Gastrointestinal Patients NCLEX (2 of 3)

The nurse is caring for a client with common bile duct obstruction. The nurse should anticipate that the health care provider (HCP) will prescribe which diet for this client? 1. Low fat 2. High protein 3. High carbohydrate 4. Low in water-soluble vitamins

1 ~ Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum. Bile acids or bile salts are produced by the liver to emulsify or break down fats. The diets listed in the remaining options are incorrect.

A client who has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome? 1. Remove fluids from the meal tray. 2. Give the client 2 large meals per day. 3. Ask the client to sit up for 1 hour after eating. 4. Provide concentrated, high-carbohydrate foods.

1 ~ Factors to minimize dumping syndrome after gastric surgery include having the client lie down for at least 30 minutes after eating; giving small, frequent meals; having the client maintain a low Fowler's position while eating, if possible; avoiding liquids with meals; and avoiding high-carbohydrate food sources. Antispasmodic medications also are prescribed as needed to delay gastric emptying.

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the health care provider? 1. Elevated serum bilirubin level 2. Below normal hemoglobin concentration 3. Elevated blood urea nitrogen (BUN) level 4. Elevated erythrocyte sedimentation rate (ESR)

1 ~ Laboratory indicators of hepatitis include elevated liver enzymes, serum bilirubin level, and ESR. However, ESR is a nonspecific test that indicates the presence of inflammation somewhere in the body. The hemoglobin concentration is unrelated to this diagnosis. An elevated BUN level may indicate renal dysfunction.

The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication? 1. Bleeding 2. Infection 3. Dehydration 4. Malnutrition

1 ~ Thrombin is produced by the liver and is necessary for normal clotting. The client who has an insufficient level of this substance is at risk for bleeding. Therefore, the client should be monitored for evidence of blood loss, such as visual cues and vital sign changes.

The ambulatory care nurse is providing instructions to a client who is scheduled for a small bowel biopsy. What should the nurse tell the client? 1. Clear liquids only are allowed on the day of the test. 2. A signed informed consent form will need to be obtained. 3. A tube will be inserted through the rectum to obtain the tissue sample. 4. A full liquid diet will need to be maintained for 48 hours after the procedure.

2 ~ A signed informed consent form is required for this procedure. The client is instructed to maintain a clear liquid diet for 24 to 48 hours before the biopsy and to withhold all food and fluids after the evening meal before the day of the scheduled biopsy. A small bowel biopsy involves removal of a tissue specimen from the small intestine for examination and aids in the diagnosis of diseases of the small intestine. A small biopsy tube is passed through the client's mouth and is monitored fluoroscopically until it reaches the desired location in the jejunum. A normal diet may be resumed after the procedure as soon as the gag reflex returns.

The nurse is caring for a client prescribed enteral feeding via a newly inserted nasogastric (NG) tube. Before initiating the enteral feeding, the nurse should perform which action first? 1. Warm the feeding to 103°F (39.4°C). 2. Confirm NG placement by x-ray study. 3. Make sure the continuous enteral feeding tubing is primed. 4. Position the head of the client's bed to 30 degrees or greater.

2 ~ Before initiating enteral feedings via a newly inserted NG tube, the placement of the tube is confirmed by x-ray. If the tube is not in the stomach, the client is at risk for aspiration. Formulas are administered at room temperature, not at 103°F. To prevent aspiration while administering a tube feeding, the nurse should place the client in an upright sitting position or elevate the head of the bed at least 30 degrees. Although an important action, it is not the priority. Priming the enteral feeding tube is important prior to initiating the feedings; however, it is not the priority action.

The nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a health care provider prescription for which type of suction? 1. High and intermittent 2. Low and intermittent 3. High and continuous 4. Low and continuous

2 ~ Gastric mucosa can be traumatized and pulled into the tube if the suction pressure is placed on high or if the suction is continuous. The suction should be set on low pressure and intermittent suction control.

