Quizlet: Lower GI Exame 4

Iggy Review 52.6 A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How would the nurse respond? A. "A change in position may be what is needed for you to have intercourse with your wife." B. "You must get clearance from your primary health care provider before you attempt to have intercourse." C. "What has your wife said about your pouch system?" D. "Have you considered going to see a marriage counselor with your wife?"

A The nurse tells the client who had an emergency ileostomy that a simple change in positioning during intercourse may alleviate apprehension and facilitate sexual relations with his wife. Suggesting marriage counseling may address the client's concerns, but it focuses on the wrong issue. The client has not stated that he has relationship problems. Asking the client what his wife has said about the pouch may address some of the client's concerns, but it similarly focuses on the wrong issue.

Iggy Review 51.15 The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) A. Yoga B. Acupuncture C. Peppermint oil capsules D. Decreasing physical activities E. Meditation

A, B, C, E Possible treatment modalities the nurse suggests for a client with IBS include: acupuncture, meditation, peppermint oil capsules, and yoga. Acupuncture is recommended as a complementary therapy for IBS. Meditation, yoga, and other relaxation techniques help many patients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.

Iggy Review 48.11 Which factor does the nurse identify that places a client at risk for gastrointestinal (GI) problems? (Select all that apply.) A. Smoking a half-pack of cigarettes per day B. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) C. Financial concerns D. Eating a high-fiber diet E. Use of herbal preparations

A, B, C, E Smoking or any tobacco use places a client in a higher-risk category for GI problems. Financial concerns can also influence the risk for GI problems; clients may not be able to afford to seek care or treatment and may put off seeking help. Some herbal preparations contribute to GI problems, such as Ayurvedic herbs, which can affect appetite, absorption, and elimination. NSAIDs can predispose clients to peptic ulcer disease or GI bleeding.High-fiber diets are generally believed to be healthy for most clients.

Iggy MQ CH 48.2 Which teaching will the nurse include when educating a client who is scheduled to have an esophagogastroduodenoscopy (EGD)? Select all that apply. A. "Anesthesia will be used for sedation." B. "The procedure takes about 20 to 30 minutes to complete." C. "Informed consent will be needed prior to the procedure." D. "A separate test will be required to obtain any needed biopsies." E. "You will need to refrain from eating for at least 6 to 8 hours before the EGD."

A, B, D, E The nurse will teach the patient undergoing an EGD that informed consent is required; anesthesia will be used for purposes of sedation during the procedure; the procedure lasts 20-30 minutes; and to refrain from eating 6-8 hours before the procedure. Specimens for biopsy and cell studies can be obtained through the endoscope, so a separate procedure is not needed.

Iggy NCLEX Ch 48.1 Which daily behavior of a client with GI problems requires further nursing assessment? Select all that apply. A. Smokes a pack of cigarettes B. Uses Fleet enemas frequently to assist with bowel movements C. Practices intentional relaxation D. Eats multiple servings of fruits E. Takes 325 mg of aspirin at night for arthritic pain F. Exercises for 30 minutes three times weekly G. Travels extensively across the world

A, B, E, G Smoking has been linked with an increased risk for most GI cancers; the nurse will need to obtain a full smoking history. If a client must use an enema frequently to assist with having bowel movements, further assessment is indicated. Aspirin and NSAID use can contribute to rectal bleeding, so this should be further assessed. Water and food variations from around the globe can impact GI health; therefore, the nurse will need to further assess the client's travel and nutrition history. Client behaviors of practicing intentional relaxation, eating multiple servings of fruit, and exercising are healthy behaviors that do not require further assessment.

Giddens Ch 17.6 The home health nurse is caring for a patient experiencing constipation. The patient asks the nurse how to prevent constipation. Which recommendations should the nurse include in their answer to the patient? (Select all that apply.) A. Increase activity or exercise. B. Avoid eating fruits with seeds. C. Increase fiber in the diet. D. Defecate when the urge is felt. E. Drink at least 1500 mL of water per day.

A, C, D, E Drinking at least 1500 mL of water, increased activity or exercise and fiber, and defecating when the urge is felt are measures that increase GI peristalsis and soften stool and thus help to avoid constipation. Eating fruits with seeds (raspberries, apples, strawberries, etc.) does not need to be avoided, rather many of them are high in fiber and should be encouraged.

Iggy Review 52.19 The nurse is caring for a client who has an enterocutaneous fistula. For what complications will the nurse monitor? (Select all that apply.) A. Skin breakdown B. Hyperkalemia C. Malnutrition D. Hypernatremia E. Dehydration F. Bowel obstruction

A, C, E The client has an abnormal tunneling between the small intestines and the skin causing spillage of the GI contents onto the skin. Enzymes in the intestines can break down skin and underlying tissues. The intestinal contents are also rich in fluids and electrolytes, especially potassium, such that the client would likely develop hypokalemia rather than hyperkalemia. Loss of fluids could lead to dehydration if the client is not carefully monitored and managed.

