Med-Surg Exam 2

The nurse cares for a 34-year-old woman after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement?

"A high protein diet that is low in carbohydrates and fat will prevent diarrhea."

The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?

"Herbs and other spices should be used to season my foods instead of salt."

34. Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome?

"How long have you had abdominal pain?"

12. Which information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)?

"It will be helpful to keep the head of your bed elevated on blocks."

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis?

"It would be beneficial for you to eliminate drinking alcohol."

A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement?

"My tongue swells when I eat shrimp.".

The severely obese patient has elected to have the Roux-en-Y gastric bypass (RYGB) procedure. The nurse will know the patient understands the preoperative teaching when the patient makes which statement?

"This surgery decreases how much I can eat and how many calories I can absorb."

26. The nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which patient statement indicates that the teaching has been effective?

"Vitamin supplements may be needed to prevent problems with anemia."

The nurse is teaching a group of college students how to prevent food poisoning. Which comment shows an understanding of foodborne illness protection?

"When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."

A community health nurse is conducting an initial assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome (select all that apply)?

Blood pressure Waist circumference Fasting blood glucose

How will an obstruction at the ampulla of Vater affect the digestion of all nutrients?

Both bile and pancreatic enzymes enter the duodenum at the ampulla of Vater.

The nurse instructs the client about appropriate foods for a high protein diet. The nurse determines teaching is effective if the client chooses which menu?

Broiled fish, cream of tomato soup with grated cheese and custard

The nurse cares for a patient diagnosed with cholelithiasis. It is most important to instruct client to avoid the following foods.(SATA)

Cabbage Cheese Chocolate

What problem should the nurse assess the patient for if the patient was on prolonged antibiotic therapy?

Coagulation problems

When the nurse identifies an individual at risk for malnutrition with nutritional screening, what is the next step for the nurse to take?

Complete a full nutritional assessment.

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient?

Control abdominal pain.

The nurse cares for a client with a Sengstaken-Blackmore tube to treat bleeding esophageal varices. The client suddenly develops respiratory distress. Which action dose the nurse take first?

Cut balloon port on Blackmore tube

Which symptom of liver disease should the nurse expect to see in a client with Laennec's cirrhosis?

Dark urine

The nurse understands the most common reason for insertion of NG tube post-op with a client diagnosed with a duodenal ulcer includes which reason?

Decompress stomach

The nurse assess the elderly clinet at LTC facility. The client tells the nurse, "I have recently developed constipation." It is most important for the nurse to take which action?

Determine the frequency and characteristics of bowel movements

After a gastrectomy for stomach cancer which of the following is the nurse's most important consideration in management of NG tube

Do not irrigate the tube

Which explanation about weight reduction should be included when teaching the obese patient and her obese husband?

Fat is not burned until the glycogen-water pool is depleted.

the school nurse is informed that a sixth grader in the school has been diagnosed with Hep A. It is most important for the nurse to teach the parents of the classmates to observe the children for which symptom?

Fatigue

Which patient has the highest morbidity risk?

Female 5 ft. 10 in. tall, obesity Class III

45. A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? d. Headache

Fever

A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately?

Fever and abdominal pain with peritonitis.

When teaching the older adult about nutritional needs during aging, what does the nurse emphasize?

Fewer calories, but the same or slightly increased amount of protein, are required as one ages.

16. A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

Fistulas can form between the bowel and bladder

A patient who has dysphagia as a consequence of a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into this patient's care?

Flush the tube before and after feedings if the patient's feedings are intermittent.

The patient being admitted has been diagnosed with anorexia nervosa. What clinical manifestations should the nurse expect to see on admission assessment?

Hair loss; dry, yellowish skin; and constipation

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer?

Hepatic structure ultrasound

The nurse identifies which diet best meets the nutritional needs of the client newly diagnosed with cirrhosis

High in protein and carbohydrates

The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient?

High-pitched sounds on abdominal auscultation

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications?

Hydrocodone with acetaminophen (Vicodin)

What may occur with failure of the sodium-potassium pump during severe protein depletion?

Hyperkalemia.

Wich of the following criteria must be met for a diagnosis of metabolic syndrome (select all that apply)?

Hypertension Elevated triglycerides Elevated plasma glucose Increased waist circumference

The nurse prepares the client for a sigmoidoscopy. the nurs should notify the HCP if client makes which statement?

I Hope that this is easier than the barium enema I had 2 days ago

The nurse monitors the laboratory results of the patient with protein-calorie malnutrition during treatment. Which result is an indication of improvement in the patient's condition?

Increased serum transferrin

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?

Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

The home care nurse makes a visit to a client receiving eternal feeding through G tube. The clients daughter reports the client has frequent loose stool. Which statement warrants further investigation?

Its so easy to give liquid meds through the tube

3. A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?

Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

Which area of the abdomen will the nurse palpate to assess for splenomegaly?

Left Upper Quadrant

Priority Decision: When caring for a patient who has had most of the stomach surgically removed, what is important for the nurse to teach the patient?

Lifelong supplementation of cobalamin (vitamin B12) will be needed.

Priority Decision: Following auscultation of the abdomen, what should the nurse's next action be?

Lightly percuss over all four quadrants

Priority Decision: The nurse is teaching a moderately obese woman interventions for the management of obesity. Initially, which strategies will support restricting dietary intake to below energy requirements (select all that apply)?

Limit alcohol Determine portion sizes

54. Which information will the nurse teach a 23-year-old patient with lactose intolerance?

Live-culture yogurt is usually tolerated.

A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider?

Liver edge 3 cm below the costal margin

When planning nutritional interventions for a healthy 83-year-old man, the nurse recognizes what factor is most likely to affect his nutritional status?

Living alone on a fixed income

What is an indication for parenteral nutrition that is not an appropriate indication for enteral tube feedings?

Malabsorption syndrome

The nurse instructs a client how to increase folic acid in diet. The nurse determines teaching is effective if the client makes which statement?

My favorite lunch is spinach salad

31. A patient with a recent 20-pound unintended weight loss is diagnosed with stomach cancer. Which nursing action will be included in the plan of care?

Offer supplemental feedings between meals.

A 58-year-old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?

Offering the patient a drink of water

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication?

