NURS 321 Exam #1
The nurse recognizes the prevention of which complication as the primary rationale for initiating total parenteral nutrition at a slow rate? A. Infection B. Hyperglycemia C. Discomfort D. Air embolism
B. Hyperglycemia
In preparing a patient for esophageal manometry, which content does the nurse include in preprocedure teaching? A. This test measures the acid content in your stomach. B. This test measures the pressure and action of the esophagus. C. This test allows a sample of the esophagus to be obtained. D. This test is used only in patients with diagnosed hiatal hernia
B. This test measures the pressure and action of the esophagus.
The nurse correlates which clinical manifestation as a normal age-related variant in an older adult? A. Diarrhea B. Melena C. Constipation D. Anorexia
C. Constipation
Patients experiencing diarrhea are at risk for which alteration in absorption? A. Decreased chyme absorption B. Increased chyme absorption C. Decreased potassium absorption D. Increased potassium absorption
C. Decreased potassium absorption
The nurse correlates a disorder of which type of cell in the patient with vitamin B12 deficiency? A. Mucous cells B. Chief cells C. Parietal cells D. Enteroendocrine cells
C. Parietal cells
Which statement by the patient scheduled for an EGD indicates the need for further teaching? A. "I will not be able to eat 8 to 10 hours before the test." B. "My throat will be anesthetized so the provider can pass the tube." C. "I will probably have a sore throat after the test." D. "It is important that I eat extra fiber after the test."
D. "It is important that I eat extra fiber after the test."
On the basis of the assessment findings of the case study, which requires immediate follow-up by the registered nurse? A. Reported bowel movement several days ago B. Missed dose of lisinopril C. Hypoactive bowel sounds present in all quadrants D. BP 130/80 mm Hg, standing 100/60 mm Hg
D. BP 130/80 mm Hg, standing 100/60 mm Hg Rationale: The decrease in blood pressure when changing from a supine to standing position is indicative of decreased intravascular system that requires immediate evaluation due to the patient's complaints of lightheadedness when changing position.
The nurse monitors for which complication in the patient who has undergone a barium swallow test? A. Fluid overload B. Dehydration C. Diarrhea D. Constipation
D. Constipation
What are common clinical findings associated with the presence of gastroesophageal reflux disease? Select all that apply. a. Dental caries b. Odynophagia c. Hoarseness throughout the day but worse in the evening d. Bronchitis e. Pelvic pain
a and d
The nurse is caring for a client who has peptic ulcer disease. Which abnormal labs may be related to the condition? Select all that apply. a. Anemia b. Metabolic acidosis c. Elevated liver enzymes d. Elevated pancreatic enzymes e. H. pylori
a and e
The nurse is creating a plan of care for a patient with peptic ulcer disease. What is important to include? Select all that apply. a. Advise the patient to refrain from caffeine intake. b. Advise the patient to limit the use of aspirin. c. Advise the patient to limit bedtime snacks. d. Administer antacids 1 hour before meals. e. Administer proton pump inhibitors (PPIs) before breakfast.
a and e Rationale: The patient should not simply limit use of aspirin or bedtime snacks; they should eliminate use completely. Antacids should be administered 1-3 hours after meals.
