GI Exam Practice Questions

When assessing a client who is recovering from a paracentesis 1 hour ago, which finding requires action by the nurse? a) UOP via urinary catheter is 20 mL/hr b) BP increases from 110/68 to 122/72 c) RR decreases from 18 to 14 breaths/min d) a decrease in the clients weight by 6 kg

a (rapid removal of acitic fluid can cause *hypovolemia* which is manifested by a UOP below 30mL/hr) -decreased RR indicates ease in breathing -weight is expected to drop after removal of fluid

The nurse cares for an older client who experiences exacerbation of UC w/ severe diarrhea. What is the nurses's priority for care? a) monitor for skin breakdown b) monitor HR & rhythm c) maintain intake & output records d) auscultate bowel sounds frequently

a (skin breakdown)

The nurse cares for a client admitted with a diagnosis of *acute pancreatitis*. An IV is begun and the nurse inserts an NG tube and attaches it to intermittent low suction. The nurse gives frequent oral hygiene and administers morphine for reports of pain. Which client behavior indicates to the nurse that the medication is effective? a) the client sleeps for one hour b) the client frequently changes positions in bed c) the client states there is less nausea d) the client does not report thirst

a (sleeps for one hour) -position changes indicate restlessness which means the client is in pain -NG tubes relieve nausea, not the morphine

Immediately following a liver biopsy, the nurse places the client in which position? a) on the right side b) on the left side c) prone d) supine

a ) on the *right* side ( important to prevent leakage of fluid or hemorrhage from occurring --> ideal position is to *lie directly on the liver* with the ribs pushing on the liver - place a pillow under the costal margin)

The nurse cares for a patient after a traditional cholecystectomy. The nurse should contact the physician if which of the following is observed? a) 800 cc bloody drainage in the first day postop b) The patient frequently complains of abdominal pain during the first 24 hours c) Nasogastric tube connected to intermittent suction the first day postop d) Temperature elevation to 100ºF the evening of the surgery

a) 800 mL bloody drainage the first day postop this amount of drainage after a cholecystectomy would indicate hemorrhage; *50 mL is an appropriate amount of drainage* --> not unusual for temp to be elevated the evening of surgery (too early to develop a wound infection)

The school nurse is informed that a sixth grader in the school has been diagnosed with hepatitis A. It is MOST important for the nurse to teach the parents of the classmates to observe the children for which of the following symptoms? a) Fatigue b) Increased appetite c) Tarry stools d) Pallor

a) Fatigue symptoms of hepatitis include fatigue, anorexia, RUQ pain, pruritus, jaundice; client will be anorexic, stools will be clay-colored, urine will be tea-colored

Which of the following are considered age-related changes in the GI system? (SATA) a) decreased hydrochloric acid production b) diminished sensation that can lead to constipation c) fat not digested as well in older adults d) increased peristalsis in the large intestine e) pancreatic vessels become calcified

a, b, c, e

What are the potential complications associated with an ERCP? (SATA) a) cholangitis b) pancreatitis c) perforation d) renal lithiasis e) sepsis

a, b, c, e (and bleeding)

Which complications are paired correctly with their physiologic processes? (SATA) a) lower GI bleeding --> erosion of bowel wall b) abscess formation --> localized pockets of infection develop in the ulcerated bowel lining c) toxic megacolon --> transmural inflammation resulting in pyuria & fecaluria d) nonmechanical bowel obstruction --> paralysis of colon resulting from CRC e) fistula --> dilation and colonic ileus caused by paralysis of the colon

a, b, d (c = fistulas b/w bowel & bladder, not toxic megacolon) (e = toxic megacolon, not fistulas)

The nurse is caring for a pt with abdominal pain. Which questions should the nurse ask the pt while assessing? (SATA) a) Is the pain burning, gnawing, or stabbing? b) can you point to where you feel the pain? c) do you have a family history of cancer? d) when did you first notice the pain? e) Does the pain spread anywhere?

