GI

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? A. "Do you want to stay here in this facility for a few more days?" B. "Have you discussed your feelings with your health care provider?" C. "You need to talk to your health care provider about these concerns." D. "Tell me more about your concerns with your diet after going home."

D. "Tell me more about your concerns with your diet after going home." Rationale: 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 provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? a. "The cimetidine (Tagamet) will cause me to produce less stomach acid." b. "Sucralfate (Carafate) will change the fluid in my stomach." c. "Antacids will coat my stomach." d. "Omeprazole (Prilosec) will coat the ulcer and help it heal."

Answer: A Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.

The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics? a. Early satiety b. Pain on eating c. Dull upper epigastric pain d. Pain on empty stomach

Answer: D Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.

Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease? a. Neutralize acid b. Reduce acid secretions c. Stimulate gastrin release d. Protect the mucosal barrier

Answer: B Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM

B. 8:00 AM, 12:00 PM, and 4:00 PM A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect? A. Tremors B. Constipation C. Double vision D. Numbness in fingers and toes

A. Tremors Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? a. Dark brown b. Bile green c. Bright red d. Cloudy white

Answer: A About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood, but large amounts of blood or excessively bloody drainage should be reported to the physician promptly.

A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: a. Reduce gastric acid output b. Protect the ulcer surface c. Inhibit the production of hydrochloric acid (HCl) d. Inhibit vagus nerve stimulation

Answer: A These drugs inhibit the action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.

The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E

Answer: B Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.

The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome? a. Eat high-carbohydrate foods b. Limit the fluids taken with meals c. Ambulate following a meal d. Sit in a high-Fowlers position during meals

Answer: B The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmidocs as prescribed.

Which of the following symptoms is common with a hiatal hernia? a. Left arm pain b. Lower back pain c. Esophageal reflux d. Abdominal cramping

Answer: C

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? A. Decreased blood pressure B. Absence of muscle tremors C. Relief of nausea and vomiting D. No further episodes of diarrhea

C. Relief of nausea and vomiting Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? A. "I should increase the fiber in my diet." B. "I will need to avoid caffeinated beverages." C. "I'm going to learn some stress reduction techniques." D. "I can have exacerbations and remissions with Crohn's disease."

A. "I should increase the fiber in my diet." Rationale: Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

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? A. "The medication will cause constipation." B. "I need to take the medication with meals." C. "I may have increased sensitivity to sunlight." D. "This medication should be taken as prescribed."

A. "The medication will cause constipation." Rationale: 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 presents to the emergency department with upper gastrointestinal (GI) bleeding and is in moderate distress. In planning care, which nursing action should be the priority for this client? A. Assessment of vital signs B. Complete abdominal examination C. Thorough investigation of precipitating events D. Insertion of a nasogastric tube and Hematest of emesis

A. Assessment of vital signs Rationale: The priority nursing action is to assess the vital signs. This would indicate the amount of blood loss that has occurred and also provides a baseline by which to monitor the progress of treatment. The client may not be able to provide subjective data until the immediate physical needs are met. Although an abdominal examination and an assessment of the precipitating events may be necessary, these actions are not the priority.

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? A. Vitamin B12 injections B. Vitamin B6 injections C. An antibiotic D. An antacid

A. Vitamin B12 injections Rationale: 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 has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching? A. "It is normal to feel gassy or bloated after the procedure." B. "The abdominal muscles may be tender from the procedure." C. "It is all right to drive once I've been home for an hour or so." D. "Intake should be light at first and then progress to regular intake."

C. "It is all right to drive once I've been home for an hour or so." Rationale: The client should not drive for several hours after discharge because of the sedative medications used during the procedure. Important decisions also should be delayed for at least 12 to 24 hours for the same reason. The client may experience gas, bloating, or abdominal tenderness for a short while after the procedure, and this is normal. The client should resume intake slowly and progress as tolerated.

The nurse is preparing to administer an intermittent enteral feeding though a nasogastric (NG) tube. Which priority assessment should the nurse perform? A. Observe for digestion of formula. B. Assess fluid and electrolyte status. C. Evaluate absorption of the last feeding. D. Evaluate percussion tone of the stomach.

C. Evaluate absorption of the last feeding. Rationale: All stomach contents are aspirated and measured before a tube feeding is administered. This procedure measures the gastric residual. The gastric residual is assessed to confirm whether undigested formula from a previous feeding remains, thereby evaluating absorption of the last feeding. It is important to assess gastric residual because administration of an enteral feeding to a full stomach could result in overdistention, predisposing the client to regurgitation and possible aspiration. The remaining options do not relate to the purpose of assessing residual.

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium (Colace)? A. Take a dose of mineral oil at the same time. B. Add extra salt to food on at least one meal tray. C. Ensure dietary intake of 10 g of fiber each day. D. Take each dose with a full glass of water or other liquid.

D. Take each dose with a full glass of water or other liquid. Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions should the nurse include in the instructions? Select all that apply. A. Eat yogurt. B. Take loperamide to treat diarrhea. C. Use stress management techniques. D. Avoid foods such as cabbage and broccoli. E. Decrease fiber intake to less than 15 g/day.

