GI

A client is hospitalized with acute pancreatitis. The nursing assistant reports to the nurse that when a blood pressure cuff was applied, the client's hand had a spasm. Which additional finding does the nurse correlate with this condition? a. Serum calcium, 5.8 mg/dL b. Serum sodium, 166 mEq/L c. Serum creatinine, 0.9 mg/dL d. Serum potassium, 4.2 mEq/dL

A

A client is refusing to take lactulose (Heptalac) because of diarrhea. Which is the nurse's best response to this client? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take Kaopectate liquid daily for loose stools." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory."

A

The client with obstructive jaundice asks the nurse why his skin is so itchy. Which is the nurse's best response? a. "Bile salts accumulate in the skin and cause the itching." b. "Toxins released from an inflamed gallbladder lead to itching." c. "Itching is caused by the release of calcium into the skin." d. "Itching is caused by a hypersensitivity reaction."

A

The nurse conducts a physical assessment for a client with abdominal pain. Which finding leads the nurse to suspect appendicitis? a. Severe, steady right lower quadrant (RLQ) pain b. Abdominal pain that started a day after vomiting began c. Abdominal pain that increases with knee flexion d. Marked peristalsis and hyperactive bowel sounds

A

The nurse is assessing health fair participants for risks for hepatitis. The nurse recognizes which client as being at greatest risk for developing hepatitis B? a. College student who has had several sexual partners b. Woman who takes acetaminophen daily for headaches c. Businessman who travels frequently d. Older woman who has eaten raw shellfish

A

The nurse is caring for a client with end-stage pancreatic cancer. The client asks the nurse, "Why is this happening to me?" Which is the nurse's best response? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's important to keep a positive attitude for your family right now." c. "Scientists have not determined why cancer develops in certain people." d. "I think that this is a trial so you can become a better person because of it."

A

The postanesthesia care unit nurse is caring for a client who has just undergone an open Whipple procedure. The client has multiple tubes and drains in place after the surgery. Which does the nurse assess first? a. Endotracheal tube with 40% fraction of inspired oxygen (FiO2) b. Foley catheter to bedside drainage c. Nasogastric tube to low intermittent suction d. Triple-lumen IV catheter with lactated Ringer's solution

A

The infection control nurse wants to decrease the number of health care professionals who contract viral hepatitis at work. Which actions does the nurse initiate? (Select all that apply.) a. Strengthen policies related to consistent use of Standard Precautions. b. Mandate hepatitis vaccination for workers in high-risk areas. c. Implement a needleless system for IV therapy. d. Reduce the number of "sharps" needed for client care where possible. e. Provide postexposure prophylaxis in a timely manner.

A C D E

A client is admitted for suspected cholecystitis. On reviewing laboratory results, the nurse notes that the client's amylase is elevated. Which action by the nurse is best? a. Document the finding in the chart. b. Ask the client about drinking habits. c. Notify the health care provider. d. Place the client on clear liquids.

B

A nurse is assessing a client in extended care facility. The nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to fecal importation? A. The client reports one bowel movement yesterday B. The client is having small, frequent liquid stools C. The client is flatulent D. The client indicates vomiting once this morning

B

The nurse correlates which data in the client's history as a predisposing factor for Laënnec's cirrhosis? a. Gallstones b. Alcohol abuse c. Viral hepatitis d. Heart disease

B

The nurse is caring for a client with acute pancreatitis. Which nursing intervention best reduces discomfort for the client? a. Administering morphine sulfate IV every 4 to 6 hours as needed b. Maintaining NPO status for the client with IV fluids c. Providing small, frequent feedings, with no concentrated sweets d. Placing the client in semi-Fowler's position at elevation of 30 degrees

B

The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery. Which statement by the client indicates understanding of the instructions? a. "I will drink at least 2 liters of fluid a day." b. "I need a diet without a lot of fatty foods." c. "I should drink fluids between meals rather than with meals." d. "I will avoid concentrated sweets and simple carbohydrates."

B

Which laboratory findings does the nurse recognize as potentially causing complications of liver disease? a. Elevated aspartate transaminase (AST) and lactate dehydrogenase (LDH) levels b. Elevated prothrombin time and international normalized ratio (INR) c. Decreased serum albumin and serum globulin levels d. Decreased serum alkaline phosphatase and alanine aminotransferase (ALT) levels

B

Which statement by a client with alcohol-induced cirrhosis indicates the need for further teaching? a. "I cannot drink any alcohol at all anymore." b. "I need to avoid protein in my diet." c. "I should not take over-the-counter medications." d. "I should eat small, frequent, balanced meals."

