Med Surg 1 (GI)

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective?

"Baked foods such as chicken or fish are all right to eat."

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?

"Beet greens, parsley, or yogurt will help to control the colostomy odor."

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?

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

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laënnec's cirrhosis. Which question related to the client's history would be most important to ask?

"Do you abuse alcohol?"

A client with viral hepatitis is having difficulty coping with the disorder. Which question by the nurse is the most appropriate in identifying the client's coping problem?

"Have you enjoyed having visitors?"

The primary health care provider has determined that a client has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis?

"I ate shellfish about 2 weeks ago at a local restaurant."

A sexually active young adult client has developed viral hepatitis. Which client statement indicates the need for further teaching?

"I can go back to work right away."

The nurse has been assigned a client who is going for a gastroesophageal (GE) reflux scan in the morning. Which statement by the client indicates a need for further teaching?

"I can have a light snack during the night or in the morning if I am hungry."

The nurse has given instructions to a client with hepatitis about postdischarge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement?

"I can resume a full activity level within 1 week."

The nurse is providing teaching to a client with suspected irritable bowel syndrome (IBS) who is scheduled to have a hydrogen breath test done to assist in confirming the diagnosis. Which of the following client statements would indicate a need for further teaching?

"I cannot have anything to eat or drink for at least 12 hours before the test."

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching?

"I eat at least 3 large meals each day."

The nurse is teaching a client with hemorrhoids about measures to prevent constipation. Which statement by the client indicates a need for further teaching?

"I need to decrease fiber in my diet."

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching?

"I need to drink liquids with meals."

The nurse is educating a client being discharged from the hospital following treatment for acute pancreatitis regarding dietary needs to prevent further acute attacks. What statement by the client indicates teaching was effective?

"I need to eat low-fat foods and fresh fruits and vegetables to help prevent further attacks."

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?

"I need to increase fiber in my diet every day."

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?

"I need to increase the fiber in my diet."

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?

"I need to limit my intake of dietary protein."

The nurse and assistive personnel (AP) are providing care for a client with confirmed appendicitis. Which response by the assistive personnel indicates a need for further teaching?

"I will go get the client hot packs to alleviate the pain."

A home care nurse visits a client who was recently diagnosed with cirrhosis. The nurse provides home care management instructions to the client. Which client statement indicates a need for further instruction?

"I will take acetaminophen if I get a headache."

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response?

"I'm not sure that I understand. Would you please explain?"

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis?

"I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

The nurse is completing an admission assessment for a client with suspected esophageal cancer. Which statement made by the client indicates the presence of a risk factor for esophageal cancer?

"I've been smoking for 20 years now."

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?

"It is all right to drive once I've been home for an hour or so."

The nurse is caring for a client recently diagnosed with a hiatal hernia, and the client asks the nurse to describe a hiatal hernia. How would the nurse respond?

"It is the herniation of the upper part of the stomach into the esophagus through an opening in your diaphragm."

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?

"It will cause diaphoresis and diarrhea."

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?

"It will help to remove gas and fluids from my stomach and intestine."

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?

"My pain comes shortly after I eat, maybe a half hour or so later."

The nurse is teaching a client with gastroesophageal reflux disease (GERD) about lifestyle modifications to take to reduce GERD symptoms. The nurse determines there is a need for further teaching if the client makes which statement?

"Skipping breakfast and lunch and eating a large dinner will decrease my symptoms."

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, the client is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern about not being able to continue the tube feedings at home. Which nursing response is most appropriate at this time?

"Tell me more about your concerns with your diet after going home."

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?

"The best position for me is to lie supine with my legs straight."

A client diagnosed with an anal fistula asks the nurse to describe this condition. Which of the following is the appropriate nursing response?

"The condition refers to an abnormal connection or tunnel originating from the anus or rectum."

The nurse is reinforcing education to a client diagnosed with gastroesophageal reflux disease (GERD) regarding surgical therapy for the condition. How would the nurse describe laparoscopic fundoplication?

"The fundus of the stomach is wrapped around the lower esophagus and then sutured in place."

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?

"The medication will cause constipation.

The client diagnosed with bilateral inguinal hernias requiring surgical repair asks the nurse to describe the condition. The nurse plans to make which appropriate nursing response?

"These types of hernias occur when abdominal contents protrude through weakened abdominal muscles near the spermatic cord."

The nurse is assisting a client who had a hemorrhoidectomy 2 days ago with a sitz bath. The client asks the nurse how long the sitz baths are recommended after surgery. What is the appropriate nursing response?

1 to 2 weeks

The nurse in a primary health care provider clinic is providing exercise recommendations to an obese client who has expressed readiness for change. Which exercise regimen would be appropriate to suggest to the client?

150 minutes of moderate-intensity aerobic exercise per week with muscle-strengthening exercises at least 2 days per week

The nurse is reviewing the laboratory results for a client diagnosed with cirrhosis. Which of the following albumin levels would the nurse anticipate?

2.0 g/dL (20 g/L)

The nurse in a primary health care provider setting is assessing a client who is there for an annual examination. After weighing and measuring the client, the nurse calculates the client's body mass index (BMI) and determines that the client falls into the morbidly obese category. Which BMI value supports this assessment finding?

40.0 kg/m2

The nurse is caring for a postoperative client who has just returned from surgery for creation of a colostomy. The nurse inspects the colostomy stoma and recognizes that which is a normal assessment finding for this client?

A brick-red color

The nurse has received the client assignment for the day. Which client would the nurse care for first?

A client who is tachycardic, febrile, and has severe abdominal pain in the right lower quadrant.

The nursing instructor is conducting a lecture on various esophageal disorders. How would the nursing instructor plan to describe achalasia?

A disorder in which peristalsis of the distal two-thirds of the esophageal smooth muscle is absent

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse would anticipate a prescription from the primary health care provider for which type of diet for this client?

A low-fiber diet

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication would the nurse look for during the client's postprocedure assessment?

A rigid, boardlike abdomen

The nurse is creating a care plan for a client diagnosed with peptic ulcer disease. The nurse plans care, knowing that ulcer perforation is a complication of this condition. Which sign or symptom is indicative of peptic ulcer perforation?

A rigid, boardlike abdomen

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?

A rigid, boardlike abdomen

The nurse is caring for a client after abdominal surgery to treat a malignant bowel tumor with creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and would expect to note which observation if this is present?

A stoma that is elongated with a swollen appearance

A primary health care provider (PHCP) prescribes a Salem sump tube for gastrointestinal intubation. Which item would the nurse obtain from the supply room?

A tube with a large lumen and an air vent

The nurse is reviewing the laboratory results of a client diagnosed with cirrhosis. The nurse notes that the previous alanine aminotransferase (ALT) level was 45 U/L. Which current laboratory value would indicate that the client's liver function is improving?

ALT 30 U/L

The nurse is reviewing the laboratory results for a client with suspected nonalcoholic fatty liver disease (NAFLD). Which of the following laboratory results would assist in the diagnosis of this condition?

