GI practice questions

Which action should the practical nurse (PN) implement to reduce the risk of infection for a client who is receiving total parenteral nutrition (TPN)? Administer antibiotics secondary to the TPN fluid. Replace the peripheral cannula every 48 hours. Change the transparent dressing every 72 hours. Use a semipermeable dressing on the insertion site.

Change the transparent dressing every 72 hours

The practical nurse (PN) recognizes which stool characteristics as typical of a client with acute cholecystitis? Pale, floating. Dark, tarry. Watery, odoriferous. Currant jelly, bloody.

A In cholecystitis, bile, which emulsifies fat in the duodenum, is impeded by gallbladder irritation, ineffective ejection from the gallbladder, or gallstone obstruction of the common bile duct. Stool with increased fecal fat are characteristically are frothy and float, and clay-colored or pale (A) due to the lack of bile which contains biliruben that colors the stool. (B) is characteristic of gastrointestinal bleeding. Watery diarrhea with a horse barn odor is classic of Clostridium difficile infection (C). Bloody, currant jelly stool typically occur with intussusception (D).

A client presents to the clinic complaining of severe stabbing pain in the epigastric region that radiates to the mid-back area. Which finding indicates to the practical nurse that the client should remain NPO? Amylase and lipase levels are 3 times the normal value. Alanine aminotransferase (ALT) is 4 times the normal value. White blood count is 14,000 mm3. Serum potassium is 3.2 mEq/L

Amylase and lipase levels are 3 times the normal value. Pancreatitis is confirmed by amylase and lipase levels that are elevated 2 to 3 times the normal value (A). Clients with pancreatitis should be kept NPO, which allows the pancreas to rest. An elevation in ALT levels (B) is characteristic of liver disease. WBC elevation (C) indicates infection. A low serum potassium level (norm is 3.5 to 5.5 mEq/L) indicates hypokalemia. Although (B, C, and D) require further assessment by the healthcare provider, they do not require an NPO status.

A client presents to the urgent care clinic with a sudden onset of left upper quadrant pain radiating to the back. Based on which laboratory values should the practical nurse (PN) ensure the client remains NPO? (Select all that apply.) Glucose is 150 mg/dL. White blood cell count of 11,000 mm3/L. Alanine Aminotransferase (ALT) is 144 units/L. Amylase is 660 units/L. Lipase is 1600 units/L. Aspartate Aminotransferase (AST) is 140 units/L.

Amylase is 660 units/L. Lipase is 1600 units/L. Elevation of amylase (D) and lipase (E) indicates the probability of pancreatitis, and the client should be NPO to prevent stimulation of pancreatic activity. Although (A and B) are elevated, they do not require the client to be NPO. (C and F) are elevated and indicative of possible liver disease, but the client does not need to be NPO.

A client who had abdominal surgery yesterday is receiving morphine via a patient-controlled analgesia (PCA) infusion pump. The client reports a pain level of 6 based on a pain scale of 1 to 10. What action should the practical nurse (PN) implement first? Take the client's blood pressure. Ask for a description of the pain. Remind client to push the PCA button. Check the intravenous tubing for kinks.

Ask for a description of the pain. The PN should obtain further information (B) about the pain the client is experiencing. (A, C and D) should be implemented after the client describes and locates the pain.

A male client with pancreatic cancer who received morphine and midazalom (Versed) during an endoscopic retrograde cholangiopancreatography (ERCP) returns to the unit. His vital signs are pulse 80 beats/minute, 16 breaths/minute, 120/80 blood pressure, and pulse oximeter 98%. Which action should the practical nurse (PN) implement? Give naloxone (Narcan) and flumazenil (Ramazicon) per protocol. Arouse the client to give warm oral fluids to sooth a sore throat. Determine client's fingerstick glucose level. Administer a 500 ml intravenous fluid bolus.

Determine client's fingerstick glucose level. A client with pancreatic involvement is likely to experience inadequate insulin secretion which places the client at risk for abnormal serum glucose, so the client fingerstick glucose level (C) should be checked. Based on the client's vital signs, (A and D) are not indicated at this time. The client's gag reflex is suppressed due to medication administered during the procedure, so fluids or food should be withheld (B) until the gag reflex returns

A client who had an abdominal cholecystectomy today has a T-tube that has drained 200 ml of greenish-brown fluid in the past 12 hours. What action should the practical nurse (PN) take? Irrigate the T-tube with 100 ml of warm normal saline. Document the findings in the electronic medical record. Clamp the T-tube and notify the healthcare provider. Assess the client's vital signs for early signs of shock.