B

The nurse is caring for a client after a Whipple procedure. Which manifestations might indicate that a complication from the operation has occurred? (Select all that apply.) a. Urinary retention b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

B C D E

A client is admitted with end-stage cirrhosis and severe vomiting. Which problem should the nurse monitor the client most carefully for? a. Intrahepatic bile stasis b. Bleeding esophageal varices c. Decreased excretion of bilirubin d. Accumulation of ascites in the abdomen

B`

A client has cirrhosis and has developed ascites and edema. Which laboratory value does the nurse correlate with this condition? a. Blood glucose, 120 mg/dL b. Serum sodium, 135 mEq/L c. Serum albumin, 2.1 g/dL d. Blood urea nitrogen, 18 mg/dL

C

The nurse is caring for a client who had a T-tube placed 3 days ago. Which assessment finding indicates to the nurse that the procedure was successful? a. Sclera that is slightly icteric b. Positive Blumberg's sign c. Soft, brown, formed stool this morning d. Sips of clear liquid tolerated without nausea

C

The nurse is caring for a client who has just been diagnosed with end-stage pancreatic cancer. The nurse assesses the client's emotional response to the diagnosis. Which is the nurse's initial action for the assessment? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the client's bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care provider's notes about the prognosis for the client.

C

The nurse is caring for a client who has just undergone traditional cholecystectomy surgery and has a Jackson-Pratt (JP) drain in place. The nurse notes serosanguineous drainage present in the drain. Which is the nurse's priority action? a. Gently milk the drain tubing. b. Notify the surgeon immediately. c. Document the finding in the client's chart. d. Irrigate the drain with sterile normal saline.

C

The nurse is caring for a client with cholecystitis. The client is a poor historian and is unable to tell the nurse when the symptoms started. Which assessment finding indicates to the nurse that the condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy's sign c. Light-colored stools d. Upper abdominal pain after eating

C

The nurse is caring for a client with cholecystitis. Which assessment finding indicates to the nurse that the condition is chronic rather than acute? a. Abdomen that is hyperresonant to percussion b. Hyperactive bowel sounds and diarrhea c. Clay-colored stools and dark amber urine d. Rebound tenderness in the right upper quadrant

C

The nurse is providing discharge teaching for a client who will be receiving pancreatic enzyme replacement at home. Which statement by the client indicates that additional teaching is needed? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

C

The nurse is teaching a community group about pancreatic cancer. Which risk factor does the nurse instruct is known for development of this type of cancer? a. Hypothyroidism b. Cholelithiasis c. BRCA2 gene mutation d. African-American ethnicity

C

The nurse is caring for a client with acute pancreatitis. During the physical assessment, the nurse notes a grayish-blue discoloration of the client's flanks. Which is the nurse's priority action? a. Prepare the client for emergency surgery. b. Place the client in high Fowler's position. c. Insert a nasogastric (NG) tube to low intermittent suction. d. Ensure that the client has a patent large-bore IV site.

D

The nurse is assessing a client for asterixis. Which instruction to the client is most appropriate? a. "Close your eyes and take turns touching your nose with your fingers." b. "Sit on the edge of the bed and hold your legs straight out for 30 seconds." c. "Extend your arm, flex your wrist upward, and extend your fingers." d. "Say 'EEEEE' while I listen to your lungs in the back on both sides."

C

The nurse is assessing a client with mild liver disease. Which assessment does the nurse perform to detect the presence of ascites in this client? a. Measure lower extremities to assess for edema. b. Inspect and palpate the abdomen for distention. c. Palpate the abdomen in assessing for a fluid wave. d. Percuss the liver while listening for dullness.

C

A female client is admitted with an exacerbation of ulcerative colitis. Which laboratory value does the nurse correlate with this condition? a. Potassium, 5.5 mEq/L b. Hemoglobin, 14.2 g/dL c. Sodium, 144 mEq/L d. Erythrocyte sedimentation rate (ESR), 55 mm/hr

D

A client admitted with hepatopulmonary syndrome is experiencing dyspnea but does not want oxygen increased because the client's nose keeps bleeding from it. The client becomes agitated when discussing this with the nurse. The client's oxygen saturation is 92%. What intervention by the nurse is best? a. Instruct the client to sit in as upright a position as possible. b. Tell the client that humidity can be added, but that the oxygen must be worn. c. Document the client's refusal in the chart, and call the health care provider. d. Call the health care provider to request an extra dose of the client's diuretic.

A

A client had a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output of 20 mL/hr b. Systolic blood pressure increase of 10 mm Hg c. Respiratory rate drop from 18 to 14 d. A 3-pound drop in weight

A

A client is in the emergency department after a motor vehicle crash. In assessing the client, which clinical sign alerts the nurse to the presence of possible liver trauma? a. Abdominal pain referred to the right shoulder b. Left upper quadrant abdominal pain and swelling c. Abdominal pain referred to the spine and legs d. Abdominal pain with accompanying rebound tenderness

A

A nurse is completing discharge teaching with a client who has IBS. Which of the following instructions should the nurse include? A. Keep a food diary to identify triggers to exacerbation B. Consume 15-20 g of fiber daily C. Plan three moderate to large meals per day D. Limit fluid intake to 1 L each day

A

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? a. "Drink plenty of fluids to prevent dehydration." b. "You should only drink 1 liter of fluids daily." c. "Increase your protein intake by drinking more milk." d. "Sips of cola or tea may help to relieve your nausea."