The nurse is caring for a client admitted with severe weight loss due to dieting. Based on the data provided, which condition should the nurse suspect is occurring in this client? 1. Lactic acidosis 2. Glycogenolysis 3. Gluconeogenesis 4. Glucose metabolism

3 ~ Gluconeogenesis is the production of glucose for energy from protein and fat stores in the body. This can occur with extreme dieting and also with diabetes mellitus. Glycogenolysis is the production of glucose from glycogen stores in the liver. Lactic acidosis occurs with excess production of lactic acid resulting from anaerobic metabolism. The body normally burns glucose for energy.

Pancreatin is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication? 1. The client's appetite improves. 2. The client experiences weight loss. 3. Vitamin B12 deficiency is controlled. 4. The stool is less fatty and decreases in frequency.

4 ~ Pancreatin aids in the digestion of protein, carbohydrate, and fat in the gastrointestinal tract. It is used to treat steatorrhea associated with postgastrectomy syndrome after bowel resection. The nurse should record the number of stools per day and the stool consistency to monitor the effectiveness of this enzyme therapy. If it is effective, the stools should become less frequent and less fatty. The remaining options are not indications of a therapeutic effect of the medication.

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laënnec's cirrhosis. Which question related to the client's history would be most important to ask? 1. "Do you abuse alcohol?" 2. "Do you have any known cardiac disease?" 3. "Does your type of employment cause you to have exposure to chemicals?" 4. "Have you ever been told that you have had obstruction to your biliary ducts?"

1 ~ Laënnec's cirrhosis results from long-term alcohol abuse; therefore, the question inquiring about alcohol abuse is most appropriate. Cardiac cirrhosis most commonly is caused by long-term right-sided heart failure. Exposure to hepatotoxins, chemicals, or infections or a metabolic disorder can cause postnecrotic cirrhosis. Biliary cirrhosis results from a decrease in bile flow and is most commonly caused by long-term obstruction of bile ducts.

A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that in this disorder because the stomach lining produces a decreased amount of a substance known as the intrinsic factor, the client will need which medication? 1. Vitamin B12 injections 2. Vitamin B6 injections 3. An antibiotic 4. An antacid

1 ~ A lack of the intrinsic factor needed to absorb vitamin B12 is a feature of pernicious anemia. Vitamin B12 is needed for the maturation of red blood cells. Vitamin B6 is not specifically lacking in pernicious anemia and can be taken orally. An antibiotic and antacids may be prescribed for certain types of gastric ulcers.

The nurse is creating a plan of care for a client with cirrhosis and ascites. Which nursing actions should be included in the care plan for this client? (SATA) 1. Monitor daily weight. 2. Measure abdominal girth. 3. Monitor respiratory status. 4. Place the client in a supine position. 5. Assist the client with care as needed.

1, 2, 3, 5 ~ Ascites is a problem because as more fluid is retained, it pushes up on the diaphragm, thereby impairing the client's breathing patterns. The client should be placed in a semi Fowler's position with the arms supported on a pillow to allow for free diaphragm movement. The correct options identify appropriate nursing interventions to be included in the plan of care for the client with ascites.

The nurse is caring for a hospitalized client with pancreatitis. Which findings should the nurse look for and expect to note when reviewing the laboratory results? (SATA) 1. Elevated lipase level 2. Elevated lactase level 3. Elevated trypsin level 4. Elevated amylase level 5. Elevated sucrase level

1, 3, 4 ~ Lipase, trypsin, and amylase are produced in the pancreas and aid in the digestion of fats, starches, and proteins, respectively. Lactase is produced in the small intestine and aids in splitting neutral fats into glycerol and fatty acids. Sucrase is produced in the small intestine and converts sucrose into glucose and fructose.

Lactulose is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated? 1. Vomiting occurs. 2. The fecal pH is acidic. 3. The client experiences diarrhea. 4. The client is able to tolerate a full diet.