Ondansetron

The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition?

Pallor and diaphoresis

Which digestive substances are active or activated in the stomach (select all that apply)?

Pepsin Gastrin

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?

Place the patient in a private room on contact isolation.

A patient has been on a 1000-calorie diet with a daily exercise routine. In 2 months, the patient has lost 20 lb (9kg) toward a goal of 50 lb (23 kg) but is now discouraged that no weight has been lost in the last 2 weeks. What should the nurse tell the patient about this?

Plateaus where no weight is lost normally occur during a weight-loss program.

The nurse recognizes that the majority of patients' caloric needs should come from which source?

Polysaccharides

48. A female patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? d. Assist patient to breathe deeply and cough.

Position patient with the knees flexed.

6. A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?

Prepare the patient for surgery.

What contributes to increased protein-calorie needs?

Surgery

A sexual contact of a patient with Hep B is given HBIg. The nurse explains to the client the purpose of medication is to:

Temporary increase resistance to Hepatitis

The nurse cares for a patient 18 hours after gastrectomy. The nurse is most concerned if which of the following is observed?

The Levin's tube is attached to low continuous suctioning

A client is being taught how to care for an ileostomy appliance. Which should the nurse emphasize as Most important when applying a new bag?

The bag should fit snug

During the initial postoperative period following bariatric surgery, the nurse recognizes the importance of monitoring obese patients for respiratory insufficiency based on what knowledge?

The body stores anesthetics in adipose tissue.

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation?

The chest x-ray showed another lung cancer lesion.

Priority Decision: Before selecting a weight reduction plan with an obese patient, what is most important for the nurse to first assess?

The patient's motivation to lose weight

What characterizes auscultation of the abdomen?

The presence of borborygmi indicates hyper peristalsis.

The nurse preforms a home care visit on a client with a diagnosis of right-sided cerebrovascular accident. the clients spouse complains about having frequent loose stools and the physician diagnosed viral gastroenteritis. The nurse is most concerned with which action?

The spouse prepares lunch for client

The patient had a car accident and was "scared to death." The patient is now reporting constipation. What affecting the gastrointestinal (GI) tract does the nurse know could be contributing to the constipation?

The sympathetic nervous system was activated, so the GI tract was slowed.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)?

Use smallest gauge needle possible when giving injections or drawing blood. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A patient received a small-bore nasogastric (NG) tube after a laryngectomy. What should be the nurse's priority intervention before starting the enteral feeding?

Verify NG tube placement on x-ray.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)?

Vitamin A Vitamin D Vitamin E Vitamin K

17. A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for

abdominal distention

A client hospitalized with ulcerative colitis reports 10-20 small diarrhea stools per day, with abdominal pain before defecation. The client appears depressed and underweight and is uninterested in self-care or suggested therapies. What is the priority nursing dx?

diarrhea r/t irritated bowel

You are caring for a client with an NG tube. Which task can be delegated to an experienced UAP?

disconnect the suction to allow ambulation to toilet.

10. A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about

proton pump inhibitors.

A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include

recommending a heart-healthy diet.

15. A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about

use of nonsteroidal anti-inflammatory drugs (NSAIDs).

The nurse confirms initial placement of a blindly inserted small-bore NG feeding tube by

x-ray.

While transferring a dirty laundry bag, a UAP sustained a puncture wound to the finger from a contaminated needle. The unit has several clients with hepatitis and AIDS; the needle source is unknown. Place in order or priority the instructions that should be given to the UAP.

341265 perform thorough aseptic handwashing. report to the occupational health nurse. have blood test(s) performed per protocol. complete and file an incident. begin prophylactic drug therapy. follow up for results and counseling.

In developing a weight reduction program with a 45-year-old female patient who weighs 197 lb, the nurse encourages the patient to set a weight loss goal of how many pounds in 4 weeks?

4-8

You must rearrange the room assignments for several clients. Which two clients would be best to put in the same room?

43 yo woman who had cholecystectomy 2 days ago 53 yo woman with pain r/t alcohol-associated pancreatitis

after inserting a needle into the ventrogluteal muscle to inject Vit K. which action does the nurse take next?

Administer Vit K slowly

What is the most common cause of secondary protein-calorie malnutrition in the United States?

An alteration in ingestion, digestion, absorption, or metabolism

The nurse understands that the primary reason for maintain a constant rate of infusion with Parenteral Nutrition(PN) is to prevent which complication?

An unstable Blood glucose level

27. A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? a. Soak in sitz baths several times each day. b. Cough 5 times each hour for the next 48 hours. c. Avoid use of acetaminophen (Tylenol) for pain. d.

Apply a scrotal support and ice to reduce swelling.

You are caring for a client with PUD. Which assessment finding is the most serious?

boardlike abdomen with shoulder pain

7. When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient's family that the patient has a history of gastroesophageal reflux disease (GERD). The nurse will plan to do frequent assessments of the patient's

breath sounds

You are caring for a client who was admitted to your med-surg unit for observation after being evaluated in the emergency department for blunt trauma to the abdomen. Which instructions are appropriate to give the UAP?

check VS every hour and report all of the values

39. A 19-year-old female is brought to the emergency department with a knife handle protruding from the abdomen. During the initial assessment of the patient, the nurse should

check for circulation and tissue perfusion..

Nursing management of the patient with acute pancreatitis includes (select all that apply)

checking for signs of hypocalcemia. monitoring for infection, particularly respiratory tract infection.

The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a

choledocholithotomy

You are taking report on an elderly client who was admitting with abdominal pain and nausea, vomiting, and diarrhea. The client also has a hx of chronic dementia. Which comment by the night shift nurse concerns you the most?

client has a fluctuating LOC and mood swings

You are providing postop care for a client who underwent laparoscopic cholecystectomy. What should be reported immediately to the HCP?

client reports RUQ pain

Which client is the most appropriate to assign to an LPN?

client with intermittent N/V r/t chemotherapy

31. The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for

cobalamin (B12) spray or injections.

When caring for a patient with a history of a total gastrectomy, the nurse will monitor for

cobalamin (vitamin B12) deficiency.

30. A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to

collect a stool specimen.enema.

18. The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about

colonoscopy.