A nurse is providing discharge teaching to a client who will be receiving TPN at home. Which of the following instructions should the nurse include? (SATA) a. "Keep the TPN refrigerated when not in use" b. "Infuse 10% dextrose and water if the solution runs out" c. "Shake the TPN bag with fat emulsion if precipitate is present" d. "Stop using TPN once weight gain is achieved" e. "Maintain TPN infusion rate when behind schedule"
a, b, and e
Which is most appropriate to advise a patient with reports of heartburn, belching, and a feeling of suffocation? Select all that apply. a. Advising the patient to avoid spicy foods b. Advising the patient to wear loose clothing c. Encouraging the patient to perform oral hygiene d. Advising the patient to maintain ideal body weight e. Advising the patient to lie on the left side after eating
a, b, and e
Which complications are associated with untreated peptic ulcer disease? Select all that apply. a. Inflammation b. Perforation c. Peritonitis d. Localized abcess e. Vomiting
a, b, c, and d
Which foods should be avoided in a client who has already been diagnosed with gastroesophageal reflux disease? Select all that apply. a. Chocolate b. Beer c. Caffeinated coffee d. Peppermint gum e. Broth or consommé
a, b, c, and d
The nurse asks a client with gastric ulcers to describe his symptoms. Which symptoms should the nurse anticipate? Select all that apply. a. Burning pain aggravated by eating b. Midline epigastric pain c. Pain radiation to the right shoulder d. Worse pain when lying flat e. Exacerbation and remission of symptoms
a, b, c, and e
What foods should a patient with a history of a hiatal hernia avoid? Select all that apply. a. Alcohol b. Carbonated beverages c. Citrus foods or drinks d. High fiber foods e. Tomatoes
a, b, c, and e
Which of these symptoms would the nurse expect to find in a client with gastroesophageal reflux disease? Select all that apply. a. Atypical chest pain b. Sleep issues c. Adult-onset asthma d. Elevated temperature e. Laryngitis
a, b, c, and e
Which subjective and objective data support the order for fecal occult blood testing? (Select all that apply.) a. Reports of stool darker than usual b. Reports of feeling tired and complaints of lightheadedness when moving from a sitting to a standing position c. Clopidogrel (Plavix) 75 mg PO daily d. Skin warm, dry, flaky, and intact e. Heart rate 115 bpm, R 18, supine BP 130/80 mm Hg, standing 100/60 mm Hg
a, b, c, and e Rationale: A: Could be an indicator of GI bleed. B: Could be an indicator of volume loss. C: This drug can cause GI bleeding. E: Could be an indica- tor of volume loss.
After receiving hand-off report, the nurse begins reflecting on the possible complications that can occur in the patient with peptic ulcer disease. Which considerations should the nurse make? Select all that apply. a. Ulcer crater penetrating through adjacent organs b. Gastrointestinal (GI) contents entering the peritoneum c. Edema, spasm, or contraction of scar tissue d. Abdominal distention and third spacing e. Abdomen tender when palpating
a, b, c, d, and e Rationale: All of the answer choices are potential complications related to penetration, perforation, or obstruction seen with PUD.
A nurse is teaching a patient with stomatitis about the precautionary measures that can promote rapid healing. Which comments by the patient indicate a need for further teaching? Select all that apply. a. "I should use a hard-bristled toothbrush to clean the mouth." b. "I should apply water soluble lubricants for lips and mouth." c. "I should use lemon-glycerin swabs to clean the mouth." d. "I should remove dentures and other oral appliances if pain persists." e. "I should limit intake of protein-rich foods in the diet."
a, c, and e Rationale: Soft-bristled tooth brushed should be used after each meal. Lemon-glycerin swabs can cause irritation and should not be used. Intake of protein-rich foods should be increased as they promote healing.
Which statement by Mr. Jhanes regarding the endoscopic procedure indicates that further teaching is required? a. "I can eat solid foods 3 hours prior to the procedure." b. "I can eat solid foods 12 hours prior to the procedure." c. "I cannot eat or drink 1 hour prior to the procedure." d. "I can return to my normal diet after the procedure."
a. "I can eat solid foods 3 hours prior to the procedure."
The nurse is teaching postsurgical care to a patient who has undergone a laparoscopic Nissen fundoplication surgery. Which statement indicates the need for further teaching? a. "I should drink water rapidly." b. "I should report severe bloating or unusual pain." c. "I will notify the primary healthcare provider if I have difficulty breathing." d. "I should continue my antireflux medication regimen unless advised by a healthcare practitioner."
a. "I should drink water rapidly."
Which of the following patients would be a candidate for parenteral nutrition? a. A 60 year old man with a small bowel obstruction b. A 80 year old man with anorexia c. A 60 year old women with a newly placed G-tube d. A 70 year old woman whom is tolerating tube feeds
a. A 60 year old man with a small bowel obstruction
What information should be included in the dietary teaching for a patient following Roux-en-Y gastric bypass? a. Avoid sugary food and limit fluids to prevent dumping syndrome. b. Gradually increase the amount of food ingested to reach preoperative levels. c. Maintain a long-term liquid diet to prevent damage to the surgical site. d. Consume foods high in complex carbohydrates, protein, & fiber
a. Avoid sugary food and limit fluids to prevent dumping syndrome. Rationale: Patients should be on a liquid diet (short term) after surgery and diet will advance to solid foods. It is recommended to eat foods high in protein, and low in carbs, fat , & fiber.
