Midterm- 38 39 40 41
With a GI feeding tube residual volume of ________ or more increases the risk of aspiration 50mL or less is normal and feeding can occur again
200 mL
The nurse records that bowel sounds are absent when no sound is heard in
3 to 5 minutes.
Hyperactive bowel sounds occur when 5 or 6 sounds are heard in less than
30 seconds.
The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis?
Antispasmodic
Which drug is considered a stimulant laxative?
Bisacodyl
The nurse is caring for a client with a history of bulimia. The client complains of retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which condition?
Boerhaave syndrome
hydrogen breath test detects the presence of
Helicobacter pylori, the bacteria that causes peptic ulcer disease.
The nurse provides client education to a client about to undergo hydrogen breath testing. The nurse evaluates that the client understands the test when the client makes which statement?
I should avoid antibiotics for 1 month before the test."
Crohn's disease is a condition of malabsorption caused by which pathophysiological process?
Inflammation of all layers of intestinal mucosa
The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?
It is the third most common cancer in the United States.
How often should you change transparent dressing over central line
Weekly unless soiled, damp or loose
Hyperventilation is a compensatory mechanism for
acidosis
Enemas are contraindicated in the setting of
any inflammatory disease of the colon
A positive McBurney sign, low grade fever, loss of appetite, vomiting, vague periumbilical or epigastric pain and/or rebound tenderness typically indicates
appendicitis
The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?
bloating after meals, weight loss, abdominal pain above the umbilicus, loss or decrease in appetite, and nausea or vomiting.
Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis
chancre
Which is a true statement regarding the nursing considerations in administration of metronidazole
leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. and increases the blood-thinning effects of warfarin.
Clients with chronic atrophic gastritis secrete
little or no acid
Enzyme deficiency interferes with the digestion and absorption of nutrients and leads to
nutritional deficits
What do you put on yeast infection of the skin
nystatin powder
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history:
CAD Coronary artery disease
Signs of fluid volume deficit include
Changes in level of consciousness, decreased urinary output, dizziness, dry mucosal membranes, hypotension, tachycardia.
Which ulcer is associated with extensive burn injury?
Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum
What information should the nurse include in the teaching plan for a client being treated for diverticulosis?
Drink at least 8 to 10 large glasses of fluid every day
a double contrast study where a duodenal tube is inserted and 500 to 1000 mL of thin barium sulfate suspension and then methylcellulose is infused.
Enteroclysis
A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir?
Every 4 to 6 hours
This diagnostic imaging is used to visualize the filling of the intestinal loops over a period of up to 6 hours. The test is used for detection of small bowel obstruction and diverticuli.
Fluoroscopy
Keep the blue vent of the salem sump tube above the waist to prevent
Gastric reflux
increases secretion of gastric juice, which is rich in HCL.
Gastrin
Muscle weakness, fatigue, muscle cramps, constipation, and inverted T waves and a U wave on an ekg are signs of
Hypokalemia
The nurse is caring for a client receiving chemotherapy. For which mouth conditions associated with HIV infection should the nurse assess?
Kaposi sarcoma, Stomatitis, Candidiasis
Alcohol must be avoided when using
Metronidazole (flagyl)
Celiac disease (celiac sprue) is an example of which category of malabsorption?
Mucosal disorders causing generalized malabsorption
A typical sign/symptom of appendicitis is
Nausea, with or without vomiting, Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen Low-grade fever
Important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells.
Pepsin
What causes a rigid board like abdomen with pain, fever, and leukocytosis
Peritonitis
Which symptom characterizes regional enteritis?
Transmural thickening is an early pathologic change of Crohn's disease. Later pathology results in deep, penetrating granulomas. Regional enteritis is characterized by regional discontinuous lesions.
Dumping syndrome
a group of symptoms, such as diarrhea, nausea, and feeling light-headed or tired after a meal, that are caused by rapid gastric emptying. Rapid gastric emptying is a condition in which food moves too quickly from your stomach to your duodenum.