2 ~ Lactulose is an osmotic laxative used to decrease ammonia levels, which are elevated in hepatic encephalopathy. The desired effect is 2 or 3 soft stools per day with an acid fecal pH. Lactulose creates an acid environment in the bowel, resulting in a fall of the colon's pH from 7 to 5. This causes ammonia to leave the circulatory system and move into the colon for excretion. Diarrhea may indicate excessive administration of the medication. Vomiting and ability to tolerate a full diet do not determine that a desired effect has occurred.

A health care provider (HCP) prescribes a Salem sump tube for gastrointestinal intubation. Which item should the nurse obtain from the supply room? 1. A Dobbhoff weighted tube 2. A Sengstaken-Blakemore tube 3. A tube with a large lumen and an air vent 4. A tube with a single lumen that connects to suction

3 ~ A tube with a large lumen and an air vent is a Salem sump tube. A Dobbhoff weighted tube is a type of feeding tube. A Sengstaken-Blakemore tube is used to control bleeding in the esophagus. A tube with a single lumen is called a Levin tube.

A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure? 1. Portal vein 2. Celiac artery 3. Vagus nerve 4. Pyloric valve

3 ~ Vagotomy is a procedure that can reduce innervation to the stomach, thereby reducing the production of gastric acid. The portal vein drains venous blood from the stomach. The celiac artery brings arterial blood to the stomach. The pyloric valve separates the stomach from the duodenum. The pyloric valve may undergo surgical repair if it becomes stenosed; this procedure is known as pyloroplasty.

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at this time? 1. "Do you want to stay here in this facility for a few more days?" 2. "Have you discussed your feelings with your health care provider?" 3. "You need to talk to your health care provider about these concerns." 4. "Tell me more about your concerns with your diet after going home."

4 ~ A client often has fears about leaving the secure, cared-for environment of the health care facility. This client has a fear about not being able to care for himself at home and of not being able to handle the tube feedings at home. A therapeutic communication statement such as "Tell me more about . . ." often leads to valuable information about the client and his concerns. The statements in the remaining options are nontherapeutic.

The nurse is assigned to care for a client with a Sengstaken-Blakemore tube. Which laboratory result is most focused on evaluating the effectiveness of this tube? 1. Sodium 2. Creatinine 3. Hemoglobin 4. Ammonia

3 ~ A Sengstaken-Blakemore tube may be used in a client with a diagnosis of cirrhosis with ruptured esophageal varices if other treatment measures are unsuccessful. The tube has an esophageal and a gastric balloon. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The gastric balloon holds the tube in the correct position and prevents migration of the esophageal balloon, which could harm the client. Evaluation of the client's hemoglobin level trends will determine if the tube is effective. Sodium, creatinine, and ammonia levels are not related to monitoring for blood loss.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP). The nurse should contact the HCP to question which prescription if noted in the client's record? 1. Maintain a semi Fowler's position. 2. Maintain on NPO (nothing by mouth) status. 3. Apply a heating pad to the lower abdomen for comfort. 4. Initiate an intravenous (IV) line with the administration of IV fluids.

3 ~ Appendicitis should be suspected in a client with an elevated WBC count who is complaining of acute right lower quadrant abdominal pain. A semi Fowler's position is maintained for comfort. The client would be on NPO status and given IV fluids in preparation for possible surgery. Heat should never be applied to the abdomen because this may increase circulation to the appendix, potentially leading to increased inflammation and perforation.

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? 1. Blood in the stool 2. Chalky gray stool 3. Loose, watery stool 4. Dry, hard, constipated stool

3 ~ Crohn's disease is characterized by nonbloody diarrhea of usually not more than 4 or 5 stools daily. Over time, the episodes of diarrhea increase in frequency, duration, and severity. Options 1, 2, and 4 are not characteristics of the stool in Crohn's disease.