a, b, d, e

What will lab values for a pt with liver disease most likely show? (SATA) a) increased prothrombin time b) increased AST & ALT c) increased albumin levels d) decreased ammonia levels e) increased unconjugated bilirubin

a, b, e

Which body structures are located in the RUQ? (SATA) a) duodenum b) liver c) stomach d) spleen e) gallbladder f) pancreas head

a, b, e, f

Which testing modalities are included in the 2014 American Cancer Society screening guidelines for people over the age of 50? (SATA) a) colonoscopy every 10 years b) colonoscopy every 5 years c) CT colonography ever 5 years d) double-contrast barium enema every 10 years e) flexible sigmoidoscopy every 10 years

a, c (colon cancer screening = colonoscopy q 10 yrs and everything else every 5 years)

Which statements should the nurse include when delegating hygiene care for a client with advanced liver cirrhosis to the UAP? (SATA) a) apply lotion to the client's dry skin areas b) use a basin with warm water to bathe this client c) for the client's oral care, use a soft toothbrush d) provide clippers so the client can trim their nails e) bathe w/ antibacterial and water-based soaps

a, c, d - clients w/ advanced cirrhosis often have *pruritis* (lotion decreases itchiness) - soft toothbrush to prevent gum bleeding (RT impaired clotting) - nails should be trimmed short to prevent scratching self (impaired clotting) - client should use *cool* (not warm) water on skin & should avoid excessive amounts of soap

The client had an open Whipple procedure yesterday for pancreatic cancer. Which nursing interventions are appropriate for this client? (SATA) a) monitor & document client's NGT drainage b) place client in side-lying position to promote wound drainage c) assess the abdomen for signs of peritonitis d) monitor the client's Hgb & Hct e) check the client's blood glucose frequently

a, c, d, e

What does the nurse teach the patient about the preparation for a colonoscopy? (SATA) a) take only clear liquids the day before b) drink lots of red, orange, or purple beverages the day before c) you should take nothing by mouth for 4-6 hrs before d) do not take aspirin, NSAIDs, or anticoagulants for several days before the test e) after you drink the bowel-cleansing solution, you will have water diarrhea in about an hour f) you will have an IV placed to receive medication to help you relax during the procedure

a, c, d, e, f

The nurse is taking GI health history from a newly admitted pt. Which questions would the nurse be sure to ask? (SATA) a) Have you lost/gained weight recently? b) Have you had any recent cardiac or resp surgeries? c) Do you wear dentures and if so, how do they fit you? d) Do you have difficulty chewing or swallowing? e) Have you traveled in the USA recently & where? f) What is your usual bowel elimination pattern?

a, c, d, f

The nurse is providing discharge instructions for a client who has undergone a laparoscopic cholecystectomy. Which instruction will the nurse include in the discharge teaching? a) keep dressings in place for 4 weeks b) report bile colored drainage from any of the incisions c) expect dark, tarry stools after surgery d) be aware that no dietary changes will be necessary

b

The nurse performs discharge teaching for a client with a diagnosis of hepatitis B. Which precaution to prevent the transmission of hepatitis B is included in the teaching? a) burn used paper tissues b) abstain from unprotected sex c) use special disinfectant in toilet d) avoid touching family members

b (abstain from unprotected sex) -can be transmitted through sexual contact

The nurse monitors a client recovering from hepatitis B. The nurse understands this client has developed which type of immunity? a) antigen b) active acquired c) antibody d) passive acquired

b (active acquired) since the client has the disease, the client produced antibodies to fight the disease (ex. of actively acquired immunity = immunization)

The nurse obtains a history on a client reporting diarrhea. Which statement is *most* important for the nurse to follow up on? a) "I eat a lot of processed foods" b) "I have been taking cephalexin for the last week" c) " I eat small meals four to six times per day" d) "I prefer to eat my food cold"

b (cephalexin for the last week) -oral ab'tics given for infection may alter natural flora of the GI tract and cause diarrhea

