NCLEX GI- MS exam 2
A client is admitted with a bowel obstruction. The client has nausea, vomiting, and crampy abdominal pain. The physician has written the following prescriptions: for the client to be up ad lib, have narcotics for pain, and have a NG tube inserted if needed, and for IV Ringer's lactate and hyperalimentation fluids. The nurse should do the following in order of priority from FIRST to LAST:
1. Assist with ambulation to promote peristalsis 2. Administer IV Ringer's lactate 3. Insert a NG 4. Start an infusion of hyperalimentation fluids
Which of the following should be a priority focus of care for a client experiencing an exacerbation of Crohn's disease?
Promoting bowel rest
Which of the following would be an expected outcome for a client with PUD? The client will:
Explain the rationale for eliminating alcohol from the diet
The nurse instructs the client on health maintenance activities to help control symptoms from a hiatal hernia. Which of the following statements would indicate that the client has understood the instructions?
"I'll avoid lying down after a meal"
A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse should tell the client:
"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding"
Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living?
Eliminating smoking and alcohol use
A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which of the following factors is most likely of greatest significance in causing an exacerbation of ulcerative colitis?
A demanding and stressful job
The nurse should instruct the client with an ileostomy to report which of the following immediately?
Absence of drainage from the ileostomy for 6 or more hours
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?
It is best for me to take my antacid 1 to 3 hours after meals"
The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the client should eat which of the following?
Any foods that are tolerated
Which of the following nursing interventions would MOST likely promote self-care behaviors in the client with hiatal hernia?
Ask the client to identify other situations in which the client changed health care habits.
The client with GERD has a chronic cough. This symptom may be indicative of which of the following?
Aspiration of gastric contents
The client with an intestinal obstruction continues to have acute pain even though the nasogastric tube is patent and draining. Which action by the nurse would be MOST appropriate?
Assess the client for a rigid abdomen -pain may be indicative of peritonitis
client with ulcerative colitis is to take sulfasalazine (Azulfidine). Which of the following instructions should the nurse provide for the client about taking this medication at home? Select all that apply:
Avoid activities that require alertness -Drink enough fluids to maintain a urine output of at least 1,200 to 1,500 mL/day. -Discontinue therapy is symptoms of acute intolerance develop and notify the health care provider
Following the acute stage of diverticulosis, which foods should the nurse encourage a client to incorporate into the diet? Select all that apply:
Bran cereal 2. Broccoli navy beans
A nurse is providing wound care to a client 1 day following an appendectomy. A drain was inserted into the incisional site during surgery. Which action should the nurse perform when providing wound care?
Clean the area around the drain moving away from the drain
Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing GERD?
Do not lie down for 2 hours after eating
The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms?
Heartburn
After instructing a client with diverticulosis about appropriate self-care activities, which of the following client comments indicate effective teaching? Select all that apply:
I should follow a diet that's high in fiber"4. "It is important for me to drink at least 2,000 mL of fluid every day"5. "I should exercise regularly"
A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate in the home care plan?
Incorporate periods of physical and mental rest in the daily schedule
The physician prescribes metoclopramide hydrochloride for the client with hiatal hernia. This drug is used in hiatal hernia therapy to accomplish which of the following objectives?
Increase tone of the esophageal sphincter
A client with peptic ulcer disease (PUD) is taking ranitidine. What is the expected outcome of this drug?
Limit gastric acid secretions
Immediately after having surgery to create an ileostomy, which goal has the HIGHEST priority?
Maintaining fluid and electrolyte balance
A client with diverticulitis has developed peritonitis following diverticular rupture. When assessing the client, the nurse should do which of the following? Select all that apply.
Monitor the VS for fever, tachypnea, and bradycardia 4. Assess presence of polyphagia and polydipsia 5. Auscultate bowel sound to note frequency
A client with PUD reports being nauseated most of the day and now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be MOST appropriate for the nurse to take? Select all that apply.
Monitoring the client's VS 3. Notifying the physician of the client's symptoms
Absence of drainage from the ileostomy for 6 or more hours
Notify the physician - there may be an obstruction
A client with a peptic ulcer reports epigastric pain that frequently causes the client to wake up during the night. The nurse should instruct the client to do which activities?
Obtain adequate rest to reduce stimulation 2. Eat small, frequent meals throughout the day 3. Take all medications on time as prescribed 4. Sit up for 1 hour when awakened at night
The nurse is admitting a client with acute appendicitis to the ED. The client has abdominal pain of 10 on a pain scale of 0 - 10. The client will be going to surgery as soon as possible. The nurse should:
Place the client on nothing-by- mouth (NPO) statu
The nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for which of the following? Select all that apply.
Projectile vomiting Rapid onset of dehydration Increased bowel sounds
A client with Crohn's disease has concentrated urine: decreased urinary output; dry skin with decreased turgor; hypotension; and weak, thready pulses. The nurse should do which of the following FIRST?
Provide parenteral rehydration therapy prescribed by the physician
what should the nurse teach a client about how to avoid the dumping syndrome? Select all that apply.
Reduce fluids with meals, but take them between meals 4. Obtain adequate amounts of protein and fat in each meal 5. Eat in a relaxing environment
The client is scheduled to have an upper GI tract series of x-rays. Following the x-rays, the nurse should instruct the client to:
Take a laxative
The nurse is caring for a client who has had a gastroscopy. Which of the following may indicate that the client is developing a complication r/t the procedure?
The client has a temperature of 100 F (37.8 C) The client experiences hematemesis The client has epigastric pain
A client has been taking aluminum hydroxide 30 mL six times per day at home to treat a peptic ulcer. The client has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the MOST likely cause of the client's constipation?
The client is experiencing an adverse effect of the aluminum hydroxide
A client who has ulcerative colitis has persistent diarrhea, and has lost 12 lb (5.4 kg) since the exacerbation of the disease. Which of the following will be most effective in helping the client meet nutritional needs?
Total parenteral nutrition (TPN)
When obtaining a nursing history from a client with a suspected gastric ulcer, which S&S should the nurse assess? Select all that apply.
Vomiting 4. Weight loss 5. Melena
A client is to take one daily dose of ranitidine (zantac) at home to treat a peptic ulcer. The client understands proper drug administration of ranitidine when the client will take the drug at which of the following times?
bedtime
The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in .....
board like abdominal rigidity, usually with extreme pain.
Which of the following lab findings are expected when the client has diverticulitis?
elevated WBC
client has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting longer than 1 week. The nurse should assess the client for which of the following complications?
hypokalemia, hyponatremia and FVD
A sudden spike in temperature following an endoscopic procedure may indicate.
perforation of the GI tract
A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these findings, the nurse should further assess the client for which of the following complications?
peritonitis
The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse would be MOST accurate?
"Hiatal hernia symptoms can usually be successfully managed with diet modifications"