Iggy MQ Ch 51.1 The nurse is caring for a client with a complete large bowel obstruction. What assessment findings would the nurse expect? Select all that apply. A. Obstipation B. Dehydration C. Metabolic alkalosis D. Abdominal distention E. Abdominal pain F. Profuse vomiting

A, D, E

Iggy Review 51.17 The nurse is reviewing medications that can be used for female clients who have constipation-predominant irritable bowel syndrome (IBS). Which drugs are available for this health problem? (Select all that apply.) A. Lubiprostone B. Cetuximab C. 5-fluorouracil D. Psyllium hydrophilic mucilloid E. Linaclotide

A, D, E Cetuximab and 5-fluorouracil are chemotherapeutic drugs used for clients who have colorectal cancer. The other drugs are available for female clients who have constipation-predominant IBS.

Iggy NCLEX Ch 48.3 Which teaching will the nurse provide to a community group about early detection of colorectal cancer? Select all that apply. A. Home testing kits are available with a prescription. B. Sigmoidoscopy should be performed every 10 years. C. People over 40 years old should be tested for colon cancer. D. Bowel preparation is necessary prior to performance of a colonoscopy. E. Virtual colonoscopies (CT colonography) can be performed every 5 years.

A, D, E The nurse will teach that (1) home testing kits are available with a prescription, (2) bowel preparation is necessary prior to undergoing a traditional colonscopy to ensure precise visualization of the colon; and (3) virtual colonoscopies (CT colonography) can be performed every 5 years, per the American Cancer Society (2019). Sigmoidoscopies should be performed every 5 years, and individuals over the age of 45 should be tested for colon cancer.

Iggy Review 52.11 The nurse is teaching a client about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advise the client? A. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." B. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." C. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet." D. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation."

B "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." The nurse teaches the client that the most effective way to manage diverticulitis is to consume a low-fiber diet while inflammation is present, followed by a high-fiber diet once the inflammation has subsided.Neither an exclusively low-fiber diet nor an exclusively high-fiber diet will effectively manage diverticulitis. A high-fiber diet while diverticulitis is active will only worsen the disease and its symptoms.

Iggy Review 52.18 The nurse is preparing to administer natalizumab for a client who has Crohn disease (CD). What is the most important client assessment for the nurse to perform before giving this drug? A. Skin integrity B. Body temperature C. Peripheral pulses D. Breath sounds

B Because this drug may cause a deadly infection that affects the brain (progressive multifocal leukencephalopathy [PML]), the nurse would want to ensure that the client does not have any type of infection. Assessing body temperature is one way to determine the presence of infection.

Iggy Review 51.10 A client with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? A. Decrease in liver function test results B. Elevated carcinoembryonic antigen C. Negative test for occult blood D. Elevated hemoglobin levels

B Carcinoembryonic antigen may be elevated in many patients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

Iggy Review 52.2 The nurse is teaching a group of senior citizens in a residential facility about how to prevent gastrointestinal (GI) infectious outbreaks, such as norovirus. What information will the nurse include as a priority intervention for the group? A. Keeping at least 6 feet apart B. Handwashing and hand sanitizing C. Avoiding group dining D. Cooking all food and boiling water

B GI infections like norovirus are typically transmitted via the fecal-oral route. Therefore, handwashing and using hand sanitizers frequently is the best method to promote health and prevent infection.

Iggy Review 48.4 The nurse is teaching an older adult client. Which gastrointestinal problem does the nurse discuss that takes place during the normal aging process? A. Increased peristalsis B. Decreased hydrochloric acid levels C. Increased liver size D. Excess lipase production

B In older adults, decreased hydrochloric acid levels (hypochlorhydria) results from atrophy of the gastric mucosa.A decrease in lipase production results from calcification of pancreatic vessels. A decrease in the number and size of hepatic cells leads to decreased liver weight and mass. Peristalsis decreases, and nerve impulses are dulled.

Iggy Review 48.3 The nurse and health care provider are discussing a client who has pernicious anemia. The nurse anticipates that the client has which deficiency? A. Hydrochloric acid B. Intrinsic factor C. Glucagon D. Pepsinogen

B Intrinsic cells are produced by the parietal cells in the stomach. This substance facilitates the absorption of vitamin B12. Absence of intrinsic factor causes pernicious anemia.Glucagon, which is produced by the alpha cells in the pancreas, is essential for the regulation of metabolism. Parietal cells secrete hydrochloric acid, but this does not facilitate the absorption of vitamin B12. Pepsinogen is secreted by the chief cells; pepsinogen is a precursor to pepsin, a digestive enzyme.

Iggy Review 52.3 The nurse is assessing an older client who has had frequent vomiting and diarrhea for the last 24 hours. Which vital sign change would be of most concern to the nurse? A. Increased oxygen saturation B. Decreased blood pressure C. Increased temperature D. Decreased pulse rate

B Older clients are most at risk for dehydration from loss of fluids. Older clients who have dehydration usually have an increased pulse and decreased blood pressure (BP). When BP decreases, the client is at risk for orthostatic hypotension which can cause dizziness and subsequent falls. The client may also experience an elevated temperature, but this change is less common in older adults when compared to their younger counterparts.

