Exam 2 practice questions

The etiology of cancer of the colon and rectum is predominantly (90%) (BLANK), a malignancy arising from the epithelial lining of the intestine.

Adenocarcinoma

The most common, primary malignant tumor of the small intestine is (BLANK).

Adenocarcinoma

Currently the most commonly used therapy for peptic ulcers is a combination of (BLANK), proton pump inhibitors, and bismuth salts that suppresses or eradicates H. pylori.

Antibiotics

(BLANK), the most common cause of a cute Surgical and Abdomen in the United States, is the most common reason for emergency abdominal surgery.

Appendicitis

(BLANK), an involuntary flapping of the hands, may be seen in stage 2 encephalopathy.

Asterixis

The nurse is completing the patient's admission history. Which statement should prompt the nurse to further question the patient about GERD? A) "I have been experiencing headaches soon after eating" B) "Lately, I have been waking up at night with a burning feeling in my chest" C) "I have been waking up at night drenched from sweating" D) "Immediately after I eat I want to go to sleep"

B) " lately, I have been waking up at night with a burning feeling in my chest"

The nurse is reviewing the health history of the patient hospitalized with Nonalcoholic Fatty Liver Disease (NAFLD). Which finding should the nurse associate with the disease process? A) 70 years old at diagnosis B) Body mass index at 35 C) History of recent antibiotic use D) Living in a colder climate

B) Body mass index at 35

The serum ammonia level of the patient with cirrhosis is elevated. What should the nurse do? A) Monitor for temperature elevation B) Observe for increasing confusion C) Measure the urine specific gravity D) Restrict the intake of oral fluids

B) Observe for increasing confusion

The nurse is performing an initial postoperative assessment on a patient following upper G.I. surgery. The patient had an NG tube to low suction. To best assess the patient for bowel sounds, which intervention should the nurse implement? A) Start auscultating to the left of the umbilicus B) Turn off the NG suction prior to auscultation C) Use the bell of the stethoscope for auscultation D) Empty the drainage canister prior to auscultation

B) Turn off the NG suction prior to auscultation

The nurse is caring for a patient with a sinkers diverticulum. Which problem should be the nurses priority? A) Pain related to heartburn from gastric reflux B) Aspiration related to regurgitation of food accumulated in the diverticula C) Constipation related to changes of the sigmoid colon D) Altered nutrition, less than body requirements, related to dysphasia

B) aspiration related to regurgitation of food accumulated in the diverticula

The liver manufactures and secretes (BLANK) which has a major role in the digestion and absorption of fats in the G.I. tract.

Bile

Abdominal pain and constipation or common clinical manifestations of Crohn's disease. T/F?

False Abdominal pain and diarrhea are common clinical manifestations of Crohn's disease. Crohn's patients NEVER have constipation, not even with opioids.

The patient with irritable bowel syndrome IBS should select foods low in fiber in order to minimize intentional irritation. T/F?

False Avoid alcohol and smoking and high-fat foods

Bleeding esophageal varices result in an increase in renal perfusion. T/F?

False Bleeding esophageal varices do not result in an increase in renal perfusion, they result in a DECREASE in renal perfusion.

The hepatitis A virus is transmitted primarily parenterally through percutaneous and permucosal routes. T/F?

False Hepatitis A is transmitted primarily through poor hand hygiene, via fecal-oral route.

Prothrombin time, normally 12-16 seconds, is decreased to 4-6 seconds in liver disease. T/F?

False Prothrombin time is increased in liver disease

The most common site for diverticulitis is the ileum. T/F?

False The most common sight for diverticulitis is the sigmoid colon.

The average weight loss after bariatric surgery is 60% of previous body weight. T/F?

False -> the average weight loss after bariatric surgery is 25-35% of previous body weight

Erosive gastritis, both acute and chronic, is most often caused by infection with Helicobacter pylori (H. pylori) bacteria. T/F?

False Acute: usually caused by dietary indiscretion Chronic: usually caused by benign or malignant ulcers of the stomach or H. pylori

Patients with the dumping syndrome, after gastric surgery, should consume at least 16 ounces of fluid with each meal. T/F?

False Avoid fluid with meals after gastric surgery to avoid dumping syndrome.

Hepatitis A, B, C, and D are all caused by exposure to blood-borne pathogens? T/F?

False B, C, and D are, but A can be from common exposures like saliva/fecal matter, and due to poor hand hygiene

The majority of blood supply to the liver, which is poor nutrients, comes from the portal vein. T/F?

