Exam 2 gi - PrepU/Nclex Questions

28. Which medications are used to decrease gastric or hydrochloric acid secretion (select all that apply)? a. Famotidine (Pepcid) b. Sucralfate (Carafate) c. Omeprazole (Prilosec) d. Misoprostol (Cytotec) e. Amoxicillin/clarithromycin/omeprazole

a, c, d, e. Famotidine (Pepcid) reduces HCl secretion by blocking histamine and omeprazole (Prilosec) decreases gastric acid secretion by blocking adenosine triphosphatase (ATPase) enzyme. Sucralfate (Carafate) coats the ulcer to protect it from acid erosion. Misoprostol (Cytotec) mixture has antisecretory effects. Amoxicillin/ clarithromycin/omeprazole are used in patients with verified H. pylori.

10. Priority Decision: A postoperative patient has a nursing diagnosis of pain related to effects of medication and decreased GI motility as evidenced by abdominal pain and distention and inability to pass flatus. Which nursing intervention is most appropriate for this patient? a. Ambulate the patient more frequently. b. Assess the abdomen for bowel sounds. c. Place the patient in high Fowler's position. d. Withhold opioids because they decrease bowel motility.

a. Ambulate the patient more frequently.

14. Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy? A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F B. Heart rate of 35, blood pressure 60/43, temperature 95.3 'F C. Soft hair, irritable, diarrhea D. Constipation, drowsiness, goiter

A patient is at risk for experiencing thyroid storm after a thyroidectomy because of manipulation of the thryroid gland that could cause excessive T3 and T4 to enter into the bloodstream during removal of the gland. Therefore, heart rate of 120, blood pressure 220/102, temperature 103.2 'F are classic signs of thyroid storm and this requires nursing intervention.

After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? Volvulus Intussusception Tumor Abdominal surgery

Abdominal surgery In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: Mild. High-pitched. Hyperactive. Absent.

Absent. Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? Administering pain medication Obtaining a blood sample for laboratory studies Preparing to insert a nasogastric (NG) tube Administering I.V. fluids

Administering I.V. fluids

Which of the following would a nurse expect to assess in a client with peritonitis? Deep slow respirations Decreased pulse rate Hyperactive bowel sounds Board-like abdomen

Board-like abdomen The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? Appendicitis Rectal fissures Bowel perforation Diverticulitis

Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. A peanut butter sandwich and fruit cup Broiled chicken with low-fiber pasta Salami on whole grain bread and V-8 juice A fruit salad with yogurt

Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? Weight loss due to malabsorption Blood and mucus in the stool Chronic constipation with sporadic bouts of diarrhea Client is awakened from sleep due to abdominal pain.

Chronic constipation with sporadic bouts of diarrhea Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? Barium enema Flexible sigmoidoscopy CT scan Colonoscopy

Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal

13. A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no excessive swelling noted. What position is best for this patient to be in? A. Fowler's B. Prone C. Trendelenburg D. Semi-Fowler's

D. Semi-Fowler's

What is the primary nursing diagnosis for a client with a bowel obstruction? Question 5 options: Deficient knowledge Acute pain Deficient fluid volume Ineffective tissue perfusion

Deficient fluid volume

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: A small bowel disorder. Intestinal malabsorption. Inflammatory colitis. A disorder of the large bowel.

Intestinal malabsorption. Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

The presence of mucus and pus in the stools suggests which condition? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

Ulcerative colitis The presence of mucus and pus in the stools suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

Patients diagnosed with malabsorption syndrome may have vitamin and mineral deficiency. Patient who easily bleed have which of the following deficiencies? Vitamin K Calcium Iron B12

Vitamin K The chief result of malabsorption is malnutrition, manifested by weight loss and other signs of vitamin and mineral deficiency (e.g., easy bruising [vitamin K deficiency], osteoporosis [calcium deficiency], and anemia [iron, vitamin B12 deficiency]).

35. Which statement by a patient with dumping syndrome should lead the nurse to determine that further dietary teaching is needed? a. "I should eat bread and jam with every meal." b. "I should avoid drinking fluids with my meals." c. "I should eat smaller meals about six times a day." d. "I need to lie down for 30 to 60 minutes after my meals."

a. "I should eat bread and jam with every meal." Dietary control of dumping syndrome includes small, frequent meals with low carbohydrate content and elimination of fluids with meals. The patient should also lie down for 30 to 60 minutes after meals. These measures help to delay stomach emptying, preventing the rapid movement of a high-carbohydrate food bolus into the small intestine.

33. Match the descriptions with the following surgical procedures used to treat peptic ulcer disease. a. Often performed with a vagotomy to increase gastric emptying b. Severing of a parasympathetic nerve to decrease gastric secretion c. Removal of distal two thirds of stomach with anastomosis to jejunum d. Removal of distal two thirds of stomach with anastomosis to duodenum 1. Billroth I 2. Billroth II 3. Pyloroplasty 4. Vagotomy

a. 3; b. 4; c. 2; d. 1

23. Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers? a. Acid back diffusion into the mucosa b. The release of histamine from GI cells c. Ammonia formation in the mucosal wall d. Breakdown of the gastric mucosal barrier

a. Acid back diffusion into the mucosa The ultimate damage to the tissues of the stomach and duodenum, precipitating ulceration, is acid back diffusion into the mucosa. The gastric mucosal barrier is protective of the mucosa but without the acid environment and damage, ulceration does not occur. Ammonia formation by H. pylori and release of histamine impair the barrier but are not directly responsible for tissue injury.