ALT 50 U/L (50 U/L)

The nurse is caring for a client with a perforated duodenal ulcer. Which of the following imaging studies would the nurse anticipate the primary health care provider ordering to most accurately diagnose this condition?

Abdominal computed tomography (CT) scan with oral contrast

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which finding would the nurse interpret as a sign or symptom of portal hypertension?

Abdominal distention

A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse would assess the client for a history of chronic use of which medication?

Acetaminophen

A client with gastritis asks the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse would tell the client that which medication is acceptable to take?

Acetaminophen

The nurse is developing a teaching plan for a client with viral hepatitis. The nurse would plan to include which information in the teaching session?

Activity would be limited to prevent fatigue.

The nurse is admitting a client with chronic peptic ulcer disease who is complaining of severe abdominal pain. Which order from the primary health care provider requires a need for follow-up?

Administer 15 milligrams (mg) ketorolac intravenously every 6 hours as needed for moderate pain.

The nurse is caring for a client with acute bacterial gastroenteritis. Which of the following primary health care provider prescriptions would require a need for follow-up?

Administer 2 mg oral loperamide as needed every 6 hours for diarrhea

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 would question which primary health care provider (PHCP) prescription documented in the client's medical record?

Administer 30 mL of milk of magnesia (MOM).

The nurse is caring for a client with acute respiratory distress syndrome on a mechanical ventilator who has a nasogastric tube in place. The nurse is assessing the pH of the gastric aspirate and notes that the pH is 4.5. Based on this finding, the nurse would take which action?

Administer a dose of a prescribed antacid.

The nurse is caring for a client who underwent a hemorrhoidectomy 4 days ago. The client's last bowel movement was the day before the procedure and the client has been receiving regular stool softeners. Which of the following orders would the nurse anticipate from the primary health care provider?

Administer a mineral oil retention enema

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How would the nurse schedule the medications for administration?

Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide.

The nurse is reviewing the management plan for a client diagnosed with irritable bowel syndrome with predominant constipation (IBS-C). Which of the following primary health care provider (PHCP) orders would require a need for follow-up?

Administer loperamide as needed for constipation.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply.

Administer stool softeners as prescribed. Encourage a high-fiber diet to promote bowel movements without straining. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction would the nurse give the client regarding when to take this medication?

After meals

The nurse is caring for a client with a serum sodium level of 149 mEq/L (149 mmol/L) concurrently experiencing fluid overload. Which clinical manifestations would the nurse expect? Select all that apply.

Agitation Intense thirst sensation Bilateral 3+ pedal edema Weight gain of 7 pounds (3.2 kilograms) in 2 days

The nurse has taught the client with chronic pancreatitis about risk factor modification to reduce the incidence of recurrences. The nurse determines that teaching was effective if the client states that it will be necessary to control which factor?

Alcohol intake

The nurse is caring for a client postoperatively after creation of a colostomy to treat a bowel tumor. What is an appropriate potential client problem?

Altered body image

The nurse is reviewing the laboratory results for a client with acute pancreatitis. Which laboratory value would the nurse expect?

Amylase 500 Somogyi units (1250 U/L)

The nurse is reviewing the risk factors for lower gastrointestinal (GI) bleeding. Which of the following conditions would the nurse identify as a cause of lower GI bleeding? Select all that apply.

Anal fissure Diverticulitis Hemorrhoids

A 4-year-old child diagnosed with Hirschsprung disease is undergoing surgery in the morning at 0700. Before the procedure the nurse can anticipate that which will be prescribed preoperatively? Select all that apply.

Antibiotics Saline enemas Laboratory studies NPO after midnight

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.

Antimicrobial Corticosteroid Aminosalicylate Biological therapy Immunosuppressant

The emergency department nurse is assessing a client presenting with right lower quadrant pain, low-grade fever, nausea, vomiting and anorexia. The client explains to the nurse that the abdominal pain was dull at first and in the middle of the abdomen but is now sharp and midway between the client's right hip and umbilicus. Physical exam reveals abdominal muscle guarding and rebound tenderness. Which of the following conditions would the nurse suspect?

Appendicitis

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 primary health care provider (PHCP). The nurse would contact the PHCP to question which order if noted in the client's record?

Apply a heating pad to the lower abdomen for comfort.

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How would the nurse assess for its presence?

Ask the client to extend the arms.

A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure?

Assessing for the presence of the gag reflex

A client presents to the emergency department with upper gastrointestinal (GI) bleeding from a gastric ulcer and is in moderate distress. In planning care, which nursing action would be the priority for this client?

Assessment of vital signs

A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing action?

Assist the client in expressing feelings.

The registered nurse (RN) is overseeing a new graduate nurse who is taking care of a client with a Clostridium difficile (C. difficile) infection. The RN would determine that the new graduate nurse requires a need for further teaching if the RN observes the new graduate nurse take which of the following actions during the care of this client?

Auscultating lung sounds with the nurse's own stethoscope

The nurse is preparing a client with suspected nonalcoholic fatty liver disease (NAFLD) for a closed liver biopsy. The client asks the nurse where on the body the needle will be inserted to obtain a tissue specimen. What is the appropriate nursing response?

Between the seventh or eighth and ninth intercostal spaces on the right side of the body

The nurse is reviewing the etiology of peritonitis. Which of the following would the nurse identify as a chemical cause of peritonitis?

Bile leakage from the gallbladder

The nurse is caring for a client with a low thrombin level as a result of cirrhosis. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication?

Bleeding

The nurse is assessing a client with nausea and vomiting. The client's abdomen is distended, and the client reports being constipated and is unable to remember the date of the last bowel movement. Based on this client data, which condition would the nurse suspect?

Bowel obstruction

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented?

Bright red blood and mucus in the stools

The nurse is giving instructions to a client with cholecystitis about food to exclude from the diet. Which food item identified by the client indicates that the educational session was successful?

Brown gravy

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?

Cecum

The nurse is assessing a client with complaints of weight loss, abdominal bloating, lack of appetite, diarrhea, and foul-smelling, fatty stools. Based on these complaints, the nurse would suspect which condition?

Celiac disease

A Penrose drain is in place on the first postoperative day in a client who has undergone a cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate?

Change the dressing.

A client who has undergone gastric surgery to remove a tumor has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action would the nurse take initially?

Check the suction device to make sure it is working.

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?

Choking with feedings

The nurse is caring for a client with esophageal varices. Knowing the pathophysiology of this disorder, which other associated condition would the nurse suspect in the client?

Cirrhosis

A client receiving a cleansing enema complains of pain and cramping. The nurse would take which corrective action?

Clamp the tubing for 30 seconds, and restart the flow at a slower rate.

The nurse is reviewing the clinical manifestations of cholecystitis. Which of the following would the nurse identify as a sign or symptom of cholecystitis? Select all that apply.

Clay-colored stools Positive Blumberg sign Epigastric pain with radiation to the right shoulder

The nurse would instruct a client with an ileostomy to include which action as part of essential care of the stoma?

Cleanse the peristomal skin meticulously.