A. Eat yogurt. B. Take loperamide to treat diarrhea. C. Use stress management techniques. D. Avoid foods such as cabbage and broccoli. Rationale: IBS is a common, chronic functional disorder, meaning that no organic cause is currently known. Treatment is directed at psychological and dietary factors and medications to regulate stool output. Options 1, 2, 3, and 4 are correct, as clients diagnosed with IBS whose primary symptoms are abdominal distention and flatulence should be advised to avoid common gas-producing foods such as broccoli and cabbage and to consume yogurt, as it may be better tolerated than milk. In addition, the probiotics found in yogurt may be beneficial because alterations in intestinal bacteria are believed to exacerbate IBS. The client should be advised to take loperamide, a synthetic opioid that slows intestinal transit and treats diarrhea when it occurs. Also, psychological stressors are associated with development and exacerbation of IBS, so stress management techniques are important. Option 5, decrease fiber intake, is incorrect, as clients should be encouraged to have a dietary fiber intake of at least 20 g/day.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? A. Notify the health care provider (HCP). B. Administer the prescribed pain medication. C. Call and ask the operating room team to perform surgery as soon as possible. D. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

A. Notify the health care provider (HCP). Rationale: On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

The nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts to slowly advance the NG tube with each swallow. The client begins to cough, gag, and choke. Which actions should the nurse take that will result in proper tube insertion and promote client relaxation? Select all that apply. A. Pull the tube back slightly. B. Instruct the client to breathe slowly. C. Assist the client to take sips of water. D. Continue to slowly advance the tube to the desired distance. E. Check the back of the pharynx using a tongue blade and flashlight.

A. Pull the tube back slightly. B. Instruct the client to breathe slowly. C. Assist the client to take sips of water.. E. Check the back of the pharynx using a tongue blade and flashlight. Rationale: As the NG tube is passed through the oropharynx, the gag reflex is stimulated, which may cause coughing, gagging, or choking. Instead of passing through to the esophagus, the nasogastric tube may coil around itself in the oropharynx, or it may enter the larynx and obstruct the airway. Because the tube may enter the larynx and obstruct the airway, pulling the tube back slightly will remove it from the larynx; advancing the tube might position it in the trachea. Swallowing closes the epiglottis over the trachea and helps move the tube into the esophagus. Slow breathing helps the client relax, which reduces the gag response. The nurse should check the back of the client's throat to note whether the tube has coiled. The tube may be advanced after the client relaxes.

The medication history of a client with peptic ulcer disease reveals intermittent use of several medications. The nurse would teach the client that which of these medications are not a part of the treatment plan because of its irritating effects on the lining of the gastrointestinal tract? A. Nizatidine B. Sucralfate C. Ibuprofen D. Omeprazole

C. Ibuprofen Rationale: Ibuprofen is a nonsteroidal antiinflammatory drug that typically is irritating to the lining of the gastrointestinal tract and should be avoided by clients with a history of peptic ulcer disease. The other medications listed are frequently used to treat peptic ulcer disease. Nizatidine is an H2-receptor antagonist that reduces the secretion of gastric acid. Sucralfate coats the surface of an ulcer to promote healing. Omeprazole is a proton pump inhibitor that blocks transport of hydrogen ions into the lumen of the gastrointestinal tract.

During a home care visit, an adult client complains of chronic constipation. What should the nurse tell the client to do? A. Increase potassium in the diet. B. Include rice and bananas in the diet. C. Increase fluid and dietary fiber intake. D. Increase the intake of sugar-free products.

C. Increase fluid and dietary fiber intake. Rationale: Increase of fluid intake and dietary fiber will help change the consistency of the stool, making it easier to pass. Increasing the intake of rice and bananas will increase constipation. Increasing sugar-free products and potassium in the diet will not assist in alleviating constipation.

The client with a small bowel obstruction asks the nurse to explain the purpose of the nasogastric tube attached to continuous gastric suction. The nurse determines that teaching has been effective if the client makes which statement? A. "It will help to provide me with nourishment." B. "It will help to relieve the congestion from excess mucus." C. "It is used to remove gastric contents for laboratory testing." D. "It will help to remove gas and fluids from my stomach and intestine."

D. "It will help to remove gas and fluids from my stomach and intestine." Rationale: Treatment of intestinal obstruction is directed toward decompression of the intestine by removal of gas and fluid. Nasogastric tubes may be used to decompress the stomach and bowel. Continuous gastric suction does not provide nourishment. The purpose of tracheal suctioning (not gastric suctioning) is to remove excess mucus that has led to congestion. Although gastric contents may be sent for laboratory analysis, it is not the main purpose for continuous gastric suction.

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? A. Carrots and ranch dip B. Whole-grain cereal and milk C. A cup of popcorn and a cola drink D. Applesauce and a graham cracker

D. Applesauce and a graham cracker Rationale: The diet for the client with ulcerative colitis should be low fiber (low residue). The nurse should avoid providing foods such as whole-wheat grains, nuts, and fresh fruits or vegetables. Typically, lactose-containing foods also are poorly tolerated. The client also should avoid caffeine, pepper, and alcohol.

Which of the following tests can be performed to diagnose a hiatal hernia? a. Colonoscopy b. Lower GI series c. Barium swallow d. Abdominal x-rays

Answer: C

If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client? a. Blood replacement b. Antacid administration c. Nasogastric tube suction d. Fluid and electrolyte replacement

Answer: B Antacids aren't helpful in perforation. The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? A. Morphine sulfate B. Zolpidem (Ambien) C. Ondansetron (Zofran) D. Dexamethasone (Decadron)

Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective? A. "Baked foods such as chicken or fish are all right to eat." B. "Citrus fruits and raw vegetables need to be included in my daily diet." C. "I can drink beer as long as I consume only a moderate amount each day." D. "I can drink coffee or tea as long as I limit the amount to 2 cups daily."

A. "Baked foods such as chicken or fish are all right to eat." Rationale: Dietary modifications for the client with peptic ulcer disease include eliminating foods that can cause irritation to the gastrointestinal (GI) tract. Items that should be eliminated or avoided include highly spiced foods, alcohol, caffeine, chocolate, and citrus fruits. Other foods may be taken according to the client's level of tolerance for that food.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? A. Sweating and pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain

A. Sweating and pallor Rationale: Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of A. impaired peristalsis. B. irritation of the bowel. C. nasogastric suctioning. D. inflammation of the incision site.

A. impaired peristalsis. Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: a. Cancer of the stomach b. Peptic ulcer disease c. Chronic gastritis d. Pylorospasm

Answer: B Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would not evidence pain or vomiting unless the pylorus was obstructed.

Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? A. Notify the physician. B. Auscultate for bowel sounds. C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one.

C. Reposition the tube and check for placement. The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply. A. Coffee B. Chocolate C. Peppermint D. Nonfat milk E. Fried chicken F. Scrambled eggs

A. Coffee B. Chocolate C. Peppermint E. Fried chicken Rationale: Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect.

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the health care provider (HCP)? A. Dark red drainage B. Dark brown drainage C. Green-tinged drainage D. Light yellowish-brown drainage

A. Dark red drainage Rationale: For the first 12 hours after gastric surgery, the nasogastric tube drainage may be dark brown to dark red. Later, the drainage should change to a light yellowish-brown color. The presence of bile may cause a green tinge. The HCP should be notified if dark red drainage, a sign of hemorrhage, is noted 24 hours postoperatively.

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? A. Decreased diarrhea B. Decreased cramping C. Improved intestinal tone D. Elimination of peristalsis

A. Decreased diarrhea Rationale: 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 stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first? A. Fecal impaction B. Perineal hygiene C. Dietary fiber intake D. Antidiarrheal agent use

A. Fecal impaction Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively? A. Low fiber B. Low calorie C. High protein D. High carbohydrate

A. Low fiber Rationale: For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food.

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply. A. Nuts B. Corn C. Liver D. Apples E. Lentils F. Bananas

A. Nuts C. Liver E. Lentils Rationale: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans, citrus fruits, green leafy vegetables, and yeast.

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? A. This is a normal, expected event. B. The client is experiencing early signs of ischemic bowel. C. The client should not have the nasogastric tube removed. D. This indicates inadequate preoperative bowel preparation.

A. This is a normal, expected event. Rationale: As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options 2, 3, and 4 are incorrect interpretations.

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information should the nurse include in the teaching plan? A. Use 500 to 1000 mL of warm tap water. B. Suspend the irrigant 36 inches above the stoma. C. Insert the irrigation cone ½ inch into the stoma. D. If cramping occurs, open the irrigation clamp farther.

A. Use 500 to 1000 mL of warm tap water. Rationale: The usual procedure for colostomy irrigation includes using 500 to 1000 mL of warm tap water. The solution is suspended 18 inches above the stoma. The cone is inserted 2 to 4 inches into the stoma but should never be forced. If cramping occurs, the client should decrease the flow rate of the irrigant as needed by closing the irrigation clamp.

When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: a. Assisting in inserting a Miller-Abbott tube b. Assisting in inserting an arterial pressure line c. Inserting a nasogastric tube d. Inserting an I.V.

Answer: C An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line (2) is not appropriate at this time and an IV (4) is optional.

A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? a. The client has not been including enough fiber in his diet b. The client needs to increase his daily exercise c. The client is experiencing a side effect of the aluminum hydroxide. d. The client has developed a gastrointestinal obstruction

Answer: C It is most likely that the client is experiencing a side effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of bowel obstruction.

After a subtotal gastrectomy, care of the client's nasogastric tube and drainage system should include which of the following nursing interventions? a. Irrigate the tube with 30 ml of sterile water every hour, if needed b. Reposition the tube if it is not draining well c. Monitor the client for N/V, and abdominal distention d. Turn the machine to high suction of the drainage is sluggish on low suction

Answer: C Nausea, vomiting, or abdominal distention indicated that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician's order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective? A. "I should be sure to eat at least 1 cucumber every day." B. "Beet greens, parsley, or yogurt will help to control the colostomy odor." C. "I will need to increase my egg intake and try to eat ½ to 1 egg per day." D. "Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."

B. "Beet greens, parsley, or yogurt will help to control the colostomy odor." Rationale: The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley, buttermilk, and yogurt. Spinach also may reduce odor, but it is a gas-forming food and should be avoided. Cucumbers, eggs, and broccoli also are gas-forming foods and should be avoided or limited by the client.

The nurse is teaching an older client about measures to prevent constipation. Which statement by the client indicates a need for further teaching? A. "I walk 1 to 2 miles every day." B. "I need to decrease fiber in my diet." C. "I have a bowel movement every other day." D. "I drink 6 to 8 glasses of water every day."

B. "I need to decrease fiber in my diet." Rationale: An older client has an increased tendency to experience constipation because of decreased stomach-emptying time and a lowered basal metabolic rate. Adequate dietary fiber is an important factor in aiding bowel function. Dietary fiber increases fecal weight and water content and accelerates the transit of fecal mass through the gastrointestinal tract. The retention of water by the fiber has the ability to soften stools and promote regularity. Fluid intake and exercise also facilitate bowel elimination.

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching? A. "I need to lie down after eating." B. "I need to drink liquids with meals." C. "I need to avoid concentrated sweets." D. "I need to eat small meals 6 times daily."

B. "I need to drink liquids with meals." Rationale: The client with dumping syndrome should avoid drinking liquids with meals. The client should be placed on a high-protein, moderate-fat, high-calorie diet and should lie down after eating. The client should avoid concentrated sweets, and frequent small meals are encouraged.

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? A. Apply a cold pack to the abdomen. B. Administer 30 mL of milk of magnesia (MOM). C. Maintain nothing by mouth (nil per os [NPO]) status. D. Initiate an intravenous (IV) line for the administration of IV fluids.

B. Administer 30 mL of milk of magnesia (MOM). Rationale: 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.

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication? A. On arising B. After meals C. On an empty stomach D. 30 minutes before meals

B. After meals Rationale: Salicylate compounds, such as sulfasalazine, act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and increase fluid intake throughout the day. The medication needs to be taken after meals to reduce gastrointestinal irritation. The other options are incorrect and could cause gastric irritation.

