GASTRO ATI NCLEX
A nurse is caring for a client who has hepatitis A. The client asks the nurse how he might have contracted the virus. Before responding which of the following questions should the nurse ask first?
"Have you eaten any shellfish lately?"
A nurse is collecting data from a client in the health clinic who is reporting epigastric pain. Which of the following statements made by the client should the nurse identify as being consistent with peptic ulcer disease?
" I feel so much better after eating"
A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease (GERD) about minimizing the effects of the reflux during sleep. Which of the following client statements indicates an understanding of the teaching?
" I should elevate the head of the bed"
A nurse is reinforcing teaching about ileostomy care with a client. The nurse should recognize which of the following statements by the client indicates a need for further teaching?
" I will be certain to take enteric coated meds"
A nurse is reinforcing teaching about pain control with a client who has acute pain following a subtotal gastric resection. Which of the following client statements indicated understanding of pain control?
" I will call for a pain med before the previous dose wears off"
A nurse is reinforcing teaching with a client who is scheduled for a barium swallow to evaluate dysphagia. Which of the following statements should indicate to the nurse that the client understands the instructions?
" I will drink plenty of fluids after this test"
A nurse is reinforcing teaching with a client who has cholelithiasis and is scheduled for an endoscopic retrograde cholangiopancreatography. Which of the following statements made by the client indicates an understanding of the teaching?
" Ill have an endoscope put down my throat so they can see my gallbladder. "
A nurse is caring for a client who is scheduled for a colonoscopy. The client asks the nurse if there will be a lot of pain during the procedure. Which of the following responses should the nurse make?
" You may feel some cramping during the procedure"
A nurse is contributing to the plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse recommend for the incision in the plan of care?
decrease the clients fluid intake
A nurse is caring for a client who had total hip arthroplasty 1 day ago and is receiving morphine sulfate by PCA pump for pain control. The client reports nausea and vomiting. Which of the following actions is the priority for the nurse to take?
auscultate bowel sounds
A nurse is reinforcing teaching with a client who is postoperative after having ileostomy established. Which of the following instructions should the nurse include in the teaching?
avoid meds In capsule or enteric form
A nurse is reinforcing teaching with a client who reports right shoulder pain following a laparoscopic cholecystectomy. Which of the following statements should the nurse make?
the pain with dissipate if you ambulate frequently
A nurse is reinforcing teaching with a client who has a new colostomy. Which of the following information should the nurse include in the teaching?
you may experience a small amount of bleeding around the stoma
A nurse is contributing to the plan of care of a client who has a small bowel obstruction. Which of the following interventions should the nurse include?
elevate the head of the bead
A nurse is reinforcing with a client who has a new prescription for epoetin alfa. The nurse should reinforce to the client to take which of the following dietary supplements with this medication?
iron
A nurse is contributing to a plan of care for a client who has hepatitis B. Which of the following should the nurse include in the plan?
limit activity
A nurse is assisting with the plan of care for a client who had an upper endoscopy 1 hr ago. The nurse should place the priority on minoring which of the following?
gag reflex
A nurse is collecting data on a client who has acute pancreatitis. Which of the following factors should the nurser anticipate in the clients history?
gallstones
A nurse is caring for a client who cirrhosis. When delivering the clients lunch tray which of the fooling food selection requires intervention by the nurse?
1 slice of ham on whole wheat bread
A nurse is reinforcing teaching about dietary recommendations for a client who has a hiatal hernia. Which of the following client statements indicate understanding of the teaching?
I will consume less caffeine and spicy foods, I will sleep with the head of my elevated, I will try not to gain weight
A nurse is reinforciing teaching to a client about how to perform fecal occult blood testing for a screening of colorectal cancer. Which of the following statements bu the client indicates a need for further teaching?
I will continue my low dose aspirin therapy regimen
A nurse is reinforcing teaching with a client prescribed bethamethasone for chronic osteoarthritis. Which of the following statements by the client indicated understating of the teaching?
I will protect adrenal glands by taking medication every other day
A nurse is reinforcing teaching with a client who has an iron deficiency anemia and is to start taking ferrous sulfate twice a day. Which of the following statements by the client indicate an understanding of the teaching?
I will take the medication with orange juice
A nurse is collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at McBurneys point?