Document the findings in the electronic medical record. This is an expected amount and color of biliary drainage from a T-tube, which may drain between 250 to 500 ml during the first 24 hours (B) after a cholecystectomy. The T-tube should not be irrigated (A) nor clamped (C). There is no indication that the client is in shock (D).

A client recovering from a gastrojejunostomy (Billroth II) surgery reports dizziness, weakness, palpitations, and an urge to defecate about 20 minutes after eating. What teaching should the practical nurse reinforce with the client? Increase fluid intake during meals. Avoid lying down after meals. Limit gluten and purine intake. Eat low-carbohydrate foods 6 times/day.

Eat low-carbohydrate foods 6 times/day. The client is experiencing the signs and symptoms of dumping syndrome related to the malabsorption of carbohydrates due to a deficiency of digestive enzymes. The client should consume smaller, more frequent meals that are low in carbohydrates and refined sugar (D), moderate in fat, and moderate to high in protein. Fluids should be taken between meals, not (A). Lying down for about 30 minutes after meals is helpful, not (B). (C) is not indicated.

A female client who is currently receiving chemotherapy (CT) for colon cancer tells the practical nurse (PN) that she plans to become pregnant in case CT is not successful. What action should the PN take? Determine how the client's spouse feels about the decision. Assess the client's ability to perform activities of daily living. Reinforce the importance of proper nutrition during pregnancy. Encourage her to wait until the completion of chemotherapy.

Encourage her to wait until the completion of chemotherapy. CT is teratogenic and causes birth defects in the first trimester, so the client should be encouraged to wait until CT is completed (D) and talk with her healthcare providers about the treatment risks in pregnancy. (A, B, and C) do not address the risk of CT in pregnancy.

The practical nurse (PN) obtains an oral temperature of 100°F (37.8°C) for a female client who is one day postoperatively after a total abdominal hysterectomy. What action should the PN implement? Evaluate the client's temperature in 4 hours. Encourage incentive spirometer use every 2 hours. Inspect abdominal dressing for purulent drainage. Administer a prescribed analgesic-antipyretic.

Evaluate the client's temperature in 4 hours. An oral temperature of 100°F (37.8°C) on the first postoperative day is not indicative of infection and should be monitored every 4 hours (A). (B, C, and D) are implemented for postoperative prevention of infections, which are more likely to manifest in 48 to 72 hours postoperatively.

A male client with coffee ground emesis is admitted with a hemoglobin of 10.2 grams that is now 7.5 grams/dl since admission. The client's blood is typed and crossmatched for 2 units of blood, and the healthcare provider prescribes STAT administration of one unit. The client indicates to the practical nurse (PN) that he wants to shower first. Which intervention should the PN implement? Allow the client to do hygienic care first at the bedside. Let the client sponge in the bathroom with assistance. Permit the client to shower with assistance as requested. Explain the need for starting the transfusion immediately.

Explain the need for starting the transfusion immediately. The client's hemoglobin indicates active bleeding, and the PN should explain the need for immediate transfusion administration (D) to prevent shock. Once the transfusion is in progress, the client may be offered hygiene (A and B) as tolerated. (C) is not indicated.

An older client who is at a health fair goes to the First Aid station and reports feeling tired after a recent screening test revealed a hemoglobin of 10.1 grams. The client asks the practical nurse (PN) what could he do to feel better. What information should the PN offer? Eat food high in iron, for example red meat. Take an over-the-counter iron supplement. Practice daily stress-relieving measures. Make appointment with healthcare provider.

Make appointment with healthcare provider. A common cause of anemia in the elderly is blood loss from the gastrointestinal or genitourinary tracts, so the PN should recommend that the client visit to the healthcare provider for further assessment (D). The cause of the anemia must first be determined before attempting to treat it as iron-deficiency anemia through diet (A) or supplements (B). Stress-relieving measures (C) are always a healthful option, but the etiology and proper treatment of the known problem is a priority.

