GI

1 Cholecystitis # inflammation of the gallbladder 1 pain in the right upper quadrant and referred pain to the right shoulder and scapula a few hours after eating high-fat foods. 2 low-grade fever, chills, nausea, vomiting, and anorexia 3 leukocytosis

++ positive Murphy's sign test # pain & inability to inhale deeply during palpation RUQ ++ choledocholithiasis # gallstones stuck in bile duct may become colonized by bacteria # need remove

1 appendicitis 1 Pain associated with acute appendicitis typically begins in the periumbilical region and migrates to the area overlying the appendix e.g. from the right lower quadrant to McBurney's point # one-third of the distance from the right anterior superior iliac spine to the umbilicus. 2 GI symptoms eg. anorexia, N/V 3 rebound tenderness & guarding

++ to decrease pain by lying still with the right leg flexed and avoiding increased intraabdominal pressure eg, from coughing, sneezing, deep inhalation

toxic ASA A parent rushes a 4-year-old to the emergency department after finding the child sitting on the kitchen floor holding an empty bottle of aspirin. The parent has no idea how many tablets were left in the container. The child is sniffling and crying quietly. The practical nurse anticipates initially assisting with the implementation of which treatment? 1 activated charcoal 2 gastric lavage 3 sodium bicarbonate 4 syrup of ipecac

1 ex 2 after 1 if life threatening 3 IV sodium bicarbonate give 4 ipecac not use anymore for toxic since SE 2nd pneumonia

colostomy Which statement made by the client demonstrates a correct understanding of the home care of an ascending colostomy? 1 " I will avoid eating foods such as broccoli & cauliflower 2 " I will empty the pouch when it is one half full of stool 3 " I will irrigate the colostomy to promote regular bowel movements." 4 " I will restrict my fluid intake to 2,000mL a day"

1 ex 2 empty when 1/3 full 3 irrigate need Rx 4 adequate fluid

1 PPI A client who has been on long-term omeprazole therapy for gastroesophageal reflux disease is admitted to the hospital for a urinary tract infection. The nurse recognizes that this client is at highest risk for which complication due to omeprazole use? 1 Clostridium difficile infection 2 Gail disturbane 3 jaw necrosis 4 tremor

1 ex 2 gait disturbance @ phenytoin toxic 3 Jaw necrosis # long term bisphosphonate eg alendronate, risedronate 4 tremor # lithium toxicity & albuterol therapy

1 Stool ass. The nurse assessing a client with an upper gastrointestinal bleed would expect the client's stool to have which appearance? 1 black tarry 2 bright red bloody 3 light gray clay colored 4 small, dry, rock hard masses

1 ex 2) Bright red bloody stool @ hematochezia # lower GI hemorrhage. 3) Decreased bile flow into the intestine due to biliary obstruction would produce a light gray "clay-colored" stool. 4) Small, dry, rocky-hard masses are an indication of constipation. Inactivity, slow peristalsis, low intake of fiber in the diet, decreased fluid intake, and some medications eg, anticholinergics may contribute to constipation.

EA & TEF A newborn is being evaluated for possible esophageal atresia with tracheoesophageal fistula. Which finding is the nurse most likely to observe? 1 choking & cyanosis during feeding 2 concave scaphoid abdomen 3 diminish lung sounds 4 projectile vomiting after feeding

1 ex 2 # congenital diaphragmatic hernia d/t the migration or abdominal organs to the thoracic space 3 # aspiration pneumonia, diaphragmatic hernia, or pneumothorax 4 hypertrophic pyloric stenosis

TPN A client receiving TPN total parenteral nutrition reports nausea, abdominal pain, and excessive thirst. What is the best action for the nurse to take? 1 check the cl's Blood glucose 2 check the cl's VS 3 report the finding to MD 4 slow down the rate of infusion

1 ex Hyperglycemia is a complication of total parenteral nutrition (TPN). Based on the client's reported symptoms related to hyperglycemia, the nurse needs to assess the client's blood sugar before implementing an intervention

intussusception The nurse is caring for a 2-year-old who is receiving a saline enema for treatment of intussusception. Which client-finding is most important to report to the supervisory registered nurse? 1 passed a normal brown stool 2 passed a stool mixed with blood 3 stopped crying 4 vomited a third time

1 ex Reduction of intussusception is often performed with a saline or air enema. The supervisory registered nurse should be notified if there is passage of a normal stool as this indicates reduction of intussusception. All plans for surgery should be stopped, and the plan of care should be modified

SATA colostomy A client 4 days post colostomy is preparing to be discharged home. Which findings are concerning and should be further investigated? 1 " I will need home health to empty the pouch." 2 " There is a little gas in the colostomy bag." # expected 3 No bowel sound are present & the cl reports nausea 4 skin surrounding the stoma is res & excoriated 5 stoma is red, edematous, & smaller than the previous day # normal

1 # indicated body image disturbance & ineffective coping R/T cl unwilling to care the ostomy 3 # absent bowel sound # postOR ileus @ should be report to MD 4 risk for skin break down d/t not proper fit between colostomy pouch bag & stoma

1 allergy lactose The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources? 1 ca2+ 2 fiber 3 iron 4 vit d 5 vit K

1 & 4 ex 1 sources of calcium include beans, dark greens, and calcium-fortified cereal and juices 4 source D sunlight, fish, egg yolks, and vitamin D-fortified food 3 iron include meats and spinach. 5 Vitamin K is an important nutrient for coagulation. Vitamin K is produced by bacteria in the large intestine and is found in food sources such as dark green vegetables, fish, and eggs, not in cow's milk.

SATA PUD The nurse is reinforcing teaching about ulcer prevention with a client newly diagnosed with peptic ulcer disease. Which of the following client statements indicate appropriate understanding of teaching? 1 I need to avoid taking meds like ibuprofen without a Rx 2 I should avoid drinking excess coffee or cola 3 I should enroll in a smoking cessation program 4 I should reduce or eliminate of alcoholic beverages 5 I will eliminate whole wheat foods, like breads & cereal, from my diet.

1 2 3 4 ex Peptic ulcer disease (PUD) is a gastrointestinal illness caused by breaks in the gastrointestinal mucosa, leading to ulcer formation. To reduce ulcer formation risk, clients with PUD should be instructed to stop smoking; avoid chronic NSAID use; avoid meals or snacks before sleeping; and limit alcohol and caffeine consumption.

SATA PUD Which instructions should the nurse include when reinforcing discharge teaching to a client with peptic ulcer disease due to Helicobacter pylori infection? 1 avoid foods that may cause epigastric distress such as spicy or acidic foods 2 It is best if you refrain from consuming alcohol products 3 Report black tarry stool to MD immediately 4 Take your amoxicillin, clarithromycin, & omeprazole for the next 14days 5 you may take OTC drugs such as aspirin if you have mild epigastric pain

1 2 3 4 ex 5 PUD should avoid NSAIDs eg, aspirin, ibuprofen Motrin; as they inhibit prostaglandin synthesis, increase gastric secretion @ high acid, and reduce the integrity of the mucosal barrier.

SATA esophageal cancer The nurse assists with data collection during a screening event at a gastroenterology clinic. Which of the following client statements include risk factors for esophageal cancer? 1 " a few year ago, I switched form smoking cigarettes to smoking cigars 1 or 2 times a week." 2 " I am proud that I was able to lose 10lb, but I'm still considered obese for my height." 3 " I drink 3 or 4 beers nightly to relax, but I did switch to light beer recently." 4 " I have struggled with daily episodes of acid reflux years, especially at nighttime." 5 " I snack on a lot of salted foods like popcorn & peanuts

1 2 3 4 # risk for esophageal cancer ex 5 # risk for gastric cancer

SATA colorectal cancer An older client comes to the outpatient clinic for a routine physical examination and health screening. Which findings does the nurse recognize as possible indications of colorectal cancer? 1 abdominal pain 2 blood in stool 3 change in bowel habit 4 low hemoglobin level 5 unexplained weight loss

1 2 3 4 5 ex Clients over age 50 should receive routine colorectal cancer screening for symptoms such as blood in the stool, anemia, abdominal discomfort, change in bowel habits, and weight loss. Symptoms result from intestinal polyps or tumors that cause intestinal bleeding, obstruction, and impaired intestinal absorption.

1 constipation diet fiber SATA The nurse is teaching about the importance of dietary fiber at a community health fair. Which health benefits of consuming a fiber-rich diet should the nurse include in the teaching plan? 1 helps prevent colorectal cancer 2 improve glycemic control 3 promote weight loss 4 reduces risk of vascular dis. 5 regulates bowel movements

1 2 3 4 5 ex Dietary fiber increases stool bulk and makes stool softer and easier to pass. A fiber-rich diet helps prevent constipation; decreases risk of colorectal cancer; promotes weight loss; improves blood glucose control; and decreases serum cholesterol levels, which reduces the risk of coronary artery disease and stroke.