Iggy Review 52.7 The nurse is reinforcing teaching provided by the registered dietitian nutritionist about dietary restrictions needed for a client who has a new ileostomy. Although each client can tolerate different foods, what food would the nurse suggest that the client avoid? A. Potatoes B. Corn C. Bread D. Green beans

B The client should avoid gas-forming foods like cabbage and foods that contain indigestible fiber such as nuts and corn.

Iggy Review 51.4 The nurse is teaching a client with irritable bowel syndrome (IBS) who has frequent constipation. Which statement by the client shows an accurate understanding of the nurse's teaching? A. "Maintaining a low-fiber diet will manage my constipation." B. "I need to go for a walk every day if possible." C. "Limiting the amount of fluid that I drink with meals is very important." D. "A cup of caffeinated coffee with cream & sugar at dinner is OK for me."

B The client statement, "I need to go for a walk every evening," shows that the client accurately understands the nurse's teaching plan to treat IBS. Walking every day is an excellent exercise for promoting intestinal motility. Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages.

Iggy Review 52.9 The nurse is caring for a client admitted with a long-term diagnosis of ulcerative colitis (UC). For what potentially life-threatening complication would the nurse monitor? A. Chronic kidney disease B. Lower gastrointestinal (GI) bleeding C. Metabolic acidosis D. Hyperkalemia

B The client who has UC is at most risk for lower GI bleeding due to inflammation and diarrhea. The client with UC is also at risk for hypokalemia and metabolic alkalosis as a result of losing intestinal contents through diarrhea.

Iggy Review 52.8 A client developed gastroenteritis while traveling outside the country. What is the most likely cause of the client's symptoms? A. Overcooked food B. Ingestion of parasites in the water C. Insufficient vaccinations D. Bacteria on the patient's hands

B The likely cause of gastroenteritis when a client travels outside the country is ingestion of water that is infested with parasites. Bacteria on the client's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.

Iggy NCLEX 52.3 The nurse is teaching a client about nutrition and diverticulosis. Which food will the nurse teach the client to avoid? A. Cucumber B. Beans C. Carrot D. Radish

A

Iggy NCLEX Ch 51.2 A client had an open partial colectomy and colostomy placement 6 hours ago. Which assessment would concern the nurse? A. Purple, moist stoma B. Stoma edema C. Liquid stool collecting in the drainage bag D. Serosanguineous fluid draining from the drain(s)

A

Iggy Review 48.10 While working in the outpatient procedure unit, the RN is assigned to four clients. Which client will the nurse assess first? A. A 51 year old who just had an endoscopic retrograde cholangiopancreatography (ERCP). B. A 58 year old who has just arrived for a sigmoidoscopy. C. A 60 year old with questions about an endoscopic ultrasound examination. D. A 54 year old who is ready for discharge following a colonoscopy.

A ERCP requires conscious sedation, so the client needs immediate assessment of respiratory and cardiovascular status. The endoscopic procedure and nursing care for a client having an ERCP are similar to those for the EGD procedure, except that the endoscope is advanced farther into the duodenum and into the biliary tract.A 54-year-old client being discharged after a colonoscopy, a 58-year-old client who is going to have a sigmoidoscopy, and a 60-year-old client with questions about an endoscopic ultrasound examination are not at risk for depressed respiratory status. They can all be seen following the client who just had an ERCP.

Giddens Ch 17.4 A patient with a history of cardiac problems talks with the nurse about bowel elimination. The nurse stresses to the patient not to strain during bowel movements. Straining can put pressure on the vagas nerve and cause bradycardia. Which physiological function is the nurse explaining? A. Valsalva maneuver B. First-degree heart block C. Eupnea D. Tachypnea

A The Valsalva maneuver happens when the cardiac patient strains to have a bowel movement. First-degree heart block is not brought on by straining. Eupnea means normal respirations and tachypnea means fast respirations; neither has any connection to straining during a bowel movement.

Iggy Review 48.6 The nurse is assessing an alert client who had abdominal surgery yesterday. Which assessment method will the nurse use to most accurately determine whether peristalsis has resumed? A. Ask if the client has passed flatus (gas) within the previous 12 to 24 hours. B. Perform auscultation with the diaphragm of the stethoscope. C. Listen for bowel sounds in all abdominal quadrants. D. Count the number of bowel sounds in each abdominal quadrant over 1 minute.

A The best and most reliable method for assessing the return of peristalsis following abdominal surgery is the client's report of passing flatus within the past 8 hours or stool within the past 12 hours.Although auscultation and counting the number of sounds can help to assess for bowel activity, it is not the most reliable method.

Giddens Ch 17.3 The nurse is caring for a patient with a colostomy of the ascending colon. What would the nurse expect of the stool in the colostomy device? A. Stool would be loose. B. Stool would have flecks of blood. C. Stool would be dark. D. Stool would be formed.

A The correct answer is C because stool in the ascending colon is loose or watery because it has not passed through much of the colon for water to have been reabsorbed. Stool should not be dark or have flecks of blood. These would be abnormal findings. Stool would not be formed, because the colon has not reabsorbed the water yet.