False Majority of blood supply to deliver, which is RICH in nutrients from the gastrointestinal tract, comes from the portal vein.

Diverticula make her anywhere in the small intestine or colon, but most commonly occurs in the ascending colon. T/F?

False Most commonly occurs in the sigmoid colon

Regular bowel habits can be established for a patient with an ileostomy. T/F?

False Regular bowel habits can NOT be established by a patient with an ileostomy. This is too high up.

The most common site for peptic ulcer formation is the pylorus. T/F?

False the most common site for peptic ulcer formation is the duodenum

For which type of hepatitis is there a highly recommended vaccine?

Hepatitis B is the only one with a recommended vaccine, the others can be prevented by lifestyle practices. I.e- safe sex, safe needle practices, good hand hygiene

(BLANK) jaundice is caused by the inability of damaged liver cells to clear normal amounts of Billy Rubin from the blood.

Hepatocellular

People with blood type (BLANK) are more susceptible to peptic ulcers than those with other blood types.

O

The immediate response of the intestinal tract to (BLANK) is hypermotility, soon followed by paralytic ileus with an accumulation of air and fluid in the bowel.

Peritonitis

Patients with cirrhosis are at increased risk for bleeding and hemorrhage because of the decreased production of (BLANK) and the decreased ability of the diseased liver to synthesize the necessary substances for blood coagulation.

Prothrombin

The patient is prescribed infliximab (Remicade) 5 mg/kg every eight weeks for treatment of Crohn's disease. The patient weighs 116 lbs. How many milligrams (mg) should the nurse administer?

Pt = 52.7 kg * 5 = 263.6 264 mg

After bariatric surgery, the average patient loses between 25% and 35% of pre-surgical bodyweight within the first 18-24 months post procedure. T/F?

True

After bowel sounds have returned an oral intake is resumed following bariatric surgery, 6 small feedings consisting of a total of 600-800 cal/ day should be consumed. T/F?

True

Benign liver tumors, such as hepatic adenomas, occur most frequently in women, in their reproductive years, who are taking oral contraceptives. T/F?

True

Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. T/F?

True

Diarrhea is defined as the increased frequency of more than three bowel movements per day. T/F?

True

Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. T/F?

True

Only persons with hepatitis B are at risk for hepatitis D. T/F?

True

The albumin to globulin ratio (normally 1.5-2.5) is reversed in liver disease. T/F?

True

The patient with an ileostomy with a Koch pouch will not need to use an external fecal collection bag. T/F?

True

When fluid accumulates in the peritoneal cavity, the presence and extent of ascites are assessed by percussing the abdomen. T/F?

True

Straining at stool initiates the (BLANK) maneuver that results in a potentially dangerous increase in BP.

Valsalva

Traditionally, the term morbid obesity applies to adults whose body mass index (BMI) exceeds (BLANK) kg/m^2.

40

The Billroth II gastrectomy procedure is a resection that involves removing approximately (BLANK)% of the stomach, thus decreasing the possibility of lymph node spread or metastatic recurrence.

75

What is the best time to teach a client to take proton pump Inhibitors? A) 30 minutes before a meal B) with a meal C) immediately after the meal D) 1-3 hours after a meal

A) 30 minutes before a meal -> It is a proton pump inhibitor and it is a delayed release medication that is to be swallowed whole and taken before a meal

The patient is admitted for conservative treatment of cirrhosis. As part of the collaborative plan of care, the nurse should plan for which intervention? A) Monitor the patient's blood sugar B) Keep patient NPO C) Administer IV antibiotics D)Encourage ambulation every 4 hours

A) Monitor the patient's blood sugar

The nurse is caring for a patient who had a vertical lap band gastroplasty. The nurse teaches that nausea can occur after surgery from which situation? A) The stomach pouch becomes overfilled B) The lower part of the stomach becomes spastic C) The duodenal incision becomes inflamed D) The dumping syndrome from a meal that is too high in protein

A) The stomach pouch becomes overfilled

The nurses assesses the patient previously diagnosed as having an inguinal hernia. The nurse considers that the patient's hernia may be strangulated when which assessment findings are present? SATA A) Abdominal distention B) dyspnea with exertion C) severe abdominal pain D) no stool for the past week E) HYPERactive bowel sounds

A, C, D

The nurse is caring for a patient recently diagnosed with cirrhosis. After completing discharge education, the nurse recognizes the need for further teaching when the patient makes which comment? A) 1."My cirrhosis was caused by too much drinking; I plan to stop drinking." B) "I need to rest more, so I plan to start back to work on a part time basis." C) "Propanolol has been ordered to help control my blood pressure." D) Furosimide will help reduce the amount of abdominal fluid I am retaining."