The nurse is teaching a client with peptic ulcer disease about lifestyle modifications to prevent exacerbations of the condition. The nurse determines that the client understood the instructions when the client states that which food item will be avoided?

Coffee

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items would the nurse include on this list? Select all that apply.

Coffee Chocolate Peppermint Fried chicken

A client with gastroesophageal reflux disease (GERD) has been assigned to the nurse for the day. The nurse plans to teach the client that which foods contribute to decreased lower esophageal sphincter pressure? Select all that apply.

Cola Coffee Chocolate Peppermint

The nurse is caring for a client prescribed enteral feeding via a newly inserted nasogastric (NG) tube. Before initiating the enteral feeding, the nurse would perform which action first?

Confirm NG placement by x-ray study.

The nurse would incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply.

Consume multiple small meals throughout the day. Allow the client to select foods that are most appealing. Eliminate fatty foods from the meal trays until nausea subsides.

The nurse is caring for a client with a serum sodium level of 152 mEq/L (152 mmol/L) at 0400. The client's serum sodium level is being closely monitored every 4 hours. The 0800 serum sodium level was 148 mEq/L (148 mmol/L) and the 1200 serum sodium level was 136 mEq/L (136 mmol/L). Which action would the nurse take?

Contact the primary health care provider.

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?

Corn

The nurse is helping a client with celiac disease (CD) in ordering food. The nurse notes there is a need for further teaching if the client selects which food item?

Couscous

The nurse is caring for a client with gallbladder disease who is experiencing nutrition problems due to biliary obstruction. The nurse understands that obstruction of which passage is related to the client's condition?

Cystic duct

The nurse is reviewing the laboratory results for a female client diagnosed with Crohn's disease (CD). Which laboratory results would indicate that the client is experiencing an acute inflammatory process related to CD? Select all that apply.

D-dimer of 75 ng/mL (4.5 mmol/L) White blood cell (WBC) count of 14,000/mm3 (14 × 109/L) Erythrocyte sedimentation rate (ESR) of 30 mm/hr

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 primary health care provider (PHCP)?

Dark red drainage

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse would monitor the client for which therapeutic effect of this medication?

Decreased diarrhea

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis?

Decreased hemoglobin

A client who has a gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact, and does not speak to the family or visitors. The nurse interprets that the client is using which coping mechanism?

Distancing

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.

Do not drink fluids with meals. Avoid foods high in carbohydrates. Eat 6 small meals a day that are high in protein.

The nurse is teaching a client diagnosed with achalasia about home care measures to improve symptoms associated with this disorder. Which instructions given by the nurse are appropriate? Select all that apply.

Do not eat meals quickly. Elevate the head of the bed while sleeping. Sip on fluids between bites while eating meals. Choose softer fruits to eat rather than hard fruits.

The nurse is caring for a client who has just returned from the operating room after colectomy to remove a bowel tumor and the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment?

Document the amount and characteristics of the drainage.

A client who underwent abdominal surgery for a bowel obstruction just returned to the surgical unit with a nasogastric (NG) tube in place. Upon assessment, the nurse notes that the client's NG tube is placed on low intermittent suction and draining dark red fluid. Which action would the nurse take?

Document the findings.

The nurse is assessing a client 24 hours after a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate?

Document the findings.

The nurse is providing postoperative instructions to a client who will undergone abdominal surgery. Which instruction needs to be included in the list?

Early ambulation begins a few hours after surgery.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions would the nurse plan to include in the instructions? Select all that apply.

Eat yogurt. Take loperamide to treat diarrhea. Use stress management techniques. Avoid foods such as cabbage and broccoli.

A client is returning to the surgical unit after a herniorrhaphy. Which postoperative instructions would the nurse include in teaching? Select all that apply.

Elevate and ice the surgical area. Take stool softeners, as these are usually indicated. Report redness or drainage of the site to the surgeon. Use the incentive spirometer and perform deep breathing.

The nurse is caring for a hospitalized client with pancreatitis. Which findings would the nurse look for and expect to note when reviewing the laboratory results? Select all that apply.

Elevated lipase level Elevated trypsin level Elevated amylase level Rationale:Lipase, trypsin, and amylase are produced in the pancreas and aid in the digestion of fats, starches, and proteins, respectively. Lactase is produced in the small intestine and aids in splitting neutral fats into glycerol and fatty acids. Sucrase is produced in the small intestine and converts sucrose into glucose and fructose.

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the primary health care provider?

Elevated serum bilirubin level

The nurse is caring for a client with acute pancreatitis. Which finding would the nurse expect to note when reviewing the laboratory results?

Elevated serum lipase level

A client suspected of cholelithiasis is admitted to the hospital. Upon assessment, the nurse notes that the client is jaundiced. Which diagnostic imaging would be most important for the client to obtain?

Endoscopic retrograde cholangiopancreatography

The nurse is preparing to administer an intermittent enteral feeding through a nasogastric (NG) tube. Which priority assessment would the nurse perform?

Evaluate absorption of the last feeding.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder?

Failure to pass meconium stool in the first 24 hours after birth

The nurse is assessing an obese female client for risk factors of metabolic syndrome. Which client data would the nurse determine are risk factors for metabolic syndrome? Select all that apply.

Fasting blood glucose of 110 mg/dL (6.1 mmol/L) Client waist circumference 37 inches (94 centimeters)

A client is admitted to the hospital with acute viral hepatitis. Which sign or symptom would the nurse expect to note based on this diagnosis?

Fatigue

The nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primary characteristics of the preicteric phase?

Fatigue, anorexia, and nausea

A client reports having six episodes of loose stools that have a foul odor. The nurse suspects that the client has Clostridium difficile. To confirm this, the nurse would anticipate which test to be ordered?

Fecal gastrointestinal pathogen panel—polymerase chain reaction

The nurse is caring for a client diagnosed with a Clostridium difficile (C. difficile) infection who has had recurrent infections over the last year. Which of the following treatments would the nurse anticipate as being the most effective treatment for this client?

Fecal microbiota transplantation

The nurse is reviewing the risk factors for cholecystitis. Which of the following would the nurse identify as risk factors for cholecystitis? Select all that apply.

Female Low-fat diet Rapid weight loss

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply.

Fever Complaints of indigestion Pain in the upper right quadrant after a fatty meal

A client has just had surgery to create an ileostomy for treatment of a bowel obstruction. The nurse assesses the client in the postoperative period for which most frequent complication of this type of surgery?

Fluid and electrolyte imbalance

A client with Crohn's disease has just had surgery to create an ileostomy. The nurse assesses the client in the postoperative period for which most frequent complication of this type of surgery?

Fluid and electrolyte imbalance

A client with severe Crohn's disease 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?

Fluid and electrolyte imbalance

The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the parent to seek health care for the infant?

Foul-smelling ribbon-like stools

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?

Frequent need to work overtime on short notice

The nurse is reviewing the primary health care provider's prescriptions written for a client admitted to the hospital with acute pancreatitis. Which prescription requires follow-up by the nurse?

