Block 3 Final: GI

The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? 1. "The cimetidine (Tagamet) will cause me to produce less stomach acid." 2. "Sucralfate (Carafate) will change the fluid in my stomach." 3. "Antacids will coat my stomach." 4. "Omeprazole (Prilosec) will coat the ulcer and help it heal."

"The cimetidine (Tagamet) will cause me to produce less stomach acid."; Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.

Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,"If I lie still and avoid turning after the operation, I'll avoid pain. Do you think this is a good idea?" What is the best response? 1. "You'll need to turn from side to side every 2 hours." 2. "It's always a good idea to rest quietly after surgery." 3. "The doctor will probably order you to lie flat for 24 hours." 4. "Why don't you decide about activity after you return from the recovery room?

"You'll need to turn from side to side every 2 hours."

Which of the following symptoms is a client with colon cancer most likely to exhibit? 1. A change in appetite. 2. A change in bowel habit. 3. An increase in body weight. 4. An increase in body temp.

A change in bowel habit; The most common complaint of the client with colon cancer is a change in bowel habits. The client may have anorexia, secondary abdominal distention, or weight loss. Fever isn't associated with colon cancer.

Which of the following definitions best describes diverticulosis? 1. An inflamed outpouching of the intestine. 2. A noninflamed outpouching of the intestine. 3. The partial impairment of the forward flow of intestinal contents. 4. An abnormal protrusion of an organ through the structure that usually holds it.

A noninflamed outpouching of the intestine; Diverticulosis involves a noninflamed outpouching of the intestine. Diverticulitis involves an inflamed outpouching. The partial impairment of forward flow of the intestine is an obstruction; abnormal protrusion of an organ is a hernia.

Which of the following symptoms would a client in the early stages of peritonitis exhibit? 1. Abdominal distention. 2. Abdominal pain and rigidity. 3. Hyperactive bowel sounds. 4. Right upper quadrant pain.

Abdominal pain and rigidity; Abdominal pain causing rigidity of the abdominal muscles is characteristic of peritonitis. Abdominal distention may occur as a late sign but not early on.

Medical management of the client with diverticulitis should include which of the following treatments? 1. Reduced fluid intake. 2. Increased fiber in diet. 3. Administration of antibiotics. 4. Exercises to increase intra-abdominal pressure.

Administration of antibiotics; Antibiotics are used to reduce the inflammation.

Which of the following factors is believed to cause ulcerative colitis? 1. Acidic diet. 2. Altered immunity. 3. Chronic constipation. 4. Emotional stress.

Altered immunity; Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis.

The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? 1. Development of laryngeal cancer 2. Irritation of the esophagus 3. Esophageal scar tissue formation 4. Aspiration of gastric contents

Aspiration of gastric contents; Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents.

Which of the following nursing interventions should be implemented to manage a client with appendicitis? 1. Assessing for pain. 2. Encouraging oral intake of clear fluids. 3. Provide discharge teaching. 4. Assessing for symptoms of peritonitis.

Assessing for symptoms of peritonitis; The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity. Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which could be lethal.

The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan? 1. Restricting pain medication 2. Maintaining bedrest 3. Avoiding coughing 4. Irrigating the drain

Avoiding coughing; Coughing is avoided to prevent disruption of the tissue integrity, which can occur because of the location of this surgical procedure.

Which of the following tests should be administered to a client suspected of having diverticulosis? 1. Abdominal ultrasound. 2. Barium enema. 3. Barium swallow. 4. Gastroscopy.

Barium enema; A barium enema will cause diverticula to fill with barium and be easily seen on x-ray.

Which of the following tests can be performed to diagnose a hiatal hernia? 1. Colonoscopy 2. Lower GI series 3. Barium swallow 4. Abdominal x-ray

Barium swallow; A barium swallow with fluoroscopy shows the position of the stomach in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.

Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication? 1. Fistula 2. Bowel perforation 3. Bowel obstruction 4. Abscess

Bowel perforation; An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications.

Surgical management of ulcerative colitis may be performed to treat which of the following complications? 1. Gastritis. 2. Bowel herniation. 3. Bowel outpouching. 4. Bowel perforation.

Bowel perforation; Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery.

If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? 1. Abdominal CT scan. 2. Abdominal x-ray. 3. Barium swallow, 4. Colonoscopy with biopsy.

Colonoscopy with biopsy; A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development.

In a client with Crohn's disease, which of the following symptoms should not be a direct result from antibiotic therapy? 1. Decrease in bleeding. 2. Decrease in temp. 3. Decrease in body weight. 4. Decrease in number of stools.

