exam 6
The nurse is admitting a 67-yr-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do youNusuRallyIdrinGk?" "Have you noticed a recent weight loss?" "What time of day do your bowels move?" "Do you eat meat or other animal products?"
"Have you noticed a recent weight loss?"
A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). What should the nurse explain about the action of the medication? "It decreases nausea and vomiting." "It inhibits development of stress ulcers." "It lowers the risk for H. pylori infection." "It prevents aspiration of gastric contents." ANS: B
"It inhibits development of stress ulcers."
What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy? Constipation Dehydration Elevated total serum cholesterol Cobalamin (vitamin B12) deficiency
Cobalamin (vitamin B12) deficiency
After change-of-shift report, which patient should the nurse assess first? A 42-yr-old patient who has acute gastritis and ongoing epigastric pain A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy
A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa
Which patient should the nurse assess first after receiving change-of-shift report? A patient with esophageal varices who has a rapid heart rate A patient with a history of gastrointestinal bleeding who has melena A patient with nausea who has a dose of metoclopramide (Reglan) due A patient who is crying after receiving a diagnosis of esophageal cancer ANS: A
A patient with esophageal varices who has a rapid heart rate
What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction? Referred back pain Metabolic alkalosis Projectile vomiting Abdominal distention
Abdominal distention
After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." What action should the nurse take? Reassure the patient that ileostomy care will become easier. Ask the patient about the concerns with stoma management. c. Postpone any teaching until the patient adjusts to the ileostomy. USNT O d. Develop a detailed written list of ostomy care tasks for the patient.
Ask the patient about the concerns with stoma management.
A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first? Inform the patient that testing of blood and stools will be needed. Suggest that the patient drink clear liquid fluids with electrolytes. Ask the patient to describe the stools and any associated symptoms. Advise the patient to use over-the-counter antidiarrheal medication.
Ask the patient to describe the stools and any associated symptoms.
A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? Teach about a low-residue diet. Monitor output from the stoma. Assess the perineal drainage and incision. Encourage acceptance of the colostomy stoma.
Assess the perineal drainage and incision.
The nurse is caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy. In which order will the nurse take actions? (Put a comma and a space between each answer choice [A, B, C, D].) a. Contact the health care provider. b. Assess blood pressure and heart rate. c. Give the PRN acetaminophen (Tylenol). d. Place the patient on contact precautions.
D, B, A, C
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care? Administer IV metoclopramide (Reglan). Discontinue the patient's oral food intake. Administer cobalamin (vitamin B12) injections. Teach the patient about total colectomy surgery.
Discontinue the patient's oral food intake.
Which item should the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting? Glass of orange juice Dish of lemon gelatin cup of coffee with cream bowl of hot chicken broth
Dish of lemon gelatin
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first? Place the patient on NPO status. Administer sedative medications. Ensure the consent form is signed. Teach the patient about the procedure.
Place the patient on NPO status.
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed? "I quit smoking years ago, but I chew gum." "I eat small meals and have a bedtime snack." "I take antacids between meals and at bedtime each night." "I sleep with the head of the bed elevated on 4-inch blocks."
"I eat small meals and have a bedtime snack."
Which statement to the nurse from a patient with jaundice indicates a need for teaching? "I used cough syrup several times a day last week." "I take a baby aspirin every day to prevent strokes." "I take an antacid for indigestion several times a week" "I use acetaminophen (Tylenol) every 4 hours for pain." ANS: D
"I use acetaminophen (Tylenol) every 4 hours for pain."
How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn? "It reduces gastroesophageal reflux by increasing the rate of gastric emptying." "It neutralizes stomach acid and provides relief of symptoms in a few minutes." "It coats and protects the lining of the stomach and esophagus from gastric acid." "It treats gastroesophageal reflux disease by decreasing stomach acid production."
"It treats gastroesophageal reflux disease by decreasing stomach acid production."
The nurse is assessing an alert and independent older adult patient for malnutrition risk. Which is the most appropriate initial question? "How do you get to the store to buy your food?" "Can you tell me the food that you ate yesterday?" "Do you have any difficulty in preparing or eating food?" "Are you taking any medications that alter your taste for food?"
"Can you tell me the food that you ate yesterday?"
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? "You will need to remain on a bland diet." "Avoid foods that cause pain after you eat them." "High-protein foods are least likely to cause pain." "You should avoid eating any raw fruits and vegetables."