Iggy Review 51.7 A 67-year-old male client with no surgical history reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? A. Reducible B. Strangulated C. Incarcerated D. Femoral

A The hernia is reducible because its contents can be pushed back into the abdominal cavity.Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. An incarcerated or irreducible hernia cannot be reduced or placed back into the abdominal cavity. Any hernia that is not reducible requires immediate surgical evaluation.

Iggy Review 52.17 A client with ulcerative colitis (UC) is prescribed sulfasalazine and corticosteroid therapy. As the disease improves, what change does the nurse expect in the client's medication regimen? A. Corticosteroid therapy will be tapered. B. Corticosteroid therapy will be stopped. C. Sulfasalazine will be stopped. D. Sulfasalazine will be tapered.

A The nurse expects that corticosteroid therapy will be tapered as the UC improves in the client who was taking both sulfasalazine and corticosteroids. Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period.Stopping corticosteroid therapy abruptly is unsafe—steroids must be gradually decreased in patients. Usually the amount that they have been taking dictates how quickly or slowly they can be stopped. Sulfasalazine therapy will be taken on a long-term basis. It may be increased or decreased, depending on the patient's symptoms, but will likely never be stopped. These decisions are made over a long period of therapy.

Iggy Review 52.13 A client returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after being situated in bed? A. Semi-Fowler B. Lateral Sims' (side-lying) C. High Fowler D. Supine

A The nurse places the postoperative abdominal laparotomy client in the semi-Fowler position in bed. The client is maintained in this position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion.High-Fowler position would be too high for the client postoperatively. It would place strain on the abdominal incision(s), and, if the client was still drowsy from anesthesia, this position would not enhance the client's ability to rest. Sims' position does not promote drainage to the lower abdomen. The supine position does not facilitate drainage to the abdomen or increased lung expansion. The client would be more likely to develop complications (wound drainage stasis and atelectasis) in the supine position.

Iggy Review 52.15 The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include? A. A slice of 5-grain bread B. Strawberries (1 cup [160 g]) C. Tomato (1 medium) D. Chuck steak patty (6 ounces [170 g])

A The nurse suggests to the client with recently diagnosed diverticular disease to include a slice of 5-grain bread in the diet. Whole-grain breads are recommended to be included in the diet of clients with diverticular disease because cellulose and hemicellulose types of fiber are found in them. Dietary fat would be reduced in clients with diverticular disease.If the client wants to eat beef, it must be of a leaner cut. Foods containing seeds, such as strawberries, must be avoided. Tomatoes would also be avoided unless the seeds are removed. The seeds may block diverticula in the patient and present problems leading to diverticulitis.

Iggy Review 52.10 The nurse is teaching a client with Crohn disease about managing the disease with the adalimumab Which instruction does the nurse emphasize to the client? A. "Do not take the medication if you are allergic to foods with fatty acids." B. "Avoid large crowds and anyone who is sick." C. "Monitor your blood pressure and report any significant decrease in it." D. "Expect difficulty with wound healing while you are taking this drug."

B The nurse emphasizes that the client taking adalimumab for Crohn disease needs to avoid being around large crowds to prevent developing an infection. Adalimumab (Humira), a biological response modifier (BRM), also known as a monoclonal antibody drug, has been approved for use in Crohn disease when other drugs have been ineffective. BRMs are approved for refractory (not responsive to other therapies) cases. These drugs cause immunosuppression and should be used with caution. Clients must be taught to report any signs of a beginning infection, including a cold, and to also avoid others who are sick.The client would not take the medication if he or she is allergic to certain proteins. Although immune suppression may occur to some degree, the client would not experience difficulty with wound healing while taking adalimumab. Also, the client would not experience a decrease in blood pressure from taking this drug.

Iggy Review 52.14 A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices? A. "Raw vegetables and high-fiber foods may help to diminish your symptoms." B. "Lactose-containing foods should be reduced or eliminated from your diet." C. "Drinking carbonated beverages will help with your abdominal distress." D. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day."

B The nurse teaches the newly diagnosed client with ulcerative colitis that lactose-containing foods are often poorly tolerated and need to be reduced or eliminated from the diet.Carbonated beverages are GI stimulants that can cause discomfort and must be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms. Nurses would never advise patients that any amount of cigarette smoking is "OK." Raw vegetables and high-fiber foods can cause GI symptoms in patients with UC.

Iggy Review 48.7 The nurse is assessing a very thin client who has come to the emergency department with acute abdominal pain. Upon assessment, visible peristaltic movements are noted. What is the appropriate nursing action? A. Prepare to administer antibiotics as prescribed. B. Report finding to the health care provider. C. Monitor laboratory values for possible pancreatitis. D. Toilet quickly as diarrhea is imminent.

B The nurse will report the finding to the health care provider, as it is possible that the client has an obstruction. Peristaltic movements are rarely seen except in thin clients.Acute diarrhea does not cause visible peristaltic movements. Pancreatitis is not characterized by visible peristaltic movement. The client likely has an obstruction, not an infection.