The nurse should anticipate that the health care provider (HCP) will prescribe which treatment for a client with pernicious anemia? 1. Oral iron tablets 2. Blood transfusions 3. Gastric tube feedings 4. Vitamin B12 injections

4 ~ A lack of the intrinsic factor needed to absorb vitamin B12 occurs in pernicious anemia. Vitamin B12 is needed for the maturation of red blood cells. Iron is used for anemia that results from a lack of iron. Blood transfusions are not needed for pernicious anemia because a lack of red blood cells is not the problem. Gastric tube feedings will not replace vitamin B12. Vitamin B12 needs to be given by injection to ensure absorption.

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The health care provider (HCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and should be reported to the HCP immediately? 1. Hematemesis 2. Bloody diarrhea 3. Swelling of the abdomen 4. An elevated temperature and a rise in blood pressure

1 ~ A Sengstaken-Blakemore tube may be inserted in a client with a diagnosis of cirrhosis with bleeding esophageal varices. It has both an esophageal and a gastric balloon. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The pressure of the esophageal balloon is released at intervals to decrease the risk of trauma to esophageal tissues, including esophageal rupture or necrosis. When the balloon is deflated, the client may begin to bleed again from the esophageal varices, manifested as vomiting of blood (hematemesis). The remaining options are unrelated to deflating the esophageal balloon.

The nurse is caring for an older client. The nurse should anticipate that medication dosages will be further adjusted if the client has dysfunction of which organ? 1. Liver 2. Stomach 3. Pancreas 4. Gallbladder

1 ~ An important function of the liver is to break down medications and other toxic substances. The older client with liver disease is at increased risk for toxic medication effects and should be monitored carefully for adverse effects. Diseases of the stomach, pancreas, and gallbladder are a lesser concern for prolonged medication effects.

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? 1. Decreased diarrhea 2. Decreased cramping 3. Improved intestinal tone 4. Elimination of peristalsis

1 ~ Diphenoxylate hydrochloride with atropine sulfate is an antidiarrheal product that decreases the frequency of defecation, usually by reducing the volume of liquid in the stools. The remaining options are not associated therapeutic effects of this medication.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical record? 1. Apply a cold pack to the abdomen. 2. Administer 30 mL of milk of magnesia (MOM). 3. Maintain nothing by mouth (nil per os [NPO]) status. 4. Initiate an intravenous (IV) line for the administration of IV fluids.

2 ~ Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain. Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible surgery.

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a most common causative factor in this client's disorder? 1. Weight gain 2. Use of alcohol 3. Exposure to occupational chemicals 4. Abdominal pain relieved with food or antacids

2 ~ Chronic pancreatitis occurs most often in alcoholics. Abstinence from alcohol is important to prevent the client from developing chronic pancreatitis. Clients usually experience malabsorption with weight loss. Chemical exposure is associated with cancer of the pancreas. Pain will not be relieved with food or antacids.

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? 1. "The medication will cause constipation." 2. "I need to take the medication with meals." 3. "I may have increased sensitivity to sunlight." 4. "This medication should be taken as prescribed."

1 ~ Sulfasalazine is an antiinflammatory sulfonamide. Constipation is not associated with this medication. It can cause photosensitivity, and the client should be instructed to avoid sun and ultraviolet light. It should be administered with meals, if possible, to prolong intestinal passage. The client needs to take the medication as prescribed and continue the full course of treatment even if symptoms are relieved.

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? (SATA) 1. Orthopnea and dyspnea 2. Petechiae and ecchymosis 3. Inguinal or umbilical hernia 4. Poor body posture and balance 5. Abdominal distention and tenderness

1, 2, 3, 5 ~ Excess fluid volume, related to the accumulation of fluid in the peritoneal cavity and dependent areas of the body, can occur in the client with cirrhosis. Ascites can cause physical problems because of the overdistended abdomen and resultant pressure on internal organs and vessels. These problems include respiratory difficulty, petechiae and ecchymosis, development of hernias, and abdominal distention and tenderness. Poor body posture and balance are unrelated to increased abdominal pressure.