54. What must the nurse do to care for a T-tube in a patient following a cholecystectomy? a. Keep the tube supported and free of kinks. b. Attach the tube to low, continuous suction. c. Clamp the tube when ambulating the patient. d. Irrigate the tube with 10-mL sterile saline every 2 to 4 hours.

a. Keep the tube supported and free of kinks.

27. Which statements are characteristic of the uses of antacids for peptic ulcer disease (select all that apply)? a. Used in patients with verified H. pylori b. Patients frequently noncompliant with use c. Prevent conversion of pepsinogen to pepsin d. Cover the ulcer, protecting it from erosion by acids e. High incidence of side effects and contraindications f. High dose and frequency stimulate release of gastrin

b, c, f. Antacids need a high dose and frequency, which may lead to noncompliance; prevent the conversion of pepsinogen to pepsin; and may stimulate the release of gastrin. Amoxicillin/clarithromycin/omeprazole are used in patients with verified H. pylori. Sucralfate (Carafate) covers the ulcer to protect it from acid erosion.

27. An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to a. offer ice chips to suck PRN. b. provide mouth care every 1 to 2 hours. c. irrigate the tube with normal saline every 8 hours. d. keep the patient supine with the head of the bed elevated 30 degrees.

b. provide mouth care every 1 to 2 hours.

20. The medications prescribed for the patient with inflammatory bowel disease include cobalamin and iron injections. What is the rationale for using these drugs? a. Alleviate stress b. Combat infection c. Correct malnutrition d. Improve quality of life

c. Correct malnutrition

22. Corticosteroid medications are associated with the development of peptic ulcers because of which probable pathophysiologic mechanism? a. The enzyme urease is produced. b. Secretion of hydrochloric acid is increased. c. The rate of mucous cell renewal is decreased. d. The synthesis of mucus and prostaglandins is inhibited.

c. The rate of mucous cell renewal is decreased. Corticosteroids decrease the rate of mucous cell renewal. H. pylori produces the enzyme urease. Alcohol ingestion increases the secretion of hydrochloric acid. Aspirin and NSAIDs inhibit the synthesis of mucus and prostaglandins.

2. Which laboratory findings should the nurse expect in the patient with persistent vomiting? a. ↓ pH, ↑ sodium, ↓ hematocrit b. ↑ pH, ↓ chloride, ↓ hematocrit c. ↑ pH, ↓ potassium, ↑ hematocrit d. ↓ pH, ↓ potassium, ↑ hematocrit

c. ↑ pH, ↓ potassium, ↑ hematocrit The loss of gastric hydrochloric acid causes metabolic alkalosis and an increase in pH; loss of potassium, sodium, and chloride; and loss of fluid, which increases the hematocrit

11. A 22-year-old patient calls the outpatient clinic complaining of nausea and vomiting and right lower abdominal pain. What should the nurse advise the patient to do? a. Use a heating pad to relax the muscles at the site of the pain. b. Drink at least 2 quarts of juice to replace the fluid lost in vomiting. c. Take a laxative to empty the bowel before examination at the clinic. d. Have the symptoms evaluated by a health care provider right away.

d. Have the symptoms evaluated by a health care provider right away.

An 82-year-old man is admitted with an acute attack of diverticulitis. What should the nurse include in his care? a. Monitor for signs of peritonitis. b. Treat with daily medicated enemas. c. Prepare for surgery to resect the involved colon. d. Provide a heating pad to apply to the left lower quadrant.

a. Monitor for signs of peritonitis.

19. For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel (select all that apply)? a. NPO b. IV fluids c. Bed rest d. Sedatives e. Nasogastric suction f. Parenteral nutrition

a. NPO b. IV fluids e. Nasogastric suction f. Parenteral nutrition

21. The patient is receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease? a. Corticosteroids b. 6-Mercaptopurine c. Antidiarrheal agents d. Sulfasalazine (Azulfidine)

c. Antidiarrheal agents

A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching? "I'll increase my intake of protein during exacerbations." "I should increase my intake of fresh fruits and vegetables during remissions." "I'll snack on nuts, olives, and popcorn during flare-ups." "I'll incorporate foods rich in omega-3 fatty acids into my diet."

"I should increase my intake of fresh fruits and vegetables during remissions." A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.

5. You are performing discharge teaching with a patient who is going home on levothyroxine. Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."

A levothyroxine is best taken in the MORNING on an empty stomach. All the other statements are correct about taking levothyroxine

1. Fill in the blank regarding the negative feedback loop for thyroid hormone production: The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______. A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH

B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? Borborygmus Tenesmus Azotorrhea Diverticulitis

Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

3. A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss

D - Hair loss

A client comes to the clinic complaining of not having a bowel movement in several days, abdominal cramping, and nausea. When the nurse puts the client on the stretcher, he vomits a large amount of fecal material. What should the first action by the nurse be? Notify the physician. Start an IV of Ringer's lactate. Insert an intestinal tube. Insert a nasogastric tube.