Health risks associated with obesity include (select all that apply)

colorectal cancer. polycystic ovary syndrome. nonalcoholic steatohepatitis.

You are preparing to administer TPN through a central line. Place the following steps for administration in the correct order.

confirm the order for TPN prior to administration. check the solution for cloudiness or turbidity. select and flush the correct tubing and filter. thread the IV tubing through an infusion pump. use aseptic technique when handling the injection cap. connect the tubing to the central line. set the infusion pump at the prescribed rate.

22. A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should

document stoma assessment findings.

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to:

parasympathetic stimulation.

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions?

"The medication is a powder and needs to be mixed with milk or juice."

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate?

"An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

30. Which information will be best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease?

"Avoid foods that cause pain after you eat them."

4. A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

"Can you tell me more about the pain?"

The nurse is assessing an alert and independent 78-year-old woman for malnutrition risk. The most appropriate initial question is which of the following?

"Can you tell me the food that you ate yesterday?"

53. The nurse is admitting a 67-year-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask?

"Have you noticed a recent weight loss?"

When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is

"Have you traveled to a foreign country in the last year?"

11. A 62-year-old patient who has been diagnosed with esophageal cancer tells the nurse, "I know that my chances are not very good, but I do not feel ready to die yet." Which response by the nurse is most appropriate?

"Having this new diagnosis must be very hard for you."

6. The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed?

"I eat small meals throughout the day and have a bedtime snack."

The nurse has completed initial instruction with a patient regarding a weight-loss program. Which patient comment indicates to the nurse that the teaching has been effective?

"I plan to join a behavior modification group to help establish long-term behavior changes."

Which statement to the nurse from a patient with jaundice indicates a need for teaching?

"I use acetaminophen (Tylenol) every 4 hours for back pain."

The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient makes which statement?

"I will keep a diary of weekly weights to illustrate my weight loss."

The nurse is caring for a patient who is 5'6" tall and weighs 186 lb. The nurse has discussed reasonable weight loss goals and a low-calorie diet with the patient. Which statement made by the patient indicates a need for further teaching?

"I will limit intake to 500 calories a day."

When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?

"I will need to be checked for chronic HCV and other liver problems."

11. Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?

"I will need to use a sunscreen when I am outdoors."

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?

"If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."

At the first visit to the clinic, the female patient with a BMI of 29 kg/m2 tells the nurse that she does not want to become obese. Which question used for assessing weight issues is the most important question for the nurse to ask?

"In what ways are you interested in managing your weight differently?"

The nurse teaches senior citizens at a community center how to prevent food poisoning at social events. Which community member statement reflects accurate understanding?

"Pasteurized juices and milk are safe to drink."

21. The health care provider orders intravenous (IV) ranitidine (Zantac) for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include?

"Ranitidine decreases secretion of gastric acid."sucralfate (Carafate).

16. Cobalamin injections have been prescribed for a patient with chronic atrophic gastritis. The nurse determines that teaching regarding the injections has been effective when the patient states,

"The cobalamin injections will prevent me from becoming anemic."

The nurse instructs an obese 22-year-old man with a sedentary job about the health benefits of an exercise program. The nurse evaluates that teaching is effective when the patient makes which statement?

"The goal is to walk at least 10,000 steps every day of the week."

25. A 34-year-old female patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups.

2

52. After change-of-shift report, which patient should the nurse assess first?

30-year-old female with a femoral hernia who has abdominal pain and vomiting

44. Which patient should the nurse assess first after receiving change-of-shift report?

30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse administers

5% dextrose solution.

The percentage of daily calories for a healthy individual consists of

50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids.

The nurse is caring for a patient admitted to the hospital for asthma who weighs 186 lb (84.5 kg). During dietary counseling, the patient asks the nurse how much protein he should ingest each day. How many grams of protein does the nurse recommend should be included in the diet based on the patient's current weight?

68

The nurse cares for a client after a traditional cholecystectomy. The nurse contact the HCP if which observation is made?

800 ml bloody drainage 1st day post-op

The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobin (IG) injection?

A caregiver who lives in the same household with the patient

Which patient would be at highest risk for developing oral candidiasis?

A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks

Which patient is at highest risk for developing metabolic syndrome?

A 38-year-old Native American man who has diabetes mellitus and elevated hemoglobin A1C.

Which patient is at highest risk for complications of obesity?

A 56-year-old woman with a BMI of 38 kg/m2, a waist measurement of 38 in (96 cm), and a hip measurement of 36 in (91 cm)

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?

A 72-year-old African American male who has smoked cigarettes for 50 years

2. A patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation is to start oral intake. Which of these should the nurse offer to the patient?

A dish of lemon gelatin

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include?

A lower-fat diet may be better tolerated for several weeks.

37. After receiving change-of-shift report, which patient should the nurse assess first?

A patient with esophageal varices who has a blood pressure of 96/54 mm Hg.

The nurse preforms pre-op teaching for a patient scheduled for a colostomy. The nurse explains to the patient that 24 hours after the surgery the colostomy drainage will be:

A scant amount of bright bloody drainage

The nurse of the surgical unit cares for several clients with new colostomies immediately after surgery. the nurse identifies which stoma is expected?

A stoma is beefy red

What is a normal finding during physical assessment of the mouth?

A thin, white coating of the dorsum of the tongue

After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected?

Drowsiness

Priority Decision: When medications are used in the treatment of obesity, what is most important for the nurse to teach the patient?

Drugs should be used only as adjuncts to a diet and exercise program as treatment for a chronic condition.

the nurse cares for a client post-appendectomy and a full liquid diet is ordered. The nurse determines that the clients breakfast is appropriate if it includes

Dry cereal

The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate?

Dry toast

a patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring?

Dumping syndrome

Checking for the return of the gag reflex and monitoring for LUQ pain, nausea and vomiting are necessary nursing actions after which diagnostic procedure?

ERCP

In preparing to care for the obese patient with cancer, what physiologic problems is this patient at a greater risk for having (select all that apply)?

Sleep apnea Type 2 diabetes mellitus Gastroesophageal reflux disease (GERD)

The nurse is reviewing the laboratory test results for a 71-year-old patient with metastatic lung cancer. The patient was admitted with a diagnosis of malnutrition. The serum albumin level is 4.0 g/dL, and prealbumin is 10 mg/dL. What should this indicate to the nurse?

Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status.

A patient had a stomach resection for stomach cancer. The nurse should teach the patient about the loss of the hormone that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Which hormone will be decreased with a gastric resection?

Gastrin

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit? Temperature over 102o F (38.9o C)

Left upper abdominal pain

Normally, which hormones and peptides affect appetite (select all that apply)?

Leptin Insulin Ghrelin Peptide YY Neuropeptide Y Cholecystokinin

This bariatric surgical procedure involves creating a stoma and gastric pouch that is reversible, and no malabsorption occurs. What surgical procedure is this?

Adjustable gastric banding

The stable patient has a gastrostomy tube for enteral feeding. Which care could the RN delegate to the LPN (select all that apply)?

Administer bolus or continuous feedings. Administer medications through the gastrostomy tube..

1. A patient with deep partial-thickness burns experiences severe pain associated with nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea?

Administer the prescribed morphine sulfate before dressing changes

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

Alcohol abuse

Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?

Absent bowel sounds

When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status?

Absorption

The nurse preforms discharge teaching for a client with Hep B. Which precaution to prevent the transmitting of Hep B is included in the teaching?

Abstain from unprotected sex

The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity?

Acetaminophen (Tylenol)

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy?

Activated partial thromboplastin time (aPTT) of 54 seconds

The nurse monitors for a client recovering from Hep B. The nurse understands this client has developed which type of immunity?

Active acquired

Which statement about obesity is explained by genetics?

Android body shape and weight gain are influenced by genetics.

The home care nurse visits a client with diagnosed with ulcerative colitis. The client reports perineal irritation due to frequent stools. Which suggestions by the nurse is BEST?

Clean peri-area with soap and water after each bowel movement

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used?

Antibiotic(s), proton pump inhibitor, and bismuth

The nurse is caring for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention?

Apply a cool washcloth to the forehead and provide mouth care

7. A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?

Apply an ice pack to the right lower quadrant.

42. Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)?

Applying petroleum jelly to the lips

14. After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all these changes. I don't want to look at the stoma." What is the best action by the nurse?

Ask the patient about the concerns with stoma management

36. A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first?

Ask the patient to describe the character of the stools and any associated symptoms.

A client has a gastroscopy and gastric aspirate taken for analysis. The nurse understands the purpose of gastric aspirate include which reason?

Assess acid secretion and bacterial activity in the stomach

The nurse is caring for a patient after bariatric surgery. What should be included in the plan of care (select all that apply.)?

Assess for incisional pain versus anastomosis leak. Maintain elevation of the head of bed at 35-45 degrees. Monitor for vomiting that is a common complication. Assist with early independent ambulation during hospitalization.

2. A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first?

Assess the patient about risk factors for constipation.

21. A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?

Assess the perineal drainage and incision.

A 68-year-old patient is in the office for a physical. She notes that she no longer has regular bowel movements. Which suggestion by the nurse would be most helpful to the patient?

Attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time.

When assessing a patient's abdomen, what would be most appropriate for the nurse to do?

Auscultate the abdomen before palpation.

What information should be included in the dietary teaching for the patient following a Roux-en-Y gastric bypass?

Avoid sugary foods and limit fluids to prevent dumping syndrome.

Which female patient is most likely to have metabolic syndrome?

BP 142/90 mm Hg, high-density lipoproteins 45 mg/dL, fasting blood glucose 130 mg/dL

The nurse teaches a client who has undergone a laparoscopic cholecystectomy prior to discharge. The nurse should include which instruction?

Begin light exercise immediately

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment?

Cancer-associated antigen 19-9

Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What is the most likely etiology for this abnormal assessment finding?

Candida albicans

A 22-year-old female is admitted with anorexia nervosa and a serum potassium level of 2.4 mEq/L. What complication is most important for the nurse to observe for in this patient?

Cardiac dysrhythmias

A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral nutrition (PN). Which principle should guide the nurse's administration of the patient's nutrition?

Central PN requires rapid dilution in a large volume of blood

9. After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective?

Cherry gelatin and fruit

The nurse is teaching a female patient with type 1 diabetes mellitus about nutrition before discharge. She had surgery to revise a lower leg stump with a skin graft. What food should the nurse teach the patient to eat to best facilitate healing?

Chicken breast

28. Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease?

Corn tortilla with scrambled eggs

49. A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?

Crackles are heard halfway up the posterior chest.

The nurse teaches a 50-year-old woman who has a body mass index (BMI) of 39 kg/m2 about weight loss. Which dietary change would be appropriate for the nurse to recommend to this patient?

Decrease fat intake and control portion sizeintake.

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

Decreased ammonia levels

A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the GI tract by doing what?

Decreasing secretions and peristaltic action

The nurse should recognize that the liver performs which functions (select all that apply)

Detoxification Protein metabolism Steroid metabolism

The nurse instructs the client with a Sigmoid colostomy how to irrigate the colostomy. Which action does the nurse include in the teaching?

Dilate the stoma with gloved finger

40. Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?

Drain and measure the output from the ostomy.

A patient who is scheduled for surgery with general anesthesia in 1 hour is observed with a moist, but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water?

Easily heard, loud gurgling in the right upper quadrant

A malnourished patient has been diagnosed with protein deficiency. Which complications should the nurse anticipate (select all that apply.)?

Edema Anemia Impaired wound healing

Which assessment should the nurse prioritize in the care of a patient who has recently begun receiving parenteral nutrition (PN)?

Electrolyte levels and daily weights

13. A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing action should be included in the postoperative plan of care?

Elevate the head of the bed to at least 30 degrees.

5. A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take?

Encourage the patient to ambulate.

8. Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?

Encourage the patient to express concerns and ask questions about IBS.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient?

Endoscopic biopsy

When preparing a patient for a capsule endoscopy study, what should the nurse do?

Ensure the patient understands the required bowel preparation.

The nurse determines a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? Nausea Belching Difficulty swallowing

Epigastric pain

During assessment of the patient with protein-calorie malnutrition, what should the nurse expect to find (select all that apply)?

