GI NCLEX

Semiliquid stool at unpredictable times a. Ascending colostomy b. Transverse colostomy c. Descending colostomy d. Ileostomy e. Continent ileostomy

b. Transverse colostomy

Formed stool on relatively regular basis a. Ascending colostomy b. Transverse colostomy c. Descending colostomy d. Ileostomy e. Continent ileostomy

c. Descending colostomy

Extremely watery stool with concentrations of digestive enzymes a. Ascending colostomy b. Transverse colostomy c. Descending colostomy d. Ileostomy e. Continent ileostomy

d. Ileostomy

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Client reports pain relieved by eating. B. Client states that pain often occurs at night. C. Client reports a sensation of bloating. D. Client states that pain occurs 30 min to 1 hr after a meal. E. Client experiences pain upon palpation of the epigastric region.

A. A client who has a duodenal ulcer will report that pain is relieved by eating. B. Pain that rarely occurs at night is an expected finding. C. CORRECT: A client report of a bloating sensation is an expected finding. D. CORRECT: A client who has a gastric ulcer will often report pain 30 to 60 min after a meal. E. CORRECT: Pain in the epigastric region upon palpation is an expected finding.

A nurse is completing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching? A. Decrease intake of calorie‑dense foods. B. Drink canned protein supplements. C. Increase intake of high fiber foods. D. Take a bulk‑forming laxative daily.

A. A high‑protein diet is recommended for the client who has Crohn's disease. B. CORRECT: A high‑protein diet is recommended for the client who has Crohn's disease. Canned protein supplements are encouraged. C. A low‑fiber diet is recommended for the client who has Crohn's disease to reduce inflammation. D. Bulk‑forming laxatives are recommended for the client who has diverticulitis.

A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. "I will plan to limit fiber in my diet." B. "I will restrict fluid intake during meals." C. "I will switch to black tea instead of drinking coffee." D. "I will try to eat three moderate to large meals a day."

A. CORRECT: A low‑fiber diet is recommended for the client who has ulcerative colitis to reduce inflammation. B. A client who has dumping syndrome should avoid fluids with meals. C. Caffeine can increase diarrhea and cramping. The client should avoid caffeinated beverages, such as black tea. D. Small, frequent meals are recommended for the client who has ulcerative colitis.

1. A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should anticipate prescriptions for which of the following medications? (Select all that apply.) A. Antacids B. Histamine2 receptor antagonists C. Opioid analgesics D. Fiber laxatives E. Proton pump inhibitor

A. CORRECT: Antacids neutralize gastric acid which irritates the esophagus during reflux. B. CORRECT: Histamine2 receptor antagonists decrease acid secretion, which contributes to reflux. C. Opioid analgesics are not effective in treating GERD. D. Fiber laxatives are not effective in treating GERD. E. CORRECT: Proton pump inhibitors decrease gastric acid production, which contributes to reflex.

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness

A. CORRECT: Manifestations of perforation include a rigid, board‑like abdomen. B. CORRECT: Tachycardia occurs due to gastrointestinal bleeding that accompanies a perforation. C. Hypotension is an expected finding in a client who has a perforation and bleeding. D. Circumoral cyanosis is not a manifestation of perforation. E. CORRECT: Rebound tenderness is an expected finding in a client who has a perforation.

A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12‑hr shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained.

A. CORRECT: The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin. B. No other medications or fluids should be administered through the IV tubing being used to administer TPN due to the increased risk of infection and disruption of the rate of TPN infusion. C. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection. D. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr. E. aPTT measures the coagulability of the blood, which is unnecessary during the administration of TPN

A nurse is caring for a client who is receiving TPN solution. The current bag of solution was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag. B. Infuse the remaining solution at the current rate and then hang a new bag. C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag. D. Remove the current bag and hang a bag of lactated Ringer's.

A. CORRECT: The current bag of TPN should not hang more than 24 hr due to the risk of infection. B. The current bag of TPN should not hang more than 24 hr due to the risk of infection. C. The rate of TPN infusion should never be increased abruptly due to the risk of hyperglycemia. D. Administration of TPN should never be discontinued abruptly due to the sudden change in blood glucose that can occur.