McBurneys point is found between the naval and the anterior iliac crest
A nurse is reinforcing dietary instructions with a client who has episodes of billary colic from chronic cholecytitis. Which of the following diets should the nurse reinforce in the teaching plan?
a low fat diet
A nurse is collecting data from a client who has a gastric ulcer. Which of the following should the nurse identify as a priority and notify the provider?
abdominal pain radiating to the shoulder
A nurse is caring for an older adult client who has dysphagia and left sided weakness following a stroke. Which of the following actions should the nurse take?
add thickener to fluids
A nurse is caring for a client who is 2 days postoperative for abdominal surgery. The client reports discomfort from abdominal distention and flatus. Which of the following suggestions should the nurse include?
ambulate several times a day
A nurse is collecting data from a client who has squamous cell carcinoma of the lower lip. Which of the following is an expected finding?
an ulcerated lesion that is bleeding and painful
A nurse is planning a menu for a client who has folic acid deficiency anemia and is selecting food high in folic acid. Which of the following should the nurse include?
aspragus
A nurse is contributing to the plan of a care who is postoperative following a gastrectomy and has a double- lumen nasogastric (NG) tube. Which of the following interventions should the nurse include in the plan?
avoid replacing the NG tube if it is accidentally dislodged
A nurse is reinforcing teaching with a client who has GERD. Which of the following statement should the nurse include in the teaching?
avoid wearing constricting clothing
A nurse is reinforcing dietary teaching with a client who has GERD. Which of the following food choices by the client indicates an understanding of the teaching?
baked turkey breast
A charge nurse is reinforcing teaching with a newly licensed nurse about the common link between ulcerative colitis and Crohn disease. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
both illnesses and inflammatory in nature
A nurse is reinforcing discharge teaching about nutrition with a client who has a new diagnosis of diabetes mellitus. Which of the following statements should be included in the teaching?
carbohydrates should comprise 45 to 65 % of daily caloric intake
A nurse is reinforcing discharge teaching with a client who has a new diagnosis of gastoesophageal disease (GERD). Which of the following foods shook the nurse include in the list of foods the client should avoid?
chocolate
A nurse is caring for a client who has a history of chronic ulcerative colitis and has a new diagnosis of anemia. The nurse should explain to the client that which of the following manifestations of colitis can result from anemia?
chronic blood loss
A nurse in a clinic is caring for a client who has alcohol use disorder. The client reports frequent bruising and nose bleeds. Which of the following conditions should the nurse suspect?
cirrhosis
A nurse is reenforcing discharge teaching with a client who has acute gastritis. Which of the following instructions should the nurse include in the teaching?
consume a glucose- electrolyte solution
A nurse is caring for a client who has a fractured tibia and is in a cast. Which of the following findings is a manifestation of compartment syndrome?
decreased capillary refill
A nurse is caring for a client who is postoperative has an NG tube that has drained 2,500 mL in the past 6 hr. The nurse should monitor the client for which of the following electrolyte imbalances?
decreased potassium level
A nurse is caring for a client who has developed clostridium difficult infection following antibiotic therapy. Which of the following actions should the nurse take?
disinfect equipment with bleach solution
A nurse is collecting data from a client who has a gastroesophageal reflux disease (GERD) and reports having heart burn every night. Which of the following actions should the nurse identify as a contributing factor to the clients heartburn?
drinking orange juice regularly
A nurse is caring for a client who has liver cirrhosis with ascites and bleeding esophageal varies. Which of the following laboratory findings indicates that the clients gastrointestinal ( GI) tract is digesting and absorbing blood?
elevated BUN
A nurse is reinforcing discharge teaching with a client who is postoperative for a traditional cholecystectomy and has a T-tube in place. Which of the following instructions should the nurse include in the teaching?
empty the drainage bag at the same time each day
A nurse is caring for a client who is postoperative following a laparoscopic cholecystectomy. Which of the following actions should the nurse take?
encourage ambulation on the day of surgery
A nurse is caring for a client who is reciting chemo for treatment ovarian cancer and experiencing nausea. Which of the following actions should the nurse take?
encourage the client to drink a carbonated beverage 1 hr before meals
A nurse is contributing to the plan of care for a client who has a gastrostomy tube through which he is receiving continuous eternal feedings. Which of the following interventions should the nurse include in the plan?
flush the tube with 30 mL of water every 4 hr
A nurse is reinforcing teaching with a client about cancer prevention and plans to address the importance of foods high in antioxidants. Which of the following foods should the nurse include in the teaching?
fresh berries
A nurse is caring for a client who is returning to the med surg unit following a procedure that is required spinal anesthesia. Which of the following findings should indicate to the nurse the client is experiencing a complication related to the anesthesia?
headache
A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse identify as a risk factor for this condition?
history of ibuprofen use
A nurse is reinforcing teaching for a client about following a low purine diet to manage gout. Which of the following statements should the nurse identify as an indication that the client understands the instructions?
ill eliminate liver from my diet
A nurse is contributing to the plan of care for a client who has cirrhosis of the liver. Which of the following interventions should the nurse include in the plan?
implement fall precautions, initiate low sodium diet, measure abdominal firth daily
A nurse is caring for a client who has cirrhosis of the liver with ascites. Which of the following interventions should the nurse take?