Full liquid diet

The nurse is assessing a client with ulcerative colitis (UC). How would the nurse classify the severity of the client's UC if the client reports 12 bloody stools per day?

Fulminant

The nurse is taking care of a child diagnosed with intussusception. Which conservative treatment can the nurse anticipate the pediatrician to order?

Gas enemas

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client?

Gelatin and a graham cracker

The nurse has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement?

Glycerin suppository

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply.

Gray-blue color at the flank Abdominal guarding and tenderness Left upper quadrant pain with radiation to the back

The nurse is performing a gastrointestinal (GI) assessment on a client with suspected appendicitis. The nurse assesses for pain at McBurney's point, knowing this landmark is located where on the abdomen?

Halfway between the umbilicus and right iliac crest

The nurse is reviewing the clinical signs and symptoms of achalasia. Which are signs and symptoms of this disorder? Select all that apply.

Halitosis Dysphagia Substernal chest pain while eating

The nurse is planning an educational session about the Clostridium difficile infection. Which topics would the nurse include in the educational session? Select all that apply.

Handwashing is important to limit the spread. Lactobacillus probiotics use may prevent infection. Client with an ileus can receive vancomycin through an enema. Clients on immunosuppressive agents are at the highest risk for transmission.

The nurse is caring for a client who is receiving bolus feedings via a nasogastric tube. As the nurse is finishing the feeding, the client asks for the bed to be positioned flat for sleep. The nurse plans to assist the client to which appropriate position at this time?

Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes

The nursing instructor is teaching a nursing student about hepatitis B and groups that would benefit from hepatitis B virus (HBV) screening. Which individuals would be recommended to receive HBV screening? Select all that apply.

Health care workers An individual with cirrhosis An individual who uses intravenous drugs An individual with multiple sexual partners

The nurse is caring for a client with new-onset abdominal pain who was diagnosed with acute gastritis. The client asks the nurse what may have caused this condition. Which of the following client factors increases the risk of acute gastritis? Select all that apply.

Helicobacter pylori infection Long-term corticosteroid therapy Consuming multiple cups of coffee daily Consuming five alcoholic beverages approximately 3 times per week

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and would be reported to the PHCP immediately?

Hematemesis

The nurse is caring for a client diagnosed with a lower gastrointestinal (GI) bleed. Which of the following laboratory tests would the nurse anticipate being drawn? Select all that apply.

Hematocrit Hemoglobin Platelet count4Alanine transaminase (ALT) Aspartate transaminase (AST)

The nurse is assigned to care for a client with a Sengstaken-Blakemore tube for the treatment of esophageal varices. Which laboratory result is most focused on evaluating the effectiveness of this tube?

Hemoglobin

The nurse is assessing a client who was in a motor vehicle accident (MVA) and has abdominal contusions from the seat belt. The nurse plans care, knowing that the client is at risk for internal bleeding and subsequent hypovolemic shock. Which of the following signs and symptoms would alert the nurse of this potential complication? Select all that apply.

Hemoglobin 9 g/dL (90 g/L) Blood pressure 88/60 mmHg Respiratory rate 24 breaths per minute

The nurse is assessing a client diagnosed with hepatitis D infection. Which other co-occurring infection would the nurse suspect?

Hepatitis B

The nurse is caring for a client complaining of acid reflux and shortness of breath. A chest x-ray demonstrates protrusion of the upper portion of the stomach through the diaphragm. Which condition would the nurse suspect?

Hiatal hernia

A client mentions to the nurse a concern about the risk of developing nonalcoholic fatty liver disease (NAFLD) as the client's parent developed it in their older age. The nurse states that which conditions are risk factors for the development of NAFLD? Select all that apply.

Hyperlipidemia Hypothyroidism Type 2 diabetes mellitus Polycystic ovarian syndrome (PCOS)

The nurse is assessing a client diagnosed with irritable bowel syndrome (IBS). The nurse asks about the client's bowel habits, and the client reports having several episodes of constipation that alternate with several episodes of diarrhea. Keeping the different types of IBS in mind, how would the nurse classify this client's symptoms?

IBS-A

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 is not a part of the treatment plan because of its irritating effect on the lining of the gastrointestinal tract?

Ibuprofen

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data would alert the nurse to this occurrence?

Inability to pass flatus

A client diagnosed with viral hepatitis is complaining of "no appetite" and "losing my taste for food." What instruction would the nurse give the client to provide adequate nutrition?

Increase intake of fluids, including juices.

The nurse is caring for a client with diverticulitis. The nurse is reviewing the client's most recent laboratory results. Which laboratory trend would the nurse expect?

Increased white blood cell count, decreased hemoglobin, decreased hematocrit

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, would the nurse question?

Indomethacin

The emergency department nurse is admitting a client who sustained several traumatic injuries after being hit by a car while crossing the street. The client has signs and symptoms of abdominal trauma in addition to several other injuries. The nurse reviews the incoming orders in the client's medical record. Which primary health care provider (PHCP) order would prompt the nurse to contact the PHCP for clarification?

Insert a nasogastric tube.

The emergency department nurse is admitting a client who sustained a pelvic fracture in a motor vehicle accident. Physical assessment reveals ecchymoses and abrasions across the client's abdomen. The nurse reviews the emergency department provider's orders and would contact the emergency department provider for clarification regarding which order?

Insert an indwelling urinary catheter.

The nurse is teaching a client diagnosed with hepatitis B infection about how the virus is transmitted. Which of the following are possible methods of transmission of hepatitis B? Select all that apply.

Intravenous drug use Sharing a razor with someone who has hepatitis B infection Through unprotected sexual contact with someone infected with hepatitis B

A client with severe ulcer disease in the distal stomach undergoes a gastrojejunostomy (Billroth II procedure). Which postoperative prescription would the nurse question and verify?

Irrigating the nasogastric tube

The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse would explain to the client that the second stage of this disease is characterized by which specific assessment findings? Select all that apply.

Jaundice Clay-colored stools Elevated bilirubin levels Dark or tea-colored urine

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse would place the infant in which best position at this time?

Left lateral position

The nurse is assessing a client experiencing an exacerbation of irritable bowel syndrome (IBS) who is experiencing localized abdominal pain. The nurse prepares to perform abdominal palpation, knowing which of the following abdominal quadrants would most likely elicit tenderness with palpation due to this condition?

Left lower quadrant

The nurse is performing an abdominal assessment on a client diagnosed with diverticulitis. The nurse palpates the abdomen, expecting to note pain and tenderness in which area?

Left lower quadrant

The nurse is caring for a teenage 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?

Leukocytosis with a shift to the left

The nurse is providing discharge instructions to a client following gastrectomy and would instruct the client to take which measure to assist in preventing dumping syndrome?

Limit the fluids taken with meals.

The nurse is caring for an older client. The nurse would anticipate that medication dosages will be further adjusted if the client has dysfunction of which organ?

Liver

The nurse is caring for a client currently being treated for a Clostridium difficile (C. difficile) infection. The client asks the nurse about factors that increase the risk of contracting this infection. The nurse would tell the client that which factors increase the risk of C. difficile infection? Select all that apply.