The nurse is caring for a client who had a subtotal gastrectomy. The nurse should assess the client for which signs and symptoms of dumping syndrome? 1. Diarrhea, chills, and hiccups 2. Weakness, diaphoresis, and diarrhea 3. Fever, constipation, and rectal bleeding 4. Abdominal pain, elevated temperature, and weakness

2 ~ Dumping syndrome occurs after gastric surgery because food is not held long enough in the stomach and is "dumped" into the small intestine as a hypertonic mass. This causes fluid to shift into the intestines, causing cardiovascular and gastrointestinal symptoms. Signs and symptoms typically include weakness, dizziness, diaphoresis, flushing, hypotension, abdominal pain and distention, hyperactive bowel sounds, and diarrhea.

The nurse is assisting a health care provider (HCP) with the insertion of a Miller-Abbott tube. The nurse understands that the procedure places the client at risk for aspiration and should therefore implement which action to decrease this risk? 1. Insert the tube with the balloon inflated. 2. Place the client in a semi Fowler's to high Fowler's position. 3. Instruct the client to cough when the tube reaches the nasal pharynx. 4. Instruct the client to perform a Valsalva maneuver if the impulse to gag and vomit occurs.

2 ~ The Miller-Abbott tube is a nasoenteric tube that is used to decompress the intestine, as in correcting a bowel obstruction. Initial insertion of the tube is an HCP responsibility. The tube is inserted with the balloon deflated in a manner similar to the proper procedure for inserting a nasogastric tube. The client is usually given water to drink to facilitate passage of the tube through the nasopharynx and esophagus. A semi Fowler's to high Fowler's position decreases the risk of aspiration if vomiting occurs. A Valsalva maneuver is not helpful and is not used if the impulse to gag occurs.

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system? 1. Ileum 2. Cecum 3. Rectum 4. Jejunum

2 ~ The appendix, sometimes referred to as the vermiform appendix, is attached to the apex of the cecum. The other locations listed are incorrect.

A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client? 1. Folate 2. Biscodyl 3. Ferrous sulfate 4. Cyanocobalamin

2 ~ The client with an ileostomy is prone to dehydration because of the location of the ostomy in the gastrointestinal tract and should not take laxatives. Laxatives will compound the potential risk for the client. These clients are at risk for deficiencies of folate, iron, and cyanocobalamin and should receive them as supplements if necessary.

The nurse has given instructions to a client with hepatitis about postdischarge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement? 1. "I need to avoid alcohol and aspirin." 2. "I should eat a high-carbohydrate, low-fat diet." 3. "I can resume a full activity level within 1 week." 4. "I need to take the prescribed amounts of vitamin K."

3 ~ The client with hepatitis is easily fatigued and may require several weeks to resume a full activity level. It is important for the client to get adequate rest so that the liver can heal. The client should avoid hepatotoxic substances such as aspirin and alcohol. The client should take in a high-carbohydrate and low-fat diet. Vitamin K may be prescribed for prolonged clotting times.

The nurse is assessing a client with a duodenal ulcer. The nurse interprets that which sign or symptom is most consistent with the typical presentation of duodenal ulcer? 1. Weight loss 2. Nausea and vomiting 3. Pain that is relieved by food intake 4. Pain that radiates down the right arm

3 ~ The most typical finding with duodenal ulcer is pain that is relieved by food intake. The pain is often described as a burning, heavy, sharp, or "hunger pang" pain that often localizes in the midepigastric area. It does not radiate down the right arm. The client with duodenal ulcer does not usually experience weight loss or nausea and vomiting; these symptoms are more typical in the client with a gastric ulcer.

The nurse is caring for a client on a mechanical ventilator who has a nasogastric tube in place. The nurse is assessing the pH of the gastric aspirate and notes that the pH is 4.5. Based on this finding, the nurse should take which action? 1. Document the findings. 2. Reassess the pH in 4 hours. 3. Instill 30 mL of sterile water. 4. Administer a dose of a prescribed antacid.