A nurse on the day shift is preparing to change a client's TPN solution, but the new TPN solution has not arrived from the pharmacy. The client receives additional IV fat emulsion during the night shift. Which of the following actions should the nurse take? a. Hang dextrose 10% in water until the TPN solution is delivered. b. Saline lock the IV catheter after discontinuing the TPN solution c. Hang the IV fat emulsion solution d. Call the provider for new TPN orders
a. Hang dextrose 10% in water until the TPN solution is delivered.
A nurse is assessing a client who is receiving TPN. Which of the following findings should the nurse recognize as a complication of this therapy? a. Hyperglycemia b. Aspiration c. Diarrhea d. Stomatitis
a. Hyperglycemia
Which assessment changes might the nurse observe in a client with peptic ulcer disease? a. Intermittent abdominal pain, fluctuating with food intake b. Nausea and vomiting c. Right lower quadrant pain with rebound tenderness d. Heartburn when lying flat in bed at night
a. Intermittent abdominal pain, fluctuating with food intake
A nurse is caring for a client who is receiving TPN via a PICC. When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first? a. Measure the circumference of both upper arms b. Notify the provider who inserted the PICC c. Remove the PICC line d. Apply a cold pack to the client's upper arm
a. Measure the circumference of both upper arms
A patient with stomatitis reports pain when swallowing. How should the nurse document this in the patient's medical report? a. Odynophagia b. Dysphasia c. Xerostomia d. Dysarthria
a. Odynophagia
A nurse is teaching a client about nutritional requirements necessary to promote wound healing. Which of the following nutrients should the nurse include in the teaching? a. Protein b. Calcium c. Vitamin B12 d. Vitamin D
a. Protein
Which medication option would have a longer duration of action in treating the clinical condition of gastroesophageal reflux disease? a. Proton pump inhibitors b. Antacids c. Corticosteroids d. Opioid analgesics
a. Proton pump inhibitors
A nurse is instructing a group of clients about nutrition. The nurse should include that which of the following foods is a good source of high-quality protein? a. Soybeans b. Grains c. Legumes d. Green vegetables
a. Soybeans
A client with gastroesophageal reflux disease has a catheter and sensor that is placed in the nose and terminates in the distal esophagus. The client has also been asked to keep a diary of symptoms and activities. Which diagnostic test has been ordered for this client? a. Twenty-four-hour ambulatory esophageal pH monitoring b. Pulmonary function tests c. Endoscopy d. Telemetry monitoring
a. Twenty-four-hour ambulatory esophageal pH monitoring
A nurse is planning care for a client who is to start receiving TPN. Which of the following interventions should the nurse include in the plan of care? a. Use a 1.2 micron filter when infusing TPN with fat emulsions added b. Allow 18 hrs for the lipids to infuse when not mixed with the TPN solution c. Change the TPN solution after 36 hrs d. Change the TPN tubing every 48 hrs
a. Use a 1.2 micron filter when infusing TPN with fat emulsions added Rationale: The nurse should use a filter when infusing TPN with fat emulsion to filter out any precipitate that is too large to pass through the filter.
Mr. Jhanes returns to the unit after an endoscopic gastroduodenoscopic procedure. The nurse will prioritize the interventions in which order? a. Vital signs, focused physical assessment, start diet, and discontinue IV fluids b. Focused physical assessment, vital signs, discontinue IV fluids, and start diet c. Discontinue IV fluids, vital signs, focused physical assessment, and start diet d. Start diet, discontinue IV fluids, focused physical assessment, and vital signs
a. Vital signs, focused physical assessment, start diet, and discontinue IV fluids
A patient was administered an IM injection of penicillin and developed dyspnea and weakness a few minutes after the injection. Which additional assessment findings indicate that the patient is having an anaphylactoid reaction? Select all that apply. a. Constricted pupils b. Feeling of impending doom c. Hypertension d. Rash on arms e. Slowed strong pulse f. Stridor
b and f
Which conditions may influence the development of gastroesophageal reflux disease? Select all that apply. a. Pernicious anemia b. Obesity c. Loss of esophageal motility d. Hiatal hernia e. Constipation
b, c, and d
What are complications of Peptic Ulcer Disease? Select all that apply. a. Cough b. Hemmorhage c. Perforation d. Pneumonia e. Obstruction
b, c, and e
Which is true regarding xerostomia? Select all that apply. a. It may be also termed as wet mouth as it increases the flow of saliva in the mouth. b. It occurs in patients receiving significant radiation exposure to the salivary glands during radiotherapy. c. It is a symptom of several diseases as well as a side effect of many different medications. d. It decreases the risk of contracting candidiasis and developing stomatitis. e. It may be caused by removal of the salivary glands, dehydration, and diabetes.
