Exam 6 Med Surg

A nurse assesses a client who is prescribed 5-FU chemotherapy IV for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider?

WBC of 1500/mm3

A nurse assesses a client with IBS. Which questions should the nurse include in this clients assessment?

Which food types cause an exacerbation of symptoms where is your pain and what does it feel like do you experience nausea associated with defecation

The nurse is teaching a patient who will have a radical neck dissection. What must the nurse teach the patient will be removed during this procedure?

sternocleidomastoid muscle cervical lymph nodes on the affected side cranial nerve XI internal jugular vein

Gaviscon should be

taken with food in the stomach. It can be take with meals at any time.

malnutrition is a serious problem after an esophagogastrectomy.

the client needs high-protein, high-calorie foods that are easy to chew and swallow.

For shallow or slow respirations after the sedation is given

the nurse's first action should be to provide a physical stimulation such as sternal rub and directions to breathe deeply.

A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this clients plan of care?

using premoistened disposable wipes for perineal care turning the client from right to left every 2 hours applying a barrier cream to the skin after cleaning

The nurse is caring for a client with sialadenitis. What comfort measures may the nurse delegate to the UAP?

Applying warm compresses offering fluids every hour

A client has a gastrointestinal hemorrhage and is prescribed two units of packed RBCs. What actions should the nurse perform prior to hanging the blood?

Ask a second nurse to double check the blood prime the IV tubing with NS Take and record a set of vitals teach the client about reaction manifestations

A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best?

Ask the client about shellfish allergies

A nurse cares for a client who has a NG tube. Which actions should the nurse take?

Assess for proper placement of the tube every hours disconnect suction when auscultating bowel peristalsis monitor the clients skin around the tube site for irritation

A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. what action by the nurse is best?

Assess the clients psychosocial status

The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the UAP?

Assisting with position changes and getting out of bed keeping the HOB elevated to at least 30 degrees Taking and recording vitals per hospital protocol

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful?

arrange dietary consult

An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best?

assess the family concerns and fears

For a colonosopy a client should be advised to

avoid beverages and gelatin that are red, orange or purple as their residue can appear to be blood.

A truss should be applied

before arising, not before bed.

A client has been discharged to an inpatient rehabilitation center after an esophagogastrectomy. What menu selections by the client indicate good understanding of dietary instructions?

boost supplement greek yogurt scrambled eggs whole milk shake

The drainage in the NG tube should initially be

brown with old blood. Presence of bright red blood indicates bleeding. The nurse should take vital signs to assess for shock and then notify the surgeon.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition?

canned unsweetened apricots potato soup

intolerance of fatty or spicy foods and pernicious anemia are signs of

chronic gastritis

For which client would the nurse suggest the provider not prescribe misoprostol (cytotec)?

client who is pregnant

For an EGD

clients are given a mild sedation but should still be able to follow commands.

Clients taking antibiotics are at risk for

clostridium difficile infection. The most common test for this disorder is a stool sample for ELISA toxin A+B

A nurse studying cancer know that job-related risks for developing oral cancer include which occupations?

coal miner metal worker plumber textile worker

a client experiencing dumping syndrome must avoid what foods

coffee cake and sweets, milk products and sweet drinks and gas forming foods such as broccoli.

The nurse working the GI clinic sees clients who are anemic. What are common causes for which the nurse assesses in these clients?

colon cancer diverticulitis inflammatory bowel disease peptic ulcer disease

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take?

contact the provider and recommend computed tomography

A nurse assess a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over te distended area. Which action should the nurse take?

determine when the client last voided

A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes?

direct inguinal hernia-a peritoneum sac passes through a weak point in the abdominal wall Ventral hernia-results from inadequate healing of an incision incarcerated hernia-contents of the hernia sac cannot be reduced back into the abdominal cavity

Which body structures are located in the RUQ?

duodenum liver gallbladder pancreas head

The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations?

dysphagia eructation halitosis

Common signs of esophageal disorders include

dysphagia, eructation, halitosis and weight loss.