4 ~ The client on a mechanical ventilator who has a nasogastric tube in place should have the gastric pH monitored at the beginning of each shift or least every 12 hours. Because of the risk of stress ulcer formation, a pH lower than 5 (acidic) should be treated with prescribed antacids. If there is no prescription for the antacid, the health care provider should be notified. Documentation of the findings should be done after the administration of an antacid. Sterile water instillation is not an appropriate treatment.

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment? 1. Bradycardia 2. Nausea and vomiting 3. Numbness in the legs 4. A rigid, boardlike abdomen

4 ~ The client with a large, deep duodenal ulcer is at risk for perforation of the ulcer. If this occurs, the client will experience sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which then becomes rigid and boardlike. Tachycardia, not bradycardia, may occur as hypovolemic shock develops. Nausea and vomiting may not occur if the pyloric sphincter is intact. Numbness in the legs is not an associated finding.

The nurse is caring for a client with spinal cord injury (SCI) who is participating in a bowel retraining program. What should the nurse anticipate to promote during the bowel retraining program? 1. Sufficiently low water content in the stool 2. Low intestinal roughage that promotes easier digestion 3. Constriction of the anal sphincter based on voluntary control 4. Stimulation of the parasympathetic reflex center at the S1 to S4 level in the spinal cord

4 ~ The principal reflex center for defecation is located in the parasympathetic center at the S1 to S4 level of the spinal cord. This center is most active after the first meal of the day. Other factors that contribute to satisfactory stool passage are sufficient fluid and roughage in the diet and the Valsalva maneuver (which is lost with SCI). During defecation, the anal sphincter relaxes.

The nurse assists a health care provider in performing a liver biopsy. After the procedure, the nurse should place the client in which position? 1. Prone 2. Supine 3. Left side 4. Right side

4 ~ To splint and provide pressure at the puncture site, the client is kept on the right side for a minimum of 2 hours after a liver biopsy. Therefore, the remaining positions are incorrect.

The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food? 1. Rice 2. Corn 3. Broiled chicken 4. Cream of wheat

2 ~ The client with irritable bowel should take in a diet that consists of 30 to 40 g of fiber daily because dietary fiber will help produce bulky, soft stools and establish regular bowel habits. The client should also drink 8 to 10 glasses of fluid daily and chew food slowly to promote normal bowel function. Foods that are irritating to the intestines need to be avoided. Corn is high in fiber but can be very irritating to the intestines and should be avoided. The food items in the other options are acceptable to eat.

Cholestyramine resin is prescribed for a client with an elevated serum cholesterol level. The nurse should instruct the client to take the medication in which way? 1. After meals 2. Mixed with fruit juice 3. Via a rectal suppository 4. At least 3 hours before meals

2 ~ This medication binds with bile salts in the intestines to form a compound that is excreted in the feces. The client should be instructed to mix the medication with 3 to 6 ounces of water, milk, fruit juice, or soup. It should be administered before meals. It is not administered via rectal suppository.

The nurse is caring for a client with altered protein metabolism as a result of liver dysfunction. Which finding should the nurse expect to note when reviewing the client's laboratory results? 1. Increased lactase level 2. Decreased albumin level 3. Increased ammonia level 4. Decreased lactic acid level

3 ~ During deamination of proteins in the liver, the amino group splits from the carbon-containing compound, which results in formation of ammonia and a carbon residue. The liver then converts the toxic ammonia substance into urea, which can be excreted by the kidneys. Clients with liver dysfunction may have high serum ammonia levels as a result. The remaining options are incorrect.

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result? 1. The client reports some pain before meals. 2. The client frequently is awakened at 2 a.m. with heartburn. 3. The client has eliminated any irritating foods from the diet. 4. The client's pain is minimal with histamine H2-receptor antagonists.