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? A. Folate B. Biscodyl C. Ferrous sulfate D. Cyanocobalamin

B. Biscodyl Rationale: 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.

What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy? A. How to care for the wound B. How to deep breathe and cough C. The location and care of drains after surgery D. Which medications will be used during surgery

B. How to deep breathe and cough Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical record? A. Abdominal pain and bloating B. No bowel movement for 3 days C. A decrease in appetite by 50% over 24 hours D. Muscle tremors and other signs of hypomagnesemia

B. No bowel movement for 3 days MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the health care provider? A. Stoma is beefy red and shiny B. Purple discoloration of the stoma C. Skin excoriation around the stoma D. Semi-formed stool noted in the ostomy pouch

B. Purple discoloration of the stoma Rationale: Ischemia of the stoma would be associated with a dusky or bluish or purple color. A beefy red and shiny stoma is normal and expected. Skin excoriation needs to be addressed and treated but does not require as immediate attention as purple discoloration of the stoma. Semi-formed stool is a normal finding.

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? A. "I can have a glass of low-fat milk at bedtime." B. "I will have to eliminate all spicy foods from my diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids."

C. "I will have to use herbal teas instead of caffeinated drinks." Rationale: Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking.

A client with gastritis asks the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse should tell the client that which medication is unlikely to cause epigastric distress? A. Ibuprofen B. Indomethacin C. Acetaminophen D. Naproxen sodium

C. Acetaminophen Analgesics, such as acetaminophen, are unlikely to cause epigastric distress. Ibuprofen, indomethacin, and naproxen sodium are nonsteroidal antiinflammatory medications (NSAIDs) and are irritating to the gastrointestinal tract, so they should be avoided in clients with gastritis.

The nurse is caring for a client postoperatively after creation of a colostomy. What is an appropriate potential client problem? A. Fear B. Sexual dysfunction C. Disturbed body image D. Imbalanced nutrition: more than body requirements

C. Disturbed body image Rationale: Disturbed body image for a client who is postoperative after creation of a colostomy relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). There are no data in the question to support sexual dysfunction or fear. Imbalanced nutrition: less (not more) than body requirements is the more likely client problem.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the health care provider prescribing? A. Enteral feedings B. Fluid restrictions C. Oral corticosteroids D. Activity restrictions

C. Oral corticosteroids Rationale: Crohn's disease is a form of inflammatory bowel disease that is a chronic inflammation of the gastrointestinal (GI) tract. It is characterized by periods of remission interspersed with periods of exacerbation. Oral corticosteroids are used to treat the inflammation of Crohn's disease, so option 3 is the correct one. In addition to treating the GI inflammation of Crohn's disease with medications, it is also treated by resting the bowel. Therefore, option 1 is incorrect. Option 2 is incorrect, as clients with Crohn's disease typically have diarrhea and would not be on fluid restrictions. Option 4, activity restrictions, is not indicated. The client can do activities as tolerated but should avoid stress and strain.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which sign(s)/symptom(s) of duodenal ulcer? A. Weight loss B. Nausea and vomiting C. Pain relieved by food intake D. Pain radiating down the right arm

C. Pain relieved by food intake Rationale: A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the mid-epigastric area. The client with duodenal ulcer usually does not 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 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? A. "I plan to eat 4 to 6 small meals a day." B. "I should sleep in the right side-lying position." C."I plan to have a snack 1 hour before going to bed." D. "I will stop having a glass of wine each evening with dinner."

C."I plan to have a snack 1 hour before going to bed." Rationale: 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 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? A. "It's due to insufficient production of vitamin B12 in the colon." B. "Increased production of intrinsic factor in the stomach leads to this type of anemia." C. "Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." D. "Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

D. "Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine." Rationale: 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.

A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure? A. Assessing pulses B. Monitoring urine output C. Monitoring for rectal bleeding D. Assessing for the presence of the gag reflex

D. Assessing for the presence of the gag reflex Rationale: Following the procedure, the client remains NPO (nothing by mouth) until the gag reflex returns, which is usually in 1 to 2 hours. The remaining options are not specific assessments related to this procedure.

A client receiving a cleansing enema complains of pain and cramping. The nurse should take which corrective action? A. Discontinue the enema. B. Reassure the client, and continue the flow. C. Raise the enema bag so that the solution can be completed quickly. D. Clamp the tubing for 30 seconds, and restart the flow at a slower rate.

D. Clamp the tubing for 30 seconds, and restart the flow at a slower rate. Rationale: Enema fluid should be administered slowly. If the client complains of fullness or pain, the flow is stopped for 30 seconds and restarted at a slower rate. This action decreases the likelihood of intestinal spasm and premature ejection of the solution. Therefore, the actions in the remaining options are incorrect.

The nurse should instruct a client with an ileostomy to include which action as part of essential care of the stoma? A. Massage the area below the stoma. B. Take in high-fiber foods such as nuts. C. Limit fluid intake to prevent diarrhea. D. Cleanse the peristomal skin meticulously.

D. Cleanse the peristomal skin meticulously. Rationale: The peristomal skin must receive meticulous cleansing because ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. The area below the ileostomy may be massaged as needed if the ileostomy becomes blocked by high-fiber foods. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. Fluid intake should be at least 6 to 8 glasses of water per day to prevent dehydration.

A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse determines that which item mentioned by the client is most likely to be responsible for the exacerbation? A. Sleeping 8 to 10 hours a night B. Ability to work at home periodically C. Eating 5 or 6 small meals per day D. Frequent need to work overtime on short notice

D. Frequent need to work overtime on short notice Rationale: Psychological or emotional stressors that exacerbate peptic ulcer disease may be found either at home or in the workplace. Of the items listed, the frequent need to work overtime on short notice is potentially the most stressful because it is the item over which the client has the least control. An ability to work at home periodically is not necessarily stressful because it allows increased client control over timing and location of work. Adequate rest and proper dietary pattern (options 1 and 3) should alleviate symptoms, not worsen them.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way? A. Increases bulk in the stool B. Lubricates the intestinal tract to soften feces C. Increases fluid retention in the intestinal tract D. Increases peristalsis by stimulating nerves in the colon wall

D. Increases peristalsis by stimulating nerves in the colon wall Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

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? A. Colectomy B. Appendectomy C. Ascending colostomy D. Small bowel resection

D. Small bowel resection Rationale: 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.

The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client on the signs and symptoms associated with dumping syndrome. Which client statement indicates that teaching was effective? A. "It will cause diaphoresis and diarrhea." B. "I have to monitor for hiccups and diarrhea." C. "It will be associated with constipation and fever." D. "I have to monitor for fatigue and abdominal pain."