Iggy Review 48.2 A client is preparing to undergo a stool DNA (sDNA) test to screen for colon cancer. What preprocedure teaching does the nurse provide? A. "Do not eat or drink anything for 12 hours before the test." B. "No special preparation is needed prior to completing this test." C. "Give yourself tap water enemas until the fluid returns are clear." D. "Begin a clear liquid diet at least 24 hours before the test."

B The nurse will teach the client that no special preparation is needed prior to completing the Cologuard test. Cologuard is a home screening test that the client can perform at any time, with no traditional bowel cleaning preparation or fasting necessary.

Iggy Review 52.16 An older client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? A. Obtain a stool specimen for culture and sensitivity. B. Start an IV solution of 5% dextrose in 0.45 normal saline. C. Draw blood for a complete blood count and serum electrolytes. D. Administer acetaminophen 650 mg rectally.

B The request the nurse implements first is to start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. Although the dextrose 5% in 0.45% sodium chloride is hypertonic in the IV bag, once it is infused, the glucose is rapidly metabolized and the fluid is really hypotonic. Fluid therapy is the focus of treatment for clients with gastroenteritis. Older clients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure.Acetaminophen 650 mg should be administered rectally soon, and blood draws and stool specimen collection would also be implemented soon, but prevention and treatment of dehydration are the priorities for this client.

Iggy NCLEX 52.1 A client had an exploratory laparotomy to treat the cause of peritonitis and has a large incision that is closed with staples and two abdominal drains. Which finding(s) would the nurse report immediately to the surgeon? Select all that apply. A. Serosanguineous drainage B. Increased abdominal distention C. Fever and chills D. Pain level 2 on a scale of 0 to 10 E. Passing flatus

B, C

Iggy MQ 52.2 A client had a colectomy with creation of an ileo-anal pouch and temporary ileostomy yesterday morning. The nurse assesses the ostomy and its functioning. Which assessment finding will the nurse report to the primary health care provider? A. Client's report of abdominal pain of 3 on a 0 to 10 pain intensity scale B. Slight abdominal distention C. No drainage from the ileostomy D. Serosanguinous effluent from the drain

C

Iggy MQ Ch 51.2 A client has a new diagnosis of irritable bowel syndrome (IBS) with diarrhea. What health teaching by the nurse is appropriate for this client? A. "Take a stool softener every day to ease defecation." B. "Avoid high-fiber foods in your diet." C. "Avoid dairy products and caffeinated beverages." D. "Ask your primary health care provider for an antidepressant."

C

Iggy NCLEX Ch 51.3 A nurse provides discharge teaching for a male client who had a minimally invasive hernia repair this morning. Which statement by the client indicates a need for further teaching? A. "I should avoid coughing if at all possible." B. "I can shower in a day or two after I remove my surgical bandage." C. "I can't go back to work for at least 6 weeks." D. "I should use an ice pack to help relieve my pain."

C

Iggy Review 51.2 A client who has colorectal cancer is scheduled for a colostomy. Which referral is initially the most important for this client? A. Home health nursing agency B. Social worker C. Certified Wound, Ostomy, and Continence Nurse (CWOCN) D. Hospital chaplain

C A CWOCN (or an enterostomal therapist) will be of greatest value to the client with colorectal cancer because the client is scheduled to receive a colostomy.The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

Iggy NCLEX Ch 48.2 While performing an abdominal assessment on a client, the nurse notes a bruit over the aorta. What is the appropriate nursing action? A. Consult another nurse to verify the bruit B. Auscultate each quadrate for 5 minutes each C. Notify the health care provider of the findings D. Perform light palpation to further assess the pulsation

C A bruit (a "swooshing" sounds) over the abdominal aorta usually indicates the presence of an aneurysm. If this sound is heard, the nurse should stop the assessment, and refrain from percussing or palpating the abdomen. It is not necessary to consult another nurse to verify the findings. It is of critical importance to notify the healthcare provider immediately of the findings

Iggy Review 51.8 A male client is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which statement by the client indicates a need for further teaching about this procedure? A. "I may have trouble urinating immediately after the surgery." B. "My chances of having complications after this procedure are slim." C. "I will need to stay in the hospital overnight." D. "I will not eat after midnight the day of the surgery."

C A need for further teaching about MIIHR is when the patient says, "I will need to stay in the hospital overnight." Usually, the patient is discharged 3 to 5 hours after MIIHR surgery.Male patients who have difficulty urinating after the procedure would be encouraged to force fluids and to assume a natural position when voiding. Patients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most patients who have MIIHR surgery have an uneventful recovery.

Iggy Review 51.9 The nurse is teaching an older client how to prevent a stool impaction that can obstruct the intestines. Which statement by the client indicates a need for further teaching? A. "I will drink lots of fluids every day, especially water." B. "I will increase my exercise, especially walking, every day." C. "I will be sure to take a laxative every night to keep my bowels moving." D. "I will try to eat more high-fiber foods, such as raw vegetables and whole grains."

