GI AQ

A client is admitted with a diagnosis of gastric ulcer. Which location is most commonly indicated by the client as being painful when the nurse assesses for the presence of pain? 1. A 2. B 3. C 4. D

2. Site B is associated most commonly with pain of a gastric ulcer. Site A is associated most commonly with problems with the heart. Site C is associated with duodenal ulcers. Site D is associated most commonly with problems that cause pain in the small intestines.

A client progresses to a regular diet after a gastrectomy for gastric cancer. After eating lunch the client becomes diaphoretic and has palpitations. What probable cause of this response does the nurse recognize? 1. Intolerance to fatty foods 2. Dehiscence of the surgical incision 3. Extracellular fluid shift into the bowel 4. Diminished peristalsis in the small intestine

3. Hypertonic food increases osmotic pressure and pulls fluid from the intravascular compartment into the intestine (dumping syndrome). Increased carbohydrates, not fats, are responsible for the increased osmotic pressure often associated with the dumping syndrome. Dehiscence of the surgical incision is separation of the wound edges, usually accompanied by a gush of pink-tinged fluid; it is unrelated to dumping syndrome. Although peristalsis may be decreased because of surgery, it does not account for the adaptations.

A client is admitted to the hospital for the implantation of radon seeds in the oral cavity. Which intervention is most important when the nurse is caring for this client after the procedure? 1. Providing a regular diet within two days 2. Administering nursing care in a short period 3. Giving frequent mouth care at least four times daily 4. Having a member of the family stay with the client continually

2. Nursing care should be organized and administered efficiently so that the nurse's exposure to radiation is kept to a minimum. A regular diet is contraindicated until the radon seeds are removed because chewing can dislodge the seeds. Frequent mouth care is contraindicated because it can dislodge the seeds; drying of the mucous membranes cannot be prevented. A family member should not be in attendance continually because this will expose the family member to excessive radiation.

A client is evaluated at a clinic, and the healthcare provider suspects that the client has anemia and a peptic ulcer. To determine if the client has a peptic ulcer, the nurse expects that what diagnostic test will be performed? 1. Barium enema 2. Gastric biopsy 3. Gastric culture 4. Stool examination

3. A gastric culture enables the healthcare provider to identify the presence of Helicobacter pylori. Two thirds of individuals with gastric or duodenal ulcers are infected with this organism. A barium enema outlines structural changes in the lower gastrointestinal tract; it will not outline the stomach or duodenum. A gastric biopsy is done to identify the presence of malignant cells. A stool examination may identify melena or parasites, but it is not definitive for peptic ulcers. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.

A client is recently diagnosed with an oral cancerous lesion. Which question should the nurse ask when assessing the client's need for instruction in relation to this condition? 1. "Are you having difficulty sleeping?" 2. "Do feel like your gums are inflamed?" 3. "How frequently are you seeing the dentist?" 4. "Have you noticed any change in your appetite?"

4. Problems involving the oral cavity often result in nutritional problems and weight loss needing nursing intervention. The question, "Have you noticed any change in your appetite?" will elicit more information. The nurse needs to determine a client's past and current appetite and nutritional status. Difficulty sleeping is not usually a characteristic symptom of cancer of the oral cavity although it may occur after the diagnosis due to anxiety. Gum infections are not typically an early problem after an oral cancer diagnosis. Although a dentist may be the first to identify oral cancer, medical treatment is needed. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

A client has a tentative diagnosis of primary biliary cirrhosis. What skin change does the nurse expect to observe when performing a physical assessment? 1. Vitiligo 2. Hirsutism 3. Melanomas 4. Telangiectasia

4. Telangiectasia is a vascular lesion associated with cirrhosis; it is thought to be related to increased estrogen levels. Vitiligo refers to patches of depigmentation resulting from destruction of melanocytes. Hirsutism is excessive growth of hair; with cirrhosis, endocrine disturbances result in loss of axillary and pubic hair. Melanomas refer to cancerous skin lesions; they are not associated with biliary cirrhosis. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety."