Living in a long-term care facility History of previous C. difficile infection Taking nitrofurantoin for a urinary tract infection (UTI) Taking pantoprazole daily for gastroesophageal reflux disease (GERD)

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse would assess the stool for which characteristic that is expected with this disease?

Loose, watery stool

The nurse is caring for a client with a small bowel obstruction who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse would anticipate a primary health care provider prescription for which type of suction?

Low and intermittent

The nurse is caring for a client with common bile duct obstruction. The nurse would anticipate that the primary health care provider (PHCP) will prescribe which diet for this client?

Low fat

The nurse is giving dietary instructions to a client who has a new colostomy created to treat a bowel obstruction. The nurse would encourage the client to eat foods representing which diet for the first few weeks postoperatively?

Low fiber

A client is diagnosed with a moderate case of acute ulcerative colitis. The nurse doing dietary teaching would give the client examples of foods to eat that represent which therapeutic diet?

Low fiber without milk

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse determines that education about positioning to reduce pain was effective if the client avoids which action?

Lying flat

A client with hiatal hernia chronically experiences heartburn following meals. The nurse would plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia?

Lying recumbent following meals

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply.

Maintain NPO (nothing by mouth) status. Encourage coughing and deep breathing. Give hydromorphone intravenously as prescribed for pain.

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding?

Malaise

The nurse is caring for a client diagnosed with gastrointestinal bleeding from a Mallory-Weiss tear. In the care plan the nurse includes monitoring the client for signs and symptoms of shock. Which client data would alert the nurse that the client may be experiencing shock due to inadequate circulating volume related to blood loss? Select all that apply.

Mean arterial pressure (MAP) of 55 mm Hg Urine output of 160 milliliters (mL) over the last 8 hours

The nurse is creating a care plan for a client diagnosed with a bleeding gastric ulcer related to Helicobacter pylori (H. pylori) infection. The nurse plans to monitor the client for which signs and symptoms that indicate an upper gastrointestinal (GI) bleed? Select all that apply.

Melena New-onset confusion Coffee-ground vomitus

A child is hospitalized because of persistent vomiting. The nurse would monitor the child closely for which problem?

Metabolic alkalosis

The nurse is caring for a client who has a small-bowel obstruction (SBO) and has reported vomiting for over the past 12 hours. The nurse assesses the client for signs and symptoms of which acid-base imbalance?

Metabolic alkalosis

The nurse is caring for a client with a small bowel obstruction located in the proximal jejunum. The nurse would monitor the client for which acid-base imbalances associated with this condition?

Metabolic alkalosis

Cholestyramine resin is prescribed for a client with an elevated serum cholesterol level. The nurse would instruct the client to take the medication in which way?

Mixed with fruit juice

The nurse is assessing a client with ulcerative colitis (UC). The nurse is gathering information related to the client's bowel habits, and the client reports having approximately five nonbloody stools a day. How would the nurse classify the severity of this client's UC?

Moderate

The nurse is creating a plan of care for a client with cirrhosis and ascites. Which nursing actions would be included in the care plan for this client? Select all that apply.

Monitor daily weight. Measure abdominal girth. Monitor respiratory status. Assist the client with care as needed.

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention is appropriate?

Monitor for fluid and electrolyte imbalance

The nurse is creating a care plan for a client diagnosed with gastrointestinal bleeding from a gastric ulcer. How would the nurse plan to monitor the client for occult signs of gastrointestinal bleeding?

Monitoring the client's respiratory rate and work of breathing

The nurse is caring for a client with acute pancreatitis. Which medications would the nurse expect to be prescribed for treatment of this problem? Select all that apply.

Morphine Dicyclomine Pantoprazole Acetazolamide

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What would the nurse expect to be prescribed for this client?

NPO (nothing by mouth) status

The emergency department nurse is assessing a client with suspected appendicitis. Which signs and symptoms of appendicitis might be noted in the assessment? Select all that apply.

Nausea Vomiting Temperature 100.6° F (38.1° C) Right lower quadrant (RLQ) pain

The nurse is assessing a client for signs and symptoms of peritonitis. Which of the following signs or symptoms would alert the nurse to the possibility of this condition? Select all that apply.

Nausea Vomiting Temperature of 102 ℉ (38.9 ℃)

A client in the emergency department is suspected of having peritonitis. Upon assessment, which findings would the nurse expect to note? Select all that apply.

Nausea and vomiting Lying in a fetal position Temperature of 101.7° F (38.7° C) Reports sudden sharp pain in the midepigastric region

The nurse is interpreting a client's laboratory screening results for hepatitis B. Which laboratory result would indicate that the client does not have an active hepatitis B infection, but has no protection against hepatitis B and would benefit from immunization?

Negative HBsAg and negative anti-HBs

The nurse is caring for a client with a serum sodium level of 151 mEq/L (151 mmol/L). Which priority assessment would the nurse include in the care plan for this client?

Neurological assessment

The emergency department nurse is assessing a client with suspected appendicitis with complaints of right lower quadrant pain, nausea, vomiting, and anorexia. Which diet orders would the nurse anticipate?

Nothing by mouth (NPO)

The nurse is creating a care plan for a client diagnosed with acute cholecystitis who does not want surgery and has chosen conservative management. The client is experiencing nausea, vomiting, and severe pain. Which interventions would the nurse expect? Select all that apply.

Nothing-by-mouth (NPO) diet. Administer analgesics as needed. Administer fat-soluble vitamins. Maintenance diet after acute episode with low-fat foods

A client comes in suspected of having a hernia. Upon assessment, the nurse notes that the bowel sounds are absent. Which nursing action is most important?

Notify the primary health care provider

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?

Notify the surgeon

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?

Notify the surgeon.

The nurse is teaching dietary modifications to a client diagnosed with gastroesophageal reflux disease (GERD). Which would the nurse recommend to prevent exacerbation of GERD symptoms? Select all that apply.

Oatmeal Watermelon Whole-grain brown rice

The nurse in a primary health care provider setting is calculating a client's body mass index (BMI). The nurse determines the client's BMI is 30.2 kg/m2. How would the nurse classify the client's BMI based on this value?

Obese

The nurse is reviewing the pathophysiology of nonalcoholic fatty liver disease (NAFLD). The nurse understands that which of the following conditions are associated with NAFLD? Select all that apply.

Obesity Metabolic syndrome Type 2 diabetes mellitus

The nurse in a medical-surgical unit is caring for a client with cholecystitis. When viewing the client's chart, the nurse notes that which findings place the client at an increased risk for cholecystitis? Select all that apply.

Obesity Pregnancy Genetic factors Sickle cell disease Hormone replacement therapy

The nurse is caring for a client with a potassium level of 5.9 mEq/L and is assisting the client in choosing lunch. The nurse determines there is a need for further teaching if the client selects which food item from the menu?

Omelet with spinach, tomato, potatoes

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention would the nurse anticipate the primary health care provider prescribing?