A. "It will cause diaphoresis and diarrhea." Rationale: Dumping syndrome occurs after gastric surgery because food is not held for as long in the stomach and is dumped into the intestine as a hypertonic mass. This causes fluid to shift into the intestine, causing cardiovascular and gastrointestinal symptoms. Symptoms can typically include weakness, dizziness, diaphoresis, flushing, hypotension, abdominal pain and distention, hyperactive bowel sounds, and diarrhea. The remaining options are not signs of dumping syndrome.

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this client? A. NPO (nothing by mouth) status B. Ambulation at least 4 times daily C. Cholinergic medications to reduce pain D. Coughing and deep breathing every 2 hours

A. NPO (nothing by mouth) status Rationale: During the acute phase of diverticulitis, the goal of treatment is to rest the bowel and allow the inflammation to subside. The client remains NPO and is placed on bed rest. Pain occurs from bowel spasms, and increased intra-abdominal pressure (coughing and deep breathing) may precipitate an attack. Ambulation and cholinergics will increase peristalsis.

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the health care provider for which type of diet for this client? A. A low-fat diet B. A low-fiber diet C. A high-protein diet D. A high-carbohydrate diet

B. A low-fiber diet Rationale: A low-fiber diet places less strain on the intestines because this type of diet is easier to digest. Clients should avoid high-fiber foods when experiencing acute diverticulitis. As the attack resolves, fiber can be added gradually to the diet.

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? A. Apply ice to the stoma site. B. Apply pressure to the stoma site. C. Notify the health care provider (HCP). D. Document the amount and characteristics of the drainage.

D. Document the amount and characteristics of the drainage. Rationale: 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 nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply. A. Antidiarrheal B. Antimicrobial C. Corticosteroid D. Aminosalicylate E. Biological therapy F. Immunosuppressant

B. Antimicrobial C. Corticosteroid D. Aminosalicylate E. Biological therapy F. Immunosuppressant Rationale: Pharmacological treatment for IBD aims to decrease the inflammation to induce and then maintain a remission. Five major classes of medications used to treat IBD are antimicrobials, corticosteroids, aminosalicylates, biological and targeted therapy, and immunosuppressants. Medications are chosen based on the location and severity of inflammation. Depending on the severity of the disease, clients are treated with either a "step-up" or "step-down" approach. The step-up approach uses less toxic therapies (e.g., aminosalicylates and antimicrobials) first, and more toxic medications (e.g., biological and targeted therapy) are started when initial therapies do not work. The step-down approach uses biological and targeted therapy first. Option 1, antidiarrheals, is incorrect. Although an antidiarrheal may be used to treat the symptoms of IBD, it does not treat the disease (the inflammation) or induce remission. In addition, antidiarrheals should be used cautiously in IBD because of the danger of toxic megacolon (colonic dilation greater than 5 cm).

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? A. Warm the feeding to 103°F (39.4°C). B. Confirm NG placement by x-ray study. C. Make sure the continuous enteral feeding tubing is primed. D. Position the head of the client's bed to 30 degrees or greater.

B. Confirm NG placement by x-ray study. Rationale: 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.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

B. Drowsiness Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication? A. Stroke B. Pernicious anemia C. Bacterial meningitis D. Peripheral arterial disease

B. Pernicious anemia Rationale: Billroth I surgery involves removing one half to two thirds of the stomach and reanastomosing the remaining segment of the stomach to the duodenum. With the loss of this much of the stomach, development of pernicious anemia is not uncommon. Pernicious anemia is a macrocytic anemia that most commonly is caused by the lack of intrinsic factor. During a Billroth I procedure, a large portion of the parietal cells, which are responsible for producing intrinsic factor (a necessary component for vitamin B12 absorption), are removed. In this anemia, the red blood cell is larger than usual and hence does not last as long in the circulation as normal red blood cells do, causing the client to have anemia with resultant fatigue. Vitamin B12 also is necessary for normal nerve function. Because of the lack of the necessary intrinsic factor, persons with pernicious anemia also experience paresthesias, impaired gait, and impaired balance. Although the symptoms could possibly indicate the other options listed, pernicious anemia is the most logical based on the surgery the client underwent.

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? A. Diarrhea, chills, and hiccups B. Weakness, diaphoresis, and diarrhea C. Fever, constipation, and rectal bleeding D. Abdominal pain, elevated temperature, and weakness

B. Weakness, diaphoresis, and diarrhea Rationale: 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 has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement? A. Fleet enema B. Fecal disimpaction C. Glycerin suppository D. Soap solution enema (SSE)

C. Glycerin suppository Rationale: The least amount of invasiveness needed to produce a bowel movement is best. Use of glycerin suppositories is the least invasive method and usually stimulates bowel evacuation within a half-hour. Enemas may be needed on an every-other-day basis, but they are used cautiously (even if not contraindicated) because the Valsalva maneuver can increase intracranial pressure. Fecal disimpaction is done only when the client's rectum has become impacted from constipation as a result of inattention or failure of other measures. Stool softeners may be prescribed on a regular schedule for some clients to avoid hard, dry stools, but oral medication is not administered to an unconscious client.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, boardlike abdomen

D. A rigid, boardlike abdomen Rationale: Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid-epigastric area and spreading over the abdomen, which becomes rigid and boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? A. Folate deficiency B. Malabsorption of fat C. Intestinal obstruction D. Fluid and electrolyte imbalance