Notify the physician. The physician should be notified immediately to examine the client because the client is exhibiting signs of an intestinal obstruction. Starting the IV and inserting a nasogastric tube would be interventions that the physician will order after seeing the client. The nurse does not insert intestinal tubes.

During thyroid surgery, a client's parathyroid glands have become damaged. Which condition does the nurse monitor for potential development? Question 9 options: Goiter Tetany Globe lag Photophobia

Tetany

12. A patient is recovering from parathyroid surgery. Morning labs values are back. Which of the following lab values would correlate as a complication from this type of surgery? A. Calcium 8.7 B. Calcium 12.5 C. Calcium 6.9 D. Calcium 9.2

The answer is C: Calcium 6.9 Patients who have had any type of neck surgery, especially parathyroid or thyroidectomy is risk for hypocalcemia.

32. On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

b. A brick-red, puffy stoma that oozes blood

How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics b. Avoidance of milk and milk products c. Supplementation with pancreatic enzymes d. Avoidance of gluten found in wheat, barley, oats, and rye

b. Avoidance of milk and milk products

12. Priority Decision: When caring for a patient with irritable bowel syndrome (IBS), what is most important for the nurse to do? a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed. b. Develop a trusting relationship with the patient to provide support and symptomatic care. c. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation. d. Inform the patient that new medications for IBS are available and effective for treatment of IBS manifested by either diarrhea or constipation.

b. Develop a trusting relationship with the patient to provide support and symptomatic care.

38. What should the nurse teach the patient with diverticulosis to do? a. Use anticholinergic drugs routinely to prevent bowel spasm. b. Have an annual colonoscopy to detect malignant changes in the lesions. c. Maintain a high-fiber diet and use bulk laxatives to increase fecal volume. d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel.

c. Maintain a high-fiber diet and use bulk laxatives to increase fecal volume.

26. The patient comes to the emergency department with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is obstructed? a. Large intestine b. Esophageal sphincter c. Upper small intestine d. Lower small intestine

c. Upper small intestine

31. The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? a. The pouch can be worn for up to 2 weeks before changing it. b. Decrease the amount of fluid intake to decrease the amount of drainage. c. The pouch can be removed when bowel movements have been regulated. d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch.

d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch.

33. Delegation Decision: The RN coordinating the care for a patient who is 2 days postoperative following an anterior- posterior resection with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)? a. Irrigate the colostomy. b. Teach ostomy and skin care. c. Assess and document stoma appearance. d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

Priority Decision: When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse take first? a. Irrigate the patient's NG tube. b. Notify the health care provider. c. Place the patient in high-Fowler's position. d. Assess the patient's abdomen and vital signs.

d. d. Assess the patient's abdomen and vital signs. Abdominal pain that causes the knees to be drawn up and shallow, grunting respirations in a patient with peptic ulcer disease are characteristic of perforation and the nurse should assess the patient's vital signs and abdomen before notifying the health care provider. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity and the patient should be placed in a position of comfort, usually on the side with the head slightly elevated.

Match the following signs and symptoms to their disease process. Ulcerative colitis = 1 Crohn's disease = 2 Located in ileum, ascending colon Treated with ostomy Coblestone appearance Located in rectum, descending colon Severe diarrhea Fistula development

2 Located in ileum, ascending colon 1 Treated with ostomy 2 Coblestone appearance 1 Located in rectum, descending colon 1 Severe diarrhea 2 Fistula development

34. A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action? a. Milk or strip the catheter every 2 hours. b. Measure ureteral urinary drainage every 1 to 2 hours. c. Irrigate the catheter with 30-mL sterile saline every 4 hours. d. Encourage ambulation to promote urinary peristaltic action.

34. b. Output from ureteral catheters must be monitored every 1 to 2 hours because an obstruction will cause overdistention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.

9. A patient is currently experiencing dumping syndrome after gastric surgery, select ALL the correct statements on how to educate this patient about decreasing their symptoms: A. "It is best to eat 3 large meals a day rather than small frequent meals." B. "After eating a meal lie down for 30 minutes." C. "Eat a diet high in protein, fiber, and low in carbs." D. "Be sure to drink at least 16 oz. of milk with meals."

The answers are B and C. The patient in question 8 is exhibiting signs and symptoms of dumping syndrome. The patient should eat small but frequent meals (NOT 3 large meals a day), lie down for 30 minutes after meals, avoid sugary drinks and foods, and follow a high protein, high fiber, and low-carb diet, and avoid consuming drinks while eating but afterwards.

12. Select-ALL-the complications associated with Crohn's Disease: A. Loss of form to the haustra B. Fistulas C. Strictures D. Hemorrhoids E. Anal Fissure

The answers are B, C, and E. Loss of form to the haustra is found in ulcerative colitis. Hemorrhoids is not a common complication in either Crohn's or ulcerative colitis.