This inhibits sodium bicarb secretion and could increase the risk for duodenal ulcers
cigarette smoking
High residue and high fiber foods stimulate peristalsis and help to prevent
constipation
The nurse collaborates with the physician and dietician to determine the best type of tube feeding for a client at risk for diarrhea due to hypertonic feeding solutions. Which type of feedings should the nurse suggest?
continuous feedings
Does spinach and parsley increase or decrease the odor of stool in an ostomy?
decrease
Which is one of the primary symptoms of irritable bowel syndrome (IBS)?
diarrhea
The nurse cares for a client after a gastroscopy for which the client received sedation. The nurse should report which finding to the physician?
difficulty swallowing
When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported?
duodenal ulcer
Streatorrhea is
fat in the stool
Steapsin digests
fats
Aspirin, red meat, turnips and vitamin C may interfere with the accuracy of _________________ and should be avoided for 72 hours
fecal occult blood tests
Signs of sepsis include
fever, chills, pain, tachycardia, hypotension and leukopenia
Classic signs of malabsorption include
foul smelling loose stools and steatorrhea (fatty stools)
The major carbohydrate that tissue cells use as fuel is
glucose
The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is
gram-negative bacteria (Helicobacter pylori)
Clients with duodenal ulcers usually secrete an excess amount of
hydrochloric acid
The nurse determines one or two bowel sounds in 2 minutes should be documented as
hypoactive
vomiting fecal matter could suggest obstruction of the
ileum
Live attenuated vaccines (nasal influenza, measles, mumps, rubella, rotavirus, varicella, and or polio) must NOT be given with ____________?
immunosuppressants
does asparagus, cabbage, eggs, fish, high cellulose products and onions increase or decrease the odor of stool in an ostomy?
increase
Which response is a parasympathetic response in the GI tract?
increased peristalsis
Corticosteroids and alcohol may increase the risk of
infection
Avoid antidiarrhea agents in the setting of
infectious diarrhea
Secretin in the stomach
inhibits gastric secretion and motility
Norepinephrine
inhibits secretions of the GI tract.
Red or white plaque located on the undersurface of the tongue can be indicative of
oral cancer
The nurse is creating a discharge teaching plan for a client after surgery for oral cancer. Which should be included in the teaching plan?
oral hygiene, follow-up dental and medical appointments, and the use of humidification to keep secretions moist.
Dumping syndrome could lead to
osmotic diarrhea, fluid volume deficit (dehydration), and hypotension. Check the rate
Caffeine, carbonated beverages, and extreme food temperatures stimulate
peristalsis
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?
peritonitis
perforation could lead to
peritonitis and shock
An enzyme that begins the digestion of starches is
ptyalin or salivary amylase, is an enzyme that begins digestion of starches. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein. Bile is an enzyme secreted by the liver and gallbladder.
A milky white stool is indicative of a client who
received barium
A client tells the nurse that the stool was colored yellow. The nurse assesses the client for
recent foods ingested or senna
The nurse inspects a client's tongue. Which finding would the nurse evaluate as an indication of potential oral cancer?
red plaque on undersurface of tongue
Proton pump inhibitors end in ______ and help to decrease gastric acid secretion
-prazole (pantoprazole, omeprazole)
H2 blockers that end in _____________ help to decrease hydrochloric acid production which decreases pancreatic function and reduces the risk for GI bleed
-tidine (famotidine, ranitidine)
A weigh gain of 2.2lbs is equal to how many liters of fluid retention
1
Blood flow to the GI tract is approximately what percentage of the total cardiac output?
20%
It could take up to how many months for a gastrostomy tube tract to form
3
Normal bowel sounds are heard every
5 to 20 seconds
The nurse recognizes which change of the gastrointestinal system is an age-related change?
A weakened gag reflex, decreased motility, atrophy of the small intestine, and decreased mucus secretion
Which neuroregulator increase gastric acid secretion?
Acetylcholine
a type of premalignant squamous cell skin cancer that presents as scaling, crusty fissures or a white overgrowth of the horny layer of the epidermis.
Actinic cheilitis
A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers
"It indicates if a cancer is present."
Which category of laxatives draws water into the intestines by osmosis?
Saline agents (e.g., magnesium hydroxide)
Which term is used to describe stone formation in a salivary gland formed mostly by calcium phosphate , usually the submandibular gland?
Sialolithiasis
inflammation of the oral mucosa
Stomatitis
What secretes sodium bicarb to neutralize gastric acid secretions in the small intestine along with digestive enzymes, amylase (carbs), lipase (fats), and trypsin (protein)
The pancreas
The nurse is caring for a client during the postoperative period following radical neck dissection. Which finding should be reported to the physician?
high epigastric pain and/or discomfort because this can be a sign of impending rupture
A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?
remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond
The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every
shift
What type of ulcer can occur in the setting of physiologically stressful events such as burns, sepsis and shock
stress
Decreased gastric secretion, blood vessel constriction, and decreased motility are what type of response in the GI tract
sympathetic responses
The nurse recognizes that blood shed in sufficient quantities into the upper GI tract produces which color of stool?
tarry black
Trypsin, amylase, and lipase are digestive enzymes secreted by
the pancreas
Which enzyme aids in the digestion of protein?
trypsin
The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented?
upper GI enteroclysis