Decrease in body weight; A decrease in body weight may occur during therapy due to inadequate dietary intake, but isn't related to antibiotic therapy. Effective antibiotic therapy will be noted by a decrease in temperature, number of stools, and bleeding.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? 1. Ineffective coping related to fear of diagnosis of chronic illness 2. Deficient knowledge related to unfamiliarity with significant signs and symptoms 3. Constipation related to decreased gastric motility 4. Imbalanced nutrition: Less than body requirements due to gastric bleeding

Deficient knowledge related to unfamiliarity with significant signs and symptoms; Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their physician.

Which of the following complications of gastric resection should the nurse teach the client to watch for? 1. Constipation. 2. Dumping syndrome. 3. Gastric spasm. 4. Intestinal spasms.

Dumping syndrome; Dumping syndrome is a problem that occurs postprandially after gastric resection because ingested food rapidly enters the jejunum without proper mixing and without the normal duodenal digestive processing. Diarrhea, not constipation, may also be a symptom. Gastric or intestinal spasms don't occur, but antispasmodics may be given to slow gastric emptying.

You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? 1. Pruritus 2. Dyspnea 3. Jaundice 4. Peripheral neuropathy

Dyspnea; Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing. The others are signs of cirrhosis that aren't relieved by paracentesis

You're caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct her to: 1. Empty her bladder. 2. Lie supine in bed. 3. Remain NPO for 4 hours. 4. Clean her bowels with an enema.

Empty her bladder; A full bladder can interfere with paracentesis and be punctured inadvertently.

You're caring for a 28 y.o. woman with hepatitis B. She's concerned about the duration of her recovery. Which response isn't appropriate? 1. Encourage her to not worry about the future 2. Encourage her to express her feelings about the illness 3. Discuss the effects of hepatitis B on future health problems 4. Provide avenues for financial counseling if she expresses the need

Encourage her to not worry about the future; Telling her not to worry minimizes her feelings.

Which of the following symptoms is common with a hiatal hernia? 1. Left arm pain 2. Lower back pain 3. Esophageal reflux 4. Abdominal cramping

Esophageal reflux; Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax, making it less effective.

Which of the following diagnostic tests should be performed annually over age 50 to screen for colon cancer? 1. Abdominal CT scan. 2. Abdominal x-ray. 3. Colonoscopy. 4. Fecal occult blood test.

Fecal occult blood test; Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of stools.

Which of the following aspects is the priority focus of nursing management for a client with peritonitis? 1. Fluid and electrolyte balance. 2. Gastric irrigation. 3. Pain management. 4. Psychosocial issues.

Fluid and electrolyte balance; Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance is the priority focus of nursing management.

You promote hemodynamic stability in a patient with upper GI bleeding by: 1. Encouraging oral fluid intake 2. Monitoring central venous pressure 3. Monitoring laboratory test results and vital signs 4. Giving blood, electrolyte and fluid replacement

Giving blood, electrolyte and fluid replacement; To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr.

Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? 1. Calcium 2. Glucose 3. Magnesium 4. Potassium

Glucose; Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of langerhans.

A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give the client? 1. Low fiber, low fat. 2. High fiber, low fat. 3. Low fiber, high fat. 4. High fiber, high fat.

High fiber, low fat; The client with irritable bowel syndrome needs to be on a diet that contains at least 25 grams of fiber per day. Fatty foods are to be avoided because they may precipitate symptoms.

A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient's blood pressure because of which change that is associated with the liver failure? 1. Hypoalbuminemia 2. Increased capillary permeability 3. Abnormal peripheral vasodilation 4. Excess rennin release from the kidneys

Hypoalbuminemia; Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidney's aren't direct ramifications of liver failure.

Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include which of the following instructions? 1. Restrict intake of high-carbohydrate foods 2. Increase fluid intake with meals 3. Increase fat intake 4. Eat three regular meals a day

Increase fluid intake with meals; Increasing fluids helps empty the stomach. A high carb diet isn't restricted and fat intake shouldn't be increased.

Which of the following definitions best describes gastritis? 1. Erosion of the gastric mucosa. 2. Inflammation of a diverticulum. 3. Inflammation of the gastric mucosa. 4. Reflux of stomach acid into the esophagus.

Inflammation of the gastric mucosa; Gastritis is an inflammation of the gastric mucosa that may be acute (often resulting from exposure to local irritants) or chronic (associated with autoimmune infections or atrophic disorders of the stomach).