Frequent cold symptoms Decreased bowel sounds Cool, rough, dry, scaly skin Prominent bony structures Decreased reflexes and lack of attention

The patient has parenteral nutrition infusing with amino acids and dextrose. In report, the oncoming nurse is told that the tubing, the bag, and the dressing were changed 22 hours ago. What care should the nurse coming on be prepared to do (select all that apply)?

Give the patient insulin. Check amount of feeding left in the bag. Check that the next bag has been ordered. Check the label to ensure ingredients and solution are as ordered.

The home care nurse visits a client diagnosed with diverticulitis. The HCP orders a clear liquid diet and the nurse instructs the family about the appropriate foods. The nurse should intervene if the clients family states:

Grandpa can have his daily glass of prune juice.

Priority Decision: The nurse is caring for a patient receiving 1000 mL of parenteral nutrition solution over 24 hours. When it is time to change the solution, 150 mL remain in the bottle. What is the most appropriate action by the nurse?

Hang the new solution and discard the unused solution.

A patient has a sliding hiatal hernia. What nursing intervention will reduce the symptoms of heartburn and dyspepsia?

Having the patient eat 4 to 6 smaller meals each day

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse will determine the medication was effective when which symptom has been resolved?

Heartburn

Priority Decision: The nurse admitting a patient for bariatric surgery obtains the following information from the patient. Which finding should be brought to the surgeon's attention before proceeding with further patient preparation?

History of untreated depression

A client with end-stage liver disease is talking to you about being on transplant list. Which statement by the client concerns you the most?

I am going to cut down on my drinking very soon

The nurse assesses a client in the outpatient with a diagnosis of rule out ulcerterive colitis. during the history the nurse expects the client to make which statement?

I feel an Intermittent cramping in my lower abdomen

The nurse obtains a history from a patient suspected of duodenal ulcer. The nurse expects which statement?

I have abdominal pain and tenderness

The nurse obtains a history from a client suspected of having cirrhosis. Which statement, if made by the client to the nurse, should the nurse recognize as most directly related to a clients development of cirrhosis?

I have been drinking a 5th of vodka a day for the last few months

The nurse in the same day surgery prepares a client for discharge after conventional herriorrhaphy. The nurse should intervene if the client makes which statement?

I should cough and deep breath q2hrs

The nurse is caring for a client with a NG with eternal feeding. The HCP orders isosorbide 2.5 sublingual as need for chest pain. The nurse instructs the clients spouse about correct administration of medication. The nurse determines the teaching is effective if the clients spouse makes which statement?

I should place tab under tongue

The home care nurse visits a client diagnosed with Hepatitis. It is most important for the nurse to intervene if the client makes which statement?

I take acetaminophen when I get a headache

The nurse cares for a patient after the HCP performs a sigmoid colostomy due to cancer. The nurse instructs the patient about how to care for the stoma. The nurse knows that teaching was successful if the patient states:

I will clean the stoma with soap and water and pat dry

The nurse instructs the client about the bowel preparation required before a sigmoidoscopy. the nurse identifies teaching is successful if the client makes which statement?

I will have an enema in morning of test

The nurse instructs a client about how to increase calories in diet. The nurse determines teaching is effective if the client makes which statement?

I will snack frequently on nuts and dried fruit

You are caring for a client with cirrhosis and portal HTN. Which statement by the client concerns you the most?

I'm very constipated and have been straining during BMs

The nurse cares for a client in the outpatient clinic. The nurse obtains history on a client reporting diarrhea. It is most important for the nurse to follow up on which statement?

I've been taking cephalexin for the last week

47. A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first?

Manually remove the impacted stool.

The nurse cares for a patient after an appendectomy the day after surgery. The patient has severe abdominal pain, temp 101F and rigid abdomen. The nurse suspects that the patient is experiencing:

Infection of the peritoneal sac

37. A 45-year-old patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120, respirations 32, and blood pressure (BP) 82/54. Which prescribed intervention should the nurse implement first?

Infuse 1 liter of lactated Ringer's solution over 30 minutes

40. All of the following orders are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first?

Infuse 1000 mL of lactated Ringer's solution.

35. A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first?

Infuse metronidazole (Flagyl) 500 mg IV.

36. The health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order will the nurse implement first?

Infuse normal saline at 250 mL/hr.

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?

Insert an NG and maintain NPO status to allow pancreas to rest.

To prepare a client for parenthesis it is essential for the nurse to take which action?

Instruct to empty bladder

What is the main underlying risk factor for metabolic syndrome?

Insulin resistance

1. Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)?

Many over-the-counter (OTC) medications can cause constipation. Bulk-forming laxatives are an excellent source of fiber. Walking or cycling frequently will help bowel motility. A good time for a bowel movement may be after breakfast.

The nurse on the surgical unit cares for a patient after an ileostomy. Which of the following actions should the nurse take first?

Measure and record output

To evaluate the effect of nutritional interventions for a patient with protein-calorie malnutrition, what is the best indicator for the nurse to use?

Mid-upper arm circumference and triceps skinfold

patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge?

Milk thistle may affect liver enzymes and thus alter drug metabolism.

Which nursing actions are indicated for a liver biopsy (select all that apply)?

Monitor for internal bleeding Position to right side after test Check coagulation status before test

10. Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

Monitor stools for blood.

The nurse cares for the client diagnosed with acute cholecystitis. .The client states, "My stomach hurts all the way up to my right shoulder, I am nauseated and have vomited twice." Which order should the nurse carry out first?

Morphine IM 15mg q 4hrs PRN

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit?

NG will have bloody drainage and it should not be repositioned.

51. Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?

Navy bean soup and vegetable salad

13. Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?

Oatmeal with cream

A frail 74-year-old man with recent severe weight loss is instructed to eat a high-protein, high-calorie diet at home. If the man likes all of the items below, which would be the most appropriate for the nurse to suggest?

Oatmeal, butter, and cream

Which statement best describes the etiology of obesity?

Obesity is the result of complex interactions between genetic and environmental factors.

What is a normal finding on physical examination of the abdomen?

Observation of visible pulsations

18. A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking?

Obtain a stool specimen for culture.

24. A patient with a peptic ulcer who has a nasogastric (NG) tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next?

Obtain the vital signs.

A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution?

Omeprazole

Immediately following a liver biopsy, the nurse places the client in which position?