A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (Select all that apply.) A. Evaluate intake and output. B. Monitor laboratory reports of electrolytes. C. Provide three large meals a day. D. Administer ibuprofen for pain. E. Observe stool characteristics.

A. CORRECT: The nurse should evaluate the client's intake and output to prevent electrolyte loss and dehydration. B. CORRECT: The nurse should monitor the client's electrolyte laboratory values to prevent fluid loss and dehydration. C. The nurse should instruct the client to eat small, frequent meals. D. The nurse should instruct the client to avoid taking ibuprofen, an NSAID, because of its erosive capabilities. E. CORRECT: The nurse should instruct the client to report to the provider any indication of the presence of blood in the stools, which can indicate gastrointestinal bleeding.

4. A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? A. "I can take my medications with soda." B. "Peppermint tea will increase my indigestion." C. "Wearing an abdominal binder will limit my symptoms." D. "I will drink hot chocolate at bedtime to help me sleep." E. "I can lift weights as a way to exercise."

A. Carbonated beverages decrease LES pressure and should be avoided by the client who has a hiatal hernia. B. CORRECT: Peppermint decreases LES pressure and should be avoided by the client who has a hiatal hernia C. Tight restrictive clothing or abdominal binders should be avoided by the client who has a hiatal hernia, as this increases intra‑abdominal pressure and causes the protrusion of the stomach into the thoracic cavity. D. The client should avoid consuming anything immediately prior to bedtime. Additionally, chocolate relaxes the lower esophageal sphincter and should be avoided by a client who has a hiatal hernia E. Heavy lifting and vigorous activities are to be avoided in the client who has a hiatal hernia.

A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding of the teaching? A. "I will continue taking my warfarin while I complete these tests." B. "I'm glad I don't have to follow any special diet at this time." C. "This test determines if I have parasites in my bowel." D. "This is an easy way to screen for colon cancer."

A. Clients are instructed to stop taking anticoagulants prior to obtaining stool specimens for fecal occult blood testing because they can interfere with the results. B. Clients are instructed to avoid consuming red meat, chicken, and fish prior to obtaining stool specimens for fecal occult blood testing because this can interfere with the results. C. Fecal occult blood testing does not identify parasites present in stool. D. CORRECT: Fecal occult blood testing is a screening procedure for colon cancer.

A nurse is completing discharge teaching for a client who has an infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding of the teaching? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."

A. Corticosteroid use is a contributing factor to an infection caused by H. pylori. B. An esophagogastroduodenoscopy is done to evaluate for the presence of H. pylori and to evaluate effectiveness of treatment. C. CORRECT: A combination of antibiotics and a histamine2 receptor antagonist is used to treat an infection caused by H. pylori. D. H. pylori is evaluated by obtaining gastric samples, not a throat swab.

A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? A. Pernicious anemia is caused when the cells producing gastric acid are damaged. B. Expect a monthly injection of vitamin B12. C. Plan to take vitamin K supplements. D. Pernicious anemia is caused by an increased production of intrinsic factor.

A. Damage to parietal cells has occurred, which leads to pernicious anemia and causes a decrease of the intrinsic factor by the stomach parietal cells. B. CORRECT: The nurse should include in the information that the client will receive a monthly injection of vitamin B12 to treat pernicious anemia due to a decrease of the intrinsic factor by the stomach parietal cells. C. Vitamin K supplements are given to clients who have a bleeding disorder. D. Parietal cell damage results in insufficient production of intrinsic factor by the stomach parietal cells.

A nurse is teaching a client who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the teaching? A. "The medicine coats the lining of my stomach." B. "The medication should stop the pain right away." C. "I will take my pill 1 hr before meals." D. "I will monitor for bleeding from my nose.

A. Famotidine decreases gastric acid output. It does not have a protective coating action. B. The client might need to take famotidine for several days before pain relief occurs when starting this therapy. C. CORRECT: The client should take famotidine 1 hr before meals to decrease heartburn, acid indigestion, and sour stomach. D. The nurse should instruct the client to monitor for GI bleeding when taking famotidine.