SATA diverticulitis A client with a history of diverticular disease is being discharged after an episode of acute diverticulitis. Which instructions should the nurse reinforce to reduce the risk of future episodes? 1 drink plenty of fluids 2 exercise regularly 3 follow a low fiber diet 4 include whole grains, fruits, & vegetables in the diets 5 increase intake of red meat

1 2 4 ex prevent recurring episodes of acute diverticulosis should take measures to prevent constipation 1 high-fiber diet eg, whole grains, fruits, vegetables 2 increased fluid intake 3 regular exercise ++ fiber supplement Rx eg. psyllium or Bran

SATA liver cirrhosis A client diagnosed with cirrhosis is experiencing pruritus. Which strategies are appropriate for the nurse to teach the client to promote comfort and skin integrity? 1 apply cool, moist washcloths to the affected areas 2 keep the fingernails trimmed short to minimize skin scratching 3 take a hot bath or shower to alleviate itching sensations 4 use skin protectant or moisturizing cream over unbroken skin 5 wear cotton gloves or long-sleeved clothing to avoid scratching

1 2 4 5 ex 3 using tepid water

SATA diet postOR A client admitted 3 days ago with upper gastrointestinal bleeding underwent an endoscopic procedure to stop the bleeding. The client is started on a clear liquid diet today. Which foods are appropriate for the nurse to offer the client? 1 apple juice 2 cherry popsicle 3 chicken broth 4 frozen yogurt 5 unsweetened tea 6 vanilla ice cream

1 3 5 ex 2 recent GI bleeding, N/V # avoid red dyes in clear liquid eg, cherry popsicle, red gelatin 4 & 6 full liquid diet

SATA BLL A 12-month-old client has a high blood lead level of 18 mcg/dL. The nurse is reinforcing teaching about lead poisoning to the parents. Which statements made by a parent indicate that teaching has been successful? 1 I should have our home inspected for the source of lead 2 I will vacuum our hard surface floors daily 3 I will wash my child's hands often, especially bf eating 4 we should use hot water from the tap for cooking 5 we will have to return for a follow up lead level

1 3 5 ex 2 vacuum # spread lead dust in air @ increase exposure. # use wet dusted or popped at least weekly 4 Hot water dissolves lead from older pipes; therefore, cold water should be used for consumption if lead plumbing is present. Taps should be flushed for several minutes to clear out contaminated water before use.

SATA Dumping syndrome The nurse is reinforcing discharge instructions with a client following partial gastrectomy. Which of the following instructions should the nurse include to prevent dumping syndrome? 1 add high protein foods to diet 2 consume high carbohydrate meals 3 eat small, frequent meals 4 increase intake of fluid with meals 5 lie down after eating

1 3 5 ex dumping syndrome 2 avoid carbohydrate 4 avoid fluid with meal to prevent passing faster

SATA meds MetoclopramideThe nurse is reinforcing information to a diabetic client with a new prescription for metoclopramide. Which of the following side effects must the nurse remind the client to report immediately to the health care provider? 1 excess blinking eyes 2 dry mouth 3 dull headache 4 lip-smacking 5 puffing of cheeks

1 3 5 SSE antipsychotic medication and metoclopramide use can be associated with significant extrapyramidal side effects eg, tardive dyskinesia ex 2 &3 CSE

SATA ESLD During morning rounds, the nurse notices that a client who was admitted 3 days ago with hepatic encephalopathy is sleepy and confused. The client is scheduled for discharge later today. Which interventions are appropriate for the nurse to implement? 1 compare current mental status to previous findings 2 encourage to ambulate in the hallway 3 hold the cl's morning dose of lactulose 4 monitor ammonia level 5 observe the cl's hand movement with arms extended

1 4 5 ex (Option 2) The client with lethargy and confusion is at risk for falling. Ambulation is not an appropriate intervention at this point. (Option 3) Lactulose is the primary drug used for treating hepatic encephalopathy. It helps to excrete ammonia through the bowels as soft or loose stools. Lactulose should not be held if the client's hepatic encephalopathy continues to worsen.

SATA GERD The nurse is reviewing lifestyle and nutritional strategies to help reduce symptoms in a client with newly diagnosed gastroesophageal reflux disease. Which strategies should the nurse include? 1 food low in fat 2 do not consume any food containing dairy 3 eat three large meals daily & minimize snacking 4 limit or eliminate the use of alcohol & tobacco 5 try to avoid caffeine, chocolate, & peppermint

1 4 5 ex 2 ok use low or non fat dairy 3 small & frequency meal

SATA colonoscopy A healthy 50-year-old client asks the nurse, "What must I do in preparation for my screening colonoscopy?" Which instructions should the nurse reinforce to correctly answer the client's question? 1 no food or drink is allowed 8h prior to the test 2 prophylactic antibiotics are taken as prescribed 3 smoking must be avoided after midnight 4 the day prior to the procedure your diet will be clear liquids 5 you will drink polyethylene glycol as directed the day before

1 4 5 ex Instructions for clients scheduled for a colonoscopy include consuming a clear liquid diet the day before the procedure, taking the bowel-cleansing agent as prescribed, and having nothing by mouth 8-12 hours prior to the examination. Avoiding smoking the day of the examination

IBS Which client-finding would be a contraindication for the nurse to administer dicyclomine hydrochloride for irritable bowel syndrome? 1 bladder scan showing 500mL urine 2 Hemoglobin of 11g/dL 3 hx of cataracts 4 report frequent diarrhea today

1 500mL bladder retention > normal bladder 300mL # urge to urinate ex dicyclomine # Anticholinergic drugs @ smooth muscle relaxation # contraindicated narrow-angle glaucoma, urinary retention including benign prostatic hyperplasia, and bowel or paralytic ileus/obstruction.

diverticulitis The practical nurse is collecting data on a client with acute diverticulitis. Which finding will the nurse report immediately to the registered nurse? 1 abdominal pain has progressed to the left upper quadrant 2 hemoglobin 11.2 g/dL 3 Lying on side with knees drawn up to abdomen & trunk flexed 4 WBC 12,000/mm3

1 Diverticulitis # inflam. of diverticula @ outpouching @ lead to abscess, bleeding; perforation; peritonitis/ Fatal # pain from left lower progressed to the left upper quadrant ex 2 anemia r/t bleeding 3 abdominal pain 4 infec. # in. WBC

1 diets toddler picky about their food choices & eat less than infant high metabolic # During toddlerhood, it is normal for a child to have a decreased appetite as the result of reduced metabolic needs. Parents should be taught to provide multiple food options, set a schedule for meals/snacks, and avoid watching TV or playing games during mealtime. Toddlers should not be forced to eat.

1 Set and enforce a schedule for all meals and snacks. 2 Offer the child 2 or 3 choices of food items. 3 Do not force the child to eat. 4 Keep food portions small (1-2 teaspoons per serving) and provide an additional serving after the first serving is consumed. 5 Expose the child repeatedly to new foods on several separate occasions. 6 Do not allow the child to watch TV and play games during meals or snacks.

intussusception The nurse assesses a child with intussusception. Which assessment findings require priority intervention? 1 abdominal rigidity with guarding 2 absence or tears in crying child with IV start 3 blood streaked mucous stool in diaper 4 sausage shaped right sides mass on palpation

1 abdominal rigidity with guarding # peritonitis # emergency life threatening ex 2 absence of tears when crying during painful procedure # dehydration # monitor VS, mucus membrane, capillary refill 3& 4 common SS of intussusception

1 IBS intervention Management focuses on reducing diarrhea or constipation, abdominal pain, and stress. Clients can manage symptoms with diet, medications, exercise, and stress management. ++ meds Dicyclomine Bentyl

1 avoiding gas-producing foods eg, broccoli, banana, cabbage, bean, bagels 2 Avoid GI irritants eg, high-fructose corn syrup, spices, dairy products, fatty food, caffeine, alcohol, 3 by increasing fiber whole grain, legume, nuts, fruits, vegetable 4 well tolerated incl. protein, breads, & bland foods

1 diets diarrhea control +++ BRAT diets banana, rice, applesauce, toast # toxic when poison food risk factor eg. Dumping syndrome, Misoprostol med, ulcerative colitis # blood diarrhea

1 continue normal diet unless other directions 2 antidiarrheal meds by Rx ++ do not use without Rx, especially Fatal paralytic ileus in children 3 monitor sign or dehydration eg, sunken eyes, mucous membranes 4 prevent skin breakdown eg, use barrier cream petrolatum or zinc oxide

the nurse correctly advise the pregnant pt to increase the number of calories in her daily diet by 1 340 kcal/day 2 500 3 750 4 1000