Oral corticosteroids

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply.

Orthopnea and dyspnea Petechiae and ecchymosis Inguinal or umbilical hernia Abdominal distention and tenderness

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 would assess the client for which manifestation of duodenal ulcer?

Pain relieved by food intake

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 would assess the client for which sign(s)/symptom(s) of duodenal ulcer?

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?

Pain that is relieved by food intake

The nurse is assessing a client diagnosed with cirrhosis. Which clinical manifestation would the nurse identify as an integumentary manifestation of cirrhosis?

Palmar erythema

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?

Pancreatic juice

A nurse is assigned to care for a client with peritonitis. The nurse reviews the client's medical record, recalling that which are potential causes of peritonitis? Select all that apply.

Pancreatitis Peritoneal dialysis Ruptured appendix Cirrhosis with ascites Blood-borne organisms Ischemic bowel disorders

The nurse is creating a care plan for a client diagnosed with a nonmechanical small bowel obstruction. Which client data would the nurse identify as contributing factors to the development of a nonmechanical small bowel obstruction? Select all that apply.

Paralytic ileus Serum calcium 8.2 mg/dL (2.05 mmol/L)

The nurse is caring for a client with a bleeding gastric ulcer. The client begins to complain of severe, penetrating epigastric pain. Which initial action would the nurse take?

Perform an abdominal assessment

The nurse is caring for a client who presented to the emergency department with a sudden onset of sharp, severe abdominal pain, nausea, vomiting, anorexia, and a rigid and board-like abdomen. The nurse notes that the client has a history of peptic ulcer disease (PUD). Which of the following conditions would the nurse suspect?

Peritonitis

The nurse is assisting a physician with the insertion of a Miller-Abbott tube. The nurse understands that the procedure places the client at risk for aspiration and would therefore plan which action to decrease this risk?

Place the client in a semi-Fowler's to high-Fowler's position.

A newly licensed registered nurse is taking care of a client admitted for a small bowel obstruction (SBO). The nurse has continuous gastric suction attached to the client's nasogastric (NG) tube. Which intervention(s), if taken by the newly licensed registered nurse, would indicate a need for further teaching? Select all that apply.

Placing the client in a supine position

The nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which food?

Pork

The nurse is caring for a client who had a laparoscopic cholecystectomy 1 day ago. The nurse plans pain-management techniques, knowing that the severity of the client's pain can be related to which factor?

Positioning of the client during surgery

The nurse is assessing a client diagnosed with acute pancreatitis. The nurse notes grayish-blue discoloration on the client's left and right flanks. How would the nurse interpret this assessment finding?

Positive Grey Turner's sign

The nurse is caring for a client diagnosed with a hepatitis D virus (HDV) infection. Which laboratory test result would the nurse anticipate that is associated with this infection?

Positive hepatitis B surface antigen (HBsAg)

A client who has undergone creation of a colostomy has a concern about body image. What action by the client indicates the most significant progress toward identified goals?

Practicing proper cutting of the ostomy appliance

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms?

Projectile vomiting

The nursing instructor asks a nursing student which substance provides a protective function for the stomach against autodigestion and subsequent gastritis. The nursing student responds correctly by identifying which substance?

Prostaglandins

A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse would plan a dietary consultation to limit the amount of which ingredient in the client's diet?

Protein

Which interventions would the nurse include when creating a care plan for a child with hepatitis? Select all that apply.

Providing a low-fat, well-balanced diet Teaching the child effective handwashing techniques Instructing the parents to avoid administering medications unless prescribed

The nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts to slowly advance the NG tube with each swallow. The client begins to cough, gag, and choke. Which actions would the nurse take that will result in proper tube insertion and promote client relaxation? Select all that apply.

Pull the tube back slightly. Instruct the client to breathe slowly. Assist the client to take sips of water. Check the back of the pharynx using a tongue blade and flashlight.

The nurse is providing care for a client with a bowel obstruction who had a transverse colostomy created. Which observation requires immediate notification of the primary health care provider?

Purple discoloration of the stoma

The nurse is providing care for a client with a recent transverse colostomy created to resolve a bowel obstruction. Which observation requires immediate notification of the primary health care provider?

Purple discoloration of the stoma

The clinic nurse is performing an abdominal assessment on a client and preparing to auscultate bowel sounds. The nurse would place the stethoscope in which quadrant first? Click on the image to indicate your answer.

RLQ

The nurse is caring for a client who underwent a fecal microbiota transplantation (FMT) to treat recurrent Clostridium difficile (C. difficile) infections. After the procedure, the client reports one episode of diarrhea and bloating. Which of the following actions would the nurse take next?

Reassure the client this is normal after this procedure

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the primary health care provider (PHCP)?

Rebound tenderness

The nurse is performing an assessment on a client with atrophic gastritis who has a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client?

Red tongue that is smooth and sore

A client asks the nurse what causes gastroesophageal reflux disease (GERD). Knowing that GERD has many causative factors, the nurse would list which as contributors to GERD? Select all that apply.

Reduced esophageal motility Reflux of bile from the small intestine Lower esophageal sphincter dysfunction Reflux of gastric contents into the esophagus

A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome?

Remove fluids from the meal tray.

The nurse provides home care instructions to the parents of a child with celiac disease. The nurse would teach the parents to include which food item in the child's diet?

Rice

A client presents with severe abdominal pain, and appendicitis is suspected. On assessment, the nurse would expect localized tenderness in which abdominal area in the later stages of appendicitis?

Right lower quadrant

The nurse is creating a care plan for a client with achalasia. Because of the disorder, the client has difficulty swallowing and must follow a semisoft diet. The client expresses anxiety over eating and drinking fluids related to a fear of choking and an inability to hold eating utensils well, which is also contributing to the client's constipation due to decreased fluid intake. Which would the nurse identify as the client's priority problem?

Risk for aspiration

The nurse is reviewing the pathophysiology of bowel perforation. Which of the following would the nurse identify as a noniatrogenic cause of a bowel perforation?

Ruptured gastric ulcer

The nurse is planning to implement the prescriptions for an assigned client with confirmed appendicitis. Which prescription(s) would the nurse question? Select all that apply.

Saline enema Polyethylene glycol laxative

The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which food would the nurse instruct the client to avoid?

Salsa and corn chips

The nurse is assisting a client with acute diverticulitis in choosing an appropriate meal. Which food items would the nurse suggest?

Scrambled eggs with low-fat yogurt

A client comes into the emergency department with suspected appendicitis. The nurse places the client in which position that would be best for the client?

Semi-Fowler's

The nurse is caring for a client diagnosed with peritonitis who is receiving intravenous (IV) fluids and antibiotics who is awaiting surgery. In which of the following positions would the nurse place the client?

Semi-Fowler's position

The nurse is caring for a client with diagnosed appendicitis that is awaiting surgical intervention scheduled the next day. In which of the following positions would it be best for the nurse to place the client?

Semi-Fowler's position

The nurse is caring for a client diagnosed with pancreatitis. The nurse is reviewing the client's morning laboratory results. Which laboratory result would require a need for follow-up?