A

The nurse is caring for a client who has acute viral gastroenteritis. Which dietary instruction does the nurse provide to the client? a. "Drink plenty of fluids to prevent dehydration." b. "You can have only clear liquids to drink." c. "Milk products will give you extra protein." d. "You can have sips of cola or tea to relieve nausea."

A

The nurse is caring for a client who has been diagnosed with a bowel obstruction. Which assessment finding leads the nurse to conclude that the obstruction is in the small bowel? A) Potassium of 2.8 mEq/L, with a sodium value of 121 mEq/L B) Losing 15 pounds over the last month without dieting C) Reports of crampy abdominal pain across the lower quadrants D) High-pitched, hyperactive bowel sounds in all quadrants

A

The nurse is caring for a client with Crohn's disease and colonic strictures. Which assessment finding requires the nurse to consult the health care provider immediately? a. Distended abdomen b. Temperature of 100.0° F (37.8° C) c. Traces of blood in the stool d. Crampy lower abdominal pain

A

The nurse is caring for a client with a parasitic gastrointestinal infection. What statement by the client indicates a need for further teaching? a. "I will have my housekeeper keep my toilet very clean." b. "I need to shower or bathe every day." c. "I need to have my well water tested." d. "My sexual partner needs to have a stool test."

A

The nurse is caring for a client with an umbilical hernia who reports increased abdominal pain, nausea and vomiting. The nurse notes high-pitched bowel sounds. Which conclusion does the nurse draw from these assessment findings? A) bowel obstruction; client should be placed on NPO status B) Perforation of the bowel; client needs emergency surgery C) Adhesions in the hernia; client needs elective surgery D) Hernia is dangerously enlarged; client needs a NG tube

A

The nurse is performing a physical examination on a client. Which assessment finding leads the nurse to check the clients abdomen for the presence of an acquired umbilical hernia> A) BMI of 41.9 B) cholecystectomy last year C) history of IBS D) daily dose of Iansoprazole (Prevacid) 30 mg orally

A

A client who had a liver transplant a month ago is admitted with fever and tachycardia. Which medication does the nurse prepare to administer to this client? a. Ceftriaxone (Rocephin) b. Cyclosporine (Sandimmune) c. Azithromycin (Zithromax) d. Ribavirin (Copegus)

B

A client with an esophagogastric tube suddenly experiences acute respiratory distress. Which is the nurse's first action? a. Call the health care provider. b. Cut the balloon ports and remove the tube. c. Place the client upright and apply oxygen. d. Reduce the balloon pressure slightly.

B

A middle-aged male client has irritable bowel syndrome that has not responded well to diet changes and bulk-forming laxatives. He asks the nurse about the new drug lubiprostone (Amitiza). What information does the nurse provide him? a. "This drug is investigational right now for irritable bowel syndrome." b. "Unfortunately, this drug is approved only for use in women." c. "Lubiprostone works well only in a small fraction of irritable bowel cases." d. "Let's talk to your health care provider about getting you a trial prescription."

B

. A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C) and right flank pain. Which is the nurse's best response? a. "The anti-rejection drugs you are taking made you susceptible to infection." b. "You should go to the hospital immediately to have your new liver checked out." c. "You should take an additional dose of cyclosporine today." d. "Take acetaminophen (Tylenol) every 4 hours until you feel better."

B

A client has been diagnosed with hepatitis A. The nurse evaluates that teaching regarding the disease is understood when the client makes which statement? a. "Some medications have been known to induce hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I may have been infected through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

B

A client has cirrhosis. Which nursing intervention would be most effective in controlling ascites? a. Monitoring intake and output b. Providing a low-sodium diet c. Increasing oral fluid intake d. Weighing the client daily

B

A client is admitted with cirrhosis and hepatopulmonary syndrome. Which clinical manifestation does the nurse monitor for progression or resolution of this problem? a. Right upper quadrant pain b. Crackles on auscultation c. Skin and scleral jaundice d. Nausea and vomiting

B

A thin, cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE). The family expresses distress that the client is receiving so little protein in the diet. Which explanation by the nurse is most appropriate? a. "A low-protein diet will help the liver rest and will restore liver function." b. "Less protein in the diet will help with the confusion." c. "Despite looking so thin, protein will not help with weight gain." d. "Less protein is needed to prevent fluid from leaking into the abdomen."