On The right side

A 50-year-old African American woman has a BMI of 35 kg/m2, type 2 diabetes mellitus, hypercholesterolemia, and irritable bowel syndrome (IBS). She is seeking assistance in losing weight, because, "I have trouble stopping eating when I should, but I do not want to have bariatric surgery." Which drug therapy should the nurse question if it is prescribed for this patient?

Orlistat (Xenical)

The nurse gives discharge instructions to a family of a client diagnosed with Hepatic encephalopathy. The nurse determines further teaching is necessary if the family makes which statement?

Our parent should eat meat at every meal

The nurse is caring for a 45-year-old woman with a herniated lumbar disc. The patient realizes that weight loss is necessary to lessen back strain. The patient is 5'6" tall and weighs 186 lb (84.5 kg) with a body mass index (BMI) of 28 kg/m2. The nurse explains to the patient that this measurement places her in which of the following weight categories?

Overweight

In the immediate postoperative period a nurse cares for a severely obese 72-year-old man who had surgery for repair of a lower leg fracture. Which assessment would be most important for the nurse to make?

Oxygen saturation

A patient is admitted to the hospital with left upper quadrant (LUQ) pain. What may be a possible source of the pain?

Pancreas

The nurse understands which of the following is principal purpose for the use of enzyme inhibitors (Diamox) in a patient with pancreatitis

Pancreatic enzymes escape into interstitial space

The spouse of a client with Hep B is given Hep B immunoglobulin (HBIg). The nurse understands this offers which type of protection ?

Passive acquired

The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem?

Peritoneal inflammation

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first?

Place the patient on NPO status.

43. After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?

Place the patient on contact precautions.

Priority Decision: During care of the severely obese patient, what is most important for the nurse to do?

Plan for necessary modifications in equipment and nursing techniques before initiating care.

A patient who is unable to swallow because of progressive amyotrophic lateral sclerosis is prescribed enteral nutrition through a newly placed gastrostomy tube. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

Position the patient with a 45-degree head of bed elevation.

After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladder. What is the mechanism responsible for this action?

Production of cholecystokinin by the duodenum

A patient with a history of peptic ulcer disease has presented to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate?

Providing IV fluids and inserting a nasogastric (NG) tube

What is a postoperative nursing intervention for the obese patient who has undergone bariatric surgery?

Providing adequate support to the incision during coughing, deep breathing, and turning

The nurse understands with of the following is the MOST likely source of Hep D?

Receiving a blood transfusion

What is a clinical manifestation of age-related changes in the GI system that the nurse may find in an older patient?

Reflux of gastric contents into the esophagus

After administration of a dose of metoclopramide, which patient assessment finding would show the medication was effective?

Relief of nausea and vomiting

The HCP orders a clear liquid diet for a patient after an appendectomy. The nurse explains to the patient a clear liquid diet ordered for which reason?

Relieve thirst and maintain fluid balance

After cholecystectomy a patient is returned to the unit with a NG tube connected to low intermittent suction, IV of D5W, T-Tube and Penrose drain. the nurse understands that the purpose of the Penrose drain is:

Remove accumulated bile and blood after surgery.

Priority Decision: Before administering a bolus of intermittent tube feeding to a patient with a percutaneous endoscopic gastrostomy (PEG), the nurse aspirates 220 mL of gastric contents. How should the nurse respond?

Return the aspirate to the stomach and continue with tube feeding as planned.

The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen?

Right upper quadrant

A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

Rigid abdomen and vomiting following indigestion

Priority Decision: An 18-year-old female patient with anorexia nervosa is admitted to the hospital for treatment. On admission she weighs 82 lb (37 kg) and is 5 ft. 3 in (134.6 cm). Her laboratory test results include the following: K+ 2.8 mEq/L (2.8 mmol/L), Hgb 8.9 g/dL (89 g/L), and BUN 64 mg/dL (22.8 mmol/L). In planning care for the patient, the nurse gives the highest priority to which of the following nursing diagnoses?

Risk for decreased cardiac output (CO) related to dysrhythmias resulting from hypokalemia

A client is scheduled for bowel surgery and the HCP orders a low-residual diet as part of the bowel preparation. The nurse instructs the client about foods allowed on Low-residual diet. The nurse determines teaching is effective if:

Roasted lamb, buttered rice and sponge cake

A 40-year-old severely obese female patient with type 2 diabetes wants to lose weight. After learning about the surgical procedures, she thinks a combination of restrictive and malabsorptive surgery would be best. Which procedure should the nurse teach her about?

Roux-en-Y gastric bypass

32. The nurse is assessing a 31-year-old female patient with abdominal pain. Th nurse,who notes that there is ecchymosis around the area of umbilicus, will document this finding as

Rovsing sign.

50. A new 19-year-old male patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?

Schedule the patient for yearly colonoscopy.

The nurse cares for a patient after a traditional cholecystectomy. It is most important for the nurse to position the patient in which position?

Semi-fowlers

55. Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question?

Senna (Senokot) 1 tablet every day

the clinic nurse monitors a client recovering for Hep D. the nurse understands which of the following indicates recovery from the illness?

Serum Aspirate Aminotransferase

The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis?

Serum amylase

An older patient was admitted with a fractured hip after being found on the floor of her home. She was extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding would be of most concern to the nurse?

Serum phosphate level of 1.9 mg/dL

The nurse is evaluating the nutritional status of a 55-year-old man who is undergoing radiation treatment for oropharyngeal cancer. Which laboratory test would be the best indicator to determine if the patient has protein-calorie malnutrition?

Serum prealbumin

Which patient has the highest risk for poor nutritional balance related to decreased ingestion?

Severe anorexia resulting from radiation therapy

The nurse is providing care for a 23-year-old woman who is a strict vegetarian. To prevent the consequences of iron deficiency, what should the nurse recommend?

Soybeans and hot breakfast cereal

The Nurse cares for a client with a NG tube in place. The client reports discomfort in back of throat. Which action by the nurse is BEST?

Spray with viscous Lidocaine solution

What characteristics describe adjustable gastric banding (select all that apply)?

Stomach restriction can be reversed. Inflatable band allows for modification of gastric stoma size.

Which teaching points are important when providing information to a patient with metabolic syndrome (select all that apply)?