b, c, and e
A patient who has undergone bariatric surgery has come for a follow-up visit. Which statements made by the patient indicate the development of dumping syndrome? Select all that apply. a. "I have frequent urination." b. "I have had nausea for 3 days." c. "I have difficulty in breathing." d. "I have severe abdominal pain." e. "I have been feeling dizzy this past week."
b, d, and e
Which nursing actions should a nurse perform when caring for a patient with peptic ulcer disease? Select all that apply. a. Include bedtime snacks for the patient. b. Document and notify the primary health-care provider about symptoms of dumping syndrome. c. Administer proton pump inhibitors (PPIs) after meals. d. Administer antacids 1 to 3 hours after meals. e. Prepare the patient for an upper endoscopy or surgery per order.
b, d, and e Rationale: Bedtime snacks will stimulate gastric acid secretion and lead to increased nighttime pain. PPIs should be administered before meals for pain relief.
Which diagnostic tests are used to detect an active infection with Helicobacter pylori? Select all that apply. a. Radiological test b. Urea breath test c. Barium x-ray test d. Serological test e. Fecal antigen test
b, d, and e Rationale: Radiological test will help detect PUD. Barium x-ray test helps detect gastric cancer.
Which statement by a nurse regarding oral cancer of the lips indicates a need for further learning? a. "Outcomes regarding carcinoma of the upper lip are less favorable." b. "Cancer of the oral cavity is primarily basal cell carcinoma." c. "Males are more prone to carcinoma of the lip than females." d. "The average age for carcinoma of the lips is 60 to 65."
b. "Cancer of the oral cavity is primarily basal cell carcinoma." Rationale: Cancer of the oral cavity is primarily squamous cell carcinoma. Squamous cell carcinomas tend to grow rapidly and metastasize, whereas basal cell carcinomas tend to grow slowly and become invasive over time.
Which statement by a patient would alert the nurse to a risk for decreased immune function? a. "I had a chest x-ray 6 months ago." b. "I had my spleen removed after a car accident." c. "I take one baby aspirin every day to prevent stroke." d. "I usually eat eggs or meat for at least two meals a day."
b. "I had my spleen removed after a car accident."
Which information about intradermal skin testing should the nurse teach to a patient with possible allergies? a. "Do not eat anything for about 6 hours before the testing." b. "Plan to wait in the clinic for 20 to 30 minutes after the testing." c. "Reaction to the testing will take about 48 to 72 hours to occur." d. "Take an oral antihistamine about an hour before the testing."
b. "Plan to wait in the clinic for 20 to 30 minutes after the testing."
Which client is most likely to be at risk for developing gastroesophageal reflux disease? a. 38-year-old male who is a vegetarian b. 25-year-old pregnant woman c. 18-year-old female who likes to eat several small meals a day d. 44-year-old male who has no reported comorbidities
b. 25-year-old pregnant woman
A Roux-en-Y-gastric bypass procedure involves which type of surgical intervention? a. A malabsorptive procedure in which part of the stomach is bypassed b. A restrictive gastric pouch that bypasses part of the small intestine c. Removal of portion of stomach with bypass of part of the large intestine d. Removal of portion of stomach
b. A restrictive gastric pouch that bypasses part of the small intestine
A patient is anxious and reports difficulty breathing after being stung by a wasp. What is the nurse's priority action? a. Administer antihistamines b. Assess the patient's airway c. Provide high-flow oxygen d. Remove the stinger from the site.