B

The community nurse is talking with a group of individuals about colorectal cancer (CRC) risk factors. Which community participant is at the highest risk for development of CRC? A) 23 year old vegetarian B) 30 year old with Crohns disease C) 39 year old with no family hx of cancer D) 46 year old with genetic predisposition to cancer

B

The nurse conducts a physical assessment for a client with severe right lower quadrant (RLQ) abdominal pain. The nurse notes that the abdomen is rigid and the client's temperature is 101.1° F (38.4° C). Which laboratory value does the nurse bring to the attention of the health care provider as a priority? a. A "left shift" in the white blood cell count b. White blood cell count, 22,000/mm3 c. Serum sodium, 149 mEq/L d. Serum creatinine, 0.7 mg/dL

B

The nurse has taught self-care measures to a client with an anal fissure. Which action by the client requires the nurse to do additional teaching? a. Taking warm sitz baths several times daily b. Administering daily enemas to prevent constipation c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories

B

The nurse is caring for a client who had ileostomy surgery 10 days ago. The client verbalizes concerns that the effluent has not become formed and is still liquid green. Which is the nurse's best response? a. "I will call your health care provider right away because the stool should be semi-solid by now." b. "Your stools will firm up in a few weeks as your body gets used to the ileostomy." c. "You should eat a high-fiber diet to help make the stool bulkier and more solid." d. "You can add buttermilk or yogurt to your diet and avoid carbonated soft drinks."

B

A nurse is completing an admission assessment for a client who has a small bowel obstruction. Which the following findings should the nurse report to the provider? Select all that apply A. emesis prior to insertion of the NG tube B. Urine Specific gravity 1.040 C. Hematocrit 60% D. Blood potassium 3.0 mEq/L E. WBC 10,000/uL

B C D

A client had an open partial colectomy and ascending colostomy 3 days ago. Which assessment findings does the nurse expect? Select all that apply A) Black, moist stoma B) Gas inside the pouch C) pain controlled with analgesics D) small amount of formed stool from the colostomy E) Serosanguineous fluid draining from two Jackson-Pratt drains

B C E

A client just returned to the nursing unit after having a trans-jugular intrahepatic portal-systemic shunt (TIPS) procedure. Which clinical finding does the nurse expect to observe in this client? a. Decreased level of consciousness b. Decreased urinary volume c. Increased blood pressure d. Increased abdominal girth

C

A client who has had fecal occult blood testing tells the nurse that the test was negative for colon cancer and wishes to cancel a colonoscopy scheduled for the next day. Which is the nurse's best response? A) "I will call and cancel the test for tomorrow." B) "You need two negative fecal occult blood tests." C) "This does not rule out the possibility of colon cancer." D) "You should wait at least a week to have the colonoscopy."

C

The nurse is caring for a client who has been newly diagnosed with colon cancer. The client has become withdrawn from family members. Which strategy does the nurse use to assist the client at this time? A) Ask the health care provider for a psychiatric consult for the client. B) Explain the improved prognosis for colon cancer with new treatment. C) Encourage the client to verbalize feelings about the diagnosis. D) Allow the client to remain withdrawn as long as he or she wishes.

C

The nurse is caring for a client who is hospitalized with exacerbation of Crohn's disease. What does the nurse expect to find during the physical assessment? a. Positive Murphy's sign with rebound tenderness b. Dullness in the lower abdominal quadrants c. High-pitched, rushing bowel sounds in the right lower quadrant d. Abdominal cramping that the client says is worse at night

C

The nurse is caring for a client with ulcerative colitis and severe diarrhea. Which nursing assessment is the highest priority? a. Skin integrity b. Blood pressure c. Heart rate and rhythm d. Abdominal percussion

C

A client is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which nursing intervention is the priority? a. Keep the client sedated to prevent tube dislodgement. b. Maintain balloon pressure at between 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Maintain the client's airway.

D

A client is receiving an infusion of vasopressin (Pitressin) to treat bleeding esophageal varices. Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring? a. Acute nausea and vomiting b. A pounding frontal headache c. Vertigo and syncope d. Midsternal chest pain

D

The client with end-stage cirrhosis presents with GI bleeding, combativeness, and confusion. The nurse anticipates an order to administer which medication? a. Omeprazole (Prilosec) b. Somatostatin (Octreotide) c. Propranolol (Inderal) d. Lactulose (Heptalac)

D

The nurse helps a client with diverticular disease choose appropriate dinner options. Which menu selections are most appropriate? a. Roasted chicken, rice pilaf, cup of coffee with cream b. Spaghetti with meat sauce, fresh fruit cup, hot tea with lemon c. Chicken Caesar salad, cup of bean soup, glass of low-fat milk d. Baked fish with steamed asparagus, dinner roll with butter, glass of apple juice

D

The nurse is screening clients at a community health fair. Which client is at highest risk for development of colorectal cancer? A) young adult who drinks eight cups of coffee every day B) middle-aged client with a history of IBS C) older client with a BMI of 19.2 who works 65 hours per week D) Older client who travels extensively and eats fast food frequently

D

The nurse is teaching a client how to care for a new ileostomy. Which client statement indicates that additional teaching is needed? a. "I will consult the pharmacist before filling any new prescriptions." b. "I will empty the ostomy pouch when it is half-filled with stool or gas." c. "I will wash my hands with antibacterial soap before and after ostomy care." d. "I will call my health care provider if I have not had ostomy drainage for 3 hours."