D. Fluid and electrolyte imbalance Rationale: A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD? A. Recently retired from a job B. Significant other has a gastric ulcer C. Occasionally drinks 1 cup of coffee in the morning D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis

D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis Rationale: Risk factors for PUD include Helicobacter pylori infection, smoking (nicotine), chewing tobacco, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress. When an NSAID is taken as often as is typical for osteoarthritis, it will cause problems with the stomach. Certain medical conditions such as Crohn's disease, Zollinger-Ellison syndrome, and hepatic and biliary disease also can increase the risk for PUD by changing the amount of gastric and biliary acids produced. Recent retirement should decrease stress levels rather than increase them. Ulcer disease in a first-degree relative also is associated with increased risk for an ulcer. A significant other is not a first-degree relative; therefore, no genetic connection is noted in this relationship. Although caffeinated drinks are a known risk factor for PUD, the option states that the client drinks 1 cup of coffee occasionally.

The nurse is caring for a client with pernicious anemia. Which prescription by the health care provider (HCP) should the nurse anticipate? A. Iron B. Folic acid C. Vitamin B6 D. Vitamin B12

D. Vitamin B12 Rationale: Pernicious anemia is caused by a deficiency of vitamin B12. Treatment consists of administration of high doses of oral vitamin B12. Monthly injections of vitamin B12 can also be administered but are less comfortable when compared to oral administration. Thiamine is most often prescribed for the client with alcoholism, folic acid is prescribed for folic acid deficiency, and vitamin B6 is ordered when there is pyridoxine deficiency.

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

D. Vitamin B12 injections Rationale: 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.

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan? 1. Monitoring the temperature 2. Monitoring complaints of heartburn 3. Giving warm gargles for a sore throat 4. Assessing for the return of the gag reflex

4. Assessing for the return of the gag reflex Rationale: The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also important; however, the client's airway is the priority.

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? A. Rice B. Corn C. Broiled chicken D. Cream of wheat

B. Corn Rationale: 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.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain

B. Heartburn Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.

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? A. Weight loss B. Nausea and vomiting C. Pain that is relieved by food intake D. Pain that radiates down the right arm

C. Pain that is relieved by food intake Rationale: 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 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? A. Sufficiently low water content in the stool B. Low intestinal roughage that promotes easier digestion C. Constriction of the anal sphincter based on voluntary control D. Stimulation of the parasympathetic reflex center at the S1 to S4 level in the spinal cord

D. Stimulation of the parasympathetic reflex center at the S1 to S4 level in the spinal cord Rationale: 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.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? a. Before meals b. With meals c. At bedtime d. When pain occurs

Answer: C Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.

The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify? a. Irrigating the nasogastric tube b. Coughing a deep breathing exercises c. Leg exercises d. Early ambulation

Answer: A In a Billroth II procedure the proximal remnant of the stomach is anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.

Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure? a. Obesity b. Volvulus c. Constipation d. Intestinal obstruction

Answer: A Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.

The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. a. The client complains of a sore throat b. The client has a temperature of 100*F c. The client appears drowsy following the procedure d. The client complains of epigastric pain e. The client experiences hematemesis

Answer: B, D, E Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication? a. The client complains of a sore throat b. The client displays signs of sedation c. The client experiences a sudden increase in temperature d. The client demonstrates a lack of appetite

Answer: C

The client with a duodenal ulcer may exhibit which of the following findings on assessment? a. Hematemesis b. Malnourishment c. Melena d. Pain with eating

Answer: C

The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? a. Supine with the head of the bed flat b. On the stomach with the head flat c. On the left side with the head of the bed elevated 30 degrees d. On the right side with the head of the bed elevated 30 degrees

Answer: C The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.

The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: a. Check that the hemostat is on the bedside b. Monitor IV fluids for the shift c. Regularly assess respiratory status d. Check that the balloon is deflated on a regular basis

Answer: C The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply. a. Epigastric pain at night b. Relief of epigastric pain after eating c. Vomiting d. Weight loss

Answer: C, D Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

Which of the following conditions can cause a hiatal hernia? a. Increased intrathoracic pressure b. Weakness of the esophageal muscle c. Increased esophageal muscle pressure d. Weakness of the diaphragmic muscle

Answer: D A hiatal hernia is caused by weakness of the diaphragmic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle pressure isn't a factor in hiatal hernia.

Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer? a. Regain weight loss within 1 month after surgery b. Resume normal dietary intake of three meals per day c. Control nausea and vomiting through regular use of antiemetics d. Achieve optimal nutritional status through oral or parenteral feedings

Answer: D An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated.

The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? a. Development of laryngeal cancer b. Irritation of the esophagus c. Esophageal scar tissue formation d. Aspiration of gastric contents

Answer: D Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.

The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves: a. Cutting the vagus nerve b. Removing the distal portion of the stomach c. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid d. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum

Answer: D Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.

Which of the following tests can be used to diagnose ulcers? a. Abdominal x-ray b. Barium swallow c. Computed tomography (CT) scan d. Esophagogastroduodenoscopy (EGD)

Answer: D The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal x-ray aren't useful in the diagnosis of an ulcer.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following? a. An intestinal obstruction has developed b. Additional ulcers have developed c. The esophagus has become inflamed d. The ulcer has perforated

Answer: D The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid, boardlike abdomen.

Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection? a. Monitoring gastric pH to detect complications b. Assessing for bowel sounds c. Providing nutritional support d. Monitoring for symptoms of hemorrhage

Answer: D The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate? A. "This will prevent air from accumulating in the stomach, causing gas pains." B. "This will prevent the heartburn that occurs as a side effect of general anesthesia." C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again." Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

B. History of colorectal polyps A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? A. Chest pain relieved with eating or drinking water B. Back pain 3 or 4 hours after eating a meal C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen and vomiting following indigestion

D. Rigid abdomen and vomiting following indigestion A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching? A. "I eat at least 3 large meals each day." B. "I eat while lying in a semirecumbent position." C. "I have eliminated taking liquids with my meals." D. "I eat a high-protein, low- to moderate-carbohydrate diet."