1 increase by 350 kcal/ day in 2nd trimeter & 450 kcal/day in 3th trimester

1 intussusception long ruot 1 occurs when part of the intestine telescopes into another adjacent part and causes a blockage # swelling and decreased blood supply to the intestine 2 severe compilations eg, intestinal perforation & peritonitis # FATAL if untreated +++ peritonitis # fever, abodminal rigidity, guarding, & rebound tenderness => surgical emergency

1 pain d/t muscle spasm, intermittent 15 -20min & is accompanied by screaming & drawing up of the knee 2 intense pain cause spasm pyloric muscles # vomit 3 stool mixed-blood & mucus = "currant jelly" stool 4 a palpable sausage-shaped mass on the right side of the abdomen

1 diets A client with obesity has just started taking orlistat. Which statement by the client indicates a need for further teaching? 1 I have started taking a daily multivitamin with my dinner time dose of meds 2 I may have oily stools & fecal incontinence when taking this medication 3 I will consume a low fat diet in which no more than 30% of my calories are from fat 4 I will take my meds with or within 1h of meals that contain fat

1 wrong ex Orlistat, a lipase inhibitor, prevents the absorption of fat from the gastrointestinal tract and is used with diet (eg, low-fat) and exercise to promote weight loss. Because orlistat blocks the absorption of fats, it also interferes with the uptake of fat-soluble vitamins. Clients should take a daily multivitamin with vitamins A, D, E, and K 2 hours after taking orlistat to prevent nutrient deficiencies.

colostomy irrigation The nurse is reinforcing teaching of proper technique for colostomy irrigation for the home health client. Which client action indicates that further instruction is required? 1 attaches an enema set to the irrigation bag, lubricates it, gently inserts it into the stoma, and hold in place 2 fills irrigation container with 500 -1000mL of lukewarm tap water & flushes the irrigation tubing 3 hangs the irrigation container on a hook at the level of the shoulder approximately 18 -24in above stoma 4 slowly opens the roller clamp, allowing the irrigation solution to flow, but clamps the tubing when cramping occurs

1 wrong # A cone-tip applicator is used to instill the irrigation solution into the stoma. An enema set should never be used to irrigate a colostomy.

1 pyloric stenosis 11 excessive hunger 12 palpable olive-shaped mass in the epigastrium to the right of the umbilicus ​

13 projectile vomiting can be up to 3 feet

The nurse cares for an 11-lb (5-kg) infant admitted with dehydration and prepares to calculate intake and output over an 8-hour shift. Using the data in the exhibit, calculate the total output in milliliters for the 8-hour shift. Intake and output record Emesis 120 mL Wet diaper 1 50 g Wet diaper 2 52 g Wet diaper 3 46 g *Weight of a dry diaper = 30 g

178mL ex 1g = 1mL Adequate urinary output for an infant is 2 mL/kg/hr.

a dietary modification that shows evidence of reducing the risk of cancer is 1 increase intake of saturated fat 2 decrease intake of saturated fat 3 decrease intake raw fruits & vegs 4 increase intake of smoke & salt cured meat

2

BLL A 12-month-old is found to have a moderately elevated blood lead level. Which of the following is the most serious concern for this child? 1 GI bleeding 2 growth retardation 3 neurocognitive impairment 4 sever liver injury

2 ex 1 GI bleeding # NSAIDs, iron poison 2 growth retardation # not a major fx of BLL, BUT common occurs with chronic anemia or pituitary dis. 4 liver injury # acetaminophen overdose or Reye syndrome

colostomy Which appearance of a stoma immediately after colostomy requires that the practical nurse contact the supervising registered nurse immediately? 1 brick red with slight moisture 2 dusky with moderate edema 3 pink with slight oozing of blood 4 rosy with no stool produced

2 ex A healthy stoma has the characteristics of mucosal tissue and should appear vascular and moist; swelling normal 2-3 day postOR 2 Indications of decreased blood supply (pale, dusky, or cyanotic color changes) should be reported to the registered nurse and health care provider immediately.

diets lose weight A client tells the nurse of wanting to lose 20 lb (9 kg) in time for the client's daughter's wedding, which is 16 weeks away. How many calories (kcal) will the client have to eliminate from the diet each day to meet this goal? 1 450 kcal/day 2 625 kcal/day 3 860 kcal/day

2 ex [3,500 kcal/1lb x 20lb] / ( 16weeks x 7days) = 625 kcal/day

CF The nurse reinforcing teaching to the parents of a child diagnosed with cystic fibrosis will advise the parents to choose foods that satisfy which recommended diet? 1 gluten free with added protein 2 high calories, high protein, high fat 3 high protein, low fat, low phosphate 4 high protein, low fat, low sodium

2 ex 1 celiac dis 3 low phosphate # certain kidney dis 4 low sodium # volume overload eg, HF, ascites, HPT

PPI The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What is that for? I don't take it at home." Which reply by the nurse is most appropriate? 1 omeprazole helps prevent nausea by making your stomach empty faster 2 Omeprazole helps prevent you from developing an ulcer d/t the stress of surgery 3 Omeprazole protects you from getting an infection while on antibiotics 4 This meds will treat your GERD

2 ex 1 metoclopramide Reglan # decrease postOR nausea by promoting gastric empty 2 PPIs # increase risk of Clostridium difficile infection # require antibiotic use 3 cl's does not take the meds at home # no hx GERD

SATA congenital Hirschsprung disease The nurse is collecting data on a 2-day-old infant with suspected Hirschsprung disease. Which findings should the nurse anticipate? 1 bright red bleeding from the anus 2 distended abdomen 3 has not passed stool meconium 4 non-bilious vomiting 5 refuses to feed

2 3 5 ex 1 # symptom of Meckel diverticulum 4 non bilious vomit # pylorus VS bilious@ green vomit # Hirschsprung

SATA diets lose weight The nurse is counseling a client with obesity who is starting a weight reduction diet. The client reports consuming 4-5 regular cola beverages daily. Which of the following beverages should the nurse recommend as healthier substitutes? 1 commercial fruit juice 2 flavored club soda 3 fresh vegetable juice 4 sports beverages 5 unsweetened tea

2 3 5 ex 1 & 4 contain high sugar & high calories

SATA assess The practical nurse is assisting the registered nurse during a physical assessment of a 10-year-old with abdominal discomfort. Which actions does the practical nurse anticipate during the assessment? 1 ask the accompanying parent to rate & describe the cl's pain 2 ask the cl to describe the most concerning symptom. 3 conduct a head to toe ex. in a manner similar to an adult ex. 4 explain the outcome of the ex. to the parent without the cl present 5 honor the cl's request to be ex. without a parent present

2 3 5 ex When performing a physical examination on a child, it is imperative that the examiner proceed according to developmental age so that the child will be more comfortable and cooperative during the examination.

SATA allergy Celiac The school nurse creates a cafeteria menu for a newly enrolled child with celiac disease. Which lunches would be appropriate for this child? 1 beef barley soup with mixed veg and French bread 2 Grilled chicken, baked potato, and strawberry yogurt 3 Mexican corn tacos with ground beef & cheese 4 peanut butter & jelly on rice cakes with an oatmeal cookie 5 rice noodles with chicken and broccoli

2 3 5 ex gluten # BROW barley, rye grain, oats, wheats gluten free rice, corn, potatoes

SATA intussusception The nurse is monitoring a 12-month-old diagnosed with intussusception. Which findings should the nurse expect? 1 palpable olive-shaped mass in the epigastrium 2 Palpable sausage-shaped mass in the upper right quadrant 3 projectile vomiting containing blood 4 Screaming & drawing the knee up to the chest 5 stool mixed with blood & mucus

2 4 5 ex 1 pyloric stenosis # olive-shape 3 intussusception # vomit without blood VS gastric ulcers, variceal bleed # vomit with blood

SATA liver cirrhosis A client with ascites due to cirrhosis has increasing shortness of breath and abdominal pain. The practical nurse is assisting the registered nurse in preparing the client for a paracentesis. Which nursing actions should be implemented prior to the procedure? 1 obtain informed consent for the procedure 2 place the cl in high Fowler position 3 Place the cl on NPO status 4 request that the cl empty the bladder 5 take baseline VS & weight

2 4 5 ex 1 # only MD responsible 2 NO require NPO since Paracentesis # bedside, or clinic with only a local anesthetic

SATA liver cirrhosis The nurse is caring for a client with cirrhosis. Assessment findings include ascites, peripheral edema, shortness of breath, fatigue, and generalized discomfort. Which interventions would be appropriate for the nurse to implement to promote the client's comfort? 1 encourage adequate sodium intake 2 semi Fowler position 3 Trendelenburg position 4 Provide alternating air pressure mattress 5 use music to provide a distraction

2 4 5 ex 1 avoid Na+ intake to prevent accumulate fluid 3 contraindicated with ascites cirrhosis to prevent SOB