D

The nurse is teaching self-care measures for a client who has hemorrhoids. Which nursing intervention does the nurse include in the plan of care for the client? a. Instruct the client to use dibucaine (Nupercainal) ointment whenever needed. b. Teach the client to choose low-fiber foods to make bowels move more easily. c. Tell the client to take his or her time on the toilet when needing to defecate. d. Encourage the client to dab with moist wipes instead of wiping with toilet paper.

D

The nurse reviews a health teaching for a client with Crohn's disease. Which instruction does the nurse provide for the client? a. "You should have a colonoscopy every few years." b. "You should eat a diet that is high in protein and fiber." c. "You should avoid heavy lifting and tight-fitting clothes." d. "You should take the Asacol whenever you have loose stools."

A

The nurse reviews laboratory results for a client with cirrhosis and finds the following: hematocrit, 72%; blood urea nitrogen (BUN), 42 mg/dL; and sodium, 166 mEq/L. Which action by the nurse is most appropriate? a. Check the client's blood pressure and pulse. b. Increase the client's oral fluid intake. c. Call the health care provider. d. Document the results in the chart.

A

The nurse is teaching a client how to use a truss for a femoral hernia. Which statement by the client indicates the need for further teaching? A) "I will put on the truss before I go to bed each night." B) "I will put power under the truss to avoid skin irritation" C) "The truss will help my hernia because I cant have surgery" D) "If I have abdominal pain, I will let my health care provider know right away"

A

The nurse monitors for which clinical manifestation in a client with a decreased fecal urobilinogen concentration? a. Clay-colored stools b. Petechiae c. Asterixis d. Melena

A

The nurse notes a bulge in a clients groin that is present when the client stands and disappears when the client lies down. Which conclusion does the nurse draw from these assessment findings? A) Reducible inguinal hernia B) Indirect umbilical hernia C) Strangulated ventral hernia D) Incarcerated femoral hernia

A

A client is bleeding from esophageal varices. The health care provider is arranging sclerotherapy for the client. Before the client goes to interventional radiology, the nurse prepares to administer which medication? a. Terlipressin (Glypressin) b. Enoxaparin (Lovenox) c. Lactulose (Heptalac) d. Spironolactone (Aldactone)

A

A client is diagnosed with hepatitis B. Which information does the nurse include in the teaching plan as a priority? a. "Avoid drinking any alcohol until the doctor says you can." b. "You will need aggressive control of your serum lipids." c. "Once your lab work returns to normal, you can donate blood again." d. "Wash your hands well after handling meat and shellfish."

A

A client is receiving lactulose (Heptalac). Which laboratory value leads the nurse to intervene? a. Serum potassium, 2.6 mEq/L b. Serum sodium, 132 mEq/L c. Serum glucose, 108 mg/dL d. Blood urea nitrogen, 16 mg/dL

A

A client tells the nurse that her husband is repulsed by her colostomy and refuses to be intimate with her after surgery. Which is the nurse's best response? A) "Let's talk to the ostomy nurse to help you and your husband work through this." B) "You could try to wear longer lingerie that will better hide the ostomy appliance." C) "You should empty the pouch first so it will be less noticeable for your husband." D) "If you are not careful, you can hurt the stoma if you engage in sexual activity."

A

The nurse is caring for a postoperative client who reports pain in the shoulder blades following laparoscopic cholecystectomy surgery. Which direction does the nurse give to the nursing assistant to help relieve the client's pain? a. "Ambulate the client in the hallway." b. "Apply a cold compress to the client's back." c. "Encourage the client to take sips of hot tea or broth." d. "Remind the client to cough and deep breathe every hour."

A

A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with the diagnosis? Select all that apply A. Emesis greater than 500 mL with fecal odor B. Report of spasmodic abdominal pain C. High pitched bowel sounds D. Abdomen flat with rebound tenderness to palpation E. Laboratory findings indicating metabolic acidosis

A B C

The ED nurse is assessing a client with a known inguinal hernia. Which assessment finding indicate that the hernia may have strangulated? Select all that apply A) Fever B) tachycardia C) Abdominal distention D) Mild abdominal pain E) Nausea and vomiting

A B C E

A nurse is planning care for a client who has a small bowel obstruction and a NG tube in place. Which of the following interventions should the nurse include? Select all that apply A. Document the NG drainage with the clients output B. Irrigate the NG tube q8h C. Assess bowel sounds D. Provide oral hygiene q2h E. Monitor NG tube for placement

A C D E

The nurse is caring for a female client with cholelithiasis. Which assessment findings from the client's history and physical examination may have contributed to development of the condition? (Select all that apply.) a. Body mass index (BMI) of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

A D F

The nurse is caring for a client who is scheduled to have fecal occult blood testing. Which instructions does the nurse give to the client? A) "You must fast for 12 hours before the test." B) "You will be given a cleansing enema the morning of the test." C) "You must avoid eating meat for 48 hours before the test." D) "You will be sedated and will require someone to accompany you home."