The nurse has provided postoperative teaching to a client who is scheduled for a bilateral herniorrhaphy. Which client statement indicates correct understanding of the teaching? 1. "I will have a nasogastric tube in place." 2. "I should cough and deep breathe regularly." 3. "I will need to be on bed rest for several days." 4. "I will have a portable wound drainage system in place."

2. After general anesthesia, coughing and breathing deeply expand alveoli and prevent atelectasis. A nasogastric tube is not necessary; the abdomen is not entered, and there should be no interference with peristalsis. Clients can ambulate after recovery from anesthesia. A portable wound drainage system is not necessary.

The nurse is caring for a client scheduled to have a percutaneous liver biopsy. Which assessment findings warrant the postponement of the procedure? Select all that apply. 1. Hemosiderosis 2. Marked ascites 3. Hepatic cirrhosis 4. Hemoglobin of less than 9 g/dL (90 mmol/L) 5. Platelet count of 150,000/mm3(150 × 109/L)

2, 4 To do a liver biopsy when a client has marked ascites increases the risk of leakage of ascitic fluid. The liver biopsy should be postponed. A client with a hemoglobin of less than 9 g/dL (90 mmol/L) should not have a liver biopsy because the client cannot take the risk of the puncture of a hepatic blood vessel. Hemosiderosis is not a reason to postpone a liver biopsy, because it is done to detect the presence of hemosiderin. A diagnosis of hepatic cirrhosis is not a reason to postpone a liver biopsy, because it is done to detect the presence of hepatic cirrhosis. Although a platelet count of 150,000/mm3 (150 × 109/L) is within the low range of the expected platelet count for an adult, a liver biopsy is not contraindicated. A count of less than 50,000/mm3 (50 × 109/L) is critical and requires postponement of the test.

A client has cholelithiasis with possible obstruction of the common bile duct. The nurse performs a nutritional assessment. What is the primary goal for this assessment? 1. To determine if follows a high fatty diet 2. To determine if deficient in vitamins A, D, and K 3. To determine if eats adequate amounts of dietary fiber 4. To determine if consumes excessive amounts of protein

2. Bile promotes the absorption of the fat-soluble vitamins. An obstruction of the common bile duct limits the flow of bile to the duodenum and thus the absorption of these fat-soluble vitamins. Most clients have pain after eating a fatty meal and do not follow this diet, but this is expected in cholelithiasis and is not the primary goal. Dietary fiber is not relevant to the situation. Although adequate dietary protein is desirable for wound healing, it is unrelated to cholelithiasis.

Which statement by an older adult most strongly supports the nurse's conclusion that the client is impacted with stool? 1. "I have a lot of gas pains." 2. "I don't have much of an appetite." 3. "I feel like I have to go, but I just seep." 4. "I haven't had a bowel movement for several days."

3. A client with a fecal impaction has the urge to defecate but is unable to do so, and liquid stool seeps around the impaction. Flatulence may occur as a result of immobility, not just obstruction. Anorexia may occur with an impaction but also may be caused by other conditions. The frequency of bowel movements varies for individuals; it may be normal for this individual not to have a bowel movement for several days.

When inserting a catheter to irrigate a client's colostomy, the nurse meets some resistance. What should the nurse do? 1. Probe with the irrigating catheter to determine the contour of the bowel 2. Obtain a more rigid tip for the irrigating catheter to insert into the stoma 3. Apply pressure to the irrigating catheter to overcome the spasm of the bowel 4. Instill a small amount of solution from the irrigating container into the stoma

4.

A client is admitted with a diagnosis of cancer of the colon. What information about malignant tumors of the colon should the nurse consider when caring for this client? 1. They are detected easily. 2. They usually are localized. 3. Women are more at risk than men. 4. Colon obstructions usually are malignant.

4. Mechanical obstruction most often is caused by obliteration of the lumen of the intestine by malignant cells. The most common cause of colon obstruction is colorectal cancer. In the early stages, symptoms of cancer of the colon are vague or absent. Localized tumors usually are benign. Cancer of the lower bowel is more common in men than in women; however, the incidence is increasing in women.