Which of the following types of diets is implicated in the development of diverticulosis? 1. Low-fiber diet. 2. High-fiber diet. 3. High-protein diet. 4. Low-carbohydrate diet.

Low-fiber diet; Low-fiber diets have been implicated in the development of diverticula because these diets decrease the bulk in the stool and predispose the person to the development of constipation.

Which of the following diets is most commonly associated with colon cancer? 1. Low-fiber, high fat. 2. Low-fat, high-fiber. 3. Low-protein, high-carbohydrate 4. Low carbohydrate, high protein.

Low-fiber, high fat; A low-fiber, high-fat diet reduced motility and increases the chance of constipation.

Which of the following associated disorders may the client with Crohn's disease exhibit? 1. Ankylosing spondylitis. 2. Colon cancer. 3. Malabsorption. 4. Lactase deficiency.

Malabsorption; Because of the transmural nature of Crohn's disease lesions, malaborption may occur with Crohn's disease..

Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her? 1. Obtain daily weights 2. Measure abdominal girth 3. Keep strict intake and output 4. Encourage her to increase fluids

Measure abdominal girth; Measuring abdominal girth provides quantitative information about increases or decreases in the amount of distention

The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient's diet? 1. Meats and beans 2. Butter and gravies 3. Potatoes and pastas 4. Cakes and pastries

Meats and beans; Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted.

A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? 1. Metabolic acidosis with hyperkalemia 2. Metabolic acidosis with hypokalemia 3. Metabolic alkalosis with hyperkalemia 4. Metabolic alkalosis with hypokalemia

Metabolic alkalosis with hypokalemia; Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and hypokalemia.

Which of the following substances is most likely to cause gastritis? 1. Milk 2. Bicarbonate of soda, or baking soda. 3. Enteric coated aspirin. 4. Nonsteroidal anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs; NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis.

Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: 1. Continuous peritoneal lavage 2. Regular diet with increased fat 3. Nutritional support with TPN 4. Insertion of a T tube to drain the pancreas

Nutritional support with TPN; With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.

Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure? 1. Obesity 2. Volvulus 3. Constipation 4. Intestinal obstruction

Obesity; Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.

The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? 1. Supine with the head of the bed flat 2. On the stomach with the head flat 3. On the left side with the head of the bed elevated 30 degrees 4. On the right side with the head of the bed elevated 30 degrees

On the left side with the head of the bed elevated 30 degrees; The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.

During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care? 1. Body image. 2. Ostomy care. 3. Sexual concerns. 4. Skin care.

Ostomy care; Although all of these are concerns the nurse should address, being able to safely manage the ostomy is crucial for the client before discharge.

Glenda has cholelithiasis (gallstones). You expect her to complain of: 1. Pain in the right upper quadrant, radiating to the shoulder 2. Pain in the right lower quadrant, with rebound tenderness 3. Pain in the left upper quadrant, with shortness of breath 4. Pain in the left lower quadrant, with mild cramping

Pain in the right upper quadrant, radiating to the shoulder; The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the shoulder.

A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: 1. Cancer of the stomach 2. Peptic ulcer disease 3. Chronic gastritis 4. Pylorospasm

Peptic ulcer disease; Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back.

Which of the following conditions is most likely to directly cause peritonitis? 1. Cholelithiasis 2. Gastritis 3. Perforated ulcer 4. Incarcerated hernia

Perforated ulcer; The most common cause of peritonitis is a perforated ulcer, which can pour contaminates into the peritoneal cavity, causing inflammation and infection within the cavity. The other conditions don't by themselves cause peritonitis.

A client has just had surgery for colon cancer. Which of the following disorders might the client develop? 1. Peritonitis. 2. Diverticulitis. 3. Partial bowel obstruction. 4. Complete bowel obstruction.

Peritonitis; Bowel spillage could occur during surgery, resulting in peritonitis. Complete or partial bowel obstruction may occur before bowel resection. Diverticulosis doesn't result from surgery or colon cancer.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? 1. Bloody diarrhea 2. Hypotension 3. A hemoglobin of 12 mg/dL 4. Rebound tenderness

Rebound tenderness; Rebound tenderness may indicate peritonitis.

Which of the following measures should the nurse focus on for the client with esophageal varices? 1. Recognizing hemorrhage 2. Controlling blood pressure 3. Encouraging nutritional intake 4. Teaching the client about varices

Recognizing hemorrhage; Recognizing the rupture of esophageal varices, or hemorrhage, is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices are and what foods he should avoid such as spicy foods.

Which of the following symptoms is associated with ulcerative colitis? 1. Dumping syndrome. 2. Rectal bleeding. 3. Soft stools. 4. Fistulas.