C

The nurse is caring for a client who just had colon resection surgery with a new colostomy. Which teaching objective does the nurse include in the client's plan of care? A) Understanding colostomy care and lifestyle implications B) Learning how to change the appliance independently C) Demonstrating the correct way to change the appliance by discharge D) Not being afraid to handle the ostomy appliance tomorrow

C

The nurse is caring for a teenage girl with a new ileostomy. She tells the nurse tearfully that she cannot go to the prom with an ostomy. Which is the nurse's best response? a. "You should get your prom dress one size larger to hide the ostomy appliance." b. "You should avoid broccoli and carbonated drinks so that the pouch won't fill with air under your dress." c. "Let's talk to the enterostomal therapist (ET) about options for ostomy supplies and dress styles so that you can look beautiful for the prom." d. "You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable."

C

The nurse is caring for an older client with gastroenteritis. Which order does the nurse consult with the health care provider about? a. IV 0.45% NS at 50 mL/hr b. Clear liquids as tolerated c. Diphenoxylate hydrochloride/atropine sulfate (Lomotil) orally, after each loose stool d. Acetaminophen (Tylenol), 325-650 mg orally every 4 hr PRN pain

C

The nurse is caring for a client who has undergone surgery to drain a pancreatic pseudocyst with placement of a pancreatic drainage tube. Which nursing intervention prevents complications from this procedure? a. Positioning the client in a right side-lying position b. Applying a skin barrier around the drainage tube site c. Clamping the drainage tube for 2 hours every 12 hours d. Irrigating the drainage tube daily with 30 mL of sterile normal saline

B

The nurse is caring for a client with chronic pancreatitis. Which instruction by the nurse is most appropriate? a. "You will need to limit your protein intake." b. "We need to call the dietitian to get help in planning your diet." c. "You cannot eat concentrated sweets any longer." d. "Try to eat less red meat and more chicken and fish."

B

The nurse is preparing a client with diverticulitis for discharge from the hospital. Which statement by the client indicates that additional teaching is needed? a. "I will ride my bike or take a long walk at least three times a week." b. "I will try to include at least 25 g of fiber in my diet every day." c. "I will take a senna laxative at bedtime to avoid becoming constipated." d. "I will use my legs rather than my back muscles when I lift heavy objects."

C

The nurse is teaching a client with a history of cholelithiasis to select menu items for dinner. Which selections made by the client indicate that the nurse's teaching was effective? a. Lasagna, tossed salad with Italian dressing, 2% milk b. Grilled cheese sandwich, tomato soup, coffee with cream c. Caesar salad with chicken, soft breadstick with butter, diet cola d. Roasted chicken breast, baked potato with chives, hot tea with sugar

D

The nurse is caring for a client who has undergone removal of a benign colonic polyp. The client asks the nurse why a follow-up colonoscopy is necessary. Which is the nurse's best response? a. "You are at risk for developing more polyps in the future." b. "You may have other cancerous lesions that could not be seen right now." c. "The doctor can remove only a few of the polyps during each colonoscopy." d. "This test will ensure that you have healed where the polyp was removed."

A

A client has liver cancer. Which statement by the client about treatment options demonstrates an accurate understanding? a. "I guess it's a good thing that surgery is usually so successful." b. "I choose hepatic arterial infusion of chemo to limit side effects." c. "Because I have only local metastases, I am thinking about transplant." d. "This disease is so rare, no wonder no good treatments are available."

B

A client just had a paracentesis. Which nursing intervention is a priority for this client? a. Monitor urine output. b. Maintain bedrest as per protocol. c. Position the client flat in bed. d. Secure the trocar to the abdomen with tape.

B

The nurse is caring for a client with perineal excoriation caused by diarrhea from acute gastroenteritis. Which client statement indicates that additional teaching about perineal care is needed? a. "I will rinse my rectal area with warm water after each stool and then apply zinc oxide ointment." b. "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." c. "I will take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry." d. "I will clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."

B

The nurse recognizes that fetor hepaticus is consistent with which assessment finding? a. Purpuric lesions on the extremities b. A fruity or musty breath odor c. Warm and bright red palms d. Jaundice of the sclera

B

The nurse is performing a physical assessment of a client with a new diagnosis of colorectal cancer. The nurse notes the presence of visible peristaltic waves and, on auscultation, hears high-pitched bowel sounds. Which conclusion does the nurse draw from these findings? A) The tumor has metastasized to the liver and biliary tract. B) The tumor has caused an intussusception of the intestine. C) The growing tumor has caused a partial bowel obstruction. D) The client has developed toxic megacolon from the growing tumor

C

The nurse recognizes which client as being at greatest risk for the development of carcinoma of the liver? a. Middle-aged client with a history of diabetes mellitus b. Young adult client with a history of blunt liver trauma c. Older adult client with a history of cirrhosis d. Older adult client with malnutrition

C

The nursing care plan specifies obtaining abdominal girth measurements each shift. The nurse takes the measurement, but when compared with the previous measurement, the new finding is several millimeters off. Which action by the nurse is best? a. Document the finding in the client's chart. b. Look to see when the client last had a dose of diuretic. c. Ensure that the client's abdomen and flanks are marked with pen. d. Obtain the measurement while the client sits upright.