Which intervention should the nurse delegate to the UAP when caring for a client scheduled for a paracentesis? a) have client sign the informed consent form b) assist the client to void before the procedure c) help the client lie flat in bed on the right side d) get the client into a chair after the procedure

b (client should void before a paracentesis)

The nurse identifies which diet BEST meets the nutritional needs of a client diagnosed with cirrhosis? a) High in calories plus vitamin supplements b) High in protein and high in carbohydrates c) High in calcium and low in fat d) High in iron and low in salt

b (high protein, high carb) (since many alcoholics are malnourished, a high-protein diet is important; there will be no change in calcium or iron requirements, and only moderate amounts of fat are allowed; *cirrhosis accompanied by ascites, sodium may be restricted as well*)

Which action should the nurse take to decrease the presence of ascites in a client with cirrhosis of the liver? a) monitor I's & O's b) provide a low-sodium diet c) increase oral fluid intake d) weigh the client daily

b (low-sodium)

Which interventions should the nurse include in the plan of care to reduce discomfort in a client with acute pancreatitis? a) administer morphine sulfate IV every 4 hrs as needed b) maintain NPO and administer IV fluids c) provide small, frequent feedings with no concentrated sweets d) place client in semi-fowler's with HOB elevated

b (pain meds should be administered around the clock, feedings are contraindicated b/c it makes the problem worse, and the client is most comfortable in a fetal position with legs drawn up)

The health care provider orders a clear liquid diet for a client after an appendectomy. The nurse explains to the client a clear liquid diet was ordered for which reason? a) provide adequate calories b) relieve thirst & maintain fluid balance c) stimulate GI tract to have BM d) provide complete nutrition

b (relieve thirst & maintain fluid balance)

The patient's potassium level is 3.1 mEq/L. Which condition would cause this value? a) malabsorption b) gastric suctioning c) acute pancreatitis d) kidney failure

b (suction) *level is low*

The nurse is monitoring a patient after an endoscopy. VS are stable and the side rails are raised but the pt tells the nurse that he is very thirsty. What is the nurse's best action? a) administer a small amount of ice chips only b) give pt small sips of water through a straw c) check if pt's gag reflex has returned d) keep pt NPO for at least 4 hrs

c

Which client is at the highest risk for developing pancreatic cancer? a) 32 yo with hypothyroidism b) 44 yo with cholelithiasis c) 50 yo with BRCA2 gene mutation d) 68 yo who is of African-American ethnicity

c

A pt admitted to the Ed that has been vomiting for the last 12 hours is likely to have which test ordered? a) endoscopic retrograde cholangiopancreatohraphy (ERCP) b) upper GI radiographic series c) esophagogastroduodenoscopy (EGD) d) barium enema

c (EGD)

The pt should be observed for cholangitis, perforations, sepsis, and pancreatitis, and the pt should report abdominal pain, fever, or N/V that fails to resolve. The pt is NPO until gag reflex returns. Which procedure does this follow-up care describe? a) enteroscopy b) EGD c) ERCP d) PTC

c (ERCP)

The nurse understands that the *most* common reason for insertion of an NG tube in a post-op client diagnosed with duodenal ulcer includes which reason? a) takes samples of gastric acid b) assess the stomach for bleeding c) decompress the stomach d) permit saline irrigations

c (decompress stomach) -prevents distention and pressure on the suture lines post-op

When assessing a client with Crohn's disease and colonic strictures, which clinical manifestation indicates that an intestinal obstruction has occurred and the HCP should be contacted immediately? a) temperature of 100* F b) loose and bloody stool c) distended abdomen d) lower abdominal cramps

c (distended abdomen) (a, b, d = common symptoms of crohn's disease)

The nurse obtains a history from a client suspected of having cirrhosis. Which statement, if made by the client to the nurse, should the nurse recognize as MOST directly related to a client's development of cirrhosis? a) "For the past several weeks I have not slept for more than five hours a night." b) "Since my spouse left me five years ago, I have been eating terribly." c) "I have been drinking about a fifth of vodka a day for the last few months." d) "My spouse was a heavy smoker, and I am concerned about second-hand smoke."