A nurse is reviewing the serum laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following laboratory tests should the nurse expect to be elevated? (Select all that apply.) A. Hematocrit B. Erythrocyte sedimentation rate C. WBC D. Folic acid E. Albumin

A. Hematocrit is decreased as a result of chronic blood loss. B. CORRECT: Increased erythrocyte sedimentation rate is a finding in a client who has Crohn's disease as a result of inflammation. C. CORRECT: Increased WBC is a finding in a client who has Crohn's disease. D. A decrease in folic acid level is indicative of malabsorption due to Crohn's disease. E. A decrease in serum albumin is indicative of malabsorption due to Crohn's disease.

3. A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Loss of tooth enamel C. Sweet taste in mouth D. Absence of eructation

A. Hypersalivation is an expected finding in a client who has GERD. B. CORRECT: Tooth erosion is an expected finding in a client who has GERD. C. A client who has GERD would report a bitter taste in the mouth. D. Increased burping is an expected finding in a client who has GERD.

A nurse is completing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse include in the teaching? ' A. Mucus will be present in stool for 5 to 7 days after surgery. B. Expect 500 to 1,000 mL of semi liquid stool after 2 weeks. C. Stoma should be moist and pink. D. Change the ostomy bag when it is ¾ full.

A. Mucus and blood can be present for 2 to 3 days after surgery. B. Output should become stool‑like, semi‑formed, or formed within days to weeks. C. CORRECT: A pink, moist stoma is an expected finding with a transverse colostomy. D. The ostomy bag should be changed when it is ¼ to ½ full.

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching? A. "Take the medication 2 hr after eating." B. "Discontinue this medication if your skin turns yellow‑orange." C. "Notify the provider if you experience a sore throat." D. "Expect your stools to turn black."

A. Sulfasalazine should be taken right after meals and with a full glass of water to reduce gastric upset and prevent crystalluria. B. yellow‑orange coloring of the skin and urine is a harmless effect of sulfasalazine. C. CORRECT: Sulfasalazine can cause blood dyscrasias. The client should monitor and report any manifestations of infection, such as a sore throat. D. Sulfasalazine can cause thrombocytopenia and bleeding. Black stools are a manifestation of gastrointestinal bleeding, and the client should report this to the provider.

A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. The nurse should recognize which of the following findings as the priority? A. Client reports difficulty sleeping. B. The client's urine is positive for glucose. C. Client reports having an elevated body temperature. D. Client reports gaining 4 lb in the last 6 months

A. The client is at risk for sleep deprivation because prednisone can cause anxiety and insomnia. However, another finding is the priority. B. The client is at risk for hyperglycemia because prednisone can cause glucose intolerance. However, another finding is the priority. C. CORRECT: The greatest risk to the client is infection because prednisone can cause immunosuppression. Therefore, the nurse should identify indications of an infection, such as an elevated body temperature, as the priority finding. D. The client is at risk for weight gain because prednisone can cause fluid retention. However, another finding is the priority.

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? A. Eat three moderate‑sized meals a day. B. Drink at least one glass of water with each meal. C. Eat a bedtime snack that contains a milk product. D. Increase protein in the diet.

A. The client should consume small, frequent meals rather than moderate‑sized meals. B. The client should eliminate liquids with meals and for 1 hr prior to and following meals. C. The client should avoid milk products. D. CORRECT: The client should eat a high‑protein, high‑fat, low‑fiber, and moderate‑ to low‑carbohydrate diet.

A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. Take the medication with food. B. Monitor for diarrhea. C. Wait 1 hr before taking other oral medications. D. Maintain a low‑fiber diet

A. The nurse should advise the client to take aluminum hydroxide on an empty stomach. B. The nurse should include in the teaching that aluminum hydroxide can cause constipation. C. CORRECT: The nurse should advise the client not to take oral medications within 1 hr of an antacid. D. The nurse should include in the teaching for the client to increase dietary fiber due to the constipating effect of the medication.

Liquid and unformed stool a. Ascending colostomy b. Transverse colostomy c. Descending colostomy d. Ileostomy e. Continent ileostomy

a. Ascending colostomy

The nurse caring for a 70-year-old patient with gastroenteritis following a camping trip to Mexico would anticipate which signs and symptoms? (Select all that apply.) a. Positive stool culture for Giardia or Shigella b. Abdominal cramping c. Fat in the stool d. Mucus in stool e. Blood in stool

a. Positive stool culture for Giardia or Shigella b. Abdominal cramping d. Mucus in stool e. Blood in stool Fat in the stool is not symptomatic of gastroenteritis.