Stop smoking. Increase level of activity. Decrease saturated fat intake. Reduce weight and maintain lower weight.

Which statement accurately describes vitamin deficiencies?

Surgery on the GI tract may contribute to vitamin deficiencies because of impaired absorption. manifestations.

29. A 62-year-old patient has had a hemorrhoidectomy at an outpatient surgical center. Which instructions will the nurse include in discharge teaching?

Take prescribed pain medications before a bowel movement is expected.

39. A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse perform first?

Taking the blood pressure (BP) and pulse

33. Which assessment finding in a patient who had a total gastrectomy 12 hours previously is most important to report to the health care provider?

Temperature 102.1° F (38.9° C)

The nurse cares for a client admitted with diagnosis of acute pancreatitis. An IV is begun and the nurse inserts NG tube and attaches to low suction. The nurse gives frequent oral hygiene and administration of morphine for reports of pain. Which client behavior indicates the med has been effective?

The client sleeps for 1hr

the nurse instructs the family of a patient diagnosed with Hepatis A how to prevent the spread of the disease. It is most important for the nurse to include which instruction

The family should not share eating utensils and drinking glasses.

The nurse cares for an elderly client admitted with diagnosis of Hep A. The client is anorexic, reports weakness, is incontinent stool and urine. The nurse determines that care is appropriate if which observation is made?

The nurse put patient on contact precautions

A 54-year-old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?

The oral temperature is 101.6° F.

A 42-year-old woman is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?

The patient ate a low-fat bagel 4 hours ago for breakfast.

38. Which of these assessment findings in a patient with a hiatal hernia who returned from a laparoscopic Nissen fundoplication 4 hours ago is most important for the nurse to address immediately?

The patient has absent breath sounds throughout the left lung.

41. Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the health care provider?

The patient has noticed blood in the stools.

34. Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

The patient is lethargic and difficult to arouse.

The nurse receives the following information about a 51-year-old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?

The patient refused to drink the ordered polyethylene glycol (GoLYTELY).

12. A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

The patient uses witch hazel compresses to decrease irritation.

19. The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include?

The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively.

41. A patient with acute gastrointestinal (GI) bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which assessment finding obtained by the nurse is most important to communicate immediately to the health care provider?

The patient's lungs have crackles audible to the midline.

In developing an effective weight reduction plan for an overweight patient who states a willingness to try to lose weight, it is most important for the nurse to first assess which factor?

The patient's social, emotional, and behavioral influences on obesity

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)?

There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.

When considering tube feedings for a patient with severe protein-calorie malnutrition, what is an advantage of a gastrostomy tube versus a nasogastric (NG) tube?

There is less irritation to the nasal and esophageal mucosa.

46. A 33-year-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching?

This type of colostomy is usually temporary.

A patient's serum liver enzyme tests reveal an elevated aspartate aminotransferase (AST). The nurse recognizes what about the elevated AST?

Tissue damage in organs other than the liver may be identified.

A patient complaining of nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report?

Tremors

The nurse evaluates that patient teaching about a high-calorie, high-protien diet has been effective when the patient selects which breakfast option from the hospital menu? a.

Two poached eggs, hash brown potatoes, and whole milk half grapefruit, and a high-protein milkshake

Which information about an 80-year-old man at the senior center is of most concern to the nurse?

Unintended weight loss

33. A 54-year-old critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence?

Use a fecal management system

23. Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

Use care when eating high-fiber foods to avoid obstruction of the ileum.

The patient cannot afford to buy the food she needs for her family, so she makes sure her children eat first, and then she eats. When she comes to the clinic, she reports bleeding gums, loose teeth, and dry, itchy skin. The nurse should know that this patient is most likely lacking which vitamin? d. Vitamin K

Vitamin C

The nurse cares for a client with a diagnosis of Ulcerative colitis. When reviewing the clients record the nurse expects to find which lab value?

WBC 15000

The nurse in the outpatient is counseling a patient diagnosed with choleycstis. the nurse determines teaching is successful if the client makes which of the following statements?

We eat a lot of broiled fish and chicken

A patient with oral cancer is not eating. A small-bore feeding tube was inserted and the patient started on enteral feedings. Which patient goal would indicate improvement?

Weight gain of 1 kg in 1 week

A 90-year-old healthy man is suffering from dysphagia. The nurse explains what age-related change of the GI tract is the most likely cause of his difficulty?

Xerostomia

An 85-year-old woman seen in the primary care provider's office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause

Xerostomia

When teaching a patient about weight reduction diets, the nurse teaches the patient that an appropriate single serving of a food is

a chicken breast the size of a deck of cards.

A client had exploratory laparotomy 2 days ago. The HCP should be called ASAP for which finding?

abdominal distention and rigidity

26. The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to

administer IV fluids.

A 62- year-old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation

after eating breakfast.

17. A patient with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the patient about

amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec).

The obesity classification that is most often associated with cardiovascular health problems is

android fat distribution.

29. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take

antacids after eating and sucralfate 30 minutes before eating.

For clients coming to the ambulatory care GI clinic, which task would be most appropriate to assign to an LPN?

assist HCP in incision and drainage of pilonidal cyst

The postop care of a morbidly obese client is being planned. Which task best utilizes the expertise of the LPN?

assist in the planning of toileting, turning, ambulation

You are planning a tx and prevention program for chronic fecal incontinence for an elderly client. Which intervention should you try first?

assist the client to the bedpan or toilet 30 minutes after meals

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that:

bilirubin is not being conjugated and excreted into the bile by the liver.

A patient is jaundiced and her stools are clay colored (gray). This is most likely related to:

decreased bile flow into the intestine.

9. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to.

discontinue the patient's oral food intake.

Place the steps for performing colostomy care in the correct order.

don a pair of clean gloves and remove old pouch. assess color and appearance of stoma. wash skin with mild soap and rinse with warm water. dry skin carefully. apply skin barrier to protect peristomal skin. fit pouch snugly around stoma.

You are providing immediate postop care for a client who had a fundoplication to reinforce the lower esophageal sphincter for the purpose of a hiatal hernia repair. What is the priority action for the care of this client?

elevate HOB at least 30

In the care of a client with acute viral hepatitis, which task should be delegated to the UAP?

emptying the bedpan while wearing gloves

14. The nurse will plan to teach the patient with newly diagnosed achalasia that

endoscopic procedures may be used for treatment.