"Avoid foods that cause pain after you eat them."
A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? "What type of foods do you eat?" "Is it possible that you are pregnant?" "Can you tell me more about the pain?" "What is your usual elimination pattern?"
"Can you tell me more about the pain?"
A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect? a. 2b. 3 c. 4 d. 5 ANS: A
2
Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? Give an IV H2 receptor antagonist. Draw blood for type and crossmatch. Administer 1 L of lactated Ringer's solution. Insert a nasogastric (NG) tube and connect to suction.
Administer 1 L of lactated Ringer's solution.
Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action? Auscultate for hypotonic bowel sounds. Notify the patient's health care provider. Check for tube placement and reposition it. Remove the tube and replace it with a new one.
Check for tube placement and reposition it.
A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? Irrigate the NG tube. Check the vital signs. Give the ordered antacid. Elevate the foot of the bed.
Check the vital signs.
Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? Encourage the patient to express concerns and ask questions about IBS. Suggest that the patient increase the intake of milk and other dairy products. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.
Encourage the patient to express concerns and ask questions about IBS.
What diagnostic test should the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis? Endoscopy Angiography Barium studies Gastric analysis
Endoscopy
A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? Fistulas can form between the bowel and bladder. Bacteria in the perianal area can enter the urethra. Drink adequate fluids to maintain normal hydration. Empty the bladder before and after sexual intercourse.
Fistulas can form between the bowel and bladder.
A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first? Administer IV ketorolac 15 mg for pain relief. Send a blood sample for a complete blood count (CBC). Infuse a liter of lactated Ringer's solution over 30 minutes. Send the patient for an abdominal computed tomography (CT) scan.
Infuse a liter of lactated Ringer's solution over 30 minutes.
At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. What should the nurse teach the patient to do? Increase the amount of fluid with meals. Eat foods that are higher in carbohydrates. Lie down for about 30 minutes after eating. Drink sugared fluids or eat candy after meals.
Lie down for about 30 minutes after eating.
An adult with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding should the nurse report to the health care provider? Tympany on percussion of the abdomen Liver edge 3 cm below the costal margin Bowel sounds of 20/min in each quadrant Aortic pulsations visible in the epigastric area ANS: B
Liver edge 3 cm below the costal margin
After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient? Medication use Fluid restriction Enteral nutrition Activity restrictions
Medication use
An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? Sucralfate (Carafate) Aluminum hydroxide Omeprazole (Prilosec) Metoclopramide (Reglan)
Metoclopramide (Reglan)
A patient who takes a nonsteroidal antiinflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What should the nurse anticipate teaching the patient? Substitution of acetaminophen (Tylenol) for the NSAID Use of enteric-coated NSAIDs to reduce gastric irritation Reasons for using corticosteroids to treat the rheumatoid arthritis Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa
Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa
Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)? Restrict oral fluid intake. Monitor stools for blood. Ambulate six times daily. Increase dietary fiber intake.
Monitor stools for blood.
What action should the nurse take after assisting with a needle biopsy of the liver at a patient's bedside? Elevate the head of the bed to facilitate breathing. Place the patient on the right side with the bed flat. Check the patient's postbiopsy coagulation studies. Position a sandbag over the liver to provide pressure.
Place the patient on the right side with the bed flat.
A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? Auscultate the bowel sounds. Prepare the patient for surgery. Check the patient's oral temperature. Obtain information about the accident.
Prepare the patient for surgery.
What should the nurse anticipate teaching a patient with a new report of heartburn? A barium swallow Radionuclide tests Endoscopy procedures Proton pump inhibitors
Proton pump inhibitors
Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer? Bleeding during tooth brushing Painful blisters at the lip border Red patches on the buccal mucosa Curdlike plaques on the posterior tongue
Red patches on the buccal mucosa
A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What should the nurse teach the patient to avoid? Emotionally stressful situations Smoked foods such as ham and bacon Foods that cause distention or bloating Chronic use of H2 blocking medications
Smoked foods such as ham and bacon
The nurse is caring for a patient with an obstructed common bile duct. What condition should the nurse expect? Melena Steatorrhea Decreased serum cholesterol level Increased serum indirect bilirubin level
Steatorrhea
A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? Assist the patient to cough and deep breathe. Palpate the abdomen for rebound tenderness. Suggest the patient lie on the side, flexing the right leg. Encourage the patient to sip clear, noncarbonated liquids.
