflexes C) bile-covered stools D) flapping hand tremor

D) flapping hand tremor

When assessing a client with portal hypertension, the nurse should be alert for indication of: A) perforation of the duodenum b) intestinal obstruction c) liver abscess D) hemorrhage from esophageal varicies

D) hemorrhage from esophageal varicies

A client with esophageal reflux who experiences regurgitation while lying flat is at risk for which compilation? A. Odynophagia B. Erosion C. Bleeding D. Aspiration

D. Aspiration

The nurse is caring for a client who has just arrived in the emergency room with complaints of epigastric pain. The client reports that an emesis earlier in the day looked like coffee-grounds. What will the nurse prepare to do for the client first? A. Insert a nasogastric tube and prepare for gastric lavage B. Determine if the client has been taking NSAIDs or has a history of ulcers C. Check the client's stool for occult blood D. Insert an 18-guage IV line with a normal saline infusion

D. Insert an 18-guage IV line with a normal saline infusion

The nurse is caring for a client who will be taking Mycostatin (nystatin) for treatment of oral candidiasis. Which instructions will the nurse provide for the client before administering the medication? A. "Let the tablet dissolve slowly in your mouth." B. "Take the medication with a snack or a light meal." C. "Swallow the pills whole, followed by a full glass of water." D. "Swish the liquid around your mouth for a minute before swallowing it."

D. Swish the liquid around your mouth for a minute before swallowing it

An experienced nurse explains to a new nurse that the definitive diagnosis of peptic ulcer disease involves: A. A urea breath test B. The string test C. Barium contrast studies D. Upper GI endoscopy with biopsy

D. Upper GI endoscopy with biopsy

The nurse finds a positive Blumberg's sign in a patient with abdominal pain. which action will the nurse plan? A) report the maneuver with the patient in the supine position b) have the patient be NPO in prep for surgery C) document as normal findings in patients chart D) immediately auscultate the patients abdomen for bowel sounds

b) have the patient be NPO in prep for surgery