Exam 5

A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? "I will take stool softeners for several weeks." "I will still take my PPI after this surgery." "After the operation I can eat anything I want." "I will have to eat smaller, more frequent meals."

"After the operation I can eat anything I want."

A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? Start a large-bore IV with normal saline. Administer PRN Morphine Sulfate. Call the Rapid Response Team. Tell the client to remain lying down.

Start a large-bore IV with normal saline.

Red streaking blood in stool?

Hemorrhoids

A nurse has auscultated a client's abdomen and noted one or two bowel sounds in a 2-minute period of time. How should the nurse document the client's bowel sounds? Hypoactive Normal Paralytic ileus Hyperactive

Hypoactive

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? Draw blood for type and crossmatch. Activate the rapid response team. Insert a nasogastric (NG) tube and connect to suction. Administer 1 L of lactated Ringer's solution.

Administer 1 L of lactated Ringer's solution.

A 57-year-old man with Escherichia coli food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question? Infuse lactated Ringer's solution at 250 mL/hr. Monitor electolytes. Prepare patient for blood transfusion. Administer loperamide (Imodium) after each stool.

Administer loperamide (Imodium) after each stool.

Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori? Omeprazole (Priolosec), nystatin (Mycostatin), and bismuth (Pepto-Bismol) Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec),

A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.) Take vital signs frequently during infusion. Can be infused with Peripheral IV line Infuse pantoprazole using an IV pump. Administer drug via piggybag with dextrose. Administer the drug through a separate IV line.

Can be infused with Peripheral IV line Infuse pantoprazole using an IV pump. admin the drug through a separate IV line.

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood? Insert a large-gauge IV catheter. Inquire if the patient is taking anticoagulation medication at home. Check blood pressure and heart rate. Prepare to deliver emergent uncrossmatched PRBCs.

Check blood pressure and heart rate.

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

Check the vital signs.

Which patient choice for a snack 2 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? Peanut butter and jelly sandwich Decaffeinated Peppermint Tea Cherry gelatin with fruit Glass of low-fat milk

Cherry gelatin with fruit

A nurse assesses a client with peritonitis related to a GI perforation. Which clinical manifestations should the nurse expect to find? (Select all that apply.) Decreased urine output Inability to pass flatus Bradycardia Hyperactive bowel sounds Distended abdomen

Decreased urine output Inability to pass flatus Distended abdomen

A nurse cares for a client who has a new colostomy. Which action should the nurse take? Start the patient on bowel training. Reinforce stoma with pressure dressing. Empty the pouch frequently to remove excess gas collection. Teach the patient about the gas difusing bag.

Empty the pouch frequently to remove excess gas collection.

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? "Drink plenty of fluids to prevent dehydration." "Drink any flavor of Gatorade to supplement fluid loss." "Increase your protein intake by drinking more milk." "You should drink approximately 1 liter of fluids daily."

"Drink plenty of fluids to prevent dehydration."

The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? Mucosal barrier fortifier Proton pump inhibitor Histamine receptor blocker Gastric acid inhibitor

Mucosal barrier fortifier

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority? Administer the prescribed pain medication. Notify the health care provider immediately. Place NG tube for decompression. Document a set of vital signs

Notify the health care provider immediately.

A client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the client, what advantage should the nurse describe? The test allows for painless biopsy collection. The test allows visualization of the entire peritoneal cavity. The test does not require fasting. The test is noninvasive

The test is noninvasive

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take antacids 30 minutes before each dose of sucralfate is taken. antacids after meals and sucralfate 30 minutes before meals. a full glass of milk with the medication. sucralfate at bedtime and antacids with each meal.

antacids after meals and sucralfate 30 minutes before meals.

The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication reduces gastroesophageal reflux by increasing the rate of gastric emptying. treats gastroesophageal reflux disease by decreasing stomach acid production. neutralizes stomach acid and provides relief of symptoms in a few minutes. protects the lining of the stomach.

treats gastroesophageal reflux disease by decreasing stomach acid production.

The nurse is preparing to perform a client's abdominal assessment. What examination sequence should the nurse follow? Inspection, percussion, palpation, and auscultation Inspection, palpation, percussion, and auscultation Inspection, palpation, auscultation, and percussion Inspection, auscultation, percussion, and palpation

Inspection, auscultation, percussion, and palpation

GI Bleed --- stool is tarry-black color?

Upper GI tract

A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client? "Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food." "The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the stomach provides this environment." "As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to form acid." "The acidic environment in the stomach exists to buffer the highly alkaline environment in the esophagus."

"Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food."

The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) "I sure hate to give up my coffee, but I guess I have to." "I just joined a gym, so I hope that helps me lose weight." "Sitting upright and lying down after meals will help." "Surgery can cure my GERD." "I will eat three small meals and three small snacks a day."

"I sure hate to give up my coffee, but I guess I have to." "I just joined a gym, so I hope that helps me lose weight." "Sitting upright and lying down after meals will help." "I will eat three small meals and three small snacks a day."

A nurse cares for a client with colon cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How should the nurse respond? "I have a good friend with a colostomy who would be willing to talk with you." "The enterostomal therapist will be able to answer all of your questions." "We will ask for a referral to talk to a specialist next time we see your doctor." "I will make a referral to the United Ostomy Associations of America."

"I will make a referral to the United Ostomy Associations of America."

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? Administer intravenous opioid medications. Insert a nasogastric tube for decompression. Position the client with knees to chest. Assess the client's bowel sounds.

Assess the client's bowel sounds.

A client with chronic GERD has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met? Lungs clear after meals and snacks Properly performing swallowing exercises Choosing foods that are easy to swallow Patient report a decrease in over the counter proton pump inhibitor use.

Lungs clear after meals and snacks

A client is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production?

Persistently low hemoglobin and hematocrit

A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) Tomato sauce, Decaffeinated coffee, Peppermint, Citrus fruits, Chocolate,

Tomato sauce Peppermint Citrus fruits Chocolate

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? Use of nicotine patches Alcohol intake of 1 to 2 drinks per week Family history of H. pylori infection Willingness to adhere to drug therapy

Willingness to adhere to drug therapy

late stage alzhiemers disease -- NG feedings

frequent lung auscultation

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) "I will use warm water and a soft washcloth to clean around the stoma." "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." "I might start bicycling and swimming again once my incision has healed." "I must change the ostomy appliance daily and as needed." "I must avoid dairy products to reduce gas and odor in the pouch."

"I will use warm water and a soft washcloth to clean around the stoma." "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." "I might start bicycling and swimming again once my incision has healed.

A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? Notify the surgeon immediately. Assess the drainage for clots. Document the findings in the chart. Take a full set of vital signs.

Take a full set of vital signs.

A client has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The client is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond? "Your body will absorb slightly fewer nutrients from the food you eat, but you won't be aware of this." "The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate." "Your small intestine will adapt over time to the absence of your appendix." "Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery."

"Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery."

A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? Abdominal pain that increases with knee flexion Severe, steady right lower quadrant pain Marked hyperactive bowel sounds Abdominal pain associated with nausea and vomiting

Severe, steady right lower quadrant pain