Suggest the patient lie on the side, flexing the right leg.
Which assessment should the nurse perform first for a patient who just vomited bright red blood? Measuring the quantity of emesis Palpating the abdomen for distention Auscultating the chest for breath sounds Taking the blood pressure (BP) and pulse
Taking the blood pressure (BP) and pulse
The nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? The patient declined to drink the prescribed laxative solution. The patient has had an allergic reaction to shellfish and iodine. The patient has a permanent pacemaker to prevent bradycardia. The patient is worried about discomfort during the examination.
The patient declined to drink the prescribed laxative solution.
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? The patient reports 7/10 (0 to 10 scale) abdominal pain. The patient is experiencing intermittent waves of nausea. The patient has no breath sounds in the left anterior chest. The patient has hypoactive bowel sounds in all four quadrants.
The patient has no breath sounds in the left anterior chest.
A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? The patient uses incontinence briefs to contain loose stools. The patient uses witch hazel compresses to soothe irritation. The patient asks for antidiarrheal medication after each stool. The patient cleans the perianal area with soap after each stool.
The patient uses witch hazel compresses to soothe irritation.
The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? The bowel sounds are hyperactive in all four quadrants. The patient's lungs have crackles audible to the midchest. The nasogastric (NG) suction is returning coffee-ground material. The patient's blood pressure (BP) has increased to 142/84 mm Hg.
The patient's lungs have crackles audible to the midchest.
Which information will the nurse provide for a patient with achalasia? A liquid diet will be necessary. Avoid drinking fluids with meals. Lying down after meals is recommended. Treatment may include endoscopic procedures.
Treatment may include endoscopic procedures.
Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "I should apply sunscreen before going outdoors." "The medication will be tapered if I need surgery." "I will need to avoid contact with people who are sick." "The medication prevents the infections that cause diarrhea."
a. "I should apply sunscreen before going outdoors."
Which action should the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? a. Obtain a stool specimen for culture. Administer antidiarrheal medication. Provide teaching about antibiotic therapy. Teach the adverse effects of acetaminophen (Tylenol).
a. Obtain a stool specimen for culture.
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)? a. "Ranitidine absorbs the excess gastric acid." b. "Ranitidine decreases gastric acid secretion." c. "Ranitidine constricts the blood vessels near the ulcer." d. "Ranitidine covers the ulcer with a protective material."
b. "Ranitidine decreases gastric acid secretion."
A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test?a. Identify any metastasis of the cancer. b. Monitor the tumor status after surgery. c. Confirm the diagnosis of a specific type of cancer. d. Determine the need for postoperative chemotherapy.
b. Monitor the tumor status after surgery.
Which is the correct technique for the nurse to palpate the liver during a head-to-toe physical assessment? a. Place one hand on top of the other and use the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. b. Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin. c. Press slowly and firmly over the right costal margin with one hand and withdraw the fingers quickly after the liver edge is felt. d. Place one hand under the patient's lower ribs and press the left lower rib cage forward, palpating below the costal margin with the other hand.
b. Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin.
A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Question the patient about risk factors for constipation. c. Suggest that the patient incUreasSe inNtakeTof highO-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.
b. Question the patient about risk factors for constipation.
A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? The patient has been vomiting for 4 days. The patient takes antacids 8 to 10 times a day c. the patient is lethargic and difficult to arouse. d. The patient has had a small intestinal resection.
c. the patient is lethargic and difficult to arouse.
After change-of-shift report, which patient should the nurse assess first? A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer
A 30-yr-old female patient with a femoral hernia who has abdominal pain and
Which patient should the nurse assess first after receiving change-of-shift report? A 30-yr-old patient who has a distended abdomen and tachycardia A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours A 40-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool
A 30-yr-old patient who has a distended abdomen and tachycardia
An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question? Infuse lactated Ringer's solution at 250 mL/hr. Monitor blood urea nitrogen and creatinine daily. Administer loperamide (Imodium) after each stool. Provide a clear liquid diet and progress diet as tolerated.
Administer loperamide (Imodium) after each stool.
A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace has severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea? Keep the patient NPO for 2 hours before dressing changes. Give the prescribed prochlorperazine before dressing changes. Administer prescribed morphine sulfate before dressing changes. Avoid performing dressing changes close to the patient's mealtimes.