The nurse is discussing high-fiber dietary selections with a patient. Later, the patient makes his menu selection. When reviewing the patients selections, what is most reflective of understanding the teaching provided? a. Turkey sandwich on whole wheat toast, pears, and water b. Fried chicken, corn, and diet soda c. Cheese pizza, salad, and cola d. Bacon, lettuce, and tomato sandwich, blackberry compote, and orange juice

a. Turkey sandwich on whole wheat toast, pears, and water A high-fiber diet is encouraged for the patient with diverticular disease. Eating whole-grain cereals and breads, as well as fruits such as apples, seedless berries, peaches, and pears adds fiber. High-fiber vegetablessquash, broccoli, cabbage, and spinachand legumes, including dried beans, peas, and lentils, provide bulk that decreases constipation and speeds the transit time in the intestine. Drinking plenty of fluids and water helps regularity.

The nurse will encourage the patient who has gastroesophageal reflux disease (GERD) to modify her diet by: a. avoiding garlic. b. drinking carbonated beverages with meals. c. using a straw to drink all fluids. d. eating three meals regularly spaced apart.

a. avoiding garlic. Avoiding highly seasoned or spicy food should be incorporated into diet changes for the patient with GERD. The avoidance of carbonated beverages with meals and the use of a straw do not reduce the impact of GERD. The frequency of dietary intake does not influence GERD.

. The nurse lists foods and beverages that may trigger an attack of irritable bowel syndromes (IBS), which include: (Select all that apply.) a. caffeine. b. dairy products. c. specific food allergies. d. wheat products. e. alcohol.

a. caffeine. b. dairy products. c. specific food allergies. d. wheat products. Irritable bowel syndrome (IBS) is a functional disorder of gastrointestinal motility. The cause of IBS is unknown, but it is thought to be due to a hypersensitivity of the bowel wall leading to disruption of the normal function of the intestinal muscles. An altered bowel pattern and abdominal pain with bloating are caused by altered motility of the small and large intestines. It is thought that with IBS there is an abnormality of nerve function in the intestine. Stress, caffeine, and sensitivity to certain foods such as dairy and wheat products seem to trigger IBS in some people. Alcohol is not considered a trigger for IBS.

The nurse is aware that the person with ulcerative colitis is at risk for: a. cancer of the colon. b. chronic urinary infections. c. intussusception. d. volvulus.

a. cancer of the colon. Ulcerative colitis is an inflammation, with the formation of ulcers, of the mucosa of the colon. It often is a chronic disease, and the patient usually is free from symptoms between acute flare-ups. The person with ulcerative colitis is 10 to 15 times more likely to develop colon cancer than those who do not have the disease.

To assist the patient with dysphagia to eat a meal, the nurse can: (Select all that apply.) a. encourage practice swallowing before the meal. b. coach the patient to chew thoroughly. c. assist the patient to sit upright with the head forward and chin tucked. d. offer fluid during the meal. e. give the patient thin liquids, such as water.

a. encourage practice swallowing before the meal. b. coach the patient to chew thoroughly. c. assist the patient to sit upright with the head forward and chin tucked. d. offer fluid during the meal. Thickened liquids should be administered to a patient with dysphagia. All other options listed would be assistive to the person with dysphagia.

The nurse lists the contributing factors to developing a hernia, which include: (Select all that apply.) a. heavy lifting. b. chronic cough. c. straining with defecation. d. ascites. e. strenuous sexual activity.

a. heavy lifting. b. chronic cough. c. straining with defecation. d. ascites. The most common locations for a hernia are in areas where the abdominal wall is normally weaker and more likely to allow a segment of intestine to protrude. These include the center of the abdomen at the site of the umbilicus and the lower abdomen at the points where the inguinal ring and the femoral canal begin. The most common contributing factors in the development of a hernia are straining to lift heavy objects, chronic cough, straining to void, straining at stool, and ascites. Sexual activity is not usually a cause for herniation.