C

Which statement made by a client traveling to a nonindustrialized country indicates the need for further teaching regarding the prevention of viral hepatitis? a. "I will drink bottled water while I'm gone." b. "I will not share my drinking glass." c. "I should eat plenty of fresh fruits and vegetables." d. "I will use careful handwashing."

C

While interviewing a 30 year old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP) the nurse will plan to assess the patients knowledge about A) preventing noninfectious hepatitis B) treating inflammatory bowel disease C) risk for developing colorectal cancer D) using antacids and proton pump inhibitors

C

A client with a mechanical bowel obstruction reports that abdominal pain, which was previously intermittent and colicky, is now more constant. Which is the priority action of the nurse? a. Measure the abdominal girth. b. Place the client in a knee-chest position. c. Medicate the client with an opioid analgesic. d. Assess for bowel sounds and rebound tenderness.

D

A client with Crohn's disease has a draining fistula. Which finding leads the nurse to intervene most rapidly? a. Serum potassium of 2.6 mEq/L b. The client not wanting to eat anything c. White blood cell count of 8200/mm3 d. The client losing 3 pounds in a week

A

The nurse is caring for a client who is taking mesalamine (5-aminosalicylic acid) (Asacol, Rowasa) for ulcerative colitis. The client has trouble swallowing the pill. Which action by the nurse is most appropriate? a. Crush the pill carefully and administer it to the client in applesauce or pudding. b. Empty the contents of the capsule into applesauce or pudding for administration. c. Contact the client's health care provider to request an order for Asacol suspension. d. Contact the client's health care provider to request an order for Rowasa enemas instead.

D

The nurse is caring for a client with Crohn's disease who has developed a fistula. Which nursing intervention is the highest priority? a. Monitor the client's hematocrit and hemoglobin. b. Position the client to allow gravity drainage of the fistula. c. Check and record blood glucose levels every 6 hours. d. Encourage the client to consume a diet high in protein and calories.

D

The nurse is providing discharge teaching for a client who will be going home with a T-tube following cholecystectomy surgery. Which statement by the client indicates the need for additional teaching? a. "I will keep the drainage bag lower than the tube itself." b. "I will inspect the T-tube drainage site daily for signs of infection." c. "I will be careful not to pull on the tube or to accidentally pull it out." d. "I will slowly pull about an inch of the tube out each day until it's out."

D

The nurse receives the following information about a 51 year old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? A) the patient has a permanent pacemaker to prevent bradycardia. B) The patient is worried about discomfort during the examination C) The patient has had an allergic reaction to shellfish and iodine in the past D) The patient refused to drink the ordered polyethylene glycol (GoLYTELY)

D

A client with hepatitis C is being treated with ribavirin (Copegus). What nursing action takes priority? a. Educating the client on ways to remain complaint with the drug regimen b. Teaching the client that transient muscle aching is a common side effect c. Ensuring that the client returns to the clinic each week for follow-up care d. Showing the client how to take and record a radial pulse for 1 minute

A

A client has an anorectal abscess. Which teaching topic does the nurse address as the priority? a. Perineal hygiene b. Comfort measures c. Nutrition therapy d. Antibiotic use

A

A client who has had a colostomy placed in the ascending colon expresses concern that the effluent collected in the colostomy pouch has remained liquid for 2 weeks after surgery. Which is the nurse's best response? a. "This is normal for your type of colostomy." b. "I will let the health care provider know, so that it can be assessed." c. "You should add extra fiber to your diet to stop the diarrhea." d. "Your stool will become firmer over the next few weeks."

A

A client is admitted with jaundice and suspected hepatitis B. Which intervention does the nurse add to the client's care plan? a. Encourage rest during this period. b. Assist the client with ambulation. c. Place the client on a clear liquid diet. d. Administer PRN prochlorperazine maleate (Compazine).

A

The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands. The client states this has not happened before. Which action by the nurse is most appropriate? a. Conduct a thorough assessment, then notify the surgeon of the findings. b. Review today's laboratory work, including liver function studies. c. Assess the client's vital signs, and offer acetaminophen if the client is febrile. d. Perform an assessment of the client's gross and fine motor skills.

A

A nurse is teaching a community group about food poisoning and gastroenteritis. Which statements by the nurse are accurate? (Select all that apply.) a. Rotavirus is more common among infants and younger children. b. Escherichia coli diarrhea is transmitted by contact with infected animals. c. Don't drink water when swimming to prevent E. coliinfection. d. All clients with botulism require hospitalization. e. Parasitic diseases may not show up for 1 to 2 weeks after infection.

