NU373 EAQ Evolve Elsevier: HESI Prep Gastrointestinal

The nurse is instructing a group of clients in the community about food preparation. Which statement indicates that a client is at an increased risk for contracting botulism? o "I do not usually brush my teeth after I finish eating a meal." o "Sometimes I eat grapes before I have a chance to wash them." o "Utensils that I use to cut up chicken are put into the dishwasher." o "I save money when I buy the slightly damaged cans of vegetables."

o "I save money when I buy the slightly damaged cans of vegetables." · Botulism is caused by improper canning procedures. Oral hygiene after meals does not affect food that has been consumed. Although fruits and vegetables should be rinsed before consumption, this will not cause botulism. Surfaces in contact with uncooked chicken should be cleaned to prevent salmonella food poisoning.

The nurse is obtaining a health history from a client with a diagnosis of peptic ulcer disease. The nurse identifies a possible contributory risk factor when the client makes which statement? o "My blood type is A positive." o "I smoke one pack of cigarettes a day." o "I have been overweight most of my life." o "My blood pressure has been high lately."

o "I smoke one pack of cigarettes a day." · Smoking cigarettes increases the acidity of gastrointestinal secretions, which damages the mucosal lining. Blood type O is more frequently associated with duodenal ulcer, but type A has no significance. Being overweight is unrelated to peptic ulcer disease. High blood pressure is not directly related to peptic ulcer disease.

A client who has just been transferred to the inpatient unit after surgery for oral carcinoma indicates to the nurse that the client's spouse is the only person who is allowed to visit. To support the client at this time, which action would the nurse take? o Comply with the client's wishes. o Ask the client why other visitors should be restricted. o Have the spouse explain to the client that everything will be okay. o Promote communication to find out how the client really feels.

o Comply with the client's wishes. · Complying with the client's wishes meets the client's immediate personal needs and demonstrates respect and concern. Asking why the client does not want others to visit may be explored when planning further support; it is not the priority at this time. Having the spouse explain to the client that everything will be okay provides false reassurance that may block communication; the nurse, not the spouse, should explore this issue with the client. The client's immediate request should be met first; feelings may be explored when the client reflects a readiness to communicate.

A client experiences occasional right upper quadrant pain attributed to cholecystitis. To prevent or minimize dyspepsia, the nurse would instruct the client to avoid which food items? o Nuts and popcorn o Meatloaf and baked potato o Chocolate and boiled shrimp o Fried chicken and buttered corn

o Fried chicken and buttered corn · Cholecystitis is often accompanied by intolerance to fatty foods, including fried foods and butter. Nuts and popcorn have a high fiber content but have less fat than fried foods; nuts and popcorn cause flatulence and pain for clients with lower intestinal problems, such as diverticulosis. Meatloaf and baked potato contain less fat than do fried foods or butter. Neither chocolate nor boiled seafood contains as much fat as fried chicken or butter.

The nurse discusses the regaining of bowel control with a client who recently had surgery for a colostomy in the descending colon. Which is important to emphasize in the teaching? o Irrigation routine o Management of fluid intake o Progressive exercise program o Maintenance of a low-residue diet

o Irrigation routine · Colostomy irrigations done daily at the same time help establish a regular pattern of bowel evacuation. Although adequate fluid intake is important to prevent hard stools, it will not help the client regain bowel control. Progressive exercise has no relationship to bowel control for a client with a distal colostomy; however, exercise does help prevent constipation. A soft, low-residue diet is not necessary.

A client who has had a laparoscopic cholecystectomy reports pain in the shoulder. In which position would the nurse place the client? o Prone o Supine o Left Sims o Trendelenburg

o Left Sims · Retained carbon dioxide can irritate the phrenic nerve. Placing the client in the left Sims position helps move the gas pocket away from the diaphragm. Deep breathing and ambulation should be encouraged. Prone, supine, and Trendelenburg positions will not alleviate the problem and could aggravate it.

A client is admitted to the hospital after taking an overdose of aspirin. A nasogastric tube is inserted for lavage. Which solution would the nurse obtain for the gastric lavage? o Normal saline o Lactated Ringer o Citrate magnesium o Sodium bicarbonate

o Normal saline · A saline solution of 0.9% is considered a physiological or isotonic solution appropriate for gastric lavage because it will not detrimentally influence the client's acid-base balance. Lactated Ringer solution contains sodium chloride, potassium chloride, and calcium chloride in purified water; it is an intravenous solution. Citrate magnesium affects the lower bowel, not the stomach. Sodium bicarbonate counteracts acidosis in some instances of salicylate toxicity, but it is undesirable for lavage because as a systemic alkalinizer, it can precipitate metabolic alkalosis.

The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. Which is an important nursing intervention? o Weigh the client daily. o Restrict the client's oral fluid intake. o Measure the client's urine specific gravity. o Observe the client for increasing confusion.

o Observe the client for increasing confusion. · An increased serum ammonia level impairs the central nervous system, causing an altered level of consciousness. Increasing ammonia levels are not related to weight. An alteration in fluid intake will not affect the serum ammonia level. Measuring the client's urine specific gravity is not the priority; the priority is to monitor the client's neurological status.

After a transurethral resection of the prostate, the retention catheter is pulled taut and secured to the client's leg. The client reports a feeling of pressure and asks why this is necessary. Which rationale would the nurse include in a response to this question? o Prevents bleeding o Limits discomfort o Reduces bladder spasms o Promotes urinary drainage

o Prevents bleeding · Pressure of the balloon against small blood vessels of the prostatic fossa causes them to constrict, thereby preventing bleeding. The taut catheter may cause discomfort or bladder spasms. The tautness of the catheter does not promote urinary drainage.

A client with Laënnec cirrhosis experiences ascites, jaundice, and confusion. Which is a nursing priority when caring for this client? o Correcting nutritional deficiencies o Measuring abdominal girth every day o Providing for the client's physical safety o Placing the client in the high-Fowler position

o Providing for the client's physical safety · Hepatic encephalopathy, related to high ammonia levels, results in central nervous system derangement; physical safety is the priority. Although correcting nutritional deficiencies is important, it is not the priority. Although measuring abdominal girth is important, it is not the priority. The high-Fowler position will be uncomfortable because of the pressure of the distended abdomen against the legs. The semi-Fowler position is more appropriate, and it promotes respiration.

A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, which would the nurse expect to observe? o Melena o Steatorrhea o Hard, dry stool o Ribbon-shaped stool

o Steatorrhea · Decreased secretion of lipase from the pancreas limits fat breakdown in the small intestine, resulting in increased fat content in feces; steatorrhea is soft, frothy, foul-smelling feces. Melena refers to black, tarry stool containing digested blood; melena is caused by upper gastrointestinal bleeding. Hard, dry stool reflects constipation; stools associated with pancreatitis are soft and frothy. Ribbon-shaped stool is associated with obstruction of the descending or sigmoid colon.

A client is transferred to the postanesthesia care unit after abdominal surgery. The client begins vomiting. Which nursing action is most important when caring for this client? o Turning the client onto the side o Measuring the amount of vomitus o Assessing the wound for dehiscence o Administering the prescribed antiemetic to the client

o Turning the client onto the side · The side-lying position promotes drainage of emesis and secretions from the mouth, reducing the risk of aspiration. Although accurate assessment of intake and output is important, prevention of aspiration is the priority. Dehiscence is not probable at this time; it is more common 5 to 7 days after surgery. Although the antiemetic may prevent additional vomiting, the nurse's priority is to prevent aspiration.