SATA constipation The nurse is reinforcing teaching about constipation prevention to a client. Which of the following client statements indicate appropriate understanding of the teaching? 1 drink more caffeinated drinks such as tea & soda helps to stimulate the bowel 2 having a routing bowel movements is important, but I should not wait if I feel the urge." 3 I can use an OTC laxative every other day if needed 4 I should try to eat more fruits & veg. every day 5 Increasing m y daily exercise level may help keep my bowel movements regular

2 4 5 ex 1 caffeinated or soda promote diuresis # in dehydration & constipation 3 avoid using laxatives & enemas UNLESS Rx since overuse can result in physical & psychological dependency

1 SATA diets The nurse is reinforcing education with the parents of a 2-year-old child about diet choices to promote growth. The family observes a strict vegan diet. Which of the following statements by the nurse are appropriate? 1 diet consisting of legumes as the only protein source is sufficient for growth 2 It is important to feed your child fortified bread & cereals to help with iron intake 3 preparing meals with veg & fruits will ensure sufficient vit B12 intake 4 try to pair foods high in iron with foods high in vit C to aid iron absorption 5 your child may require calcium & vit D sup due to lack of dairy intake

2 4 5 ex Pediatric clients consuming a vegan diet are at risk for dietary deficiencies (eg, iron, protein, calories, vitamin B12, calcium, vitamin D). Parent education about supplementation and adequate food sources of these nutrients is necessary.

1 diet PostOR 1 bariatric surgery # reduces stomach capacity ++ Clear liquids with red dyes should not be given to clients with recent gastrointestinal bleeding.

2 Clients recovering from bariatric surgery are given small, frequent meals to prevent nausea, vomiting, and regurgitation related to overstretching of the stomach. 3 The bariatric postoperative diet is restricted to foods that are high in nutrients (eg, protein, fiber) and low in simple carbohydrates to prevent dumping syndrome.

1 toxic infant botulism 1 Pathogenesis 11 Ingestion of Clostridium botulinum spores eg, environmental dust/soil, honey 12 Spores colonize GI tract & produce toxin 13 Toxin inhibits presynaptic acetylcholine release 3 Diagnosis 31 Clinical 32 Confirmation by stool C botulinum spores or toxins 4 Treatment +++ Botulism immune globulin IV

2 Clinical presentation 21 Age 12 months 22 Constipation, poor feeding, hypotonia 23 Oculobulbar palsies (eg, absent gag reflex, ptosis) 24 Symmetric, descending paralysis 25 Autonomic dysfunction (eg, decreased salivation, fluctuating HR/BP)

IBS The nurse is reviewing prescriptions for the assigned clients. Which prescription should the nurse question? 1 Allopurinol for a cl-who developed tumor lysis syndrome from chemotherapy for acute leukemia 2 Dicyclomine for a cl with a hx of IBS who develops a POSTOR paralytic ileus 3 IV morphine for cl after percutaneous nephrolithotripsy who reports the last Bowel movement was 2 days ago 4 Levofloxacin for cl with a UTI who has a hx of anaphylaxis to penicillin drugs

2 Dicyclomine is an antispasmodic drug that decreases intestinal motility and is contraindicated in clients with paralytic ileus. ex 1 allopurinol # promote purine excretion & prevent acute kidney injury af hyperuricemia tumor lysis syndrome 3 nephrolithotripsy surgery # severe pain 4 levofloxacin # fluoroquinolones reccomend if allergic to penicillin

ESLD The nurse is caring for a client with cirrhosis who has hepatic encephalopathy. The client is prescribed lactulose. Which assessment by the nurse will most likely indicate that the medication has achieved the desired therapeutic effect? 1 low K+ 2 improved mental status 3 looser stool consistency 4 reduced abdominal distension

2 Lactulose is a laxative used to trap and expel ammonia in clients with cirrhosis who have hepatic encephalopathy. Elevated ammonia levels cause mental confusion. ex 1 hypoK+ d/t hyperAldosteronism; diuretic # treat HPT & cirrhosis 3 lactulose # laxative. In cirrhosis, constipation (which allows more ammonia to be absorbed) and hard stool (which irritates hemorrhoids) are to be avoided. However, the main purpose of lactulose is expelling the ammonia, with resulting benefits. 4 cirrhosis # diuretic & paracentesis @ reduced abdominal distension

Cholecystitis The nurse is caring for a client with cholelithiasis and acute cholecystitis. The client suddenly vomits 250 mL of greenish-yellow emesis and reports severe right upper quadrant pain with radiation to the right shoulder. Which intervention would have the highest priority? 1 administer promethazine suppository # antiemetic 2 initiate NPO status 3 insert nasogastric tube set to low suction # provides gastric decompression, alleviates N/V & promote bowel rest 4 obtain Rx pain meds

2 NPO ex Additional interventions include management of nausea/vomiting, pain, and fluid and electrolyte balance; and gastric decompression. ++ nonpharma. intervention pain eg positioning

an adequate diet to promote tissues healings, the correct vits need to increase 1 a & d 2 a& c 3 b6 & d

2 a& c ex a&d fracture

which dietary modification provides an Athlete with maximum endurance during a marathon run? 1 high fat 2 high carbohydrates 3 increase consumption all nutrients 4 high protein

2 cho

1 diverticulitis chronic constipation 1 diverticulum @ outpouching in the large intestine leading to chronic constipation common in the left descending, sigmoid colon ​

2 diverticuliterm-35tis # inflam. diverticula with SS 21 acute pain left lower quadrant abdomen 22 systemic Signs infection eg. fever, tachyHR, nausea, leukocytosis 23 abscess formation eg. palpable mass, cont. fever despite antibiotic 24 bleeding # large amount of bright red blood stool @ anemia 25 ++ FATAL report immediately if peritonitis # progressive pain in other abdominal quadrants, rigidity, guarding, rebound tenderness

CF A child with cystic fibrosis is to receive a dose of pancrelipase at 12:00 PM. The client states that he is not hungry and will eat his lunch in an hour. Which action is appropriate for the nurse to take? 1 administer the Rx pancrelipase 2 hold the pancrelipase until the cl eats 3 notify MD 4 skip this dose of the pancrelipase

2 hold until eat ex Pancrelipase is a medication containing lipase, protease, and amylase. In cystic fibrosis, the client's pancreas does not excrete these necessary enzymes. To prevent malabsorption syndrome, the enzymes must be taken with every snack and every meal. # hold until eat

1 anemia 1 risk factor hemorrhage, reduce hemoglobin produce d/t lack B12, decrease immune fx, kidney dis, iron

2 intervention iron intake 21 iron take with juice vit C & on empty stomach 22 CSE constipation

1 pancreatitis 1 acute pancreatitis are at risk for pancreatic abscess R/T severe infection or necrosis eg, high fever, increasing abdominal pain, and leukocytosis may indicate abscess formation # emergency surgical management

2 other SS 21 in.blood glucose # insulin 22 severe burning mid epigastric abdominal pain # relieve pain by positioning in knee-chest position to decrease intra-abdominal pressure 3 steatorrhea eg, fatty, yellow, foul-smelling stools d/t a decrease in lipase production # fluid & nutrition

treatment 1 non-surgery by using hydrostatic/ saline or pneumatic/ air enema +++ if the passage of normal brown stool # successful reduction of intussusception => SO report MD to stop all plans for surgery & modify the plan of care

2 otherwise, surgery required

which resources is the mist appropriate in assisting the consumer to better follow a sodium restrictions diet? 1 handbook from local pharmacist 2 packet label 3 butcher form grocery store 4 website nutrition

2 packet label

1 TPN complication intervention 1 report RN ​

2 reducing the amount of carbohydrate in the TPN solution 3 slowing down the infusion rate 4 administering subcutaneous insulin

1 PUD peptic ulcer disease Discharge instructions 1 Lifestyle modifications 11 Avoid spicy foods, acidic foods, black pepper. 12 Avoid substances that may stimulate acid secretion & delay healing eg, NSAIDs, alcohol, caffeine, chocolate, tobacco SMOKE 13 Reduce stress & obtain sufficient rest.