Rectal bleeding; In ulcerative colitis, rectal bleeding is the predominant symptom.

Which of the following therapies is not included in the medical management of a client with peritonitis? 1. Broad-spectrum antibiotics. 2. Electrolyte replacement. 3. IV fluids 4. Regular diet.

Regular diet; The client with peritonitis usually isn't allowed anything orally until the source of peritonitis is confirmed and treated.

Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He's jaundiced and reports weakness. Which intervention will you include in his care? 1. Regular exercise. 2. A low-protein diet. 3. Allow patient to select his meals. 4. Rest period after small, frequent meals.

Rest period after small, frequent meals; Rest periods and small frequent meals is indicated during the acute phase of hepatitis B.

Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? 1. Restrict fluids. 2. Encourage ambulation. 3. Increase sodium in the diet. 4. Give antacids as prescribed.

Restrict fluids; Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space.

Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? 1. Serum creatinine and BUN 2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 3. Serum amylase and lipase 4. Cardiac enzymes

Serum amylase and lipase; Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.

The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is: 1. Severe and unrelenting, located in the epigastric area and radiating to the back. 2. Severe and unrelenting, located in the left lower quadrant and radiating to the groin. 3. Burning and aching, located in the epigastric area and radiating to the umbilicus. 4. Burning and aching, located in the left lower quadrant and radiating to the hip.

Severe and unrelenting, located in the epigastric area and radiating to the back; The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back.

Which of the following terms best describes the pain associated with appendicitis? 1. Aching 2. Fleeting 3. Intermittent 4. Steady

Steady; The pain begins in the epigastrium or periumbilical region, then shifts to the right lower quadrant and becomes steady. The pain may be moderate to severe.

Which of the following symptoms may be exhibited by a client with Crohn's disease? 1. Bloody diarrhea. 2. Narrow stools. 3. N/V 4. Steatorrhea.

Steatorrhea; fatty stools.

Which of the following medications is most effective for treating the pain associated with irritable bowel disease? 1. Acetaminophen. 2. Opiates. 3. Steroids. 4. Stool softeners.

Steroids; The pain with irritable bowel disease is caused by inflammation, which steroids can reduce.

The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom indicates this occurrence? 1. Abdominal cramping and pain 2.Bradycardia and indigestion 3.Sweating and pallor 4.Double vision and chest pain

Sweating and pallor; Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

Crohn's disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? 1. The entire length of the large colon. 2. Only the sigmoid area. 3. The entire large colon through the layers of mucosa and submucosa. 4. The small intestine and colon; affecting the entire thickness of the bowel.

The small intestine and colon; affecting the entire thickness of the bowel; Crohn's disease can involve any segment of the small intestine, the colon, or both, affecting the entire thickness of the bowel.

Colon cancer is most closely associated with which of the following conditions? 1. Appendicitis. 2. Hemorrhoids. 3. Hiatal hernia. 4. Ulcerative Colitis.

Ulcerative colitis; Chronic ulcerative colitis, granulomas, and familial polposis seem to increase a person's chance of developing colon cancer. The other conditions listed have no known effect on colon cancer risk.

Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis? 1. Treating constipation with chronic laxative use, leading to dependence on laxatives. 2. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents. 3. Herniation of the intestinal mucosa, rupturing the wall of the intestine. 4. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.

Undigested food blocking the diverticulum, predisposing the area to bacterial invasion; Undigested food can block the diverticulum, decreasing blood supply to the area and predisposing the area to invasion of bacteria.

Which of the following interventions should be included in the medical management of Crohn's disease? 1. Increasing oral intake of fiber. 2. Administering laxatives. 3. Using long-term steroid therapy. 4. Increasing physical activity.

Using long-term steroid therapy; Management of Crohn's disease may include long-term steroid therapy to reduce the inflammation associated with the deeper layers of the bowel wall.

Which of the following conditions can cause a hiatal hernia? 1. Increased intrathoracic pressure 2. Weakness of the esophageal muscle 3. Increased esophageal muscle pressure 4. Weakness of the diaphragmic muscle

Weakness of the diaphragmic muscle; A hiatal hernia is caused by weakness of the diaphragmic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle pressure isn't a factor in hiatal hernia.

Which of the following laboratory results would be expected in a client with peritonitis? 1. Partial thromboplastin time above 100 seconds 2. Hemoglobin level below 10 mg/dL 3. Potassium level above 5.5 mEq/L 4. White blood cell count above 15,000

White blood cell count above 15,000; Because of infection, the client's WBC count will be elevated.