3 ~ Expected outcomes for the client with PUD who is experiencing pain include elimination of irritating foods from the diet, effectiveness of prescribed medications to eliminate pain, self-reporting of absence of pain with medication, and an ability to sleep through the night without pain. The client who continues to be awakened by pain requires further modification of medication therapy, which may include adjustment of timing of histamine H2-receptor antagonist administration or an additional dose of antacid before the time when pain usually awakens the client.

The nurse is caring for a client who has just returned from the operating room after the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment? 1. Apply ice to the stoma site. 2. Apply pressure to the stoma site. 3. Notify the health care provider (HCP). 4. Document the amount and characteristics of the drainage.

4 ~ During the first 24 to 72 hours following surgery, mucus and serosanguineous drainage are expected from the stoma. Applying ice or pressure to the stoma site are inappropriate actions. Notifying the HCP is unnecessary because this is an expected finding.

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis? 1. "It's due to insufficient production of vitamin B12 in the colon." 2. "Increased production of intrinsic factor in the stomach leads to this type of anemia." 3. "Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." 4. "Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

4 ~ Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the small intestine. This vitamin is not produced or absorbed in the large intestine.

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis? 1. "I have epigastric pain radiating to my neck." 2. "I have severe abdominal pain that is relieved after vomiting." 3. "My temperature has been running between 96°F (35.5°C) and 97°F (36.1°C)." 4. "I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

4 ~ Nausea and vomiting are common presenting manifestations of acute pancreatitis. A hallmark symptom is severe abdominal pain that is not relieved by vomiting. The vomitus characteristically consists of gastric and duodenal contents. Fever also is a common sign. Epigastric pain radiating to the neck area is not a characteristic symptom.

The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients? 1. Colectomy 2. Appendectomy 3. Ascending colostomy 4. Small bowel resection

4 ~ The small intestine is responsible for the absorption of most nutrients. The client who has undergone removal of a segment of the small bowel is the one who has a decreased area with which to absorb nutrients. Decreased absorption is not a likely complication with the surgical procedures identified in the remaining options.

A Penrose drain is in place on the first postoperative day in a client who has undergone a cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate? 1. Change the dressing. 2. Continue to monitor the drainage. 3. Notify the health care provider (HCP). 4. Use a pen to circle the amount of drainage on the dressing.

1 ~ Serosanguinous drainage with a small amount of bile is expected from the Penrose drain for the first 24 hours. Drainage then decreases, and the drain is usually removed within 48 hours. A sterile dressing covers the site and should be changed if wet to prevent infection and skin excoriation. Although the nurse would continue to monitor the drainage, the most appropriate intervention is to change the dressing. The HCP does not need to be notified.

The nurse is caring for a client with biliary obstruction. The nurse interprets that obstruction of which passage is related to the client's condition? 1. Cystic duct 2. Liver canaliculi 3. Common bile duct 4. Right hepatic duct

1 ~ The gallbladder receives bile from the liver through the cystic duct. The liver collects bile in the canaliculi, from which bile flows into the right and left hepatic ducts and then into the common hepatic duct. From there, the bile can be transported for storage in the gallbladder through the cystic duct, or it can flow directly into the duodenum by way of the common bile duct.

The nurse is assessing a client with liver disease for signs and symptoms of low albumin. Which sign or symptom should the nurse expect to note? 1. Weight loss 2. Peripheral edema 3. Capillary refill of 5 seconds 4. Bleeding from previous puncture sites

2 ~ Albumin is responsible for maintaining the osmolality of the blood. When the albumin level is low, osmotic pressure is decreased, which in turn can lead to peripheral edema. Weight loss is not a sign or symptom for hypoalbuminemia. Capillary refill of 5 seconds is a delayed filling time but is not associated with decreased albumin levels. Clotting factors produced by the liver (not albumin) are responsible for coagulation, and lack of clotting factors can result in bleeding from old puncture sites. The total protein level may decrease if the albumin level is low.