8. You're providing discharge teaching to a patient who was hospitalized for the treatment of a kidney stone. The type of kidney stone the patient experienced was a uric acid type stone. What type of foods will you educate the patient to avoid? A. Cabbage, spinach, tomatoes, strawberries B. Ice cream, milk, pork, cheese C. Beans, potatoes, corn, peas D. Liver, scallops, anchovies, sardines, pork

D. Liver, scallops, anchovies, sardines, pork The patient should avoid foods high in purine and foods high in animal proteins. Foods that are high in purine or animal proteins breakdown into uric acid. Foods high in purine are any type of organ meats (liver), most seafood (scallops, anchovies, sardines), pork, red meats, beer etc.

A client is being treated for diverticulosis. Which information should the nurse include in this client's teaching plan? Avoid unprocessed bran in the diet Avoid daily exercise; indulge only in mild activity Drink at least 8 to 10 large glasses of fluid every day Use laxatives or enemas at least once a week

Drink at least 8 to 10 large glasses of fluid every day The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? Hot roast beef sandwich with gravy Mashed potatoes White rice Vanilla pudding

Hot roast beef sandwich with gravy The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as fried chicken, because fatty foods may bring on an episode of cholecystitis.

A primary health care provider diagnoses a client with acute cholecystitis with biliary colic. Which clinic findings should the nurse expect when performing a health history and physical assessment? Select all that apply. Question 3 options: Diarrhea with black feces Intolerance to foods high in fat Vomiting of coffee-ground emesis Gnawing pain when stomach is empty Pain that radiates to the right shoulder

Intolerance to foods high in fat Pain that radiates to the right shoulder

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find? Decreased white blood cell count Increased albumin levels Negative stool cultures Decreased erythrocyte sedimentation rate

Negative stool cultures Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and white blood cells (WBCs) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition.

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? The bowel twists and turns itself and obstructs the intestinal lumen. One part of the intestine telescopes into another portion of the intestine. The bowel protrudes through a weakened area in the abdominal wall. A loop of intestine adheres to an area that is healing slowly after surgery.

One part of the intestine telescopes into another portion of the intestine. In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery.

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? Beefy red stoma site Stoma site not sensitive to touch Red, sensitive skin around the stoma site Clear mucus mixed with yellow urine drained from the appliance bag

Red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make? Take a mild laxative such as magnesium citrate when necessary. Take a stool softener such as docusate sodium (Colace) daily. Administer a tap-water enema weekly. Administer a phospho-soda (Fleet) enema when necessary.

Take a stool softener such as docusate sodium (Colace) daily. Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing a dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation.

13. Which type of colostomy can allow a patient to have bowel continence? A. Descending or Sigmoid Colostomy B. Ascending or Transverse Colostomy C. Transverse or Descending Colostomy D. Ascending or Descending Colostomy

The answer is A. Patients with a colostomy in locations most distal in the GI track have the highest chance of bowel continence (hence, learn to control their bowel movements).

12. You are providing discharge teaching to a patient taking Sucralfate. Which statement by the patient demonstrates they understand how to take this medication? A. "I will take this medication at the same time I take Ranitidine." B. "I will always take this medication on an empty stomach." C. "It is best to take this medication with antacids." D. "I will take this medication once a week."

The answer is B. This statement is the only correct statement about how to take Carafate. It should always be taken on an empty stomach without food so it can coat the site of ulceration. This medication should NOT be taken with H2 blockers (Ranitidine) or antacids because these drugs affect the absorption of Carafate.

7. A patient, who had a colostomy placed yesterday, calls on the call light to say their surgical dressing "fell off". You will re-apply what type of dressing over the stoma? A. Wet to dressing B. No dressing is needed. You will keep it open to air. C. Petroleum gauze dressing D. Telfa gauze

The answer is C. A petroleum gauze dressing will be kept in place (or a sterile dry dressing) until a pouch system is in place.

9. You receive a doctor's order for a patient to take Aspirin EC by mouth daily. The patient has the following medication history: diabetes type 2, peripheral vascular disease, and a permanent ileostomy. What is your next nursing action? A. Administer the medication as ordered. B. Crush the medication and mix it in applesauce. C. Hold the medication and notify the doctor the patient has an ileostomy. D. Crush the medication and mix it in pudding.

The answer is C. Aspirin EC is an enteric-coated form of Aspirin. A patient with an ileostomy should not take enteric-coated or sustained-released medications. Enteric-coating medications don't dissolve until reaching a specific part of the small intestine, and sustained-released medications release slowly over a period of time. Remember a patient with an ileostomy does not have the ability to fully utilize the function of the small intestine and this medication will not be able to perform properly. The nurse should hold the medication and notify the doctor for further orders.

6. In regards to question 5, this patient signs and symptoms are starting to subside. Which of the following food items would be best for the patient to consume? A. Oatmeal and bran B. Orange juice and eggs C. Chicken broth and Jello D. Salad with chicken

The answer is C. During the recovery phase of diverticulitis, once the symptoms start subsiding, the patient should start out with clear liquids like broth, jello, ice etc. and then low-fiber foods until healed. After the patient has fully recovered, they should consume a high-fiber diet and stay hydrated.