2 report Complications 22 Gastrointestinal bleeding: Orthostatic hypotension = lightheadedness, dizziness; tachycardia & melena/black stools 23 Perforation: Increased epigastric pain, nausea, vomiting & fever Medications 24 full course triple drug therapy if H. Pylori = amoxicillin, clarithromycin, and omeprazole for 7 -14 days

1 TPN total parenteral nutrition 1 highest complication 11 hyperglycemia SS excessive thirst, increased urination, abdominal pain, headache, fatigue, and blurred vision 12 venous thrombosis

2 risk factor 21 Excessive dextrose infusion 22 Increased production of counterregulatory hormones in response to acute illness 23 High infusion rate 24 Administration of medications such as corticosteroids 25 infection

1 esophageal cancer VS gastric cancer 1 risk factor for esophageal cancer incl. alcohol, smoke, N nitroso foods, hx esophageal dis eg. achalasia, injury, GERD, Barrett esophagus; Obesity

2 risk factor for gastric cancer incl. salty food; nitrosamine food eg. picked food, beer; thermal injury eg. extremely hot beverages; deficient intake of fruits & vegetables

allergy Celiac An adult diagnosed with celiac disease 3 weeks ago was placed on a gluten-free diet. The client returns for ambulatory care follow-up reports continuation of symptoms and does not seem to be responding to therapy. Which is the best response by the nurse? 1 It should take about 6-8 week bf symptoms improve 2 tell me what you had to eat yesterday 3 we will refer you to the dietition 4 you must not be following your diet ​

2 tell me what you had to eat yesterday

constipation The nurse is reinforcing teaching on behavioral strategies to treat fecal incontinence due to functional constipation to the parent of a 6-year-old. Which statement by the parent indicates a need for further teaching? 1 I will give my child a picture book to look at during toilet time 2 I give my child a reward for each bowel movement made while sitting on the toilet 3 I will keep a log of my child's bowel movement, laxative use, & episodes of soiling 4 I will schedule regular toilet sitting time for my child

2 wrong

PPI A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse? 1 take this in the morning 1h bf breakfast 2 take this with your other stomach meds 3 take your heart meds 2h af sucralfate 4 you might experience constipation while taking this

2 wrong ex Sucralfate should be taken on an empty stomach with a glass of water because it forms a better protective layer at a low pH level. Therefore, acid-reducing agents (eg, antacids, proton pump inhibitors, H2 blockers) should be avoided within 30 minutes of taking sucralfate, and all other medications should be taken ≥1-2 hours before or after sucralfate.

diets diarrhea The clinic nurse supervises a graduate nurse who is reinforcing teaching about home management to the parents of a 2-year-old with acute diarrhea. The nurse would need to intervene when the graduate nurse reinforces which instruction? 1 do not give your child antidiarrheal meds 2 follow the bananas, rice, applesauce, & toast diet for the next few days 3 record the number of wet diapers & return to the clinic if you notice a decrease 4 use skin barrier cream eg, zinc oxide in the diaper area until diarrhea subsides

2 wrong ex When a child has acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods)

GERD The nurse is observing the parent feed a 3-month-old diagnosed with gastroesophageal reflux. Which action by the parent indicates that further teaching is necessary? 1 the parent does not push the infant to finish the bottle 2 the parent engages the infant in active play after the feeding 3 The parent interrupts the feeding to burp the infant 4 The parent support the infant upright during the feeding

2 wrong ex GERD risk of aspiration SO Infants with GERD should be offered small frequent feeds, burped frequently during the feeding, and kept in an upright position during and after the feeding; & not be rocked or agitated by active play BUT should be kept calm & upright at least 30m after feeding

1 meds Misoprostol # synthetic prostaglandin CSE # abdominal cramp, diarrhea 1.1 take with FOOD help decrease CSE 1.2 Rx antiacids # avoid Mg2+ eg, Gaviscon @ severe SE diarrhea, dehydration

21 prevent gastric ulcer during SE of NSAID therapy 22 used for labor induction +++ mismarried SSE # rule out pregnancy & using reliable birth control

1 Liver cirrhosis discomfort of SOB intervention 21 positioned in the semi-Fowler or Fowler position to promote comfort and lung expansion. ​

22 distraction to promote comfort eg, music, TV, games, hobbies 23 paracentesis

appendicitis The nurse monitoring a client with appendicitis will expect the client to give which description of the associated abdominal pain? 1 a burning sensation, in the upper abdomen 2 an 8/10 on the left side below the belly button 3 excruciating in the lower abdomen above the right hip 4 intermittent in the abdomen & right shoulder

3

1 diets The nurse is reviewing a nutritional plan for a 6-month-old who has recently been started on solid foods. Which of the following recommendations has the highest priority in the plan? 1 canned baby food is more expensive than food prepared at home 2 finger foods can be introduced before the child has teeth 3 new food should be introduced at least 5-7 days apart 4 rice cereal can be mixed with cow's mild to increase nutrional intake ​

3 ex Solid foods are introduced at age 4-6 months, beginning with iron-fortified cereal and progressing to soft fruits and vegetables. 5 to 7 days should elapse before a new food is introduced to observe for allergies. Simple finger foods may be introduced at age 6-9 months. Cow's milk should not be introduced until after age 1 year.

anemia The clinic nurse is caring for several clients during well-child visits. The nurse should recognize which client as being the most at risk for anemia? 1 one-month-old infant born at term gestation who exclusively breastfeeds 2 two month infant born at preterm gestation who exclusively receives iron-fortified formula 3 three-month-old infant born at preterm gestation who is exclusively bottle-fed with breastmilk 4 six-month-old infant born at term gestation who breastfeeds & eats iron-fortified infant cereal

3 ex During gestation, the amount of iron a fetus stores is dependent on the length of gestation. Infants born at preterm gestation have lower iron stores at birth and are at an increased risk for iron-deficiency anemia. Iron supplementation (eg, oral iron drops, iron-fortified formula) is usually needed by preterm infants at an earlier age (2-3 months).

allergy Celiac The nurse is reinforcing meal planning teaching to a group of clients with celiac disease. Which meal is appropriate for the nurse to include? 1 bake salmon with rice, steamed vegetables, and dinner roll 2 breaded pork chops, corn on the cob, & steamed snow peas 3 grilled chicken, green beans, & mashed potatoes 4 spaghetti with Italian tomato sauce & meatballs

3 ex celiac disease # gluten free to prevent damage of intestinal villi 1 dinner roll # wheat gluten 2 marinated & breaded # gluten e.g wheat 4 pasta # wheat @ gluten

what responds about iodine is essential to heath because it 1 strengthens bone and teeth 2 blood clotting 3 cell to grow 4 allow oxygen travel safely to cells

3 ex 1 ca2+ and phosphorus 2 ca2+ and k 4 iron for hemoglobin

a pt who is receiving chemotherapy is concerned because she is unable to eat well because of stomatitis. which intervention should the nurse recommend? 1 eat as much as possible when able 2 drink as much fluid as possible along with food at meals 3 small, frequent meals consisting of food at room temperature 4 eat protein rich food when able

3 ​

PPI A client has been on long-term therapy with esomeprazole. What is essential for the nurse to ask the client? 1 are u drinking plenty of water with med> 2 are u taking the med after meals 3 have you had a bone density test recently? 4 have you had your BP taken regularity

3 # Long-term use of PPIs SSE osteoporosis, C difficile infection, and pneumonia. # increase calcium and vitamin D intake ex 2 extra water & upright for 30min af taking biphosphonates eg, risedronate; alendronate to prevent esphogitis 2 bf meals

1 anemia iron The nurse is reinforcing teaching to the parents of a 6-month-old child who has been given a new prescription for a liquid iron supplement. Which statements by the parents indicate a need for further teaching? SATA 1 our child might become constipated while taking this med 2 our child stools might become black & tarry 3 we can give the dose with milk to prevent gastric irritation 4 we will administer the dose into the back of our child's cheek 5 we will administer the dose with meals to increase absorption ​

3 & 5 wrong ex Liquid iron supplements are best absorbed on an empty stomach & with vitamin C Milk products and antacids should be avoided for 2 hours following oral iron administration. Iron may be given with meals to reduce gastric irritation; however, this will decrease absorption.

SATA ulcerative colitis The nurse is caring for a client diagnosed with ulcerative colitis and prescribed sulfasalazine. Which instructions should be reinforced at discharge? 1 avoid small, frequent meals 2 consume a cup of coffee with each meal if desired 3 continue meds even after resolution of symptoms 4 eat a low residue, high protein, high calorie diet 5 increase fluid intake to at least 2000mL/day

3 4 5 ex Dietary management of ulcerative colitis includes eating small, frequent meals; following a low-residue, high-protein, high-calorie diet; taking supplemental vitamins and minerals; avoiding caffeine, alcohol, and tobacco; and drinking at least 2000-3000 mL/day of fluid. Continued use of sulfasalazine prevents relapse and prolongs symptom remission.

SATA Cholecystitis When monitoring a client with cholelithiasis and acute cholecystitis, which findings might the nurse note during the health history and physical examination? 1 flank pain radiating to the groin 2 ingestion of high protein food bf onset of pain 3 low-grade fever with chills 4 pain at the umbilicus 5 right upper quadrant pain radiating to the right shoulder

3 5 ex 1 # renal colic @ ureteral stones 2 high fat intake eg. cheese, avocado, fried foods, hamburger 4 # acute appendicitis

1 colonoscopy 1 to evaluate the mucosa of the colon 2 prePRO the day before the test. 21 clear liquid 22 take bowel cleansing eg. cathartic, enema, polyethylene glycol GoLYTELY ​

3 NPO 8-12h prior to the exam. ++ avoiding smoking the day of the examination

1 ESLD hepatic encephalopathy 1 is a serious complication of ESLD end-stage liver disease caused by high levels of ammonia in the blood. 2 SS confusion, slurred speech, lethargy, and asterixis/ hand tremor when arm extension; coma and death if untreated.