A. "I eat at least 3 large meals each day." Rationale: Dumping syndrome describes a group of symptoms that occur after eating. It is believed to result from rapid dumping of gastric contents into the small intestine, which causes fluid to shift into the intestine. Signs and symptoms of dumping syndrome include diarrhea, abdominal distention, sweating, pallor, palpitations, and syncope. To manage this syndrome, clients are encouraged to decrease the amount of food taken at each sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid consumption of high-carbohydrate meals.

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How should the nurse schedule the medications for administration? A. Drink 8 ounces of water between taking each medication. B. Administer the cimetidine and magnesium hydroxide at the same time twice daily. C. Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide. D. Collaborate with the health care provider (HCP), as the client should not be receiving both medications.

C. Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide. Antacids, such as magnesium hydroxide, can decrease absorption of cimetidine. At least 1 hour should separate administration of an antacid and cimetidine. The remaining options are incorrect.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

C. Antibiotic(s), proton pump inhibitor, and bismuth To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, should the nurse question? A. Digoxin B. Furosemide C. Indomethacin D. Propranolol hydrochloride

C. Indomethacin Rationale: Indomethacin is a nonsteroidal antiinflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Digoxin is a cardiac medication. Furosemide is a loop diuretic. Propranolol hydrochloride is a beta-adrenergic blocking agent. Digoxin, furosemide, and propranolol are not contraindicated in clients with gastric disorders.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? A. Leg exercises B. Early ambulation C. Irrigating the nasogastric tube D. Coughing and deep-breathing exercises

C. Irrigating the nasogastric tube Rationale: In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? A. Ambulate following a meal. B. Eat high-carbohydrate foods. C. Limit the fluids taken with meals. D. Sit in a high Fowler's position during meals.

C. Limit the fluids taken with meals. Rationale: Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

The nurse is performing an admission assessment on a client who has been admitted to the hospital with a diagnosis of suspected gastric ulcer. The nurse is asking the client questions about pain. Which client statement supports the diagnosis of gastric ulcer? A. "The pain doesn't usually come right after I eat." "B. The pain gets so bad that it wakes me up at night." C. "The pain that I get is located on the right side of my chest." D. "My pain comes shortly after I eat, maybe a half-hour or so later."

D. "My pain comes shortly after I eat, maybe a half-hour or so later." Rationale: Gastric ulcer pain often occurs in the upper epigastrium, with localization to the left of the midline, and may be exacerbated by intake of food. The pain occurs 30 to 60 minutes after a meal and rarely occurs at night. Duodenal ulcer pain is usually located to the right of the epigastrium. The pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often awakens the client at night.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction

D. High-pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse would question the use of which cathartic agent in a patient with renal insufficiency? A. Bisacodyl (Dulcolax) B. Lubiprostone (Amitiza) C. Cascara sagrada (Senekot) D. Magnesium hydroxide (Milk of Magnesia)

D. Magnesium hydroxide (Milk of Magnesia) Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? A. Digoxin (Lanoxin) B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan)

D. Promethazine (Phenergan) A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching? A. "I know I can massage my abdomen." B. "I will continue using antispasmodic medication." C. "One of the best things I can do is use relaxation techniques." D. "The best position for me is to lie supine with my legs straight."

D. "The best position for me is to lie supine with my legs straight." Rationale: Pain associated with Crohn's disease is alleviated by the use of analgesics and antispasmodics and also by practicing relaxation techniques, applying local cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate inflamed intestinal tissues as the abdominal muscles are stretched.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position

A. Providing IV fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

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? A. Remove fluids from the meal tray. B. Give the client 2 large meals per day. C. Ask the client to sit up for 1 hour after eating. D. Provide concentrated, high-carbohydrate foods.

A. Remove fluids from the meal tray. Rationale: 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 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? A. The client reports some pain before meals. B. The client frequently is awakened at 2 a.m. with heartburn. C. The client has eliminated any irritating foods from the diet. D. The client's pain is minimal with histamine H2-receptor antagonists.

C. The client has eliminated any irritating foods from the diet. Rationale: 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 provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? A. "I need to limit my intake of dietary fiber." B. "I need to drink plenty, at least 8 to 10 cups daily." C. "I need to eat regular meals and chew my food well." D. "I will take the prescribed medications because they will regulate my bowel patterns."

A. "I need to limit my intake of dietary fiber." Rationale: IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. A. Administer stool softeners as prescribed. B. Instruct the client to limit fluid intake to avoid urinary retention. C. Encourage a high-fiber diet to promote bowel movements without straining. D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed. E. Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

A. Administer stool softeners as prescribed. C. Encourage a high-fiber diet to promote bowel movements without straining. D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed. Rationale: Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture. Stool softeners and a high-fiber diet will help the client to avoid straining, thereby reducing the chances of rupturing the incision. An ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect interventions.

The nurse is providing discharge instructions for a client following a Roux-en-Y gastric bypass surgery 3 days ago. What will the nurse include in the instructions? Select all that apply. A. Do not drink fluids with meals. B. Avoid foods high in carbohydrates. C. Take an extended-release multivitamin daily. D. Maintain a clear liquid diet for about 6 weeks. E. Eat 6 small meals a day that are high in protein.

A. Do not drink fluids with meals. D. Maintain a clear liquid diet for about 6 weeks. E. Eat 6 small meals a day that are high in protein. Rationale: A Roux-en-Y gastric bypass is a combination of restrictive and malabsorptive surgery in which the size of the stomach is made much smaller and a large part of the small intestine (which absorbs food) is bypassed. Because the stomach is so small, clients are instructed to not drink fluids with meals because providers do not want them to fill up on less nutritional liquids before having food; to avoid foods high in carbohydrates because they are not as nutritional and tend to promote diarrhea and dumping syndrome; and to eat frequent, small meals that are high in protein. An extended-release vitamin will not be absorbed by the client since much of the small intestine is bypassed and food moves through quickly, and 6 weeks is too long a period to be on clear liquids. The typical bariatric surgery client is only on clear liquids for a few days and should then be on a high-protein diet.