C) "Propanolol has been ordered to help control my blood pressure."

The nurse is assessing the patient who is 24 hours post G.I. hemorrhage. The findings are BUN 40 mg/dL and SCr 0.8 mg/dL which action should be taken by the nurse? A) Immediately called the HCP to report the results B) Monitor urine output as this may be a sign of kidney failure C) Document the finding and continue to monitor the patient D) encourage the patient to limit his protein intake

C) Document the finding and continue to monitor the patient

The nurse is admitting a patient for a follow up colonoscopy. Which information, if found in the patient's medical record, should the nurse consider as the primary reason for the patient colonoscopy? A) Chronic constipation B) Urostomy placed three years ago C) History of colon polyps D) Hemoglobin 10 g/dL

C) History of colon polyps

The patient is scheduled for a percutaneous liver biopsy. Where can the nurse expect to have the needle inserted so she can help teach the patient about the procedure? A) Left upper abdominal quadrant B) Right lower abdominal quadrant C) Right upper abdominal quadrant D) Right side of back, just below the rib cage

C) Right upper abdominal quadrant

In Crohn's disease, the clusters of alterations on the intestinal mucosal have a (BLANK) appearance.

Cobblestone

The nurse is taking an admission history on the new patient. He considers the patient may have IBS when the patient makes which statement? A) "I am having a lot of bloody diarrhea" B) "I have been vomiting for two days" C) "I have lost 10 pounds in the last month, without trying" D) "I have noticed mucus in my stools"

D) "I have noticed mucus in my stools"

The nurse is preparing to administer amitriptyline 10 mg PO to the patient with IBS. The patient wants to know why he has been receiving this since he is not depressed. The best response by the nurse is: A) "So, the medication is working. People with chronic disease often also suffer from depression." B) "People with IBS often have difficulty falling back to sleep when awakening with diarrhea. This will help." C) "The anti-cholinergic side effects of this drug will help to prevent bowel irritability and constipation." D) "Tricyclic antidepressants reduce abdominal pain by affecting the communication system from the bowel to the brain."

D) "Tricyclic antidepressants reduce abdominal pain by affecting the communication system from the bowel to the brain."

A nurse is admitting a patient with gastric cancer to the unit. What assessment finding would prompt the nurse to review the medical history to see if the cancer had spread to the peritoneal cavity? A) The patient is complaining of nausea B) Grey Turner's sign is present C) The patient states a rapid weight loss D) Ascites is noted in the abdomen

D) Ascites as noted in the abdomen

What is an example of a laxative osmotic agent? A) Bisacodyl (Dulcolax) B) Dioctyl sodium sulfosuccinate (Colace) C) Magnesium hydroxide (milk of magnesia) D) Polyethylene glycol and electrolytes (Colyte)

D) Polyethylene glycol and electrolytes Colyte Bisacodyl (Dulcolax) is a stimulant laxative. Dioctyl sodium sulfosuccinate (Colace) is a fecal softener. Magnesium hydroxide (milk of magnesia) is a saline agent.

The nurse is planning to care for a patient diagnosed with hepatitis A. Which interventions should the nurse include? A) Teach the patient to limit use of alcohol and drugs containing acetaminophen. B) Provide a high-protein, high-carbohydrate diet with 3 large meals per day. C) Wear gloves, masks, and gowns when providing personal care. D) Provide rest periods, alternating with moderate activity during the day.

D) Provide rest periods, alternating with moderate activity during the day.

What diuretics medication would most often be used for a patient with ascites? A) Actazolamide (Diamox) B) Ammonium chloride C) Furosemide (Lasix) D) Spironolactone (Aldactone)

D) Spironolactone (Aldactone)

After receiving report for four patients on your unit, you must prioritize the order in which to see these patients. A) The patient with ascites who is having mild dyspnea with activity B) The patient with a peptic ulcer who is now having severe vomiting C) The patient who had a colonoscopy a couple hours ago and is now having diarrhea D) The patient with Crohn's disease who received an initial dose of certolizumab (Cimzia) and is having a generalized rash

D, B, C, A

What are normal Bilirubin levels?

Direct: 0.1-0.4 mg/dL (1.7 to 3.7 mcmol/L) Total: 0.3-1 mg/dL (5-17 mcmol/L) (*most measure totals)

The most significant source of bleeding in a patient with cirrhosis is (BLANK) varices.

Esophageal