c (drinking fifth of vodka/day for last few months) alcohol has a toxic effect on the liver, which causes liver inflammation; s/s include N/V, anorexia, weight loss, flatulence, fatigue, headache, ascites, jaundice, and spider angiomas

The patient should be monitored for signs of perforation such as pain, bleeding, or fever, and the pt is instructed not to drive for 12 hrs after the test. A hoarse voice and sore throat may persist for several days; throat lozenges may be used to relieve the discomfort. Which procedure does this follow-up care describe? a) EGD b) ERCP c) Enteroscopy d) small bowel series

a (EGD)

The nurse will prepare to administer which medication *first* to a client who has been exposed to hepatitis B? a) HBiG b) Hep A vaccine c) Hep B vaccine d) Hib

a (HBiG) -provides passive immunity to those exposed to hep B (injection of antibodies against hep B surface antigens)

The home care nurse visits a client diagnosed with hepatitis. It is most important for the nurse to intervene if the client makes which statement? a) "I take acetaminophen when I get a headache" b) "I do not drink wine with meals anymore" c) "I keep my fingernails short" d) "I wash my hands before I eat"

a (acetaminophen for headache) contraindicated b/c it is *hepatotoxic* (instruct pt to avoid all meds unless prescribed by HCP)

On assessment, the pt has areas of the abdomen with pain that also show rebound tenderness. What is the correct term for this finding? a) blumberg's sign b) bruits c) tympanic d) cullen's sign

a (blumberg's)

The nurse instructs the client with a sigmoid colostomy how to irrigate the colostomy. Which action does the nurse include in the teaching? a) dilate the stoma gently with gloved finger b) irrigate the colostomy using 30 mL of NS c) continue the irrigations until no stool is returned d) returns should occur 5-10 min after instilling water

a (dilate stoma gently with gloved finger)

The nurse instructs the client about the bowel preparation required prior to a sigmoidoscopy. The nurse identifies teaching is successful if the client makes which statement? a) "I cannot eat eight hours prior to test" b) "I will be asleep during the test" c) "I will have an enema the morning of the test" d) "I will have NG suction decompression"

c (enema morning of test) -tap water enema or fleet's given until returns are clear the morning of the procedure (for visualization)

Which finding describes a common complication of Crohn's disease? a) reflux esophagitis b) chronic constipation c) fistulas d) hypothermia

c (fistulas)

The nurse cares for a patient after an appendectomy. The day after surgery, the patient has severe abdominal pain, a temperature of 101 F, and a rigid abdomen. The nurse suspects that the patient is experiencing which of the following? a) anesthesia intolerance b) abnormal pain tolerance c) infection of the peritoneal sac d) bladder distension

c (infection of the peritoneal sac) -peritonitis can be caused by ruptured appendix (s/s = severe abdominal pain, rigid abdomen, decreased bowel sounds, N/V, increased temp, shock, paralytic ileus) ---> monitor VS, admin ab'tics and IVs, NG tube to suction, NPO, surgery to correct cause

The nurse assesses a client with a diagnosis of R/O ulcerative colitis. During the history, the nurse expects the client to make which statement? a) "I feel an intermittent sharp pain in my lower abdomen" b) "I feel an intermittent gnawing in my lower abdomen" c) "I feel an intermittent cramping pain in my lower abdomen" d) "I feel a constant crushing pain in my lower abdomen"

c (intermittent cramping in lower abdomen) -pain RT ulcerative colitis usually occurs prior to defecation (pain usually described as cramping) -obtain diet history & assess for bowel sounds and areas of tenderness

The nurse is caring for the patient who had an EGD. What is the first priority action after this diagnostic study? a) monitor VS b) auscultate breath sounds c) keep NPO until gag reflex returns d) keep accurate I's & O's

c (keep NPO til gag reflex returns)