b. Assess the patient's airway
Which type of immunity results in the production of cytokines? a. Auto Immunity b. Cell mediated Immunity c. Humoral Immunity d. Innate Immunity
b. Cell mediated Immunity
A nurse is assessing a client who is receiving TPN therapy via an infusion pump. Which of the following actions should the nurse take? a. Obtain the client's blood glucose every 12 hrs b. Change the IV tubing every 24 hrs c. Change the IV site dressing every 4 days d. Weigh the client every other day
b. Change the IV tubing every 24 hrs
A nurse is planning care for a client who has a decreased level of consciousness. The client is receiving continuous enteral feedings via a g-tube due to an inability to swallow. Which of the following is the priority action by the nurse? a. Observe client's respiratory status b. Elevate the HOB 30 to 45 degrees c. Monitor intake and output every 8 hours d. Check residual volume every 4-6 hours
b. Elevate the HOB 30 to 45 degrees
A patient with peptic ulcer disease is being discharged on several new medications. When performing medication education, which medication should the nurse say helps block gastric secretions? a. Antacids b. H2-receptor antagonists c. Metoclopramide d. Sucralfate
b. H2-receptor antagonists
A patient with oral cancer has dysphagia. Which complication is associated with this condition? a. Anxiety b. Imbalanced nutrition c. Ineffective airway clearance d. Impaired oral mucous membrane
b. Imbalanced nutrition Rationale: Dysphagia is difficulty or discomfort in swallowing. Imbalanced nutrition is associated with eating less than the body requirements due to dysphagia.
Which of the following describes proper patient teaching for a patient with chronic gastritis? a. Eliminate alcohol & caffeine from the diet when symptoms occur. b. Maintain a nonirritating diet with six small meals a day. c. Take antacids before meals to decrease stomach acidity. d. Use nonsteriodal anti-inflammatory drugs (NSAIDs) instead of aspirin for pain relief.
b. Maintain a nonirritating diet with six small meals a day.
When caring for a patient in the initial post-operative period after a partial glossectomy with a radial neck dissection, which of the following is the nurse's primary concern? a. Assessing the patient's coping. b. Maintaining a patent airway. c. Providing adequate nutrition d. Relieving the patient's pain.
b. Maintaining a patent airway.
A nurse is prioritizing care for two clients at the start of the shift. The first client, who is 1 day postoperative following a partial bowel resection, requires a dressing change, TPN administration and reports a pain level of 6 on a scale of 0-10. The second client, who has a newly inserted percutaneous g-tube, requires a tube feeding, dressing change, and daily weight. Which of the following nursing actions should the nurse plan to complete first? a. Weigh the second client b. Obtain vital signs for both clients c. Administer pain medications to the first client d. Change the dressing of both clients
b. Obtain vital signs for both clients
What medications used in the treatment of gastroesophageal reflux disease work by increasing gastric emptying? a. Antacids b. Prokinetics c. Proton pump inhibitors d. Histamine receptor antagonists
b. Prokinetics
A nurse is assessing a client and discovers the infusion pump with the client's TPN solution is not infusing. The nurse should monitor the client for which of the following conditions? a. Excessive thirst and urination b. Shakiness and diaphoresis c. Fever and chills d. Hypertension and crackles
b. Shakiness and diaphoresis
Which medication can help to decrease the gag reflex if administered to a patient with stomatitis? a. IV acyclovir b. Viscous lidocaine c. Nystatin d. Histamine receptor agonists
b. Viscous lidocaine Rationale: Lidocaine provides pain relief for those with stomatitis but can decrease the gag reflex. Aspiration precautions, like elevating the head of bed and keeping suction equipment nearby, should be taken.
A nurse is proving community education about peptic ulcer disease, its causes, treatment, and symptoms. Which statement by the nurse is incorrect? a. "The most common form of chronic gastritis is caused by Helicobacter pylori infection." b. "The incidence of H pylori infection increases in patients who are older than 60." c. "H pylori infection is more prevalent in industrialized countries than in developing countries." d. "Urea breath testing can be used to detect active infection with H pylori."
c. "H pylori infection is more prevalent in industrialized countries than in developing countries."
The nurse is teaching about caring for a patient who has undergone bariatric surgery. Which statement indicates a need for further teaching? a. "I will elevate the head of the bed to 40 degrees." b. "I will encourage the use of an incentive spirometer." c. "I will reposition the nasogastric tube whenever required." d. "I will administer IV patient controlled analgesia (PCA) for the first 48 hours after surgery."