2. Which patient below is at MOST risk for developing uric acid type kidney stones? A. A 53 year old female with recurrent urinary tract infections. B. A 6 year old male with cystinuria. C. A 63 year male with gout. D. A 25 year old female that follows a vegan diet and report eating high amounts of spinach and strawberries on a regular basis.

The answer is C. Patients with gout experience high uric acid levels which can lead to the development of uric acid kidney stones. In option A, the patient is at risk for struvite kidney stones. In option B, the patient is at risk for cystine kidney stones, and in option C, the patient is at a small risk for calcium oxalate stones due to the high consumption of foods with oxalates.

7. Which of the following is NOT a potential complication associated with ulcerative colitis? A. Toxic megacolon B. Anemia C. Stricture D. Peritonitis

The answer is C. Strictures are a common complication found in CROHN'S DISEASE not ulcerative colitis.

4. A patient asks what type of testing is performed to assess for diverticulosis. As the nurse, you know that which of the following is NOT used to assess for diverticulosis? A. Colonoscopy B. Barium enema C. Bronchoscopy D. CT scan with contrast of the abdomen

The answer is C. This is the only option that can NOT assess for diverticulosis. A bronchoscopy assesses the lungs.

10. A patient has a calcium level of 12.5. Which medication will most likely be ordered for this patient? A. Calcium Chloride B. 10% Calcium Gluconate C. Calcitonin D. Hydrochlorothiazide

The answer is C: Calcitonin Its main actions are to increase bone calcium content and decrease the blood calcium level when it rises above normal.

8. You're providing discharge teaching to a patient who was hospitalized for the treatment of a kidney stone. The type of kidney stone the patient experienced was a uric acid type stone. What type of foods will you educate the patient to avoid? A. Cabbage, spinach, tomatoes, strawberries B. Ice cream, milk, pork, cheese C. Beans, potatoes, corn, peas D. Liver, scallops, anchovies, sardines, pork

The answer is D. The patient should avoid foods high in purine and foods high in animal proteins. Foods that are high in purine or animal proteins breakdown into uric acid. Foods high in purine are any type of organ meats (liver), most seafood (scallops, anchovies, sardines), pork, red meats, beer etc.

6. A patient's lab work shows that they have a high parathyroid hormone level. Which condition is the patient at risk for? A. Hyperkalemia B. Hypocalcemia C. Hypokalemia D. Hypercalcemia

The answer is D: Hypercalcemia

1. True or False: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the small intestine, specifically the terminal ileum. True False

The answer is FALSE: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the LARGE (not small) intestine. The inflammation tends to start in the rectum and spreads throughout the colon. The small intestine is usually not involved.

3. A patient with a history of diverticulosis is admitted with abdominal pain. The physician suspects diverticulitis. What other findings would correlate with diverticulitis? SELECT-ALL-THAT-APPLY: A. Abdominal pain that is mainly present in the upper right quadrant B. Unrelenting cramping type pain C. Pain found at McBurney's Point D. Blood in stool E. Fever F. Reports of constipation G. Abdominal bloating H. Positive Cullen's Sign

The answers are : B, D, E, F, and G. These are typical signs and symptoms found with diverticulitis. Option C is found in appendicitis and Option H is found in acute pancreatitis. Option A is wrong because abdominal pain is typically found in the left lower quadrant not upper right.

9. Which of the following are treatment options for hyperthyroidism? Please select all that apply: A. Thyroidectomy B. Methimazole C. Liothyronine Sodium "Cytomel" D. Radioactive Iodine

The answers are A, B,and D. Liothyronine Sodium "Cytomel" is a treatment for hypothyroidism. All the other options are for hyperthyroidism.

9. Your patient arrives back to their room after having extracoporeal shock wave lithotripsy (ESWL) for treatment of a kidney stone. What will be included in the patient's plan of care? SELECT-ALL-THAT-APPLY: A. Keep the patient in bed B. Encourage fluid intake of 3-4 liters per day C. Maintain nephrostomy tube D. Strain urine E. Keep dressing dry and intact

The answers are B and C. Extracoporeal shock wave lithotripsy (ESWL) is NONINVASIVE (no incisions...no dressings or nephrostomy tubes are placed). Shockwaves are created to penetrate though the skin and body tissue. Shockwaves will hit the stone and break it down into grain of sand like particles which will be passed out by the patient. Option A is wrong because the patient should be kept mobile (as tolerated) to assist the passage of the kidney stone fragment.

3. Which medications are used in the treatment of Crohn's Disease and ulcerative colitis? SELECT-ALL-THAT-APPLY: A. Guanylate Cyclase-C agonists B. Anticholinergics C. 5-Aminosalicylates D. Antacids E. Corticosteroids F. Immune suppressors

The answers are C, E, and F. 5-Aminosalicylates, corticosteroids, and immune suppressors drugs are used to treat Crohn's Disease and ulcerative colitis.