The nurse gives discharge instructions to the family of a pt diagnosed with hepatic encephalopathy. The nurse determines further teaching is necessary if the family makes which of the following statements? a) "We should contact the HCP if dad is restless at night" b) "Cephulac will cause Dad to have 2-3 stools per day" c) "Dad should eat meat at every meal" d) "Cephulac may cause bloating and cramps"

c (meat at every meal) -low protein, high calorie diet

The nurse closely monitors the patient with acute pancreatitis for which complication? a) duodenal ulcer b) infection c) pneumonia d) heart failure

c (pneumonia)

A liver scan is ordered for a client prior to surgery. The nurse understands which description best describes the procedure? a) the client will be strapped to a table & irradiated by a cobalt scanner b) the client will stand in front of a large machine that takes x-rays of the liver c) the client will be asked to lie still while a scanning probe is passed back & forth over the body d) the client's skin will be lubricated with oil & U/S pics will be taken

c (probe passes back & forth)

The nurse instructs a client about how to increase calories in the diet. The nurse determines teaching is effective if the client makes which statement? a) "I will broil all my meats" b) "I will eat bread with all my meals" c) "I will snack frequently on nuts and dried fruits" d) "I only use low-fat salad dressings"

c (snack frequently on nuts & dried fruits) *this adds calories* (also spread butter and/or cream cheese on rolls and add butter to foods)

A nurse teaches a client who is recovering from a colon resection, which statement should the nurse include in the plan of care? a) You may experience N/V for the first few weeks b) Carbonated beverages can help decrease acid reflux from anastomosis sites c) take a stool softener to promote softer stools for ease of defecation d) you may return to your normal workout schedule, including heavy lifting

c (stool softener) -N/V are signs of intestinal obstruction and perforation and should be reported asap -advise the client to avoid gas-producing foods and carbonated beverages -advice client to avoid heavy lifting or straining with BMs

The nurse cares for a patient after the physician performed a sigmoid colostomy due to cancer. The nurse instructs the patient about how to care for the stoma. The nurse knows that teaching is successful if the patient makes which of the following statements? a) "I will drape the area and wash the stoma with hexachlorophene soap." b) "I will clean the stoma vigorously with alcohol wipes and pat dry." c) "I will clean around the stoma with soap and water and pat dry." d) "I will drape the area and cleanse the stoma with povidone iodine."

c) "I will clean around the stoma with soap and water and pat dry." provides adequate cleaning with limited irritation; observe for skin breakdown; hexachlorophene soap and alcohol wipes are both too drying and povidone iodine will cause irritation to the mucous membranes; moisturizing soaps lubricate the area, interfering with the appliance adhering to the skin

The nurse instructs the family of the client diagnosed with hepatitis A how to prevent the spread of the disease. It is most important for the nurse to include which instruction? a) the family should not share eating utensils or drinking glasses b) do not come into contact with the client's blood c) do not donate blood during the next year d) no special precautions are requried

a (don't share eating/drinking materials) -hep A spread via fecal-oral route --> client should wash hands before eating and after using the toilet

The nurse teaches a client who has undergone cholecystectomy prior to discharge. The nurse should include which instruction? a) begin light exercise immediately b) limit diet to liquid and soft foods for 3 days c) contact the HCP if there is pain in the right shoulder d) remove adhesive strips over puncture wounds in 5 days

a (light exercise immediately) --> walking (avoid lifting more than 5 lbs for 1 week) -no diet restrictions (gradually add fat to diet) -right shoulder pain is caused by gas used to inflate the abdomen, instruct the client to walk or sit upright -do not pull adhesive strips off, allow them to fall off

The home care nurse visits a client with a diagnosis of ulcerative colitis. The client complains of perineal irritation due to frequent stools. Which suggestion by the nurse is BEST? a) Apply a heat lamp to the perineal area three times per day b) Use protective plastic bed pads c) Clean the perineal area with soap and water after each bowel movement d) Increase roughage in the diet to prevent the frequent stools

c) Clean the perineal area with soap and water after each bowel movement keeps the skin free of stool; important to keep perineal area clean and dry; sitz baths; apply petroleum jelly or vitamin A and D ointment; low residue diet recommended