c. "I will reposition the nasogastric tube whenever required." Rationale: The ng tube should not be repositioned to avoid perforation of the suture lines
A nurse is caring for a client who has cancer and is receiving TPN. Which of the following lab values indicates the treatment is effective? a. Hct 43% b. WBC 8,000/uL c. Albumin 4.2 g/dL d. Calcium 9.4 mg/dL
c. Albumin 4.2 g/dL Rationale: This value is within the expected reference range and indicates the client is receiving adequate amounts of protein
A nurse is caring for a client who needs to increase his protein intake. The client tells the nurse some of the food he enjoys. Which of the following foods should the nurse recommend as the best source of protein among the suggestions? a. Yams b. Eggs c. Chicken d. Peanuts
c. Chicken
A nurse is teaching a client who has a prescription of an NG to treat a pyloric obstruction. Which of the following rationales for the use of an NG tube should the nurse include in the teaching? a. Determine the pH of gastric secretions b. Supply nutrients via tube feedings c. Decompress the stomach d. Administer medications
c. Decompress the stomach
A patient is diagnosed with medication-induced nonsteroidal anti-inflammatory drug (NSAID) peptic ulcer disease. Which clinical finding is the nurse most likely to find in the patient? a. Decrease in pepsin secretion b. Increase in bicarbonate levels c. Decrease in mucus production d. Increase in gastric mucosal blood flow
c. Decrease in mucus production Rationale: Reduced blood flow to the mucus membrane leads to decreased mucus production.
A nurse prepares to replace the nearly empty container of TPN for a client when she finds that there has been a delay in receiving the new container of solution from the pharmacy. Which of the following solutions should the nurse infuse until the TPN becomes available? a. Lactated ringer's b. 3% sodium chloride c. Dextrose 10% in water d. 0.9% sodium chloride
c. Dextrose 10% in water
Which of the following is the most common sign of GERD? a. Aphagia b. Cough c. Heartburn d. Itching throat
c. Heartburn
A patient has been admitted to the hospital due to experiencing vomiting for several days. The cause of the patient's vomiting is unknown. Which of the following interventions should be considered the nurse's priority in providing care for this patient? a. Administration of parental antiemetics. b. Insertion of an NG tube for suction. c. IV replacement of fluid and electrolytes. d. Oral administration of broth & tea.
c. IV replacement of fluid and electrolytes.
The nurse is admitting a client with mid-epigastric pain. Which medication is most concerning from the client's list of current medications? a. H2 blockers b. Antacids c. Ibuprofen d. Iron
c. Ibuprofen
Which action taken by the nurse may cause aspiration in a patient with oral cancer? a. Providing elixir form of medications b. Instructing the patient to refrain from talking when eating c. Lowering the head of the bed d. Assessing the patient's ability to swallow
c. Lowering the head of the bed
The nurse correlates poor dentition in patients to which digestive disorder? a. Chemical digestion of protein b. Mechanical digestion of chyme c. Mechanical digestion of protein d. Chemical breakdown of carbohydrates to simple sugars
c. Mechanical digestion of protein
A nurse is caring for a client who has Crohn's disease and is receiving parenteral nutrition. Which of the following interventions should the nurse include in the care of this client? a. Remove the parenteral nutrition solution from the refrigerator 2 hrs before infusion b. Remove unused parenteral nutrition after 12 hrs of use c. Monitor daily laboratory values and report as needed d. Monitor the flow rate of parenteral nutrition carefully and increase the rate as needed if it falls behind
c. Monitor daily laboratory values and report as needed
When providing care for a severely obese patient, which of the following is the most important action for the nurse to take? a. Avoid reference to the patient's weight to avoid embarrassing the patient. b. Emphasize to the patient how important it is to lose weight to maintain health. c. Plan for necessary modifications in equipment and nursing techniques before initiating care. d. Recognize that an assessment of each body system might not be possible because of increase skin fold layers.
c. Plan for necessary modifications in equipment and nursing techniques before initiating care.
A patient is admitted to the ER with bright red emesis. What is the nurse's first priority during the initial care of this patient? a. Establish two IV sites with large gauge catheters b. Obtain a thorough health history to assist in determining the cause of the bleeding c. Provide a focused nursing assessment of the patient's status d. Provide a gastric lavage with cool tap water in preparation for an endoscopic procedure
c. Provide a focused nursing assessment of the patient's status
Which of the following is a clinical manifestation of an age-related change (of the GI tract) that a nurse may find in an older adult? a. Increased production of gastric acid b. Intolerance to fatty foods c. Reflux of gastric content into the esophagus d. Yellowish tinge/coloring to the skin
c. Reflux of gastric content into the esophagus Rationale: In the elderly, there is decreased tone in the lower esophageal sphincter which allows gastric contents back into the esophagus, causing heartburn and belching. Gastric acid is decreased in the elderly. Intolerance to fatty foods could be attributed to gallbladder or liver disease. Yellowing of the skin (Jaundice) suggests liver problems or disease.