31. Priority Decision: A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the best action by the nurse? a. Check the patency of the NG tube. b. Place the patient in a recumbent position. c. Assess the patient's vital signs and circulatory status. d. Encourage the patient to deep breathe and consciously relax.

a. Check the patency of the NG tube. If symptoms of gastric outlet obstruction, such as nausea, vomiting, and stomach distention, occur while the patient is on NPO status or has an NG tube, the patency of the NG tube should be assessed. A recumbent position should not be used in a patient with a gastric outlet obstruction because it increases abdominal pressure on the stomach and vital signs and circulatory status assessment are important if hemorrhage or perforation is suspected. Deep breathing and relaxation may help some patients with nausea but not when stomach contents are obstructed from flowing into the small intestine.

23. Priority Decision: A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? a. Measure the ileostomy output to determine the status of the patient's fluid balance. b. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. c. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. d. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

a. Measure the ileostomy output to determine the status of the patient's fluid balance.

What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have? a. Melena b. Occult blood c. Coffee-ground emesis d. Profuse bright-red hematemesis

a. Melena Melena is black, tarry stools from slow bleeding from an upper GI source when blood passes through the GI tract and is digested. Occult blood is the presence of guaiac-positive stools or gastric aspirate. Coffee-ground emesis is blood that has been in the stomach for some time and has reacted with gastric secretions. Profuse bright-red hematemesis is arterial blood that has not been in contact with gastric secretions, as in esophageal or oral bleeding.

51. What treatment for acute cholecystitis will prevent further stimulation of the gallbladder? a. NPO with NG suction b. Incisional cholecystectomy c. Administration of antiemetics d. Administration of anticholinergics

a. NPO with NG suction

41. What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes? a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind should be avoided. c. Antacids should be taken with all prescribed medications to prevent gastric irritation. d. Misoprostol (Cytotec) should be used to protect the gastric mucosa in individuals with peptic ulcers.

b. All over-the-counter (OTC) drugs should be avoided because their contents may include drugs that are contraindicated because of the irritating effects on the gastric mucosa. Patients are taught to test suspicious vomitus or stools for occult blood but all stools do not need to be tested. Antacids cannot be taken with all medications because they prevent the absorption of many drugs. Misoprostol is used to protect the gastric mucosa in patients who must take NSAIDs for other conditions because it inhibits acid secretion stimulated by NSAIDs.

Priority Decision: A patient is admitted to the emergency department with profuse bright-red hematemesis. During the initial care of the patient, what is the nurse's first priority? a. Establish two IV sites with large-gauge catheters b. Perform a focused nursing assessment of the patient's status c. Obtain a thorough health history to assist in determining the cause of the bleeding d. Perform a gastric lavage with cool tap water in preparation for endoscopic examination 40.

b. Perform a focused nursing assessment of the patient's status Although all of the interventions may be indicated when a patient has upper GI bleeding, the first nursing priority with bright-red (arterial) blood is to perform a focused assessment of the patient's condition, with emphasis on blood pressure (BP), pulse, and peripheral perfusion to determine the presence of hypovolemic shock.

25. A physician just told a patient that she has a volvulus. When the patient asks the nurse what this is, what is the best description for the nurse to give her? a. Bowel folding on itself b. Twisting of bowel on itself c. Emboli of arterial supply to the bowel d. Protrusion of bowel in weak or abnormal opening

b. Twisting of bowel on itself

17. What laboratory findings are expected in ulcerative colitis as a result of diarrhea and vomiting? a. Increased albumin b. Elevated white blood cells (WBCs) c. Decreased Na+, K+, Mg+, Cl-, and HCO3 d. Decreased hemoglobin (Hgb) and hematocrit (Hct)

c. Decreased Na+, K+, Mg+, Cl-, and HCO3

55. During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching? a. Keep the incision areas clean and dry for at least a week. b. Report the need to take pain medication for shoulder pain. c. Report any bile-colored or purulent drainage from the incisions. d. Expect some postoperative nausea and vomiting for a few days.

c. Report any bile-colored or purulent drainage from the incisions.

30. A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report? a. Vomiting of bright-red blood b. Projectile vomiting of undigested food c. Sudden, severe upper abdominal pain and back pain d. Hyperactive stomach sounds and upper abdominal swelling

c. Sudden, severe upper abdominal pain and back pain Perforation of an ulcer causes sudden, severe abdominal pain that is often referred to the back, accompanied by a rigid, boardlike abdomen and other signs of peritonitis. Vomiting of blood indicates hemorrhage of an ulcer and gastric outlet obstruction is characterized by projectile vomiting of undigested food, hyperactive stomach sounds, and upper abdominal swelling.

42. The nurse evaluates that management of the patient with upper GI bleeding is effective when assessment and laboratory findings reveal which result? a. Hematocrit (Hct) of 35% b. Urinary output of 20 mL/hr c. Urine specific gravity of 1.030 d. Decreasing blood urea nitrogen (BUN)

d. Decreasing blood urea nitrogen (BUN) The patient's blood urea nitrogen (BUN) is usually elevated with a significant hemorrhage because blood proteins are subjected to bacterial breakdown in the GI tract. With control of bleeding, the BUN will return to normal. During the early stage of bleeding, the hematocrit (Hct) is not always a reliable indicator of the amount of blood lost or the amount of blood replaced and may be falsely high or low. A urinary output of ≤20 mL/hr indicates impaired renal perfusion and hypovolemia and a urine specific gravity of 1.030 indicates concentrated urine typical of hypovolemia.