The nurse cares for the client diagnosed with acute cholecystitis. The client states, "My stomach hurts all the way up to my right shoulder. I am nauseated and have vomited twice." Which order should the nurse carry out FIRST? a) Insert nasogastric (NG) tube and attach to intermittent low suction b) Trimethobenzamide 200 mg rectally three times daily c) Morphine 15 mg IM q4h PRN d) Nothing by mouth

c) Morphine 15 mg IM q4h PRN address pain to make client more comfortable before performing other orders

The nurse reviews the records of a client diagnosed with Laennecs cirrhosis. The nurse expects to find which lab value? a) serum albumin 4.0 g/dL b) Serum asparate aminotransferase (AST, SGOT) 38 units c) Serum alanine amino-transaminase (ALT, SGPT) 600 units d) serum lactate dehydrogenase (LDH) 150 units

c) serum ALT 600 units *elevation indicates liver damage* (normal = 5-35) -normal albumin = 3.5-5 g/dL (decreased in liver disease) -normal AST = 10-40 units (elevated in liver damage) -normal LDH = 100-200 units (elevated in liver disease)

Lab values for a pt with acute pancreatitis may show which abnormal findings? (SATA) a) increased Hgb b) decreased serum amylase c) increased serum lipase d) decreased urine nitrates e) increased serum amylase

c, e

Which foods will the nurse teach the client with chronic pancreatitis to avoid? (SATA) a) blueberries b) green beans c) bacon d) baked fish e) fried potatoes

c, e

The HCP prescribes prednisone for a patient with UC. What health teaching should the nurse provide before the client begins this medication? a) determine if the client's insurance pays for the drug b) teach the client to take this drug at night c) ask the client if he has any allergies to sulfa-type drugs d) teach the client the importance of avoiding large crowds

d

The nurse in the outpatient clinic is counseling a client with a diagnosis of cholecystitis. The nurse determines teaching is successful if the client makes which of the following statements? a) "I really like a lot of cream in my oatmeal." b) "We eat a lot of broiled fish and chicken." c) "I can't wait to eat the chocolate my children gave me." d) "My favorite dish is broccoli with cheese and sauce."

b) "We eat a lot of broiled fish and chicken." patients with cholecystitis should eat foods high in protein and low in fat, such as broiled lean meats; cooked fruits, non-gas forming veggies, and bread are also allowed; patients should avoid high fat and gas-forming veggies such as cabbage, onions, broccoli, and cucumbers as these foods may precipitate pain, N/V

The nurse on the surgical unit cares for several clients with new colostomies. Immediately after surgery, the nurse identifies which of the following stomas is expected? a) A stoma is bluish and dry b) A stoma is beefy-red c) A stoma is gray and small d) A stoma is dark and pulsating

b) A stoma is beefy-red immediately following surgery the stoma, which is part of the intestine, is brought out to the abdominal wall and appears beefy-red; *it should be moist and protrude about 2 cm from the abdominal wall*; it there is no ostomy pouch in place, cover the lumen with petrolatum gauze covered by a dry, sterile dressing

The nurse cares for a client diagnosed with cholelithiasis. It is MOST important to instruct the client to avoid which of the following foods? SATA a) Apples b) Cabbage c) Lettuce d) Cheese e) Chocolate f) Carrots

b) Cabbage d) Cheese e) Chocolate avoid gas-forming vegetables such as onions, broccoli, radishes, beans, foods high in cholesterol/fat, egg yolks, avocado

Which symptoms of liver disease should the nurse expect to see in a client with Laënnec 's cirrhosis? a) Cloudy urine b) Dark urine c) Orange-colored stools d) Tarry stools

b) Dark urine normally bilirubin is not excreted in urine; urine with abnormal bilirubin is mahogany-colored and has yellow foam when shaken; clients with cirrhosis may have clay-colored stools due to decreased fecal urobilinogen