The nurse reads a clients chart and sees that the health care provider assessed mucosal erythroplasia. What should the nurse understand that this means for the client?

early sign of oral cancer

xerostomia

excessive mouth dryness

Common side effects of 5-FU include

fatigue, leukopenia, diarrhea, mucositis and mouth ulcers and neuropathy. WBC at 1500 is very low so HCP should be notified.

The nurse should assess a NG tube

for proper placement, tube patency and output every hours.

Which types of ulcers are included in peptic ulcer disease?

gastric ulcers duodenal ulcers stress ulcers

A nurse assesses a cient who is prescribed alosetron (lotronex). Which assessment question should the nurse ask this client?

have you been experiencing any constipation?

urobilinogen evaluates

hepatic and bilary function

clients with IBS are advised to eat a

high-fiber diet (30-40g/day) with 8-10 cups of liquid daily.

Famotidine and ranitidine are

histamine blockers

pyloric stenosis can lead to

hypokalemia which is manifested by muscle weakness. The nurse first obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias.

A nurse plans care for a client who is recovering from an inguinal hernia repair. Which interventions should the nurse include in this clients plan of care?

Encouraging ambulation 3 times a day encouraging normal urination providing ice bags and scrotal support

A client who has been taking antibiotics reports severe watery diarrhea. About which test does the nurse teach the client?

Enzyme-linked immunosorbent assay (ELISA) toxin A+B

What manifestations are expected when a patient has esophageal diverticula?

Halitosis dysphagia nocturnal cough regurgitation

The nurse has taught a client about lifestyle modifications for GERD. What statements by the client indicate good understanding of the teaching?

I just joined a gym, so I hope that helps me lose weight I sure hate to give up my coffee, but I guess I have too I will eat 3 small meals and 3 small snacks a day Sitting upright and not lying down after meals will help

A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective?

I should take this on a full stomach

After teaching a client who has a femoral hernia, the nurse assesses the clients understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss?

I will put on the truss before I go to bed each night

After teaching a client who is recovering from a colon resection, the nurse assesses the clients understanding. Which statement indicates a correct understanding of the teaching?

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

An older female client has been prescribed esomeprazole (nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?

Increase intake of calcium and vitamin D

What will laboratory values for a patient with liver disease most likely show?

Increased PTT Increased AST & ALT Increased unconjugated bilirubin

A client with a bleeding gastric ulcer is having a nuclear scan. What action by the nurse is most appropriate?

Inform the client a second scan may be needed a second scan may be performed in 1 or 2 days to see if interventions worked.

The nurse is caring for a patient with abdominal pain. While assessing the patient, which questions will the nurse ask?

Is the pain burning, gnawing or stabbing? can you point to where you feel the pain when did you first notice the pain does the pain spread anywhere?

A client is prescribed cetuximab (erbitux) for oral cancer and asks the nurse how it works. What response by the nurse is best?

It blocks epidermal growth factor

Which statements about barrett's esophagus are accurate?

It is considered to be a premalignant condition It results from exposure to acid and pepsin It is associated with pickled and fermented foods Normal cells undergo dysplasia to become cancerous

A nurse working with a client who has possible gastritis assesses the clients gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis?

intolerance to fatty foods pernicious anemia

PTC uses

iodinated dye so the client should be asked about seafood allergies.

Lubiprostone (amitiza)

is a new drug for IBS with constipation that works by simulating receptors in the intestines to increase fluid and promote bowel transit time. currently approved only for use in women.

Omeprazole (prilosec)

is a proton pump inhibitor used in the treatment of GERD

After a colonoscopy a patient should report to the ER for

large amounts of bleeding, severe pain, or dizziness.

To promote comfort after colonoscopy, in what position does the nurse place the client?

left lateral

The student nurse studying the gastrointestinal system understand that chyme refers to what?

liquefied food ready for digestion

Alanine aminotransferase and ammonia are related to the

liver

Clients who have IBS do not usually

lose weigh or have black stools

NG tubes placed during surgery should

not be irrigated or moved unless prescribed by the surgeon.