19. A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for

endoscopy

In planning care for a patient with metastatic liver cancer, the nurse should include interventions that

focus primarily on symptomatic and comfort measures.

The best nutritional therapy plan for a person who is obese is

foods from the basic food groups.

You would be most concerned about an order for TPN fat emulsion for a client with which condition?

fractured femur

You are supervising a nursing student who is caring for a client who had a cholecystectomy. There is a T-tube in place. You would intervene if the student performs which action?

gently aspirates drainage from tube

A patient asks the nurse about taking phentermine and topiramate (Qsymia) for weight loss. To avoid side effects, it is important for the nurse to determine whether the patient has a history of

glaucoma.

During starvation, the order in which the body obtains substrate for energy is

glycogen, skeletal protein, fat stores, visceral protein

24. The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient

hangs the irrigating container 18 inches above the stoma.

An 80-year-old man states that, although be adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult decreased.

has a loss of taste buds, especially for sweet and salty.

You are taking an initial hx for a client seeking surgical treatment for obesity. Which finding should be called to the attention of the surgeon before proceeding with additional hx taking or physical?

hx of counseling for body dysmoprhic disorder

A patient with anorexia nervosa shows signs of malnutrition. During initial referring, the nurse carefully assesses the patient for

hypophosphatemia.

22. The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will

inhibit the development of stress ulcers

The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that

laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic..

27. A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to

lie down for about 30 minutes after eating.

During an examination of the abdomen the nurse should

listen in the epigastrium and all four quadrants for 2 minutes for bowel sounds.

A severely obese patient has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient

may have only liquids orally, and in very limited amounts, during the postoperative period.

15. A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about

medication use

Clients who are undernourished or starved for prolonged periods are at risk for refeeding syndrome when nourishment is first given. What is the priority nursing assessment to prevent complications associated with this?

monitor for peripheral edema, crackles in lungs, JVD

20. A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to

monitor the tumor status after surgery.

A normal physical assessment finding of the GI system is/are (select all that apply)

nonpalpable liver and spleen. tympany on percussion of the abdomen.

25. Twelve hours after undergoing a gastroduodenostomy (Billroth I), a patient complains of increasing abdominal pain. The patient has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The most appropriate action by the nurse at this time is to

notify the surgeon.

A woman is 5 ft, 6 in (166 cm) tall and weighs 200 lb (90.9 kg) with a waist-to-hip ratio of 0.7. The nurse counsels the patient with the knowledge that the patient is at greatest risk for

osteoporosis.

You are caring for a client who was admitted for advanced cirrhosis. The client has massive ascites, peripheral dependent edema in the lower extremities, nausea and vomiting, and dyspnea r/t pressure on diaphragm. For the nursing dx of FVE, which indicator is the most reliable for tacking fluid retention?

performing daily weights with same amount of clothing

23. A patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse

periodically aspirates and tests gastric pH

After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should

place the patient on the right side with the bed flat.

To palpate the liver during a head-to-toe physical assessment, the nurse

places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin.

The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that

portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.

A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that

pruritus is a common problem with jaundice in this phase.

You are teaching the client and family how to perform colostomy irrigation. Place the following info in the correct order.

put on a pair of clean gloves. put 500-1000 mL of lukewarm water in the container. hang the container at about shoulder height. lubricate the stoma cone and gently insert the tubing tip into the stoma. allow the solution to flow slowly and steadily for 5-10 minutes. allow 15-20 minutes for the initial evacuation. clip the irrigation sleeve and have the client walk for 30-45 minutes for secondary evacuation. clean, rinse, and dry the skin, apply a new drainage pouch

When a client is being prepared for a colonoscopy procedure, which task is most suitable to delegate to a UAP?

reinforce the NPO status 8 hours before procedure

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the

release of bicarbonate by the pancreas.acid in the chyme.

In the care of client with GERD, which task would be appropriate to assign to a UAP?

remind client not to lie down for 2-3 h after eating

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves

removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum

Teaching in relation to home management after a laparoscopic cholecystectomy should include

reporting any bile-colored drainage or pus from any incision.

A complete nutritional assessment including anthropometric measurements is important for the patient who

reports an unintentional weight loss of 10 lb in 2 months.

38. Four hours after a bowel resection, a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to

reposition the tube and check for placement.

While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about

risk for developing colorectal cancer.

In preparing a patient for a colonoscopy, the nurse explains that

sedation may be used during the procedure.

The nurse reviews the records of a client diagnosed with Laennec's cirrhosis. The nurse expects to find which lab value?

serum Alanine amino transaminase (ALT,SGPT) 600

A client with proctitis needs a rectal suppository. A senior nursing student assigned to care for the client tells you that she is afraid to insert a suppository because she has never done it before. What is the most appropriate action in supervising this student?

show the student to insert the suppository and talk to the instructor

32. When counseling a patient with a family history of stomach cancer about ways to decrease risk for developing stomach cancer, the nurse will teach the patient to avoid d. emotionally or physically stressful situations.

smoked foods such as bacon and ham.

You are caring for an obese postop client who had surgery for bowel resection. As the client is moving in bed, he comments, "Something popped open." Upon examination, you note wound evisceration. Place the steps for handling this complication in order.

stay calm and stay with client. put client into semi-Fowler position with knees slightly flexed. check VS, especially BP and pulse. have colleague gather sterile supplies and contact HCP. cover intestine with sterile moistened gauze. prepare client for surgery as ordered.

The nurse will plan to monitor a patient with an obstructed common bile duct for

steatorrhea.

You are caring for a client who was recently admitted for severe diverticulitis. Which task is appropriate to delegate for the care of this client?

tell the UAP that a stool specimen must be saved to test for occult blood

A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about

the benefits of misoprostol (Cytotec) in protecting the gastrointestinal (GI) mucosa.

8. A patient with recurring heartburn receives a new prescription for esomeprazole (Nexium). In teaching the patient about this medication, the nurse explains that this drug

treats gastroesophageal reflux disease by decreasing stomach acid production.

A patient with acute hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to

use a condom during sexual intercourse