A nurse is assigned to care for a client who had an open partial colectomy and descending colostomy this morning. What assessment findings are expected for this client? (SATA) a) the colostomy stoma is purple & dry b) the NGT is draining yellowish green fluid c) the client has pain that is controlled by analgesics d) the colostomy is not draining any stool e) the perineal incision is covered with a surgical dressing

b, c, d

When providing care for a client in the healing phase of acute pancreatitis, which statements focused on nutritional requirements should the nurse include when delegating care to the UAP? (SATA) a) do not allow client to eat between meals b) make sure the client receives a protein shake c) do not allow caffeine containing beverages d) make sure the foods are bland with little spice e) do not allow high-carb food items

b, c, d (in the healing phase, a client should be provided small, frequent, moderate to high-carb, high-protein, and low-fat meals that are bland and caffeine free beverages)

Which GI changes occur in older adults? (SATA) a) increased hydrochloric acid secretion b) decreased absorption of iron & vitamin B12 c) decreased peristalsis may cause constipation d) increased cholesterol synthesis e) decreased lipase with decreased fat digestion

b, c, e

The nurse working with clients who have GI problems knows that which lab values are RT what organ dysfunctions? (SATA) a) alanine aminotransferase : biliary system b) ammonia : liver c) amylase : liver d) lipase : pancreas e) urine urobilinogen : stomach

b, d (alanine aminotransferase = liver, amylase = pancreas, urobilinogen = liver & biliary system)

The pancreas performs which functions? (SATA) a) breaks down amino acids b) secretes enzymes for digestion from the exocrine part of the organ c) breaks down fatty acids & triglycerides d) produces glucagon from the endocrine part of the organ e) produces enzymes that digest carbohydrates, fats, & proteins

b, d, e

When teaching a client who is recovering from acute pancreatitis, which statements should the nurse include? (SATA) a) take a 20 min walk at least 5 days/week b) attend AA meetings weekly c) chose whole grains rather than foods w/ simple sugars d) use cooking spray rather than margarine or butter e) stay away from milk and dairy products that contain lactose f) we can talk to your doctor about a prescription for nicotine patches

b, d, f (advise the client to stay sober, consume a *low-fat, high-carb, high-calorie diet*, stop smoking, and to rest until strength returns*

A client had a bowel resection yesterday for CRC. Which assessment finding does the nurse report immediately to the surgeon? a) abdominal discomfort b) mild abdominal distention c) distended, board-like abdomen d) minimal abdominal bowel sounds

c

The nurse is seeing clients in the GI clinic. Which client should the nurse see *first*? a) 50 yo diagnosed with IBS reporting cramping & loose stools b) 25 yo reporting not having a BM in 2 days c) 8 yo diagnosed with gastroenteritis who had 5 diarrheal stools in the last 3 days d) 3 week-old infant experiencing projectile vomiting & irritabiltiy

d (3 week old w/ projectile vomiting & irritability) -indicates pyloric stenosis; at risk for F/E imbalance a --> expected with IBS (encourage to eat meals at reg intervals, chew slowly, and don't drink fluids w/ meals) b --> determine normal bowel pattern & encourage fluids & foods high in roughage c ---> doesn't require immediate attention but has potential for dehydration

Which diagnostic test allows a physician to visually examine the pt's liver, gallbladder, bile ducts, and pancreas to identify the cause and location of an obstruction? a) EGD b) upper GI radiographic series c) percutaneous transhepatic cholangiography (PTC) d) ERCP

d (ERCP)

The nurse cares for a female with a diagnosis of ulcerative colitis. When reviewing the patient's chart, the nurse expects to find which of the following lab values? a) RBC = 4 mil/mm3 b) platelets = 75,000/mm3 c) Hgb = 18.2 g/dL d) WBC = 15,000/mm3

d (WBC = 15,000/mm3) -due to *inflammation* (ESR will also be elevated)