A nurse is examining a client reporting RUQ pain. What technique should the nurse use to assess this client's abdomen?

palpate the RUQ last

amylase and lipase are related to the

pancreas

A nurse inserts a NG tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly?

performs hand hygiene and positions the client in high-fowlers with pillows behind head and shoulders checks for correct placement by checking the pH of the fluid aspirated from the tube Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

Esophageal dilation can

provide immediate relief of esophageal strictures that impair swallowing. It is attempted before enteral tube feeding is implemented.

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride (versed). The clients respiratory rate is 8 breaths/min. What action by the nurse is best?

provide physical stimulation

A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (maalox). What instruction is most appropriate?

report diarrhea to your provider

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis?

serum potassium 2.8 abdominal pain in upper quadrants serum sodium of 121

small bowel obstructions often lead to

severe fluid and electrolyte imbalances and abdominal pain in upper quadrants and high pitched sounds

A patient has a Kaposi's sarcoma lesion on his hard palate. ow is this lesion described?

small raised lesion purplish-brown nodule usually not painful

A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching?

After the operation I can eat anything I want.

A client is having a temporary tracheostomy placed during surgery for oral cancer. What action by the nurse is best to relieve anxiety?

Agree on a postoperative communication method

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to what organ functions?

Amonia:Liver Lipase:Pancreas

A client is scheduled for a colonscopy and the nurse has provided instructions on the bowel cleansing regimen. Which statement by the client indicates a need for further teaching?

"It's a good thing I like orange and cherry gelatin"

A nurse assess clients at a community health center. Which client is at the highest risk for the development of colorectal cancer?

A 72 year old who eats fast food frequently.

The student nurse learns about risk factors for gastric cancer. Which factors does this include?

Achlorhydria Chronic atrophic gastritis helicobacter pylori infection pernicious anemia

A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition?

Administer B12 injections ask the provider about folic acid replacement provide iron supplements for the client

A nurse is teaching clients with GERD about foods to avoid. Which foods should the nurse include in the teaching?

Chocolate citrus fruits peppermint tomato sauce

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse instructs the client and family about the signs of potential complications, which include what problems?

Cholangitis, Pancreatitis, Perforation and sepsis

The nurse is aware of the 2014 American Cancer Society Screening Guidelines for colon cancer, which include which testing modalities for people over the age of 50?

Colonoscopy every 10 years & CT scan every 5 years

The nurse working with older clients understands age related changes in the GI system. Which changes does this include?

Decreased hyrdocloric acid production diminished sensation that can lead to constipation Fat not digested as well in older adults pancreatic vessels become calcified

The nurse is aware that which factors are related to the development of GERD.

Delayed gastric emptying Eating large meals Hiatal Hernia Obesity

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

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients abdomen is tense and rigid. What action takes priority?

Notify the healthcare provider immediately.

A client presents to the emergency department reporting severe abdominal pain. On assessment the nurse finds a bulging, pulsating mass in the abdomen. What action by the nurse is the priority?

Notify the provider immediately.

A client is 1 day post op after having Zenker's diverticula removed. The client has a NG tube to suction and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate?

Notify the surgeon about this finding

fundoplication

Procedure in which the fundus is wrapped around the lower part of the stomach to securely anchor and support the esophageal sphincter below the diaphragm.

A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority?

Request an electrocardiogram (ECG)

A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best?

Slippery elm is often used for this disorder

A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling catheter, a 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?

Take a full set of vital signs

A nurse is preparing to administer pantoprazole (protonix) intravenously. What actions by the nurse are most appropriate?

administer the drug through a separate IV line infuse pantoprazole using an IV pump use an in-line IV filter when infusing

The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following?

alcohol caffeine corticosteroids NSAIDS

Ischemic colitis is a life-threatening complication of

alosetron.

A bulging, pulsating mass in the abdomen could indicate

an abdominal aortic aneurysm which could be life threatening and should never be palpated.

Maalox is an

antacid