The patient who has had an incarcerated hernia for many years begins to experience abdominal pain and vomit dark material with a fecal odor. The nurse recognizes these signs as indications of: a. intestinal obstruction. b. ruptured bowel. c. gastroenteritis. d. duodenal ulcer.

a. intestinal obstruction. Flow of bowel content is blocked by incarceration, causing bowel obstruction with its attendant signs and symptoms of vomiting fecal contents and pain from ischemia and distention of the bowel.

The nurse explains that the most beneficial diet for a person with inflammatory bowel disease (IBD) is a _____ diet. a. low-fat, low-fiber. b. high-fiber, low-protein. c. mechanical soft, low-sodium. d. low-protein, low-calorie.

a. low-fat, low-fiber. A low-fat, low-fiber, high-protein, high-calorie diet is recommended for the patient with IBD to make up for the loss of fluid and nutrients in the frequent stools.

Instruction to a patient who self-medicates with bismuth subsalicylate (Pepto Bismol) tablets should include that the tablets: a. may cause aspirin toxicity. b. should be swallowed whole. c. may stain teeth. d. will cause the stool to be black.

a. may cause aspirin toxicity. The drug may cause aspirin toxicity if taken excessively. The patient should not take other medication containing aspirin while taking this drug. The drug should be chewed well. This medication often turns the stool black. It does not affect the teeth.

The nursing care of a patient with an acute exacerbation of inflammatory bowel disease (IBS) will include: (Select all that apply.) a. measuring intake and output. b. assessing bowel sounds. c. documenting the patients weekly weight. d. encouraging periods of rest. e. assessing for internal bleeding.

a. measuring intake and output. b. assessing bowel sounds. c. documenting the patients weekly weight. d. encouraging periods of rest. e. assessing for internal bleeding. The patient should be weighed on a daily basis during an acute exacerbation of IBS. All other options reflect nursing interventions that are significant in the care of a patient with IBS.

For the patient with a hiatal hernia, the nurse recommends avoidance of fats because fats: a. relax the sphincter, allowing reflux. b. may cause nausea and vomiting. c. cause hypermobility of the colon. d. may initiate the strangulation of the hernia.

a. relax the sphincter, allowing reflux. Hiatal hernia is the result of a defect in the wall of the diaphragm where the esophagus passes through. A hiatal hernia is formed by the protrusion of part of the stomach or the lower part of the esophagus up into the thoracic cavity. Intake of alcohol, chocolate, caffeine, and fatty food is limited, and smoking should be avoided. Ingestion of fats relaxes the sphincter, allowing reflux.

The patient with an incarcerated hernia is at risk for the hernia to become: a. strangulated. b. indirect. c. direct. d. irreducible.

a. strangulated. The incarcerated hernia may become strangulated, which cuts off the blood supply and can lead to necrosis of the trapped bowel loop. Hernias are classified as reducible, which means the protruding organ can be returned to its proper place by pressing on the organ, and irreducible, which means that the protruding part of the organ is tightly wedged outside the cavity and cannot be pushed back through the opening. Another name for an irreducible hernia is incarcerated hernia. Anindirect hernia protrudes through the inguinal ring. A direct hernia protrudes through the posterior inguinal wall.

. The nurse is caring for a patient who has been diagnosed with Crohns disease. When providing education concerning dietary recommendations, which statement by the patient indicates an understanding of the teaching? a. I should try to eat as much fiber daily as I can. b. Reducing dietary fat and fiber will be helpful in managing my condition. c. I should not have lactose-containing products. d. Eating a larger breakfast and smaller lunch and dinner portions is recommended.

b. Reducing dietary fat and fiber will be helpful in managing my condition. A diet of low-fat, low-fiber foods that have a high protein and caloric content is instituted. Small frequent feedings are best. Lactose avoidance helps some patients but is not a global recommendation.

The nurse is assessing the efficiency of swallowing in a patient with dysphagia. During the assessment, the nurse will use what finding to evaluate the process? a. An audible gurgle b. Rising of the larynx c. Tilting of the head backward d. Nodding of the head forward

b. Rising of the larynx An effective swallow will be accompanied by the rising of the larynx.