The nurse prepares the client for a sigmoidoscopy. The nurse should notify the health care provider if the client makes which statement? a) "I took my BP med with a sip of water this am" b) "I haven't eaten any fruits or veggies since the day before yesterday" c) "I had good results from the tap water enema this morning" d) "I hope that this is easier than the barium enema I had two days ago"

d (barium enema two days ago) -barium makes it difficult to visualize the colon; *no barium studies for 3 days before a sigmoidoscopy*

A feeling of fullness, cramping, and passage of flatus can be expected for several hours after the test, and a small amount of blood may be present in the first stool after the test if a biopsy specimen is taken or a polypectomy is performed. VS should be taken every *15 min* and the pt should be monitored for signs of perforation or hemorrhage, and excessive bleeding should be reported immediately. For which procedure is this follow-up care describing? a) EGD b) enteroscopy c) small bowel series d) colonoscopy

d (colonoscopy)

The nurse cares for an elderly client admitted with a diagnosis of hepatitis A. The client is anorexic, reports weakness, is incontinent of urine, and involuntary of stool. The nurse determines that care is appropriate if which observation is made? a) the staff caring for the client follows standard precautions b) the client is offered more frequent feeding during the afternoon & evening hours c) the nurse maintains the client on strict bedrest d) the nurse places the client on contact precautions

d (contact precautions) -hep A spread by fecal-oral route --> contact precautions required due to fecal incontinence (inform client about importance of good handwashing)

To prepare a client for a paracentesis, it is essential for the nurse to take which action? a) administer cleansing enema b) premedicate with a narcotic analgesic c) restrict intake of fluids d) instruct client to empty the bladder

d (instruct client to empty bladder) -the procedure involves removal of fluid for the client's abdomen through a trocar; the client may have bladder injured by the procedure if is is not empty & small

The home care nurse makes a visit to a client receiving enteral feeding through a gastrostomy tube. The client's daughter reports the client has frequent loose stools. Which of the following statements, if made by the daughter to the nurse, warrants further investigation? a) "My dad gets 300 mL of formula in 1 hr" b) "I warm the formula in a basin of hot water" c) "I hang a new bag & tubing every 24 hrs" d) "It's so easy to give liquid medicine through the tube"

d (liquid medicine through the tube) -nurse needs to determine what medication the client is receiving and if it contains sorbitol (which will cause diarrhea)

The nurse understands which of these factors is the MOST likely source of hepatitis D? a) Eating infected shellfish b) Overly exerting oneself c) Practicing poor hygiene d) Receiving a blood transfusion

d (receiving a blood transfusion) -hepatitis D co-infects with hepatitis B; spread by contact with blood and bodily fluids

The nurse cares for a client with a nasogastric tube in place. The client reports discomfort in the back of the throat. Which action by the nurse is BEST? a) Move the tube out 2 inches b) Change feedings to full liquids c) Reinsert tube into other nostril d) Spray with viscous lidocaine solution

d) Spray with viscous lidocaine solution viscous lidocaine is a local anesthetic; spraying it on the irritated surface may relieve the discomfort in the back of the client's throat; tube only repositioned if the tube isn't draining after irrigation

The client with alcoholic cirrhosis is at great risk to develop which complication? a) hepatitis B b) pancreatic cancer c) weight gain d) epistaxis

d) epistaxis *bleeding is common due to decreased formation of coag factors* --> GI bleeding is very common! (Hep B is the *cause* of cirrhosis)

The nurse preforms preoperative teaching for a patient scheduled for a colostomy. The nurse explains to the patient that 24 hours after the surgery the colostomy drainage will be which of the following? a) A large amount of bloody output b) A large amount of liquid stool c) Formed stool with water d) A scant amount of bright bloody drainage

d) scant amount of bright bloody drainage -small amt of bleeding at stoma is expected (report excessive amounts)