A client who is 2-days postoperative for abdominal surgery has a nasogastric tube (NGT) to low continuous suction. The client tells the practical nurse (PN) that his mouth is so dry, he has been drinking water to quench his thirst. Which potential imbalance should the PN monitor for development in the client? Fluid volume excess. Metabolic alkalosis. Hyperkalemia. Hypercalcemia.

Metabolic alkalosis. The continuous gastric suction and the fluids the client drank increases the washing out gastric hydrochloric acid, which places the client at risk for metabolic alkalosis (B). (A, C, and D) are unlikely with gastric suction.

The practical nurse (PN) is reviewing the side effects associated with chlopromazine (Thorazine) rectal suppository for a client with nausea and vomiting. Which information should the PN review with the client? Limit fresh fruit and dietary roughage intake. Report any signs of urinary frequency. Minimize exposure to sunlight during therapy. Eat a balance diet to minimize weight loss.

Minimize exposure to sunlight during therapy

Which action should the practical nurse (PN) implement for a client who is having a liver biopsy? Document bowel sound assessment prior to biopsy. Keep the client NPO for 8 hours before the procedure. Place the client on the left side after the procedure. Monitor for signs of dyspnea after return from biopsy.

Monitor for signs of dyspnea after return from biopsy. Biopsy of the liver may cause a pneumothorax due to the liver's proximity to the lung. After the biopsy, the client should be monitored for signs of dyspnea (D). (A and B) are not required before the biopsy. The liver is located in the upper hypochondriac region, so the client should be placed on the right side, not (C), to facilitate external compression to the puncture site.

A client with a peptic ulcer develops severe upper abdominal pain. Which finding is most important for the practical nurse (PN) to report to the charge nurse? Deep, rapid respirations. Rigid, board-like abdomen. Vomiting of undigested food. Hyperactive bowel sounds.

Rigid, board-like abdomen. A rigid, board-like abdomen indicates perforation of a bleeding peptic ulcer (B) and possible peritonitis. (A, C, and D) should be reported, but a rigid, board-like abdomen is a surgical emergency.

Which finding should the practical nurse (PN) report to the healthcare provider that indicates a client with cirrhosis is progressing to hepatic encephalopathy (hepatic coma)? 2+ pitting edema up to the lower thighs. Serum clotting results three times above normal. Spider nevi (telangiectasias). Serum ammonia levels twice the normal value.

Serum ammonia levels twice the normal value. Hepatic coma results in cerebral dysfunction when serum ammonia is not eliminated and builds up in the bloodstream (D). (A, B, and C) are all expected findings for clients with cirrhosis, but elevated serum ammonia level is indicative of hepatic failure.

A client is 24 hours post-endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis. Which finding should the practical nurse (PN) report to the healthcare provider? Serum bilirubin elevation four times above normal value. Serum amylase elevation 3 times above normal value. Steatorrhea. Jaundiced sclera.

Serum amylase elevation 3 times above normal value. ERCP can cause a gallstone to move into the common bile duct, obstructing flow into the duodenum and cause pancreatitis, which is evidenced by an elevation of serum amylase (B) and lipase levels. Elevated bilirubin (A), steatorrhea (C), and jaundice (D) are expected findings with cholelithiasis

Two days after a small bowel resection, a male client reports tingling of fingers and toes and feels dizzy. The client's nasogastric tube (NGT) is draining per low intermittent suction, and the practical nurse (PN) suspects the client has a fluid and electrolyte imbalance because he has been taking oral ice chips PRN. Which assessment finding should the PN report when monitoring the client? Distended neck veins and bounding pulse. Elevated pulse and dysrhythmia noted on telemetry. Feelings of heaviness and pain to the legs. Decrease in blood pressure baseline and headache.

Elevated pulse and dysrhythmia noted on telemetry. Nasogastric suctioning that increases the loss of gastric secretions that are diluted by the client's oral intake of ice chips contributes to fluid and electrolyte imbalances and can cause a metabolic alkalosis. The client's cardiovascular function should be monitored for signs an elevated pulse and cardiac dysrhythmias (B) related to fluid loss and potassium imbalances. (A) describes symptoms of fluid volume excess, not loss. Deep vein thrombosis typically causes heaviness in the leg and unilateral pain (C). (D) are signs related to metabolic acidosis, not alkalosis.