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy? 1. Restlessness 2. Presence of asterixis 3. Complaints of fatigue 4. Decreased serum ammonia levels

2 ~ Asterixis is a flapping tremor of the hand that is an early sign of hepatic encephalopathy. The exact cause of this disorder is not known, but abnormal ammonia metabolism may be implicated. Increased serum ammonia levels are thought to interfere with normal cerebral metabolism. Tremors and drowsiness also would be noted.

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching? 1. "I plan to eat 4 to 6 small meals a day." 2. "I should sleep in the right side-lying position." 3. "I plan to have a snack 1 hour before going to bed." 4. "I will stop having a glass of wine each evening with dinner."

3 ~ The control of GERD involves lifestyle changes to promote health and control reflux. These include eating 4 to 6 small meals a day; avoiding alcohol and smoking; sleeping in the right side-lying position to promote oxygenation and frequent swallowing to clear the esophagus; and avoiding eating at least 3 hours before going to bed because reflux episodes are most damaging at night.

The nurse is caring for a client with pancreatitis. Which finding should the nurse expect to note when reviewing the client's laboratory results? 1. Elevated level of pepsin 2. Decreased level of lactase 3. Elevated level of amylase 4. Decreased level of enterokinase

3 ~ The serum level of amylase, an enzyme produced by the pancreas, increases with pancreatitis. Amylase normally is responsible for carbohydrate digestion. Pepsin is produced by the stomach and is used in protein digestion. Lactase and enterokinase are enzymes produced by the small intestine; lactase splits lactose into galactose and fructose, and enterokinase activates trypsin.

The nurse is completing an admission assessment for a client with suspected esophageal cancer. Which statement made by the client indicates the presence of a risk factor for esophageal cancer? 1. "I've been smoking for 20 years now." 2. "I eat plenty of fresh fruits and vegetables." 3. "I'm 5 feet, 8 inches tall and weigh 160 pounds." 4. "My alcohol consumption is about 2 beers per month."

1 ~ Primary risk factors associated with the development of esophageal cancer are smoking and obesity. The compounds in tobacco smoke may be responsible for the genetic mutations seen in many squamous cell carcinomas of the esophagus. Malnutrition, untreated gastroesophageal reflux disease (GERD), and excessive alcohol intake are also associated with esophageal cancer. Diets that are chronically deficient in fresh fruits and vegetables have also been implicated in the development of squamous cell carcinoma of the esophagus.

A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which source of complete proteins to maximize the availability of essential amino acids? 1. Nuts 2. Meats 3. Cereals 4. Vegetables

2 ~ Complete proteins contain all of the essential amino acids, which are acids that the body cannot produce from other available sources. Complete proteins derive from animal sources, such as meat, cheese, milk, and eggs. Incomplete proteins can be found in fruits, vegetables, nuts, cereals, breads, and legumes.

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which finding should the nurse interpret as a sign or symptom of portal hypertension? 1. Flat neck veins 2. Abdominal distention 3. Hemoglobin of 14.2 g/dL (142 mmol/L) 4. Platelet count of 600,000 mm3 (600 × 109/L)

2 ~ With portal hypertension, proteins shift from the blood vessels via the larger pores of the sinusoids (capillaries) into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, they leak through the liver capsule into the peritoneal cavity. This is called ascites, and abdominal distention would be the consequence. Increased portal pressure can lead to findings associated with right-sided heart failure, such as distended jugular veins. Thrombocytopenia, leukopenia, and anemia are caused by the splenomegaly that results from backup of blood from the portal vein into the spleen (portal hypertension).

A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body? 1. Bile 2. Parietal cells 3. Liver enzymes 4. Pancreatic juice

4 ~ Pancreatic juice is rich is bicarbonate, which helps to neutralize the gastric acid in food entering the small intestine from the stomach. The duodenal papilla, which is an opening about 10 cm below the level of the pylorus, is responsible for carrying bile and pancreatic juices into the duodenum. Bile, parietal cells, and liver enzymes are not substances rich in bicarbonate and are incorrect.