GI Part II
A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure? 1.Portal vein 2.Celiac artery 3.Vagus nerve 4.Pyloric valve
3. Vagus nerve
The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? 1. Hypercalcemia 2.Hypernatremia 3.Frothy, fatty stools 4.Decreased hemoglobin
4. Decreased hemoglobin
A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? 1. Assessment of vital signs 2.Completion of abdominal examination 3.Insertion of the prescribed nasogastric tube 4.Thorough investigation of precipitating events
1. Assessment of vital signs
The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective? 1."Baked foods such as chicken or fish are all right to eat." 2."Citrus fruits and raw vegetables need to be included in my daily diet." 3."I can drink beer as long as I consume only a moderate amount each day." 4."I can drink coffee or tea as long as I limit the amount to 2 cups daily."
1."Baked foods such as chicken or fish are all right to eat."
A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching? 1."I eat at least 3 large meals each day." 2."I eat while lying in a semirecumbent position." 3."I have eliminated taking liquids with my meals." 4."I eat a high-protein, low- to moderate-carbohydrate diet."
1."I eat at least 3 large meals each day."
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? 1."I need to limit my intake of dietary fiber." 2."I need to drink plenty, at least 8 to 10 cups daily." 3."I need to eat regular meals and chew my food well." 4."I will take the prescribed medications because they will regulate my bowel patterns."
1."I need to limit my intake of dietary fiber."
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? 1."I should increase the fiber in my diet." 2."I will need to avoid caffeinated beverages." 3."I'm going to learn some stress reduction techniques." 4."I can have exacerbations and remissions with Crohn's disease."
1."I should increase the fiber in my diet."
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? 1."It will cause diaphoresis and diarrhea." 2."I have to monitor for hiccups and diarrhea." 3."It will be associated with constipation and fever." 4."I have to monitor for fatigue and abdominal pain."
1."It will cause diaphoresis and diarrhea."
Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? 1."The medication will cause constipation." 2."I need to take the medication with meals." 3."I may have increased sensitivity to sunlight." 4."This medication should be taken as prescribed."
1."The medication will cause constipation."
Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? 1.Decreased diarrhea 2.Decreased cramping 3.Improved intestinal tone 4.Elimination of peristalsis
1.Decreased diarrhea
The nurse is caring for a client who had a subtotal gastrectomy. The nurse should assess the client for which signs and symptoms of dumping syndrome?
1.Diarrhea, chills, and hiccups 2.Weakness, diaphoresis, and diarrhea 3.Fever, constipation, and rectal bleeding 4.Abdominal pain, elevated temperature, and weakness
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. 1.Do not drink fluids with meals. 2.Avoid foods high in carbohydrates. 3.Take an extended-release multivitamin daily. 4.Maintain a clear liquid diet for about 6 weeks. 5.Eat 6 small meals a day that are high in protein.
1.Do not drink fluids with meals. 2.Avoid foods high in carbohydrates. 5.Eat 6 small meals a day that are high in protein.
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. 1.Eat yogurt. 2.Take loperamide to treat diarrhea. 3.Use stress management techniques. 4.Avoid foods such as cabbage and broccoli. 5.Decrease fiber intake to less than 15 g/day.
1.Eat yogurt. 2.Take loperamide to treat diarrhea. 3.Use stress management techniques. 4.Avoid foods such as cabbage and broccoli.
The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate? 1.Encourage the client to ambulate. 2.Position the client on the left side. 3.Frequently irrigate the nasogastric tube (NG) with 30 mL saline. 4.Discourage the use of the patient-controlled analgesia (PCA) machine.
1.Encourage the client to ambulate.
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? 1.Lying recumbent following meals 2.Consuming small, frequent, bland meals 3.Taking H2-receptor antagonist medication 4.Raising the head of the bed on 6-inch (15 cm) blocks
1.Lying recumbent following meals
A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this client? 1.NPO (nothing by mouth) status 2.Ambulation at least 4 times daily 3.Cholinergic medications to reduce pain 4.Coughing and deep breathing every 2 hours
1.NPO (nothing by mouth) status
A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome? 1.Remove fluids from the meal tray. 2.Give the client 2 large meals per day. 3.Ask the client to sit up for 1 hour after eating. 4.Provide concentrated, high-carbohydrate foods.
1.Remove fluids from the meal tray.
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1.Sweating and pallor 2.Bradycardia and indigestion 3.Double vision and chest pain 4.Abdominal cramping and pain
1.Sweating and pallor
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? 1.This is a normal, expected event. 2.The client is experiencing early signs of ischemic bowel. 3.The client should not have the nasogastric tube removed. 4.This indicates inadequate preoperative bowel preparation.