3 Pharmacologic treatments include lactulose and antibiotics eg, rifaximin ++note The client with worsening encephalopathy is not stable enough for discharge.

1 IBS meds Dicyclomine hydrochloride Bentyl 1 anticholinergic antispamodic meds. 2 relax smooth muscle and dry secretions. ​

3 SE pupillary dilation, dry mouth, urinary retention, and constipation. +++ Therefore, the classic contraindications are closed-angle glaucoma, bowel ileus, and urinary retention.

1 meds Metoclopramide REGLAN 1 antiemetic, GERD, delayed gastric emptying 2 CSE sedation, fatigue, restlessness, headache, sleeplessness, dry mouth, constipation, and diarrhea

3 SSE extrapyramidal adverse effects, including tardive dyskinesia TD # uncontrollable movements such as: 31 Protruding and twisting of the tongue 32 Lip smacking 33 Puffing of cheeks 34 Chewing movements 35 Frowning or blinking of eyes 36 Twisting fingers 37 Twisted or rotated neck torticollis +++ antipsychotic meds SSE extrapyramidal

1 Dumping syndrome # gastric contents dump too rapidly into the small intestine, causing a fluid shift into the small intestine 1 is a complication of gastrectomy or wrong diet postOR bariatric surgery e.g CHO intake 2 SS hypotension, abdominal pain @ cramp, N/V, diarrhea, sweating, tachycardia

3 To delay gastric emptying and reduce the risk of dumping syndrome, clients should 31 consume meals low in carbohydrates and high in fiber, proteins, and fats 32 avoid fluids during meals 34 eat small, frequent meals; 35 lie down after eating.

1 Paracentesis 1 remove fluid from abdomen eg. improve SOB or pain d/t ascites 2 request empty bladder @ void prior to procedure to prevent puncturing the bladder ++ NOT required NPO ​

3 VS, abdominal girth, weight bf & af 4 high Fowler position during procedure 5 monitor dressing at puncture site for bleeding

1 diets infant 1 Cow's milk should not be introduced until after age 1 year 2 age 4-6 months # introduce solid food beginning with iron-fortified cereal and progressing to soft fruits and vegetables. 5 to 7 days should elapse before a new food is introduced to observe for allergies.

3 age 6-9 months pureed fruit & veg; Simple finger foods eg, teething crackers, small pieces of fruit, soft vegs or cheese

1 Colostomy # surgical opening @ stoma in the colon 1 The stool changes from liquid to more solid as it passes through the colon. 2 normal stoma

3 colostomy care

diet PostOR Which group of food selections would be the best choice for a client advancing to a full liquid diet 3 days after bariatric surgery? 1 apple juice, mashed potatoes, chocolate pudding 2 chicken broth, low-fat cheese omelet, strawberry ice cream 3 Creamy wheat cereal, blended cream of chicken soup, protein shake 4 low-fat vanilla yogurt, smooth peanut butter, vegetable juice

3 cream soup, refined cook cereal, suger free dirnk, low sugar protein shakes, dairy food ex fruit juices, yogurt, ice cream & pudding # high sugar @ not for bariatric full liquid diet

toxic infant botulism The clinic nurse is interviewing the parents of a 6-month-old client about the infant's diet. Which statement by the parents is most concerning? 1 because apples are healthy, we make apple pie & feed small, soft bites to our baby # excessive fat & sugar 2 if our baby refuses to finish foods, we continue to offer small bites, so food isn't wasted # risk obesity 3 infant oatmeal sweetened with fresh honey is our baby's favorite breakfast. 4 we found that the food in TV dinners can be easily pureed & is convenient. # high sodium # sugar

3 honey # toxic botulism EX Clostridium botulinum spores in honey can colonize an infant's (age 12 months) immature gastrointestinal system and release a toxin that causes botulism eg. muscle paralysis # risk for resp. failure & death @ life-threatening illness.

1 colorectal cancer 1 risk factor age >50yo; hx of colon polyps; family hx; inflam. bowel dis. e.g Crohn dis, ulcerative colitis; hx of other cancer e.g gastric, ovarian 2 regular routine colorectal cancer screening test e.g occult blood annual; colonoscopy Q10years

3 may be painless or SS 31 Blood stool eg, positive occult blood, melena; from fragile, bleeding polyps or tumors 32 Abdominal discomfort and/or mass 33 Anemia due to intestinal bleeding, which may result in fatigue and dyspnea with exertion 34 Change in bowel habits eg, diarrhea, constipation due to obstruction by polyps or tumors 35 Unexplained weight loss due to impaired nutrition from altered intestinal absorption

1 Liver cirrhosis 1 is ascites, discomfort is often due to pressure of the fluid on the surrounding organs. 2 SOB occurs due to the upward pressure exerted by the abdominal ascites on the diaphragm, which restricts lung expansion.

3 pruritus' @ severe itching; risk for skin breakdown R/T build up bile salts beneath skin

diets lose weight A client with a 10-year history of major depressive disorder has relapsed and is now hospitalized. The client is currently on phenelzine and weighs 115 lb (52.2 kg) but weighed 150 lb (68 kg) 3 months before admission. Which foods would be best for this client? 1 crackers & cheddar cheese 2 hard boiled egg with tomatoes 3 steamed fish & potatoes 4 tortilla chips with avocado dip

3 severe unintentional lose weigh 35lbs/3months # need diet high in calories & protein ex phenelzine antidepressant MAOIs # prevent hypertensive crisis by avoiding food high tyramine eg. aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, avocados

toxic Lead blood lead level BLL >=5 mcg/dL 1 severe complication of the neurological system eg, developmental delays, permanent cognitive impairment, seizure, blindness, DEATH 2 severe complication of kidney

3 source lead-based paint in houses, toys, glaze pottery, pipes, dust, soil 4 more dangerous in young children # screen test at ages 1-2 or up to age 6 5 removed exposure, wet dusted or mop regular, cold water if directly from older pipes; handwashing; follow up MD; Chelation therapy

intussusception A 2-year-old in the emergency department is suspected of having intussusception. Which assessment finding should the nurse expect? 1 black, sticky stools 2 greasy, foul-smelling stools 3 Stool mixed with blood & mucus 4 thin, ribbon-like stools

3 stool mixed blood & mucus

1 ulcerative colitis Dietary management 1 eating small, frequent meals; 2 following a low-residue @ easily digested, high-protein, high-calorie diet; eg, enriched bread, rice, pasta, cooked vegetables, canned fruits, and tender meats NO raw fruits/ veg., whole grain, high seasoned food, fried food

3 taking supplemental vitamins and mineral 4 avoiding caffeine, alcohol, and tobacco 5 drinking at least 2000-3000 mL/day of fluid.

allergy Celiac Which of the following statements made by the mother of a child recently diagnosed with celiac disease indicates a need for further teaching? 1 I will need to read the label of all processed food 2 It is OK if my child eats rice, corn, & potatoes 3 My child can have small amounts of foods Containing Wheat as long as she remains symptom-free 4 My child will need to be on a gluten-free diet for the rest of her life

3 wrong ex gluten free for the rest of life; rice, corn, potatoes # gluten free supplement fat soluble vit; iron, folic acid

IBS The nurse is reinforcing education to a client with irritable bowel syndrome who is experiencing diarrhea. Which of these meals selected by the client indicates an understanding of diet management? 1 bean, yogurt, & fruit cup 2 beef, broccoli, & glass of wine 3 eggs, a bagel, & black coffee 4 steak, tomato basil soup, & corn bread

4

which statement by the LVN conveys the reason for caffeine restriction diet in pt with PUD? 1 caffeine hydrates body 2 caffeine increase gastric ulcer 3 caffeine neutralize stomach acidity 4 caffeine stimulates gastric acid secretion

4

Stoma The nurse caring for a client with an ileal conduit observes that the stoma appears bluish-gray. What is the nurse's best action? 1 administer antibacterial agent & assess for additional signs of infection 2 document the finding & continue to monitor for change 3 measure the stoma & obtain a larger pouching device 4 report the finding to MD immediately

4 ex 1 fever, in.WBC, odor, & delay healing # infection VS bluish gray color # impaired perfusion 3 size pouching sys > 0.1in of the stoma to prevent decreased perfusion & skin irritation; prevent urine backflow & reduces risk for infection during night time

diets A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m2 (95th percentile). The licensed practical nurse (LPN) is collaborating with the registered nurse (RN) to formulate a weight loss plan. Which is most important for the nurse to determine? 1 pattern of daily physical activity 2 family's eating habits 3 Family's financial 4 Famly's readiness for change

4 ex Before initiating a treatment program that requires a client and family to make major lifestyle and behavior changes, the nurse needs to assess readiness for change. Motivation and a desire for change are the keys to successful weight loss.

colostomy A newborn had a bowel resection with a temporary colostomy for Hirschsprung disease. The practical nurse should alert the supervising registered nurse about which postoperative finding? 1 moderate amount of blood-tinged mucus from the stoma on postOR day 2 small amount of non-formed stool in the colostomy bag on PostOR day 6 3 Stoma bleeds a small amount during colostomy bag change on postOR day 3 4 stoma is gray tinged at the edges but pink at the center on postOR day 5

4 ex The colostomy stoma should be beefy red in the immediate postoperative period. Any discoloration of the stoma could indicate decreased blood supply to the area; the nurse should notify the supervising registered nurse.

