GI Practice Questions

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 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 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

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.

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.

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.

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.

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 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.

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 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.

A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take this medication: A. with antacid B. 1 hr before meals C. with food or milk D. immediately after meals

B. 1 hr before meals rationale: Sucralfate is a mucosal protectant, the client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness

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.

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

B. Cecum Rationale:The appendix, sometimes referred to as the vermiform appendix, is attached to the apex of the cecum. The other locations listed are incorrect.

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? A. Leukopenia with a shift to the left B. Leukocytosis with a shift to the left C. Leukopenia with a shift to the right D. Leukocytosis with a shift to the right

B. Leukocytosis with a shift to the left Rationale:Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white blood cells). Options 1, 3, and 4 are incorrect because they are not associated findings in acute appendicitis.

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.

A nurse is caring for a caring for a client who is receiving esomeprazole (Nexium) to manage GERD. Which of the following best indicates the desired therapeutic effect? A. " I don't pass gas a often" B. "my abdomen is no longer firm" C. "I don't have pain in my stomach" D. " I have regular bowel movement"

C. "I don't have pain in my stomach" rationale: esomeprazole (Nexium) is proton pump inhibitor (PPI) and works in the parietal cells of the stomach by inhibiting the proton pump enzyme that generates gastric acid secretion.- Treatment is for gastric ulcers, duodenal ulcers and GERD.- an expected finding if medication is effective will be a decrease in the client's symptoms of an ulcer or GERD. Heartburns are a common sign of GERD, so absence of pain means the medication is working

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.

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. Rationale: 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 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 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 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 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 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.

A physician orders a colonoscopy b/c of the client's persistent diarrhea. The nurse instructs the client to drink 250 mL of an electrolyte solution called GOLYTELY every 15 minutes over a 2 hour period. Which observation by the nurse provides the best evidence that the solution has achieved its primary purpose? A. the client's serum electrolyte levels are normal B. the client's intake approximates the output C. the client's stools become clear liquid D. the client's bladder fills with urine

C. the client's stools become clear liquid Rationale: GOLYTELY is given as a colonic lavage. Within 30 minutes of ingesting the 1st volume of the solution, the client should experience the 1st of many bowel movements. The bowel must be clear of feces for the colonoscopy to be effective! The solution is preferable to other forms of bowel clensing its less likely to deplete electrolytes or cause water intoxification

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

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

The 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.

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.

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 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 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 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 charge nurse and a newly licensed nurse are providing care for a client who reports nausea and has a presciption for metoclopramide (Reglan) as an antiemetic. Which of the following statements by the newly licensed nurse indicates a correct understanding of the actions of the medication. "Metoclopramide": A. depresses vagal nerve activity B. decreases gastric acid secretions C. slows peristalsis D. promotes gastric emptying

D. promotes gastric emptying Rationale: Metoclopramide is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and persistent feeling of fullness after meals.- Metoclopramide works by promoting gastric emptying

A client has been taking omeprazole (Prilosec) for the past 4 weeks. The nurse determines that the medication is effective when the client reports? A. nausea B. diarrhea c.headache d. acid indigestion

d. acid indigestion Rationale: Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease and erosive esophagitis

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 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.

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.

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.

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.

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.

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.

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 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.

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 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.

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.

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 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 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

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 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.

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.

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 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 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 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).