Serum calcium 7.0 mg/dL (1.83 mmol/L)

The nurse is reviewing the risk factors for the development of an anal fissure. Which of the following would the nurse determine are risk factors? Select all that apply.

Sigmoidoscopy Crohn's disease Anal intercourse Straining with defecation

The nurse is providing care for a client with ulcerative colitis who underwent the creation of a transverse colostomy. Which observation requires immediate notification of the surgeon?

Stoma has a purple discoloration.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

Sweating and pallor

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?

Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

The nurse is providing dietary education to a client with gastroesophageal reflux disease (GERD). The nurse indicates that the client understands the teaching if the client states a plan to avoid which foods to prevent symptom exacerbation? Select all that apply.

Tea Beer Coffee Chocolate

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?

The client has eliminated any irritating foods from the diet.

A nurse is obtaining a past medical history for a client suspected of cholecystitis. Which finding would the nurse report to the primary health care provider?

The client is taking oral contraceptives.

Lactulose is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated?

The fecal pH is acidic.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which would the nurse expect the client to report about the pain?

The pain usually increases after vomiting.

The nurse is caring for a client being evaluated for peritonitis due to suspected gastric ulcer perforation. Which of the following findings on an abdominal x-ray supports this diagnosis?

The presence of free air in the abdominal cavity

The nurse is reinforcing education provided by the gastroenterologist regarding surgical techniques used to repair a hiatal hernia to a client diagnosed with a hiatal hernia. How would the nurse describe the gastropexy technique?

The upper portion of the stomach is attached below the diaphragm.

The nurse provides feeding instructions to the parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction would the nurse give to the parent to assist in reducing the episodes of emesis?

Thicken the feedings by adding rice cereal to the formula.

A client had a colectomy 2 days earlier to remove a bowel tumor and had a new colostomy created. The client is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

This is a normal, expected event.

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?

This is a normal, expected event.

The nurse is reviewing the pathophysiology of cirrhosis and the associated diagnostic laboratory studies. Which laboratory trend(s) is associated with cirrhosis? Select all that apply.

Thrombocytopenia Increased ammonia level Decreased serum albumin

A client is newly diagnosed with gastroesophageal reflux disease (GERD). Which lifestyle modifications would be most important for the nurse to encourage when educating the client? Select all that apply.

To stop smoking. Eat four to six small meals a day. Weight-management measures.

The nurse is caring for a client diagnosed with Clostridium difficile (C. difficile) infection. Which potential complication from C. difficile infection would the nurse suspect?

Toxic megacolon

The nursing instructor is reviewing the pathophysiology of gastrointestinal (GI) bleeding. The nursing instructor determines there is a need for further teaching if the nursing student identifies which of the following conditions as a cause of upper GI bleeding?

Ulcerative colitis

A nurse is planning care for a client with suspected peritonitis. What diagnostic studies would the nurse expect to most likely be performed? Select all that apply.

Ultrasound Peritoneoscopy Abdominal x-ray Computerized tomography (CT) scan

The nurse plans care for a client postoperatively following creation of a colostomy. Which potential client problem would the nurse include in the plan of care?

Upset about appearance

The nurse is caring for a client who sustained abdominal injuries in a motor vehicle accident. Which laboratory result would alert the nurse the client sustained kidney damage?

Urinalysis positive for trace amounts of blood

The nurse is caring for a client who sustained abdominal injuries in a motor vehicle accident. Which of the following client data would prompt the nurse to contact the primary health care provider (PHCP)?

Urine output of 175 milliliters (mL) over the last 10 hours

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information would the nurse include in the teaching plan?

Use 500 to 1000 mL of warm tap water.

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a most common causative factor in this client's disorder?

Use of alcohol

A client with gastritis experiencing chronic 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?

Vagus nerve

The nurse is assisting a client diagnosed with diverticulosis with dietary management to prevent acute diverticulitis. The nurse determines that the client requires a need for further teaching if the client states that which food item is high in fiber?

Vanilla yogurt

The nurse is reviewing the pathophysiology of bowel obstruction and the mechanical and nonmechanical causes of obstruction. Which would the nurse identify as a mechanical cause of intestinal obstruction? Select all that apply.

Ventral hernia Gastric malignancy Bowel intussusception

The nurse caring for a client with chronic gastritis understands that the client is at risk for malnutrition. The client is at increased risk for malabsorption if which nutrient is deficient due to the lack of intrinsic factor (IF)?

Vitamin B12

The nurse is caring for a client with pernicious anemia. Which prescription by the primary health care provider would the nurse anticipate?

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?

Vitamin B12 injections

The nurse would anticipate that the primary health care provider (PHCP) will prescribe which treatment for a client with pernicious anemia?

Vitamin B12 injections

The nurse is caring for a client with Crohn's disease. The client has poor oral intake and reports memory loss and weight loss. Upon assessment, the nurse notes a smooth tongue, which the client reports is sore; brittle nails; and pale skin. The client's complete blood cell count (CBC) indicates a high mean corpuscular volume (MCV) and a low mean corpuscular hemoglobin (MCH). Based on the assessment, the nurse would suspect which nutrient deficiency?

Vitamin B9 deficiency

The nurse is caring for a client admitted to the hospital with suspected acute appendicitis. Which laboratory result would the nurse expect to note if the client does have appendicitis?

WBC count of 18,000 mm3 (18 × 109/L)

The nurse in a primary health care provider setting is assessing an obese male client for risk factors of metabolic syndrome. Based on the assessment, the nurse determines that which finding is a risk factor for metabolic syndrome?

Waist circumference 40 inches (102 centimeters)

The nurse is caring for a client who had a subtotal gastrectomy. The nurse would assess the client for which signs and symptoms of dumping syndrome?

Weakness, diaphoresis, and diarrhea

The nurse is reviewing the medical record of a client with chronic pancreatitis. Which manifestations would the nurse expect to note documented in the record? Select all that apply.

Weight loss Steatorrhea Constipation Mild jaundice Gnawing, burning, cramping epigastric pain

The nurse is reviewing the laboratory results of a client diagnosed with peritonitis. Which of the following laboratory results supports this diagnosis?

White blood cell (WBC) count 22,000 mm3 (22 × 109/L)

A client with cholecystitis is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching?

Whole milk

The nurse is reviewing the electrocardiogram (ECG) of a client with a potassium level of 5.6 mEq/L (5.6 mmol/L). Which may be noted on this client's ECG? Select all that apply.

Wide, flat P wave Tall, peaked T wave ST segment depression

A client with a new ileostomy is concerned about the odor from stool in the ostomy drainage bag. The nurse would teach the client to include which food in the diet to reduce odor?

Yogurt

During a home care visit, an adult client complains of chronic constipation. What would the nurse tell the client to do?

Increase fluid and dietary fiber intake.

The nurse is caring for a client with altered protein metabolism as a result of liver dysfunction. Which finding would the nurse expect to note when reviewing the client's laboratory results?