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products. b. avoiding taking aspirin and drugs containing aspirin. c. only taking drugs prescribed by the health care provider. d. taking all drugs 1 hour before mealtime to prevent further bleeding. e. reading all OTC drug labels to avoid those containing stearic acid and calcium

b. avoiding taking aspirin and drugs containing aspirin. c. only taking drugs prescribed by the health care provider.

The nurse explains that diverticula occur in the older adult because: a. loss of bowel tone reduces motility. b. changes in bowel wall allow herniation. c. the diet may be deficient in bulk. d. multipharmacy has altered bowel mucosa.

b. changes in bowel wall allow herniation. The bowel wall in the older adult becomes thickened and rigid. Intra-abdominal pressure causes herniation of the mucosa through the bowel wall, causing a small pocket in the colon.

The nurse explains that conservative treatment of diverticulosis includes: (Select all that apply.) a. low-fiber diet. b. increased fluids. c. stool softeners. d. NSAIDs for discomfort. e. bulk laxatives.

b. increased fluids. c. stool softeners. d. NSAIDs for discomfort. e. bulk laxatives. A high-fiber diet is indicated for the treatment of diverticulosis. All other options would be part of a conservative, nonsurgical approach to treatment.

The nurse is aware that the diagnostic criteria for the confirmation of irritable bowel syndrome include: (Select all that apply.) a. pain increased by defecation. b. pain associated with stool frequency. c. mucorrhea. d. abdominal tenderness. e. bloating.

b. pain associated with stool frequency. c. mucorrhea. d. abdominal tenderness. e. bloating. Diagnosis of IBS is based on clinical manifestations and ruling out the presence of organic bowel disease. Defecation typically decreases pain. All other options are confirmation of the diagnosis of IBS.

The nurse is aware that patients who have chronic gastritis from renal failure may present with the first sign of this disorder as: a. an increase in the WBC count. b. sudden massive hemorrhage. c. asthma-like symptoms. d. extreme dyspnea.

b. sudden massive hemorrhage. Sudden massive GI hemorrhage may be the first indication of chronic gastritis. Many of these patients do not have any symptoms at all until the hemorrhage.

A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate? a. This is common after the type of surgery you had. b. Try to eat your meals slower to promote absorption. c. Reduce the amount of refined sugars that you are eating. d. You may be experiencing a postoperative infection.

c. Reduce the amount of refined sugars that you are eating. Patients who have had gastric bypass surgery are at risk for dumping syndrome, which results in nausea, weakness, sweating, and diarrhea. These symptoms tend to occur after meals that include concentrated sweets; therefore patients should be advised to avoid refined sugars. Although this is not an uncommon manifestation after this type of surgery, informing the patient that this is common provides limited information to the patient and is not the best response. Reducing the speed of eating will not provide relief from the problems being described. This is not a symptom of a postoperative infection

The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen. The patient is receiving total parenteral nutrition (TPN). The physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response by the nurse is indicated? a. It is likely you have developed diabetes as a result of your illness. b. Do you have a family history for diabetes? c. The TPN you are receiving has high amounts of glucose. d. Insulin is needed to manage your stomachs inability to adequately metabolize food at this time.

c. The TPN you are receiving has high amounts of glucose. People on TPN are prone to hyperglycemia from the high glucose content of the solution.

The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria resulting from an increase in acid-secreting parietal cells and degradation of RBCs.

c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa.

The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur: a. in the morning. b. erratically, without pattern. c. at bedtime. d. with meals.

c. at bedtime. Pain occurs at bedtime because the stomach is empty but the gastric juices are still high. Pain is absent in the morning when the digestive juices are low and when the stomach is filled with food.

A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours. Before giving the bolus, the nurse aspirates a residual of 100 mL. After returning the residual to the patient, the nurse should: a. give the 200 mL feeding. b. record the residual and give 100 mL of the feeding. c. document the residual and hold the feeding. d. position the patient in high Fowlers and give the feeding.

c. document the residual and hold the feeding. On finding a large residual, the nurse should return the residual to the patient, document the amount of the residual, and hold the feeding to avoid possible aspiration

When the patient with a Salem sump tube for decompression complains of feeling full and has dyspnea and nausea, the initial intervention by the nurse should be to: a. increase the amount of suction from low to high. b. notify the charge nurse. c. irrigate the tube with normal saline. d. pull the tube out about 3 inches.

c. irrigate the tube with normal saline. Irrigation of the tube to restore patency is the first intervention when assessment indicates inadequate decompression. The suction should remain on low. Pulling the tube out may cause inappropriate placement. Irrigating an obstructed sump tube is a standard of care.