Administer prescribed morphine sulfate before dressing changes.
A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? Soak in Sitz baths several times each day. Cough 5 times each hour for the next 48 hours. Avoid using acetaminophen (Tylenol) for pain. Apply a scrotal support and ice to reduce swelling.
Apply a scrotal support and ice to reduce swelling.
A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)? Auscultate the bowel sounds. Assess for signs of dehydration. Assist the patient with oral care. Ask the patient about the nausea.
Assist the patient with oral care.
Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa? Use sunscreen even on cloudy days. Avoid cigarettes and smokeless tobacco. c. Complete antibiotic courses used to treat throat infections. d. Use antivirals to treat herpes simplex virus (HSV) infections.
Avoid cigarettes and smokeless tobacco.
A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), what should the nurse plan to assess more frequently than is routine? Apical pulse Bowel sounds Breath sounds Abdominal girth
Breath sounds
Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? Auscultating for bowel sounds Brushing the teeth and tongue Assessing the nares for irritation Irrigating the nasogastric (NG) tube
Brushing the teeth and tongue
Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.) Stimulant and saline laxatives can be used regularly. Bulk-forming laxatives are an excellent source of fiber. Walking or cycling frequently will help bowel motility. A good time for a bowel movement may be after breakfast. Some over-the-counter (OTC) medications cause constipation.
Bulk-forming laxatives are an excellent source of fiber. Walking or cycling frequently will help bowel motility. A good time for a bowel movement may be after breakfast. Some over-the-counter (OTC) medications cause constipation.
A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. What should the nurse do during the initial assessment of the patient? Remove the knife and assess the wound. Determine the presence of Rovsing sign. Check for circulation and tissue perfusion. Insert a urinary catheter and assess for hematuria.
Check for circulation and tissue perfusion.
A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? Skin is dry with tenting and poor turgor. Patient has not voided for the last 2 hours. Crackles are heard halfway up the posterior chest. Patient has had 5 loose stools over the previous 6 hours.
Crackles are heard halfway up the posterior chest.
the nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus? Cullen sign Rovsing sign McBurney sign Grey-Turner's sign
Cullen sign
A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take? Place ice packs around the stoma. Notify the surgeon about the stoma. Monitor the stoma every 30 minutes. Document stoma assessment findings.
Document stoma assessment findings.
Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? Document the appearance of the stoma. Place a pouching system over the ostomy. Drain and measure the output from the ostomy. Check the skin around the stoma for breakdown.
Drain and measure the output from the ostomy.
A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? Fever Nausea Joint pain Headache
Fever
Which information will the nurse plan to teach a patient who has lactose intolerance? Ice cream is relatively low in lactose. Live-culture yogurt is usually tolerated. Heating milk will break down the lactose. Nonfat milk is tolerated better than whole milk
Live-culture yogurt is usually tolerated.
A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? Administer bulk-forming laxatives. Assist the patient to sit on the toilet. Manually remove the impacted stool. Increase the patient's oral fluid intake.
Manually remove the impacted stool.
Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? Navy bean soup and vegetable salad Whole grain pasta with tomato sauce Baked potato with low-fat sour cream Roast beef sandwich on whole wheat bread
Navy bean soup and vegetable salad
After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? Notify the health care provider. Obtain a stool specimen for analysis. Teach the patient about hand washing. Place the patient on contact precautions.
Place the patient on contact precautions.
A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? Position patient with the knees flexed. Avoid use of opioids or sedative drugs. Offer frequent small sips of clear liquids. Assist patient to breathe deeply and cough.
Position patient with the knees flexed.
A 19-yr-old patient has familial adenomatous polyposis (FAP). Which action will the nurse the gastrointestinal clinic include in the plan of care? Obtain blood samples for DNA analysis. Schedule the patient for yearly colonoscopy. Provide preoperative teaching about total colectomy. Discuss lifestyle modifications to decrease cancer risk.
Schedule the patient for yearly colonoscopy.
54. Which prescribed intervention for a patient with chronic short bowel syndrome should the nurse question? Senna 1 tablet daily Ferrous sulfate 325 mg daily Psyllium (Metamucil) 3 times daily Diphenoxylate with atropine (Lomotil) PRN loose stools
Senna 1 tablet daily
Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider? The patient has a history of constipation. The patient has noticed blood in the stools. The patient had an appendectomy at age 27. The patient smokes a pack/day of cigarettes.