1.This is a normal, expected event.
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? 1.Use 500 to 1000 mL of warm tap water. 2.Suspend the irrigant 36 inches above the stoma. 3.Insert the irrigation cone ½ inch into the stoma. 4.If cramping occurs, open the irrigation clamp farther.
1.Use 500 to 1000 mL of warm tap water.
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? 1."I should be sure to eat at least 1 cucumber every day." 2."Beet greens, parsley, or yogurt will help to control the colostomy odor." 3."I will need to increase my egg intake and try to eat ½ to 1 egg per day." 4."Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."
2."Beet greens, parsley, or yogurt will help to control the colostomy odor."
The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching? 1."I need to lie down after eating." 2."I need to drink liquids with meals." 3."I need to avoid concentrated sweets." 4."I need to eat small meals 6 times daily."
2."I need to drink liquids with meals."
A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the primary health care provider for which type of diet for this client? 1.A low-fat diet 2.A low-fiber diet 3.A high-protein diet 4.A high-carbohydrate diet
2.A low-fiber diet
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? 1.On arising 2.After meals 3.On an empty stomach 4.30 minutes before meals
2.After meals
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. 1.Antidiarrheal 2.Antimicrobial 3.Corticosteroid 4.Aminosalicylate 5.Biological therapy 6.Immunosuppressant
2.Antimicrobial 3.Corticosteroid 4.Aminosalicylate 5.Biological therapy 6.Immunosuppressant
The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food? 1.Rice 2.Corn 3.Broiled chicken 4.Cream of wheat
2.Corn
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? 1.Stroke 2.Pernicious anemia 3.Bacterial meningitis 4.Peripheral arterial disease
2.Pernicious anemia
The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the primary health care provider? 1.Stoma is beefy red and shiny 2.Purple discoloration of the stoma 3.Skin excoriation around the stoma 4.Semiformed stool noted in the ostomy pouch
2.Purple discoloration of the stoma
The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching? 1."I plan to eat 4 to 6 small meals a day." 2."I should sleep in the right side-lying position." 3."I plan to have a snack 1 hour before going to bed." 4."I will stop having a glass of wine each evening with dinner."
3."I plan to have a snack 1 hour before going to bed."
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? 1."It is normal to feel gassy or bloated after the procedure." 2."The abdominal muscles may be tender from the procedure." 3."It is all right to drive once I've been home for an hour or so." 4."Intake should be light at first and then progress to regular intake."
3."It is all right to drive once I've been home for an hour or so."
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? 1.Ibuprofen 2.Indomethacin 3.Acetaminophen 4.Naproxen sodium
3.Acetaminophen
A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How should the nurse schedule the medications for administration? 1.Drink 8 ounces of water between taking each medication. 2.Administer the cimetidine and magnesium hydroxide at the same time twice daily. 3.Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide. 4.Collaborate with the primary health care provider (PHCP), as the client should not be receiving both medications.
3.Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide.
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? 1.Nizatidine 2.Sucralfate 3.Ibuprofen 4.Omeprazole
3.Ibuprofen
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? 1. Digoxin 2.Furosemide 3.Indomethacin 4.Propranolol hydrochloride
3.Indomethacin
The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? 1.Leg exercises 2.Early ambulation 3.Irrigating the nasogastric tube 4.Coughing and deep-breathing exercises
3.Irrigating the nasogastric tube
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? 1.Ambulate following a meal. 2.Eat high-carbohydrate foods. 3.Limit the fluids taken with meals. 4.Sit in a high-Fowler's position during meals
3.Limit the fluids taken with meals.
The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? 1.Blood in the stool 2.Chalky gray stool 3.Loose, watery stool 4.Dry, hard, constipated stool
3.Loose, watery stool
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? 1.Maintain a high-carbohydrate diet. 2.Increase fluid intake, particularly at mealtime. 3.Maintain a low-Fowler's position while eating. 4.Ambulate for at least 30 minutes following each meal.
3.Maintain a low-Fowler's position while eating.