C All of these statements are correct except that the client should not take laxatives because they can decrease the tone of the abdominal muscles.

Giddens Ch 17.2 The nurse is caring for a confused patient who is wearing a vest restraint in bed. The nurse speaks with an unlicensed assistant about toileting the patient. The nurse knows the unlicensed assistant understands the toileting procedure when making which statement? A. The patient must remain in the restraints all day. B. The patient will use the call bell when he or she feels the urge to void. C. The patient needs to be toileted to maintain a regular toileting schedule. D. The patient needs to be provided with adult briefs for incontinence.

C The correct answer is toileting the patient so he or she can maintain a normal toileting schedule. Leaving the patient in restraints all day is against the standard of care. Providing the patient with briefs when he or she is not incontinent does not meet the patient's toileting needs.

Iggy Review 51.6 The Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a client with colorectal cancer how to care for a newly created colostomy. Which statement by the client indicates a correct understanding of the necessary self-management skills? "If I have any leakage, I'll put a towel over it." "I can put aspirin tablets in the pouch in order to reduce odor" "I will apply a nonalcoholic skin sealant and let it dry before applying the bag." "I will have my spouse change the bag for me."

C The nurse would teach the client and family to apply a skin sealant (preferably without alcohol) and allow it to dry before application of the appliance (colostomy bag) to facilitate less painful removal of the tape or adhesive. It is not realistic that the spouse will always change the patient's bag and does not reflect correct understanding of self-management skills. A towel is not an acceptable or effective way to cope with leakage. Putting an aspirin in the pouch will not reduce odor and can lead to ulcers in the stoma.offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place patients on the defense and are not therapeutic because they close the conversation.

Iggy Review 51.5 A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The client asks whether he will inherit the disease. How would the nurse respond? A. "Have you asked your primary health care provider about your chances ?" B. "It is hard to know what can predispose a person to develop a certain disease." C. "The only way to know whether you are predisposed to CRC is by genetic testing." D. "No. Just because they both had CRC doesn't mean that you will have it, too."

C The nurse's best response to the client who asks if he will inherit CRC is "the only way to know whether you are predisposed to CRC is by genetic testing." Genetic testing is the only definitive way to determine whether the patient has a predisposition to develop CRC.

Iggy Review 51.13 The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which statement by the client demonstrates a correct understanding of the nurse's instructions? A. "I will take laxatives after the surgery to 'keep things moving?0'." B. "To help with the pain, I'll apply ice to the surgical area." C. "I will need to eat a diet high in fiber, including raw vegetables." D. "Limiting my fluids will help me with constipation."

C The statement that shows that the hemorrhoidectomy patient correctly understands the nurse's instruction is, "I will need to eat a diet high in fiber." A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements.Laxatives are discouraged because they can be habit-forming and decrease abdominal muscle tone. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications.

Iggy Review 51.14 The nurse is caring for a client who had an anterior-posterior surgical resection for colorectal cancer this morning. What will the nurse anticipate as the client's priority problem at this time? A. Intestinal obstruction B. Nausea and vomiting C. Severe pain D. Constipation

C The surgical incisions are in the perineal area and are very painful due to the number of nerves in that region of the body. Pain control is the biggest challenge for the nurse and health care team to promote client comfort.

Iggy Review 48.12 A hospitalized client with ongoing abdominal tenderness reports an increase in generalized abdominal pain today. Which assessment technique will the nurse perform? (Select all that apply.) A. Percuss to determine size of liver and spleen. B. Auscultate beginning in the RLQ. C. Visually observe for contour and symmetry. D. Ask for a pain scale rating on a scale of 0-10. E. Deeply palpate the area of tenderness.

C, D The abdominal assessment is performed in the order of inspection, auscultation, percussion, and palpation. The nurse will visually observe the abdomen for contour and symmetry, auscultate beginning in the RUQ (not the RLQ), lightly palpate for any large masses or areas of tenderness, ask the client to rate the pain level on a 0-10 scale, and document the findings.The nurse will not perform deep palpation nor percussion, as the health care provider conducts this portion of the examination.

Iggy MQ: Ch 48.1 Immediately following a colonoscopy, which client behavior will the nurse report to the health care provider? Select all that apply. A. Passing of flatus B. Blood pressure 128/80 mm Hg C. Abdominal guarding D. Change in mental status E. Report of mild abdominal cramping

C, D The nurse will report abdominal guarding, as this can be a sign of bowel perforation. The nurse will also report any changes in mental status, as this can be a sign of hypovolemic shock. In older adults, this is often the first sign. A blood pressure of 128/80, and reports of mild abdominal cramping, are considered normal findings that do not require the nurse to notify the healthcare provider.

Giddens Ch 17.1 The patient talks with the nurse about bladder health. What is one of the most important recommendations the nurse can make for this patient A. Visit the urologist once yearly. B. Exercise in the morning and evening. C. Eat foods high in fiber. D. Drink six to eight glasses of noncaffeinated fluids daily.