The patient has noticed blood in the stools.
A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching? Stool will be expelled from both stomas. This type of colostomy is usually temporary. Soft, formed stool can be expected as drainage. Irrigations can regulate drainage from the stomas.
This type of colostomy is usually temporary.
Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse? Decreased appetite Occasional indigestion Unintended weight loss Difficulty chewing food
Unintended weight loss
A critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence? Apply incontinence briefs. Use a fecal management system. Insert a rectal tube with a drainage bag. Assist the patient to a commode frequently.
Use a fecal management system.
Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. Use care when eating high-fiber foods to avoid obstruction of the ileum. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. Change the pouch every day to prevent leakage of contents onto the skin.
Use care when eating high-fiber foods to avoid obstruction of the ileum.
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What should the nurse ask the patient about to determine possible risk factors for gastritis? The amount of saturated fat in the diet A family history of gastric or colon cancer Use of nonsteroidal antiinflammatory drugs A history of a large recent weight gain or loss
Use of nonsteroidal antiinflammatory drugs
A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate? "You may have quite a few years still left to live." "Thinking about dying will only make you feel worse." "Having this new diagnosis must be very hard for you." "It is important that you be realistic about your prognosis."
"Having this new diagnosis must be very hard for you."
Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? "Have you been passing a lot of gas?" "What foods affect your bowel patterns?" "Do you have any abdominal distention?" "How long have you had abdominal pain?"
"How long have you had abdominal pain?"
Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? "Peppermint tea may reduce your symptoms." "Keep the head of your bed elevated on blocks." "You should avoid eating between meals to reduce acid secretion." "Vigorous physical activities may increase the incidence of reflux."
"Keep the head of your bed elevated on blocks."
Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective? "The cobalamin injections will prevent gastric inflammation." "The cobalamin injections will prevent me from becoming anemic." "These injections will increase the hydrochloric acid in my stomach." "These injections will decrease my risk for developing stomach cancer."
"The cobalamin injections will prevent me from becoming anemic."
Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? "I will drink more liquids with my meals." "I should choose high carbohydrate foods." "Vitamin supplements may prevent anemia." "Persistent heartburn is common after surgery."
"Vitamin supplements may prevent anemia."
Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly? a. 1 b. 2 c. 3 d. 4
2
Vasopressin 0.2 unit/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 100 units/250 mL normal saline. How many mL/hr will the nurse infuse?
30
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? Loud gurgles High-pitched gurgles Absent bowel sounds Frequent clicking sounds
Absent bowel sounds
25. What should the nurse admitting a patient with acute diverticulitis plan for initial care? Administer IV fluids. Prepare for colonoscopy. Encourage a high-fiber diet. Give stool softeners and enemas.
Administer IV fluids.
An older patient reports chronic constipation. To promote bowel evacuation, when should the nurse suggest that the patient attempt defecation? In the mid-afternoon After eating breakfast c. Right after awakening in the morning immediately before the first daily meal
After eating breakfast
A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient? Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix)
Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? Chocolate pudding Glass of low-fat milk Cherry gelatin with fruit Peanut butter and jelly sandwich
Cherry gelatin with fruit
What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia? Iron dextran infusions Oral ferrous sulfate tablets Routine blood transfusions Cobalamin (B12) supplements
Cobalamin (B12) supplements
A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do? Collect a stool specimen. Prepare for colonoscopy. Schedule a barium enema. Have blood cultures drawn.
Collect a stool specimen.
What should the nurse preparing for the annual physical exam of a 45-yr-old man plan to teach the patient about? Endoscopy Colonoscopy Computerized tomography screening Carcinoembryonic antigen (CEA) testing
Colonoscopy
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. What is the highest priority action by the nurse? Monitor drainage. Contact the surgeon. Irrigate the NG tube. Give prescribed morphine.
Contact the surgeon.
Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? Wheat toast with butter Oatmeal with nonfat milk Bagel with low-fat cream cheese Corn tortilla with scrambled eggs
Corn tortilla with scrambled eggs
A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? Send the patient for a CT scan. Insert a urinary catheter to drainage. Infuse metronidazole (Flagyl) 500 mg IV. Place a nasogastric tube to intermittent low suction.