A C D E

The nurse is performing a physical assessment for a client who underwent a hemorrhoidectomy the previous day. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which is the nurse's priority action? A) Assess the clients vital signs B) Determine the last time the client voided. C) Insert a rectal tube to facilitate passage of flatus D) Document the findings in the clients chart

B

The nurse is providing preoperative teaching for a client who will undergo herniorrhaphy surgery. Which instruction does the nurse give to the client? A) "Eat a low-residue diet for the first week after surgery" B) "Change the dressing every day until the staples are removed" C) Take acetaminophen (Tylenol) 1000 mg q4h for pain D) "Cough and deep breathe q2h for the first week after surgery"

B

The nursing assistant is helping a client who has advanced cirrhosis with a bath and other hygiene. Which action by the assistant requires intervention by the registered nurse? a. Helping the client apply lotion to dry skin areas b. Giving the client a basin of warm water and soap to use c. Providing a soft toothbrush for oral care d. Helping the client keep nails trimmed short

B

Which laboratory data does the nurse correlate with advanced disease in a client with cirrhosis? a. Elevated serum protein level b. Elevated serum ammonia level c. Decreased serum ammonia level d. Decreased lactate dehydrogenase level

B

A client has irritable bowel syndrome. Which menu selections by this client indicate good understanding of dietary teaching? A) Tuna salad on white bread, cup of applesauce, glass of diet cola B) Broiled chicken with brown rice, steamed green beans, glass of apple juice C) Grilled chicken sandwich, small ripe banana, cup of hot tea with lemon D) Grilled steak, green beans, dinner roll with butter, cup of coffee with cream

B

A client is in the emergency department after a motor vehicle crash, and the nurse notices a "steering wheel mark" across the client's chest. Which action by the nurse is most appropriate? a. Ask the client where in the car he or she was during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to come draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

B

A client is scheduled for a paracentesis. Which activity does the nurse delegate to the unlicensed assistive personnel? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed, on the right side. d. Get the client into a chair after the procedure.

B

The nurse is caring for a client with colon cancer and a new colostomy. The client wishes to talk with someone who had a similar experience. Which is the nurse's best response? A) "Most people who have had a colostomy are reluctant to talk about it." B) "I will make a referral to the United Ostomy Associations of America." C) "You can get all the information you need from the enterostomal therapist." D) "I do not think that we have any other clients with colostomies on the unit right now."

B

The nurse is caring for a client with severe ulcerative colitis who has been prescribed adalimumab (Humira). Which client statement indicates that additional teaching about the medication is needed? a. "I will avoid large crowds and people who are sick." b. "I will take this medication with food or milk." c. "Nausea and vomiting are common side effects." d. "I will wash my hands after I play with my dog."

B

The nurse is providing discharge teaching for a client who has undergone colon resection surgery with a colostomy. Which statements by the client indicate that the instruction was understood? (Select all that apply.) a. "I will change the ostomy appliance daily and as needed." b. "I will use warm water and a soft washcloth to clean around the stoma." c. "I will start bicycling and swimming again once my incision has healed." d. "I will notify the doctor right away if any bleeding from the stoma occurs." e. "I will check the stoma regularly to make sure that it stays a deep red color." f. "I will avoid dairy products to reduce gas and odor in the pouch." g. "I will cut the flange so it fits snugly around the stoma to avoid skin breakdown."

B C G

The nurse is caring for a client who is being discharged from the hospital after an attack of acute pancreatitis. Which discharge instructions does the nurse provide for the client to help prevent a recurrence? (Select all that apply.) a. "Take a 20-minute walk at least 5 days each week." b. "Attend local Alcoholics Anonymous (AA) meetings weekly." c. "Choose whole grains rather than foods with simple sugars." d. "Use cooking spray when you cook rather than margarine or butter." e. "Stay away from milk and dairy products that contain lactose." f. "We can talk to your doctor about a prescription for nicotine patches."

B D F

The nurse is caring for a client who had undergone a Whipple procedure 2 days previously. The nurse notes that the client's hands and feet are edematous, and urine output has decreased from the previous day. Which intervention does the nurse expect to provide for the client? a. Increase the client's IV fluid infusion rate. b. Monitor the client's blood sugar level every 4 hours. c. Add colloids to the client's IV solutions. d. Reinsert the client's nasogastric (NG) tube.

C

The nurse monitors for which serologic marker in the client who is a carrier of chronic hepatitis B? a. Anti-hepatitis C virus (HCV) antibodies b. Anti-hepatitis B (HBs) antibodies c. Hepatitis B surface antigen (HBsAg) antibodies d. Hepatitis A virus (HAV) antibodies

C

A client with rectal bleeding who is preparing to undergo a colonoscopy tells the nurse, "I'm very afraid of having polyps and cancer." What is the appropriate nursing response? A) "Lets worry about that after the procedure" B) "Polyps are never cancerous, so you don't need to worry" C) "Unfortunately all polyps are malignant, so you may already have cancer" D) "Its understandable that you are fearful. Tell me what frightens you the most?"

D

A client with severe esophageal varices is scheduled for trans-jugular intrahepatic portal-systemic shunt (TIPS) insertion. The nurse determines that teaching has been effective when the client makes which statement? a. "I will be discharged home after I wake up completely." b. "The procedure may be painful because I get only light sedation." c. "My liver will function normally within 8 hours of placement of the shunt." d. "I will be monitored closely for a while after the procedure is over."

D