D Drinking six to eight glasses of noncaffeinated fluids daily helps with bladder health because urine is not stagnating in the bladder. Exercising and eating foods high in fiber help with bowel elimination but do not have an effect on urination. Visiting the urologist is good if there is a problem, but this is not the most important recommendation from the nurse.

Iggy Review 48.5 A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? A. Has the client lie in a supine position with legs straight and arms above the head. B. Assesses the following sequence: inspection, palpation, percussion, auscultation. C. Palpates any bulging mass very gently and documents findings. D. Examines the RUQ of the abdomen last following all other assessment techniques.

D If the client reports pain in the RUQ, the nurse examines this area last. This sequence prevents the client from tensing abdominal muscles because of the pain, which would make the assessment difficult.The sequence for examining the abdomen is inspection, auscultation, percussion, and then palpation. This sequence prevents the increase in intestinal activity and bowel sounds caused by palpation and percussion. The client would be positioned supine with the knees bent while keeping the arms at the sides to prevent tensing of the abdominal muscles. If a bulging, pulsating mass is present during assessment of the abdomen, the nurse must never touch the area because the client may have an abdominal aortic aneurysm, a life-threatening problem. The nurse would notify the health care provider of this finding immediately!

Iggy Review 52.5 The nurse is teaching a client about caring for a new ileostomy. What information is most important to include? A. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." B. "Remember that you must wear a pouch system at all times." C. "Notify the primary health care provider if output from your stoma has a sweetish odor." D. "Call your primary health care provider if your stoma has a bluish or pale look."

D It is most important for the nurse to tell the client with a new ileostomy to call the primary health care provider if the stoma has a bluish or pale look. If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the primary health care provider must be notified immediately.

Iggy Review 52.4 The nurse is preparing to provide health teaching for a client who is starting sulfasalazine. Which statement by the client indicates a need for further teaching? A. "I'll let my primary health care provider know if the drug upsets my stomach." B. "I will be sure to take a folic acid supplement while on this drug." C. "I will follow up with getting labs done to check my blood counts." D. "This drug can make me dehydrated because I'm already on a diuretic."

D Sulfasalazine can cause nausea and vomiting, and can interfere with folic acid absorption. In high doses, it can also cause anemia and agranulocytosis, so blood work would be important for ongoing monitoring. However, the drug does not cause dehydration.

Iggy Review 51.11 The nurse is providing teaching on ways to promote bowel health and disease prevention. Which statement will the nurse include in this teaching? A. "You should start colorectal cancer screening when you are over 70 years of age." B. "You only need to have regular colonoscopies if there is colorectal cancer in your family.' C. "If you perform fecal occult blood tests every 5 years, you don't need a colonoscopy." D. "You should have a colonoscopy every 10 years starting at 45 years of age."

D The American Cancer Society recommends that for individuals of average risk for colorectal cancer (CRC), a colonoscopy every 10 years or flexible sigmoidoscopy every 5 years is adequate. The screening should begin for adults of 45 years of age or older unless individuals are at high risk for CRC.

Iggy Review 48.9 Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit? A. A 40 year old who needs administration of IV midazolam hydrochloride during an upper endoscopy. B. A 36 year old who needs teaching about an endoscopic retrograde cholangiopancreatography. C. A 46 year old who is admitted with abdominal cramping and diarrhea of unknown causes. D. A 32 year old with constipation who has received a laxative.

D The LPN/LVN can best assist the RN by monitoring the client with constipation who has received a laxative.Assessment, IV hypnotic medication administration, and client teaching must be done by an RN.

Iggy Review 51.12 A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. After a complete assessment, what action would the nurse plan implement at this time? A. Change the nasogastric suction level from "intermittent" to "continuous." B. Administer medication for pain based on the client's pain level. C. Position the client in a semi- or high-Fowler position. D. Prepare the client for emergency surgery in collaboration with the health team.

D The appropriate nursing action for a client with intestinal obstruction whose pain changes from "colicky" intermittent type to constant discomfort is to prepare surgery because this change is most likely indicative of perforation or peritonitis and will require immediate surgical intervention.Pain medication may mask the client's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the client's pain and could be particularly ineffective if a nonvented tube is in use.

Iggy Review 52.1 A client is admitted to the hospital with right lower quadrant abdominal pain, nausea, and vomiting. What assessment would the nurse monitor to identify a potentially life-threatening complication based on the client's condition? A. Intake and output B. Electrolyte values C. Abdominal assessment D. Vital signs

D The client most likely has appendicitis which can result in perforation of the appendix and peritonitis. If this complication occurs, the client would develop tachycardia and a fever. Therefore, the nurse would monitor for changes in vital signs.

Iggy Review 48.8 Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient gastrointestinal (GI) clinic? A. Client admitted with nausea, abdominal pain, and abdominal distention. B. Client who needs discharge teaching after an endoscopic retrograde cholangiopancreatography (ERCP). C. Client with epigastric pain who needs conscious sedation during endoscopy. D. Client who has had laxatives administered and needs monitoring before a colonoscopy.