Infuse metronidazole (Flagyl) 500 mg IV.
A 49-yr-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first? Insert a nasogastric (NG) tube. Infuse normal saline at 250 mL/hr. Administer IV ondansetron (Zofran). Provide oral care with moistened swabs.
Infuse normal saline at 250 mL/hr.
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?a. Reposition the NG tube if drainage stops. Elevate the head of the bed to at least 30 degrees. Start oral fluids when the patient has active bowel sounds. Notify the doctor for any bloody nasogastric (NG) drainage.
Elevate the head of the bed to at least 30 degrees.
A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take? Administer morphine sulfate. Encourage the patient to ambulate. Offer the prescribed promethazine. Instill a mineral oil retention enema.
Encourage the patient to ambulate.
A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins. Dietary sources of fiber should be eliminated to prevent excessive gas formation. Use of this type of laxative to prevent constipation does not cause adverse effects. Large amounts of fluid should be taken to prevent impaction or bowel obstruction. ANS: D
Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention should the nurse anticipate? Nystatin tablets Antiviral agents Referral to a dentist Hydrogen peroxide rinses
Nystatin tablets
Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? Scrambled eggs White toast and jam Oatmeal with cream Pancakes with syrup
Oatmeal with cream
A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care? Refer the patient for hospice services. Infuse IV fluids through a central line. Teach the patient about antiemetic therapy. Offer supplemental feedings between meals.
Offer supplemental feedings between meals.
A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? Offering the patient a pitcher of water Positioning the patient on the right side Checking the vital signs every 30 minutes Swabbing the patient's mouth with a wet cloth
Offering the patient a pitcher of water
After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective? Patient orders nonfat milk for each meal. Patient uses the prescribed corticosteroid inhaler. Patient schedules an appointment for allergy testing. Patient takes ibuprofen (Advil) to control throat pain.
Patient schedules an appointment for allergy testing.
Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile? Teach the patient about proper food storage. Order a diet without dairy products for the patient. Place the patient in a private room on contact isolation. Teach the patient about why antibiotics will not be used.
Place the patient in a private room on contact isolation.
While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). What area of patient knowledge should the nurse plan to assess? Preventing noninfectious hepatitis Treating inflammatory bowel disease Risk for developing colorectal cancer Using antacids and proton pump inhibitors
Risk for developing colorectal cancer
After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching? . Maintain a low-residue diet until the surgical area is healed. Use ice packs on the perianal area to relieve pain and swelling. Take prescribed pain medications before you expect a bowel movement. Delay having a bowel movement for several days until you are well healed.
Take prescribed pain medications before you expect a bowel movement.
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider? Hemoglobin (Hgb) 10.8 g/dL Temperature 102.1° F (38.9° C) Absent bowel sounds in all quadrants Scant nasogastric (NG) tube drainage
Temperature 102.1° F (38.9° C)
The nurse and a licensed practical/vocational nurse (LPN/VN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/VN requires that the nurse intervene? The LPN/VN uses soft swabs to provide oral care. The LPN/VN positions the head of the bed in the flat position. The LPN/VN includes the enteral feeding volume when calculating intake. The LPN/VN encourages the patient to use pain medications before coughing.
The LPN/VN positions the head of the bed in the flat position.
A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? The patient is very drowsy. The patient reports a sore throat. The oral temperature is 101.4° F. d. The apical pulse is 100
The oral temperature is 101.4° F.
A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? The patient took a laxative the previous evening. The patient had a high-fat meal the previous evening. The patient has a permanent gastrostomy tube in place. The patient ate a low-fat bagel 4 hours ago for breakfast.
The patient ate a low-fat bagel 4 hours ago for breakfast.
The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include? The patient will need to remain on bedrest for three days after surgery. An additional surgery in 8 to 12 weeks will be done to create an ileal-anal reservoir. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria. The site where the stoma will be located will be marked on the abdomen preoperatively.
The site where the stoma will be located will be marked on the abdomen preoperatively.
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. What should the nurse teach the patient to take? Sucralfate at bedtime and antacids before each meal Sucralfate and antacids together 30 minutes before meals Antacids 30 minutes before each dose of sucralfate is taken d. Antacids after meals and sucralfate 30 minutes before meals
d. Antacids after meals and sucralfate 30 minutes before meals