18. What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease? a. Celiac disease and gallstones b. Peptic ulcer disease and uveitis c. Conjunctivitis and colonic dilation d. Erythema nodosum and osteoporosis

d. Erythema nodosum and osteoporosis

36. Priority Decision: While caring for a patient following a subtotal gastrectomy with a gastroduodenostomy anastomosis, the nurse determines that the NG tube is obstructed. Which action should the nurse take first? a. Replace the tube with a new one. b. Irrigate the tube until return can be aspirated. c. Reposition the tube and then attempt irrigation. d. Notify the surgeon to reposition or replace the tube.

d. Notify the surgeon to reposition or replace the tube. If the patient's NG tube becomes obstructed following a gastrectomy with an intestinal anastomosis, gastric secretions may put a strain on the sutured anastomosis and cause serious complications. Be sure that the suction is working and the health care provider may order periodic gentle irrigation with normal saline solution. Because of the danger of perforating the gastric mucosa or disrupting the suture line, the nurse should notify the health care provider if the tube needs to be repositioned or replaced.

40. A patient with upper GI bleeding is treated with several drugs. Which drug should the nurse recognize as an agent that is used to decrease bleeding and decrease gastric acid secretions? a. Nizatidine (Axid) b. Omeprazole (Prilosec) c. Vasopressin (Pitressin) d. Octreotide (Sandostatin)

d. Octreotide (Sandostatin) Octreotide is a somatostatin analog that has been shown to reduce upper GI bleeding and inhibit the release of GI hormones such as gastrin, thereby decreasing hydrochloric acid secretion. Nizatidine is a histamine (H2)-receptor blocker that decreases acid secretion and omeprazole inhibits the proton pump necessary for the secretion of hydrochloric acid. Vasopressin has a vasoconstriction action useful in controlling upper GI bleeding.

26. What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation? a. Stop spillage of GI contents into the peritoneal cavity b. Remove excess fluids and undigested food from the stomach c. Feed the patient the nutrients missing from the lack of ingestion d. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty

d. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty NG intubation is used with acute exacerbation of peptic ulcer disease to remove the stimulation for hydrochloric acid (HCl) and pepsin secretion by keeping the stomach empty. Stopping the spillage of GI contents into the peritoneal cavity is used for peritonitis. Removing excess fluids and undigested food from the stomach is the rationale for using NG intubation for gastric outlet obstruction.

35. In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

d. Semiformed stools in a pouch with the need to monitor fluid balance

34. Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by a. distention of the smaller stomach by too much food and fluid intake. b. hyperglycemia caused by uncontrolled gastric emptying into the small intestine. c. irritation of the stomach lining by reflux of bile salts because the pylorus has been removed. d. movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine.

d. movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine. Because there is no sphincter control of food taken into the stomach following a Billroth II procedure, concentrated food and fluid move rapidly into the small intestine, creating a hypertonic environment that pulls fluid from the bowel wall into the lumen of the intestine, reducing plasma volume and distending the bowel. Postprandial hypoglycemia occurs when the concentrated carbohydrate bolus in the small intestine results in hyperglycemia and the release of excessive amounts of insulin into the circulation, resulting in symptoms of hypoglycemia. Irritation of the stomach by bile salts causes epigastric distress after meals, not dumping syndrome.

Diet therapy for clients diagnosed with IBS includes caffeinated products. spicy foods. high-fiber diet. fluids with meals.

high-fiber diet. A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? lack of free water intake lack of solid food lack of exercise increased fiber

lack of free water intake A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? leukocytosis; elevated hematocrit; low sodium, potassium, and chloride leukopenia, decreased hematocrit; low sodium, potassium, and chloride leukocytosis; metabolic alkalosis; elevated sodium, potassium, and chloride leukopenia; metabolic acidosis; elevated sodium, potassium, and chloride

leukocytosis; elevated hematocrit; low sodium, potassium, and chloride Tests of serum electrolytes may indicate low levels of sodium, potassium, and chloride. Metabolic alkalosis is evidenced by arterial blood gas results. A complete blood count (CBC) shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops.

2. With a right sided Stoma after a colostomy, what type of stool would you expect the stoma to be excreting? A. Liquid stool B. Lose to partly formed stool C. Similar to normal stool D. Semi-solid stool

The answer is A. Stool from an ascending colostomy will be liquid. Stool from a Transverse Colostomy: lose to partly formed stool, Descending/Sigmoid: similar to normal solid consistency. An ileostomy will always excrete liquid stool.

1. Most patients with diverticulosis are most likely to have diverticula located in the? A. Transverse colon B. Sigmoid Colon C. Rectum D. Ascending Colon

The answer is B: sigmoid colon. Diverticulosis can occur throughout the GI tract, however, it tends to be most common in the sigmoid colon.

52. Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? a. Return to work in 2 to 3 weeks b. Be hospitalized for 3 to 5 days postoperatively c. Have a T-tube placed in the common bile duct to provide bile drainage d. Have up to four small abdominal incisions covered with small dressings

d. Have up to four small abdominal incisions covered with small dressings

23. Priority Decision: Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria. b. Encourage fluid intake of 3 L/day. c. Apply moist heat to the flank area. d. Strain all urine through gauze or a special strainer.

23. b. A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic and all urine should be strained in patients with renal stones to collect and identify stone composition but these are not related to infection.

24. What type of pain does the nurse expect a patient with an ulcer of the posterior portion of the duodenum to experience? a. Pain that occurs after not eating all day b. Back pain that occurs 2 to 4 hours following meals c. Midepigastric pain that is unrelieved with antacids d. High epigastric burning that is relieved with food intake

24. b. Back pain that occurs 2 to 4 hours following meals Back pain is a common manifestation of ulcers located on the posterior aspect of the duodenum and is important for nurses to keep in mind during assessment of the patient, because the more typical epigastric burning and pain may not be present. Duodenal ulcers are more often relieved by food than are gastric ulcers and when epigastric discomfort occurs, it is lower than that of gastric ulcers. Eating stimulates gastric acid production, increasing discomfort for patients with gastric ulcers, whereas the pain of duodenal ulcers usually occurs several hours after eating.

The nurse is caring for four clients with diarrhea. Which client is most likely to be diagnosed with Crohn's disease? A 24 year-old Caucasian eastern European Jewish female A 46 year-old African American male A 32 year-old female from Vietnam A 63 year-old Hispanic female with a history of cancer of the vulva

A 24 year-old Caucasian eastern European Jewish female Clients who are more prone to this disorder include those with a family history of the disease, those who are white with a European and/or Jewish ancestry, and those who smoke. The other client's listed do not have these risk factors.

48. Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)? a. Fasting b. Hypothyroidism c. Parenteral nutrition d. Prolonged immobility e. Streptococcus pneumoniae f. Absence of bile in the intestine

ACD

49. A patient with an obstruction of the common bile duct has clay-colored fatty stools, among other manifestations. What is the pathophysiologic change that causes this clinical manifestation? a. Soluble bilirubin in the blood excreted into the urine b. Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion c. Contraction of the inflamed gallbladder and obstructed ducts, stimulated by cholecystokinin when fats enter the duodenum d. Obstruction of the common duct prevents bile drainage into the duodenum, resulting in congestion of bile in the liver and subsequent absorption into the blood

B Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion

9. Your patient arrives back to their room after having extracoporeal shock wave lithotripsy (ESWL) for treatment of a kidney stone. What will be included in the patient's plan of care? SELECT-ALL-THAT-APPLY: A. Keep the patient in bed B. Encourage fluid intake of 3-4 liters per day C. Maintain nephrostomy tube D. Strain urine E. Keep dressing dry and intact

B. Encourage fluid intake of 3-4 liters per day D. Strain urine Extracoporeal shock wave lithotripsy (ESWL) is NONINVASIVE (no incisions...no dressings or nephrostomy tubes are placed). Shockwaves are created to penetrate though the skin and body tissue. Shockwaves will hit the stone and break it down into grain of sand like particles which will be passed out by the patient. Option A is wrong because the patient should be kept mobile (as tolerated) to assist the passage of the kidney stone fragment.

7. You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care? A. Restrict calcium intake B. Strain urine with every void C. Keep patient in supine position to alleviate pain D. Maintain fluid restriction of 1-2 Liter per day

B. Strain urine with every void It is vital the nurse strains every void and assesses the urine very closely for stones. This is crucial so it can be determined what type of kidney stone is causing the problem, therefore, appropriate treatment can be ordered. Restricting calcium intake is no longer recommended unless the patient has a metabolic or renal tubule problem. It is important to avoid placing the patient in the supine position for long periods because this impedes the flow of urine and the patient's ability to pass the stone. Fluid should not be restricted (unless the patient has a condition that requires it like heart failure etc.) because this concentrates the urine...hence increases the chances of another stone developing.

53. A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse? a. "A low-fat diet will prevent the development of further gallstones and should be continued." b. "Yes; because you will not have a gallbladder to store bile, you will not be able to digest fats adequately." c. "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile." d. "Removal of the gallbladder will eliminate the source of your pain associated with fat intake, so you may eat whatever you like."

C "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile."

3. A patient is scheduled for an intravenous pyelogram (IVP) to assess for kidneys stones. Which finding below requires the nurse to contact the physician? A. Patient reports flank pain that radiates downward B. Patient has hematuria C. Patient is allergic to shellfish D. Patient has cloudy urine

C. Patient is allergic to shellfish During an IVP a special dye, which is iodine based, will be given through an IV. Then x-ray images will be taken to assess the kidneys, bladder, ureters, and urethra. It is very important to make sure the patient isn't allergic to iodine or shellfish, pregnant, nursing, has impaired renal function, or is taking Metformin. All the other options are typical signs and symptoms that can occur with a kidney stone.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? Inform the patient that it will only last a minute and continue with the procedure. Clamp the tubing and give the patient a rest period. Stop the irrigation and remove the tube. Replace the fluid with cooler water since it is probably too warm.

Clamp the tubing and give the patient a rest period. When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.