The nurse caring for the patient with an ileostomy will include special interventions to prevent skin breakdown and irritation at the stomal site because the: a. large adhesive patch for the collection bag is irritating. b. ileostomy stoma is very large and difficult to cover completely with the adhesive faceplate. c. liquid stool from the ileum contains digestive enzymes that are especially harmful to the skin. d. soft stool is difficult to remove from the skin without abrading the skin.

c. liquid stool from the ileum contains digestive enzymes that are especially harmful to the skin. The liquid stool from the ileum has many digestive enzymes, unlike stool that is expelled from the colon.

The patient with a 4-day-old ileostomy complains of cramping. The nurse notes a drop in the effluent for the ileostomy. The bowel sounds are rapid with a tinkling sound. The nurse should: a. ambulate the patient to help expel gas. b. irrigate the ileostomy with 500 mL of warm water. c. notify the charge nurse immediately of possible obstruction. d. turn the patient on the left side to help drain the ileostomy.

c. notify the charge nurse immediately of possible obstruction. Cramping and reduced effluent from a new ileostomy should be reported immediately as these are signs of obstruction, which could lead to perforation. Ileostomies are not irrigated except by the physician or an enterostomal therapist.

The nurse urges the patient with diverticulitis to seek treatment because the inflamed bowel wall may: a. extend the inflammation to the entire bowel. b. progress into ulcerative colitis. c. perforate and cause peritonitis. d. cause appendicitis.

c. perforate and cause peritonitis. The term diverticulum refers to a small, blind pouch resulting from a protrusion of the mucous membranes of a hollow organ through weakened areas of the organs muscular wall. Diverticula occur most often in the intestinal tract, especially in the esophagus and colon. The infected diverticula can perforate through the bowel wall and cause peritonitis. Diverticulitis does not result in ulcerative colitis or appendicitis.

The nurse caring for a patient who has peritonitis and has developed a paralytic ileus assesses that the patient is passing gas. The assessment is an indication of: a. gas forming in bowel contents. b. the result of forceful vomiting. c. returned peristalsis. d. inadequate decompression.

c. returned peristalsis. The passing of gas or stool in the patient who has a paralytic ileus is an indication that peristalsis has returned.

A 36-year-old woman who had an ascending colostomy angrily declares, I dont want this hateful thing on my body! This nasty thing is not me. The nurses most therapeutic response would be: a. The colostomy is part of you now. b. Let me change the collection bag so you wont feel so nasty. c. All ostomates feel this way at first. Ill go get a list of support groups you may want to join. d. What about this colostomy concerns you the most?

d. What about this colostomy concerns you the most? Asking the patient to name the specific concerns helps to conceptualize where the adjustment problem lies. All other options negate the patients feelings, reinforce the patients negative feelings, and do not offer any therapeutic response.

The nurse explains to the patient with gastroesophageal reflux disease (GERD) that this disorder a. results in acid erosion of the esophagus from frequent vomiting. b. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms. c. is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm. d. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus.

d. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus.

The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylori. d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.

d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.

The nurse assessing the stoma of a patient 1 day after a transverse colostomy will immediately report the finding of a(n): a. wet, glistening stoma. b. stoma with slight bleeding around the margin. c. edematous stoma. d. purplish-red stoma.

d. purplish-red stoma. The purple hue in the new stoma is an indication of reduced perfusion to the stoma and should be reported immediately. A new stoma should have a pink or beefy red color, be slightly edematous, and have some small bleeding around the stoma.

The nurse preparing a teaching plan for lifestyle changes for the patient with GERD would include: a. sleeping on the right side on a flat bed. b. wearing tight belts to reduce reflux. c. lying down after each meal for 20 minutes. d. smoking cessation.

d. smoking cessation. Smoking stimulates gastric secretion. The patient with GERD should wait at least 2 hours after a meal to lie down and should sleep with the head of the bed elevated 4 to 6 inches. The patient should avoid restrictive clothing.