increase daily calorie intake
A nurse is preparing a client who has advanced cirrhosis for an abdominal paracentesis. Which of the actions should the nurse take?
instruct the client to empty his bladder
The nurse is caring for a client who has a bowel obstruction and a new prescription for the insertion of a nasogastric tube. Which of the following interventions should the nurse take when inserting the nasogastric tube?
instruct the client to place his chin to his chest and swallow
A client who is scheduled for a barium swallow asks a nurse why a laxative is necessary following the procedure. Which of the following responses should the nurse make?
it helps eliminate the barium
A nurse is collecting data from a client who has diverticular disease. The nurse should expect the client to report abdominal pain in which of the following locations?
lower left quadrant
A nurse is contributing to the plan of care for a client who has an intestinal obstruction and is receiving continuous gastrointestinal decompression using a NG tube. Which of the following interventions should the nurse include in the plan of care?
maintain the client in Fowlers position
A nurse is assisting with the care of a client who has cirrhosis of the liver with ascites. Which of the following actions should the nurse take?
measure the clients abdominal girth every 8 hr
A nurse is planning care for a client who is 1 day postoperative following a partial bowel resection. The client requires a complete dressing change, total parental nutrition administration, daily weight and is reporting pain at a level of 6 on a scale of 0 to 10 scale. Which of the following nursing actions should the nurse plan to complete first?
obtain the clients vitals
A nurse is planning care for a client who has a peptic ulcer and a new prescription for sucralfate 2 gm administered twice daily. Which of the following times should the nurse plan to administer the medications?
one hour before breakfast and the evening meal
The nurse is caring for a client on the third day following abdominal surgery and asses the absence of bowel sounds, abdominal distention, and the client passing no flatus. These findings indicate the client is expiring which of the following postoperative complications?
paralytic ileus
A nurse is assisting in the plan of cate for a client who had surgery for a bowel obstruction. The client has a nasogastric tube in place. Which of the following actions should the nurse include in the clients plan of care?
perform leg excursus every 2 hr, courage hourly use of an incentive spirometer while awake, document the color, consistency and nasogastric drainage
A nurse is caring for a client who has dysphasia following a stroke. Which of the following is the priority action for the nurse to take when feeding the client?
place the client in the upright position
A nurse is collecting data from a client who has acts gastroenteritis . Which of the following data collection findings should the nurse identify as the priority?
potassium 2.5 mEq/L
A nurse is assisting with the plan of care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan?
provide periods of rest
A nurse is collecting data from a client who is 12 hr postoperative following a colectomy with colostomy placement. Which of the following findings should the nurse report to the provider?
purplish colored stoma
A nurse is collecting data from a client who is postoperative following the placement of a pouch ileostomy. Which of the following should the nurse identify as a priority finding?
report of nausea
A nurse is planning a diet who has an iron deficiency. To increase the clients iron intake, which of the following foods should the nurse include in the clients diet?
roast beef
A nurse is reviewing home medications of a male client who has a new prescription for warfarin. Which of the following of the clients herbal medications should the nurse identify as being contraindicated to warfarin?
saw palmetto, glucosamine, gingko biloba
A nurse is collecting data from a client who has peptic ulcer disease. Which of the following findings is a manifestation of gastrointestinal perforation?
severe upper abdominal pain
A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestation should the nurse expect to find?
spider angioma
A nurse is reinforcing teaching with a client who has myasthenia gravis and has a new prescription for pyridostigmine orally. Which of the following instructions should the nurse include?
take the medication 45 minutes before eating
A nurse in a providers office is reinforcing teaching with a client who has anemia and has been taking ferrous gluconate for several weeks. Which of the following instructions should the nurse include?
take this med between meals
A nurse is reinforcing teaching with a community group about the prevention of viral hepatitis. Which of the following information should the nurse include in the teaching?
thoroughly cook foods prepared with tap eater
A nurse is assisting with discharge teaching for a client who is postoperative following a laryngectomy. Which of the following instructions should the nurse include in the teaching?
to aid in swallowing food, tip the chin before swallowing, swallow twice after each bite
A nurse is caring for a client who has a second and third degree burns and a prescription for a high calorie, high protein diet. Which of the following menu choices should the nurse recommend?
turkey and cheese sandwich with scalloped potatoes
A nurse is caring for a client who has a gastrointestinal (GI) bleed. Which of the following findings is the priority for the nurse to report to the provider?
urine output of 50 mL in 2 hr
A nurse is reinforcing teaching about pernicious anemia with a client following a total gastrectomy. Which of the following dietary supplements should the nurse include in the teaching as a treatment for pernicious anemia?
vitamin b12