D The client who needs laxatives administered and effectiveness monitored before a colonoscopy is the least complicated client. This client would be assigned to the float nurse who would have the experience and education to adequately care for this client.Discharge instructions following an ERCP, assessment of an admitted acutely ill client, and monitoring a client who is receiving conscious sedation is accomplished best by a nurse with experience in caring for adults with acute GI problems.

Iggy Review 51.3 The home health nurse is teaching a client about the care of a new colostomy. Which statement by the client demonstrates a correct understanding of the health teaching? A. "If the skin around the stoma is red or scratched, it will heal soon." B. "I need to strive for a very tight fit when applying the barrier around the stoma." C. "A dark or purplish-looking stoma is normal and would not concern me." D. "I need to check for leakage underneath my colostomy."

D The client's statement, "I need to check for leakage underneath my colostomy" shows that the patient correctly understands the instructions about how to care for a new colostomy. The pouch system must be checked frequently for evidence of leakage to prevent excoriation.A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma must be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

Iggy Review 52.12 A client who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What intervention would the nurse recommend for the client to do? A. "Avoid all solid foods to allow complete bowel rest." B. "Take an over-the-counter antidiarrheal medication." C. "Contact your primary health care provider for an antibiotic medication." D. "Consume extra fluids to replace fluid losses."

D The nurse tells the client to drink extra fluids to replace fluid lost through vomiting and diarrhea.It is not necessary to stop all solid food intake. Antidiarrheal medications are used if diarrhea is severe. Antibiotics are used if the infection is bacterial.

Giddens Ch 17.5 The nurse is talking with a patient who was just diagnosed with a urinary tract infection. The patient asks the nurse how to prevent such infections in the future. The nurse should make which appropriate recommendations for the patient? (Select all that apply.) A. Increase fiber in the diet. B. Eat fruit twice daily. C. Exercise daily. D. Drink six to eight glasses of noncaffeinated fluids daily. E. Void when the urge is felt.

D, E Drinking noncaffeinated drinks and voiding when the urge happens are the most appropriate measures for avoiding a urinary tract infection. Increasing fiber, exercising, and eating fruit do not prevent a urinary tract infection.

Iggy Review 51.16 The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods should be avoided? (Select all that apply.) A. Mushrooms B. Peas C. Onions D. Broccoli E. Buttermilk F. Yogurt

A, B, C, D Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: broccoli, mushrooms, onions, and peas. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

Iggy NCLEX 52.2 The nurse is caring for an older adult client who experiences an exacerbation of ulcerative colitis with severe diarrhea and rectal bleeding that have lasted a week. For which complication(s) will the nurse assess? Select all that apply. A. Increased BUN B. Hypokalemia C. Leukocytosis D. Anemia E. Hyponatremia

A, B, C, D, E

Iggy NCLEX Ch 51.1 The nurse is talking with a group of older clients about colorectal cancer (CRC) risk factors. Which of the following factors are considered to be common CRC risk factors? Select all that apply. A. High-fat diet B. Crohn's disease C. Smoking D. Alcoholism E. Family history of cancer F. Obesity

A, B, C, D, E, F

Iggy Review 52.20 The nurse is teaching a family how to prevent the client's transmission of gastroenteritis at home. Which instructions will the nurse include in the health teaching? (Select all that apply.) A. "Clean and disinfect all bathrooms often to avoid stool exposure." B. "Everyone in the home should wash their hands for at least 30 seconds with an antibacterial soap using friction." C. "Contact the primary health care provider if GI symptoms last more than 3 days." D. "Wear a mask at home to prevent transmission of the disease." E. "Do not share dishes, glasses, and silverware among members of the family."

A, B, C, E All of these interventions are important to prevent the spread of gastroenteritis except there is no need to wear a mask because the disease is spread via the fecal-oral route rather than by droplets.

Iggy MQ 52.1 The nurse is caring for a client with peritonitis from a perforated appendix. Which abdominal assessment finding will the nurse most likely expect? A. Soft abdomen B. Board-like abdomen C. Slightly distended abdomen D. Absent bowel sounds

B

Iggy Review 51.1 A client has a nasogastric tube (NGT) connected to low continuous suction. What is the nurse's priority to ensure client safety? A. Assess for peristalsis at least once every 8 to 12 hours. B. Assess placement of the NGT for placement every 4 hours. C. Measure the gastric drainage every 8 to12 hours and document. D. Monitor the nasal skin and membranes around the tube for irritation.

B Assessing the NGT for placement every 4 hours can help prevent aspiration which could lead to pneumonia. The other actions are appropriate for some clients, checking tube placement is the priority for care.

Iggy Review 48.1 A client is being observed after a routine sigmoidoscopy with a tissue biopsy. Which assessment finding will the nurse report to the health care provider? A. Flatulence B. Rectal bleeding C. Mild abdominal pain D. Borborygmi

B Bleeding is a possible complication following a sigmoidoscopy. It must be reported immediately to the health care provider.Mild abdominal pain (usually gas pain) and flatulence are expected findings after a sigmoidoscopy. Borborygmi may be heard, especially if the client is hungry if they have followed a clear liquid diet prep before the procedure.