Increased ammonia level

The nurse is caring for a client diagnosed with acute pancreatitis. The nurse reviews the client's laboratory results, expecting which trend in the laboratory report?

Increased lipase

The nurse is caring for a client diagnosed with a large duodenal ulcer. The client begins to complain of sudden, severe abdominal pain that radiates to the back and shoulders. The nurse further assesses the client and determines that the client's bowel sounds are absent and respirations are shallow and rapid. Which complications would the nurse suspect?

Bowel perforation

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis?

"Does the pain in your stomach radiate to your back?"

The nurse provides instructions to a client about measures to treat irritable bowel syndrome (IBS). Which statement by the client indicates a need for further teaching?

"I need to limit my intake of dietary fiber."

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?

"I plan to have a snack 1 hour before going to bed."

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?

"I will drink plenty of liquids with meals."

A client diagnosed with a severe ulcerative colitis (UC) exacerbation has developed an intestinal abscess. The client asks the nurse to explain what this means. How would the nurse describe this complication?

"The bowel has developed localized pockets containing pus in the ulcerated bowel lining."

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?

"When my bowels begin to function again, and I begin to pass gas."

The nurse is reviewing the laboratory results of a client diagnosed with cirrhosis. Which of the following international normalized ratios (INR) would the nurse expect in a client with cirrhosis?

1.6

The nurse is preparing a client with suspected nonalcoholic fatty liver disease (NAFLD) for a closed liver biopsy. What is the minimum amount of time the client would need to maintain a right side-lying position after the procedure?

2 hours

The nurse is caring for a client with a history of a small perforated duodenal ulcer that spontaneously healed on its own. The client asks the nurse about potential complications from a healed ulcer. The nurse would tell the client that which of the following is a complication of a self-healed duodenal ulcer?

Bowel stricture

The nurse is caring for a client with a serum sodium level of 151 mEq/L (151 mmol/L) related to sodium excess. The client is experiencing central nervous system (CNS) symptoms, including agitation and twitching. The nurse would contact the primary health care provider for clarification if which intervention was included in the treatment plan?

Administer intravenous (IV) 0.9% sodium chloride

The nurse is performing discharge teaching for a client with chronic pancreatitis. Which information would the nurse include?

Avoid caffeine because it may aggravate symptoms.

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

Biscodyl

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which assessment data would alert the nurse to this occurrence?

Inability to pass flatus

The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed that the nasogastric tube be removed. What is the priority nursing assessment prior to removing the tube?

Checking for the presence of bowel sounds in all four quadrants

The nurse checks the gastric residual of an unconscious client receiving nasogastric tube feedings continuously at 50 mL/hr. The nurse notes that the residual is 250 mL at 0800 and 300 mL at 0900. The nurse determines that the client is experiencing which complication?

Delayed gastric emptying

The nurse is reviewing the pathophysiology of hypernatremia. The nurse correctly identifies which conditions as risk factors for hypernatremia? Select all that apply.

Diarrhea Diabetes insipidus Primary hyperaldosteronism

The nurse is reviewing the risk factors for hemorrhoids. Which of the following would the nurse identify as a risk factor for the development of hemorrhoids? Select all that apply.

Diarrhea Pregnancy Constipation Prolonged sitting or standing

The nurse is caring for a client with pancreatitis. Which finding would the nurse expect to note when reviewing the client's laboratory results?

Elevated level of amylase

The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate?

Encourage the client to ambulate.

A client with cirrhosis complicated by ascites is admitted to the hospital. The client reports a 10-lb weight gain over the past 1½ weeks. The client has edema of the feet and ankles, and the abdomen is distended, taut, and shiny with striae. Which client problem is most appropriate at this time?

Excessive body fluid volume

A client with chronic pancreatitis needs information on dietary modification to manage the health problem. Which item in the diet would the nurse teach the client to limit?

Fat

The nurse is caring for a client admitted with severe weight loss due to dieting. Based on the data provided, the nurse plans care knowing that which condition is likely occurring in this client?

Gluconeogenesis

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply.

Gray-blue color at the flank Abdominal guarding and tenderness Left upper quadrant pain with radiation to the back

The nurse is performing an assessment on a client with suspected irritable bowel syndrome (IBS). Which laboratory test would the nurse anticipate being ordered to confirm this diagnosis?

Hydrogen breath test

The nurse is assessing a client with acute cholecystitis. The nurse notes that the client's sclerae are yellow. How would the nurse document this finding?

Icterus

The nurse is caring for a client with suspected celiac disease undergoing diagnostic evaluation. Which laboratory tests would the nurse expect to be ordered to aid in the diagnosis of this disease?

IgA

The nurse is caring for a client with suspected celiac disease who had a skin biopsy of a red, pruritic lesion located on the buttocks. If the suspicious lesion is dermatitis herpetiformis, which skin biopsy result would the nurse expect?

IgA deposits in the dermis

The nurse is reviewing an abdominal x-ray series of a client diagnosed with bowel perforation. Which finding would the nurse anticipate on the client's x-ray results?

Intraperitoneal gas

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse would make which suggestion to the client?

Maintain a low-Fowler's position after eating.

A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which source of complete proteins to maximize the availability of essential amino acids?

Meats

The nurse is assessing a client diagnosed with acute gastritis. Which of the following clinical manifestations would the nurse expect? Select all that apply.

Nausea Dyspepsia Hematemesis

The nurse is caring for a client who is postoperative day three after extensive abdominal surgery. Which clinical manifestations would the client present that would alert the nurse of a bowel obstruction? Select all that apply.

Nausea Vomiting Constipation Abdominal pain Abdominal distention

The nurse is caring for a client who has a small-bowel obstruction (SBO) caused by surgical adhesions. The nurse would anticipate that the nurse practitioner will order which of the following initially?

Nothing-by-mouth (NPO) status

Upon assessment of a client with a hernia, the nurse notes that the hernia cannot be reduced. Which nursing action is the priority?

Notify the primary health care provider.

The nurse is performing a gastrointestinal assessment on a client with a small bowel obstruction. The nurse notes that the client has absent bowel sounds. Which would the nurse suspect as the cause of the obstruction?

Paralytic ileus

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the client?

Pasta with sauce

The nurse is assessing a client with cirrhosis for signs and symptoms of low albumin. Which sign or symptom would the nurse expect to note?

Peripheral edema

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?

Pernicious anemia

The nurse is caring for a client diagnosed with a hiatal hernia. Which priority nursing action would the nurse include in the care plan for this client?

Place the client in semi-Fowler's position

The nurse is assessing a client diagnosed with acute pancreatitis. The nurse notes grayish-blue discoloration surrounding the client's umbilicus. How would the nurse interpret this assessment finding?

Positive Cullen's sign

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy?

Presence of asterixis

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?

Small bowel resection

The nurse is assessing a client with cholecystitis due to an obstructing cholelithiasis. The nurse notes that the client's stools are foul-smelling and oily. How would the nurse document this finding?

Steatorrhea

A client with ulcerative colitis 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?

This is a normal, expected event.