LVN is preparing to give an injection of vit b12 to. a nursing home resident to prevent the order : 1 scurvy 2 pellagra 3 marasmus 4 pernicious anemia

4 ex 1 vit C 2 niacin 3 marasmus @ starvation

1 diets During the client interview for a developmentally normal 18-month-old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention? 1 check the child for parasitic infection 2 consult a pediatric nutritionist for suspected eating disorder 3 notify MD 4 Reinforce teaching about the toddler's nutritional needs

4 ex 1 & 2 parasitic infection # malnutrition eg, failure to thrive BUT there is no indication that the child is suffering from any malnutrition 3 evaluation of a toddler's nutrition status is a routine assessment & within the nurse scope of practice

EA & TEF A nurse discovers a cyanotic newborn with excessive frothy mucus in the mouth. What should be the nurse's first action? 1 administer 100% oxygen 2 Auscultate lung 3 place infant in the knee-chest position 4 suction

4 ex Option 1) Oxygen cannot be delivered to the lungs if secretions obstruct the airway. Therefore, suctioning is a priority. (Option 2) This infant is aspirating and in immediate distress, which should be addressed without delay. After suctioning the excess saliva and ensuring a clear airway, the nurse may perform further assessments. (Option 3) This infant's cyanosis is a result of aspirating secretions and does not indicate a circulatory problem. The knee-chest position is appropriate to increase pulmonary blood flow in infants with a cyanotic heart defect (eg, tetralogy of Fallot).

meds The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction? 1 I can take this med with food if it hurts my stomach 2 I must use a reliable form of birth control while taking this med 3 I should continue to take my ibuprofen as Rx 4 I will take this med with an antacid to decrease stomach upset

4 # only antacid without Mg+ & misoprostol ex Misoprostol prevents gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug therapy. It should not be taken with antacids but can be taken with food to reduce gastrointestinal upset. Women of childbearing age should be educated on using reliable birth control methods as misoprostol can induce labor.

meds Metoclopramide The nurse is preparing to administer a scheduled dose of metoclopramide IV to a client with diabetic gastroparesis. Which clinical finding causes the nurse to question the prescription? 1 diarrhea 2 frequent burping 3 headache 4 sucking lip motion

4 # tardive dyskinesia TD eg uncontrollable lip smacking, hand wringing, rocking ex 1 & 3 CSE

1 diets The nurse is reinforcing teaching to parents about childhood nutrition and feeding practices. The nurse recognizes that which snack is best for a toddler? 1 half cup orange juice 2 dry. sweetened cereal 3 raw carrot stick 4 slice of cheese

4 # todder 1-3yo foods # safety prevent chocking; nutrient density eg. protein, vits; precaution for foodborne eg, partially cooked eggs; raw fish; raw bean sprouts ex 1 large of sugar & lacks fiber 2 high sugar & low nutrients 3 choking risk ​

1 Liver cirrhosis PRURITUS & skincare 1 short nail; wear long-sleeved cotton shirts & cotton gloves. 2 Baking soda baths, calamine lotion, and cool, wet cloths also help. 3 Meticulous skin care interventions eg, specialty mattress, turning schedule are important to prevent tissue breakdown.

4 Meds Cholestyramine Questran powder 41 increases the excretion of bile salts through feces, thereby decreasing itching. 42 mixed with juice or food eg. applesauce & should give 1h af other meds

1 GERD intervention 1 weight loss to prevent gastric pressure form abdominal fat 2 small, frequent meals with sips of fluid 3 avoid triggers alcohol, café, chocolate, nicotine @ smoke, high fat food, spice food, peppermint, carbonated beverage

4 chewing gum to promote salivation @ help neutralize & clear acid 5 sleep with the head of bed elevated 6 retrain from eating at bedtime & lying down immediately after eating

VitB12 The nurse monitors a client who has followed a vegan diet for several years. Which client statement would indicate a possible complication resulting from a vegan diet? 1 "I have had some visual disturbance while driving at night." 2 " I have had trouble failing asleep over the past few month." 3 " Scaly patches of skin are developing on my elbows & knees." 4 " Sometimes my hands & feet get a tingling sensation."

4 d/t deficiency vit B12 #anemia & neurological manifestation R/T vegan diet

The nurse is monitoring a client who had an esophagogastroduodenoscopy 2 hours ago. Which finding requires an immediate report to the registered nurse? 1 BP drop from 122/88 to 106/72 mmHg 2 Gag reflex has not returned 3 sore throat when swallowing 4 temp. spike to 101.2F / 38.4 C

4 fever # infection or perforation ex 1 BP drop without other symptoms indicate emergency condition eg. sedation, blood loss, sepsis => still normal 2) The gag reflex may take a few hours to return as the EGD involves applying a topical anesthetic to the throat. Absent gag reflex after a prolonged period (6 hours) would require reporting to the health care provider. 3) A sore throat is expected after certain procedures EGD or intubation due to local irritation. Warm saline gargles could provide some relief

pancreatitis The nurse is caring for a client admitted to the hospital 2 days ago with acute pancreatitis. Which finding is the most concerning? 1 Blood glucose >=250mg/dL for past 24h 2 cl is lying with knees drawn up to the abdomen to alleviated pain 3 five large, liquid stools are yellow & foul smelling 4 Temp. 102.2F/ 39C & abdominal pain is increasing

4 fever @ infection # require emergency surgery if develop pancreatic abscess

1 vegan diet # risk for nutrient deficiencies 1 protein 2 calories 3 Ca2+ # dairy, eggs, fish # take with vit D

4 iron # take with Vit C 5 vit B12

1 meds Sucralfate # agent coast GI mucosa formation 1 take on an empty stomach # 1h bf meals & at HS with a glass of water because it forms a better protective layer at a low pH level 2 .Therefore, acid-reducing agents (eg, antacids, proton pump inhibitors, H2 blockers) should be avoided within 30 minutes of taking sucralfate 3 and all other medications should be taken ≥1-2 hours before or after sucralfate. eg, digoxin, warfarin, phenytoin

4 to treat and prevent both stomach and duodenal ulcers 5 CSE constipation

1 Colostomy irrigation Rx +++ NOT use EDEMA 1 use 500-1000 mL of lukewarm water 2 sit on the toilet, & hang the bag 18-24 inches above the stoma 3 lubricate the cone tipped irrigator, attached to stoma & hold in place ​

4 use the cone-tipped irrigator to slowly infuse 5-10min the solution, and allow stool to drain through the sleeve and into the toilet. ++ clamps the tubing when cramping occurs

hiatal hernia The nurse is reinforcing teaching to a client with a hiatal hernia. Which statement by the client indicates that further teaching is needed? 1 " I need to raise the head of my bed on blocks by at least 6in." 2 " I will remain sitting up for several hours after I eat any food." 3 " If my reflux & abdominal pain don't improve, I might need surgery." 4 " Losing weight may reduce my reflux, so I plan to take a weight-lifting class."

4 wrong ex avoid activities that increase abdominal pressure eg, weight lifting sleep with the head of the bed elevated remain upright for several hours after meals.

1 Colostomy care 1 ensuring sufficient fluid intake 2 eliminate food that gas and odor eg, broccoli, cauliflower, dried beans, brussels sprouts 3 and changing the pouching system when it becomes one-third full to prevent leaks. 4 irrigation by Rx

5 Careful assessment of clients with new ostomies should include 51 the stoma site eg, perfusion, approximation to the skin 52 gastrointestinal function (eg, bowel sounds, flatus, stool 53 self-care and body image. 54 Appliances must be properly fitted to prevent skin breakdown eg, excoriation

1 allergy Celiac dis. autoimmune dis. # gluten free to prevent damage the small intestine or instinal cancer @ lymphoma

Celiac intervention 1 eliminated gluten food incl. wheat e.g bread, barley, rye, oat, process food e.g marinated, chocolate, hot dogs, starch, malt, soy sauce 2 gluten-free all the rest of life incl. rice, corn, potatoes, meat, fish 3 gluten-free label reading

1 CF cystic fibrosis # excessive secretion, thicker, ^ sticker exocrine gland 1 block airway 2 block GI track eg, pancreatic ducts # deficient enzyme, abnormal digestion & absorption

Clients require multiple vitamin supplements and supplemental pancreatic enzymes that are administered with meals. To meet the growth needs of clients with CF, a diet high in calories, fat, and protein is required.