The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the primary health care provider prescribing? 1.Enteral feedings 2.Fluid restrictions 3.Oral corticosteroids 4.Activity restrictions
3.Oral corticosteroids
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 manifestation of duodenal ulcer? 1.Weight loss 2.Nausea and vomiting 3.Pain relieved by food intake 4.Pain radiating down the right arm
3.Pain relieved by food intake
The nurse is assessing a client with a duodenal ulcer. The nurse interprets that which sign or symptom is most consistent with the typical presentation of duodenal ulcer? 1.Weight loss 2.Nausea and vomiting 3.Pain that is relieved by food intake 4.Pain that radiates down the right arm
3.Pain that is relieved by food intake
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 primary health care provider (PHCP)? 1.Hypotension 2.Bloody diarrhea 3.Rebound tenderness 4.A hemoglobin level of 12 mg/dL (120 mmol/L)
3.Rebound tenderness
The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result? 1.The client reports some pain before meals. 2.The client frequently is awakened at 2 a.m. with heartburn. 3.The client has eliminated any irritating foods from the diet. 4.The client's pain is minimal with histamine H2-receptor antagonists.
3.The client has eliminated any irritating foods from the diet.
The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of a gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis? 1."It's due to insufficient production of vitamin B12 in the colon." 2."Increased production of intrinsic factor in the stomach leads to this type of anemia." 3."Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." 4."Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."
4."Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."
A client is resuming a diet after hemigastrectomy, and the nurse provides dietary instructions. Which statement by the client indicates a need for further teaching? 1."I plan to lie down after eating." 2."I know to avoid sweets in my diet." 3."I will eat several small meals per day." 4."I will drink plenty of liquids with meals."
4."I will drink plenty of liquids with meals."
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? 1."The pain doesn't usually come right after I eat." 2."The pain gets so bad that it wakes me up at night." 3."The pain that I get is located on the right side of my chest." 4."My pain comes shortly after I eat, maybe a half hour or so later."
4."My pain comes shortly after I eat, maybe a half hour or so later."
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? 1."I know I can massage my abdomen." 2."I will continue using antispasmodic medication." 3."One of the best things I can do is use relaxation techniques." 4."The best position for me is to lie supine with my legs straight."
4."The best position for me is to lie supine with my legs straight."
A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment? 1.Bradycardia 2.Nausea and vomiting 3.Numbness in the legs 4.A rigid, board-like abdomen
4.A rigid, board-like abdomen
The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1.Bradycardia 2.Numbness in the legs 3.Nausea and vomiting 4.A rigid, board-like abdomen
4.A rigid, board-like abdomen
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? 1.A sunken and hidden stoma 2.A narrow and flattened stoma 3.A stoma that is dusky or bluish 4.A stoma that is elongated with a swollen appearance
4.A stoma that is elongated with a swollen appearance
A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? 1.Carrots and ranch dip 2.Whole-grain cereal and milk 3.A cup of popcorn and a cola drink 4.Applesauce and a graham cracker
4.Applesauce and a graham cracker
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
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? 1. Folate deficiency 2.Malabsorption of fat 3.Intestinal obstruction 4.Fluid and electrolyte imbalance
4.Fluid and electrolyte imbalance
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? 1.Sleeping 8 to 10 hours a night 2.Ability to work at home periodically 3.Eating 5 or 6 small meals per day 4.Frequent need to work overtime on short notice
4.Frequent need to work overtime on short notice
A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body? 1.Bile 2.Parietal cells 3.Liver enzymes 4.Pancreatic juice
4.Pancreatic juice
The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients? 1.Colectomy 2.Appendectomy 3.Ascending colostomy 4.Small bowel resection
4.Small bowel resection
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? 1.Recently retired from a job 2.Significant other has a gastric ulcer 3.Occasionally drinks 1 cup of coffee in the morning 4.Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis
4.Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis
Pancreatin is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication? 1.The client's appetite improves. 2.The client experiences weight loss. 3.Vitamin B12 deficiency is controlled. 4.The stool is less fatty and decreases in frequency.
4.The stool is less fatty and decreases in frequency.
The nurse is caring for a client with pernicious anemia. Which prescription by the primary health care provider (PHCP) should the nurse anticipate? 1.Iron 2.Folic acid 3.Vitamin B6 4.Vitamin B12
4.Vitamin B12
A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that in this disorder, because the stomach lining produces a decreased amount of a substance known as the intrinsic factor, the client will need which medication? 1.An antacid 2.An antibiotic 3.Vitamin B6 injections 4.Vitamin B12 injections
4.Vitamin B12 injections
The nurse should anticipate that the primary health care provider (PHCP) will prescribe which treatment for a client with pernicious anemia? 1.Oral iron tablets 2.Blood transfusions 3.Gastric tube feedings 4.Vitamin B12 injections
4.Vitamin B12 injections
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. 1. Coffee 2.Chocolate 3.Peppermint 4.Nonfat milk 5.Fried chicken 6.Scrambled eggs
Coffee Chocolate Peppermint Fried Chicken
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. 1.Nuts 2.Corn 3.Liver 4.Apples 5.Lentils 6.Bananas
Nuts, Liver, Lentils