The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate? A. Encourage the client to ambulate. B. Position the client on the left side. C. Frequently irrigate the nasogastric tube (NG) with 30 mL saline. D. Discourage the use of the patient-controlled analgesia (PCA) machine.

A. Encourage the client to ambulate. Rationale: Bariatric clients are at risk for developing deep vein thrombosis and atelectasis. It is important to encourage ambulation to promote both venous return in the legs and lung expansion. Therefore, the correct option is 1. Option 2 is incorrect, as positioning on the left side is not indicated and positioning on the right side would be more appropriate to facilitate gastric emptying. Option 3 is incorrect, as the stomach after a Roux-en-Y procedure is very small and often holds only 30 mL, so frequent irrigation with 30 mL could lead to disruption of the anastomosis or staple line. Option 4 is incorrect because clients who have gastric bypass surgery are often in a considerable amount of pain and it is important for their pain to be controlled so that they are able to do the activities required, such as coughing and deep breathing and ambulation, to prevent complications.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? A. Lying recumbent following meals B. Consuming small, frequent, bland meals C. Taking H2-receptor antagonist medication D. Raising the head of the bed on 6-inch (15 cm) blocks

A. Lying recumbent following meals Rationale: Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals; use of H2-receptor antagonists and antacids; and elevation of the thorax following meals and during sleep.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? A. Keep the patient NPO. B. Put the bed in the Trendelenberg position. C. Have the patient eat 4 to 6 smaller meals each day. D. Give various antacids to determine which one works for the patient.

C. Have the patient eat 4 to 6 smaller meals each day. Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially? A. Call the surgeon to report the problem. B. Reposition the NG tube to the proper location. C. Check the suction device to make sure it is working. D. Irrigate the NG tube with saline to remove the obstruction.

C. Check the suction device to make sure it is working. Rationale: After gastric surgery, the client will have an NG tube in place until bowel function returns. It is important for the NG tube to drain properly to prevent abdominal distention and vomiting. The nurse must ensure that the NG tube is attached to suction at the level prescribed and that the suction device is working correctly. The tip of the NG tube may be placed near the suture line. Because of this possibility, the nurse should never reposition the NG tube or irrigate it. If the NG tube needs to be repositioned, the nurse should call the surgeon, who would do this repositioning under fluoroscopy.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? A. Nausea B. Belching C. Epigastric pain D. Difficulty swallowing

C. Epigastric pain Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.

The nurse is caring for a client who is receiving bolus feedings via a nasogastric tube. As the nurse is finishing the feeding, the client asks for the bed to be positioned flat for sleep. The nurse understands that which is the appropriate position for this client at this time? A. Head of bed flat, with the client supine for 60 minutes B. Head of bed flat, with the client in the supine position for at least 30 minutes C. Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes D. Head of bed in a semi Fowler's position, with the client in the left lateral position for 60 minutes

C. Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes Rationale: Aspiration is a possible complication associated with nasogastric tube feeding. The head of the bed is elevated 30 to 45 degrees for 60 minutes after a bolus tube feeding to prevent vomiting and aspiration. The right lateral position uses gravity to facilitate gastric emptying and thus prevent vomiting. The flat supine position is to be avoided for the first 30 minutes after a tube feeding.

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? A. Blood in the stool B. Chalky gray stool C. Loose, watery stool D. Dry, hard, constipated stool

C. Loose, watery stool Rationale: 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 is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client? A. Maintain a high-carbohydrate diet. B. Increase fluid intake, particularly at mealtime. C. Maintain a low Fowler's position while eating. D. Ambulate for at least 30 minutes following each meal.

C. Maintain a low Fowler's position while eating. Rationale: The client at risk for dumping syndrome should be instructed to maintain a low Fowler's position while eating and lie down for at least 30 minutes after eating. The client also should be told that small, frequent meals are best and to avoid liquids with meals. Avoiding high-carbohydrate food sources also will assist in minimizing dumping syndrome.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider (HCP)? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. A hemoglobin level of 12 mg/dL (120 mmol/L)

C. Rebound tenderness Rationale: Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the HCP.

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period? A. "When I can tolerate food without vomiting." B. "When my gastrointestinal system is healed enough." C. "When my health care provider says the tube can come out." D. "When my bowels begin to function again, and I begin to pass gas."

D. "When my bowels begin to function again, and I begin to pass gas." Rationale: NG tubes are discontinued when normal function returns to the gastrointestinal (GI) tract. Food would not be administered unless bowel function returns. The tube will be removed before GI healing. Although the health care provider (HCP) determines when the NG tube will be removed, it does not determine effectiveness of teaching and the need for the NG tube.

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? A. Bradycardia B. Nausea and vomiting C. Numbness in the legs D. A rigid, boardlike abdomen

D. A rigid, boardlike abdomen Rationale: 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 after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present? A. A sunken and hidden stoma B. A narrow and flattened stoma C. A stoma that is dusky or bluish D. A stoma that is elongated with a swollen appearance

D. A stoma that is elongated with a swollen appearance Rationale: A prolapsed stoma is one in which the bowel protrudes, causing an elongated and swollen appearance of the stoma. A retracted stoma is characterized by sinking of the stoma. A stoma with a narrow opening is described as being stenosed. Ischemia of the stoma would be associated with a dusky or bluish color.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? A. Hypercalcemia B. Hypernatremia C. Frothy, fatty stools D. Decreased hemoglobin

D. Decreased hemoglobin Rationale: Ulcerative colitis is an inflammatory disease of the large colon. Findings associated with ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia (not hypercalcemia). Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).