1 diets lose weight severe as unintentionally lose weight # diet high in calories & protein eg, 1 Whole milk and dairy products (eg, milkshakes), fruit smoothies 2 Granola, muffins, biscuits 3 Potatoes with sour cream and butter 4 Meat, fish, eggs, dried beans, almond butter 5 Pasta/rice dishes with cream sauce

Clients with major depressive disorder are likely to have a significant change in weight (either increased or decreased). Interventions to promote adequate nutritional intake include providing small frequent meals and snacks that are dense in protein and calories. In addition, drug-food interactions need to be considered when choosing foods for a client taking a monoamine oxidase inhibitor.

1 Anticholinergic effects Sites of action Effects # Adverse effects 1 Cardiovascular ↑ Heart rate # Tachycardia 2 Respiratory Dilates airways & ↓ Secretions # Dry, thick bronchial secretions, & Bronchial plugging 3 Gastrointestinal ↓ Salivation, ↓ Peristalsis, ↓ Gastric secretions # Dry mouth, Constipation 4 Urinary Contracts bladder detrusor & Inhibits bladder contractions # Urinary retention 5 Ocular Dilates pupils & Paralyzes ciliary muscle # ↑ Ocular pressure, Blurred vision, Photophobia 6 Glandular ↓ Sweating # Anhidrosis suppression of sweating ​

Indications: 1 Bradycardia atropine 11 Eye examinations atropine 2 Chronic obstructive pulmonary disease ipratropium, tiotropium 3 Motion sickness scopolamine 4 Perioperative scopolamine, glycopyrrolate 5 Irritable bowel syndrome dicyclomine 6 Overactive bladder oxybutynin, tolterodine 7 Hyperhidrosis glycopyrrolate, oxybutynin 8 antiemetic Metoclopramide 9 antihistamine

1 IBS irritable bowel syndrome 1 diagnosis# Recurrent abdominal pain/discomfort ≥3 days a month for last 3 months & ≥2 of the following: 11 Improvement with bowel movement 12 Change in frequency of stool 13 Change in form of stool

Irritable bowel syndrome is a chronic bowel condition characterized by altered intestinal motility, causing abdominal discomfort with diarrhea and/or constipation.

1 Vit B12 cobalamin water-soluble 1 source # animal protein eg. meat, fish, and dairy products @ not in plant 2 deficiency B12 21 anemia @ fx of RBC formation 22 affects the entire nervous sys. from peripheral nerves to the spinal cord & brain

Peripheral neuropathy manifests as tingling and numbness. Spinal cord involvement can cause gait problems. Brain involvement causes memory loss/dementia (late).

1 diets obesity meds Orlistat 1 Orlistat, a lipase inhibitor, prevents the absorption of fat from the gastrointestinal tract 2 and is used with diet eg, low-fat 3 and exercise to promote weight loss. 4 take with or within 1h of meals that contain fat. If the food that do not contain fat; the meds may be skipped

SE 1 Because orlistat blocks the absorption of fats, it also interferes with the uptake of fat-soluble vitamins. Clients should take a daily multivitamin with vitamins A, D, E, and K > 2 hours after taking orlistat to prevent nutrient deficiencies. 2 Clients may experience fecal incontinence, flatulence, oily stools, and oily spotting because unabsorbed fat is eliminated through defecation.

1 meds PPI proton pump inhibitor H+ eg, omeprazole, pantoprazole, esomeprazole, lansoprazole 1 antacid before a meal 2 treat GERD, stress ulcer postOR

SSE 1 hypoCa2+# risk for osteoporosis 2 PPI suppression of acid # risk for pneumonias d/t Clostridium difficile # diarrhea

1 Vitamin fat soluble vit A vit D

Vit E Vit K

1 bowel obstruction

a blockage in the intestine # abdominal cramp pain

1 congenital Hirschsprung disease or congenital aganglionic megacolon, a child is born with a lack of specialized nerve cells in some sections of the distal large intestine; this renders the internal anal sphincter unable to relax. As a result, there is no peristalsis & stool is not passed. Newborns exhibit symptoms of distal intestinal obstruction eg, distended abdomen, difficulty feeding, vomiting green bile and do not pass meconium within the expected 24-48 hours. ​

a portion of the colon has no innervation and must be removed. Some children require a temporary colostomy. The stoma created from the surgery should remain beefy red in the immediate postoperative period. Any paleness or graying of the stoma indicates decreased blood supply to that area

1 Stoma care 1 normal pink to brick red & moist 2 appropriate size pouch 0.1 in/ 0.25cm lager than stoma to prevent decreased perfusion, skin irritation, & infection 3 irrigation

abnormal 31 infection # fever, inc.WBC, odor, delayed healing 32 impaired perfusion # bluish gray color @ emergency, report MD immediately

1 Vitamin water soluble Vit C Vit B #Tina requests Niacin Papa pick boyfriend's call 1 B1,2 & 3 # stress, sleep & student 2 B5 # hormone 3 B6 # circulation 4 B7 # skin, nail, hair 5 B9 & B12 # fertility; pregnancy; fetus develop; prevent anemia # RBC

b1 Thiamine b2 Riboflavin b3 Niacin b5 Pantothenic acid b6 pyridoxine b7 biotin b9 Folate b12 cobalamin # Animal sources or supp eg, multivitamins or fortified grains

glaucoma # eye HPT

cataract # clouding of the lens

1 ulcerative colitis 1 chronic inflammation and ulcerations in the large intestines, resulting in bloody diarrhea and decreased nutrient absorption

intervention 1 diet management 2 med Continued use of sulfasalazine prevents relapse and prolongs symptom remission. Because sulfasalazine hinders the absorption of folate, folic acid supplements are encouraged

1 EA Esophageal atresia & TEF tracheoesophageal fistula 1 consist of a variety of congenital malformations that occur when the esophagus and trachea do not properly separate or develop 2 frothy saliva, coughing, choking, drooling, and a distended abdomen @ risk for aspiration SS apnea & cyanosis while feeding

intervention 1 if SS of aspiration # immediately NPO 2 report MD 3 surgery corrected ++ The initial nursing action for a client experiencing cyanosis and excess oral secretions is suctioning the mouth (ie, oropharynx) to clear the airway (Option 4). Excessive frothy mucus and cyanosis in a newborn could be due to EA& TEF. If EA/TEF is suspected, the infant should be kept supine with the head elevated at least 30 degrees to prevent aspiration. A nasogastric tube should be inserted and connected to continuous or intermittent suction until surgical repair.

1 constipation 1 risk factors incl. disease processes 11 Parkinson disease, diabetic neuropathy, depression, IBS; diverticulitis, Fecal incontinence 12 procedures eg, abdominal surgery, bowel manipulation; 13 medications eg, anticholinergics, diuretics, opioids. 14 Immobility, low-fiber diets, decreased fluid intake, and irregular bowel habits increase the likelihood of constipation.

intervention 1 increase daily fiber intake 2 drink 2-3 L of fluids daily 3 increase daily activity levels 4 initiate a bowel regimen eg, avoiding delay of defecation, defecating at the same time each day.

1 hiatal hernia 1 asymptomatic or SS heartburn, chest pain, dysphagia, SOB due to increased abdominal pressure 2 risk factor obesity

intervention Hiatal hernia is characterized by abnormal movement of the stomach and/or esophagogastric junction into the chest due to diaphragmatic weakness. Nurses educating clients with hiatal hernias about symptom management should instruct them to avoid activities that increase abdominal pressure (eg, weight lifting), sleep with the head of the bed elevated, and remain upright for several hours after meals.

1 diets lose weight 1 3,500 kcal = 1 lb 2 avoid high of sugar & high calories 3 precaution unexplain OR unintentional weight chage eg. depressive

refer use low or no calories eg. water; club soda; unsweetened tea or coffee; fresh veg. juice; nonfat or low fate milk

1 gFOBT Guaiac fecal occult blood test +++ avoid red meat, vit C or Rx hold meds eg. aspirin, anticoagulants, iron, ibuprofen, & corticosteroids

steps 1 obtain supplies, wash hand, & apply non-sterile gloves 2 open the side flap & use the wooden applicator to apply 2 separate stool samples to the boxes on the side. Close & let dry 3-5min 3 open the back of the side & apply 2 drops of developing solution to the boxes on the sides 5 wait 30-60 sec & reading result eg. positive if test paper turn blue