The nurse is admitting a client with peptic ulcer disease. During a dietary assessment the client lists these as his favorite types of foods. What is most concerning? a. Pasta with white sauce b. Fresh fish and green salad c. Rice with curry and spices d. Ham and potatoes
c. Rice with curry and spices
A patient with a history of PUD is hospitalized with symptoms of a perforation. During the initial assessment, the nurse expects the patient to report which of the following signs and symptoms? a. Hyperactive bowel sounds and upper abdominal swelling b. Projectile vomiting of undigested foods c. Sudden, severe upper abdominal pain and back pain d. Vomiting of bright red blood
c. Sudden, severe upper abdominal pain and back pain
A client has a banding procedure for treatment of clinical obesity. Which statement is accurate with regard to this type of bariatric surgery? a. Client will report decreased satiety. b. Procedure will allow for limited absorption of nutrients. c. The amount of food consumption will be decreased. d. The stomach will have an increased ability to process food.
c. The amount of food consumption will be decreased.
The nurse is caring for a patient with a peptic ulcer. Which symptom would suggest that it is in the duodenum? a. The patient is dizzy, sweating, and has palpations. b. The patient has ulcer-like pain that cannot be relieved by antacids. c. The patient has burning epigastric pain, which can be relieved after taking antacids. d. The patient feels stomach fullness.
c. The patient has burning epigastric pain, which can be relieved after taking antacids. Rationale: Choice "a" correlates with a patient who has dumping syndrome. Choices "b" and "d" are seen in patients with gastric cancer.
A nurse is reviewing the risk factors that may increase the risk for developing esophageal cancer. Which risk factor listed indicates a need for further training? a. Nutritional deficiency b. Barrett's esophagus c. Weight loss d. Gastroesophageal reflux disease (GERD)
c. Weight loss Rationale: Obesity, not weight loss, is a risk factor.
The nurse is discussing dietary considerations with a patient diagnosed with peptic ulcer disease. Which responses made by the patient indicate the need for further discussion? a. "I must refrain from drinking coffee." b. "I should consume six small meals a day." c. "I must limit my alcohol consumption." d. "I must restrict my intake of fluids."
d. "I must restrict my intake of fluids." Rationale: There are no fluid restrictions for patients with PUD.
The biopsy results are positive for H. pylori. Which statement by the patient indicates understanding of these results? a. "There is no cure for this disease, and I will have it for the rest of my life." b. "I hope that I don't pass this on to my wife." c. "I think I contracted this infection from eating shellfish." d. "I will need to take antibiotics to get rid of the infection."
d. "I will need to take antibiotics to get rid of the infection."
Which patient is at highest risk for having a gastric ulcer? a. A 27 year old male who is in the middle of a divorce & experiencing back pain b. A 37 year old male who smokes and recently fell at home c. A 45 year old female admitted for illicit drug detoxification d. A 55 year old female who smokes and reports severe nausea and vomiting
d. A 55 year old female who smokes and reports severe nausea and vomiting
A nurse is admitting a client who reports anorexia and is experiencing malnutrition. Which of the following laboratory findings should the nurse expect to be altered? a. Creatine kinase b. Troponin c. Total billirubin d. Albumin
d. Albumin
Which treatment option would be implemented for a client with a body mass index of 36 kg/m2 who has significant comorbidities associated with obesity? a. Very low kilocalorie diet b. Hormone replacement therapy c. Referral to dietitian d. Bariatric surgery
d. Bariatric surgery
Which imaging diagnostic test is preferred for patients who are obese? a. Fluoroscopy b. Ultrasound scan c. Plain radiograph d. Computed tomography (CT) scan
d. Computed tomography (CT) scan
A patient has a body mass index (BMI) of 35 kg/m2 and a history of hyperthyroidism. Which medication should be administered with caution? a. Orlistat b. Lorcaserin c. Topiramate d. Diethylpropion
d. Diethylpropion Rationale: Diethylpropion has sympathomimetic effects and should be used with caution.
A patient with a body mass index (BMI) of 28 kg/m2 has arrived at the healthcare facility for obesity treatment. The patient reports that diet therapy did not help in losing weight and wants to opt for bariatric surgery. Which intervention would be suitable for the patient? a. Preparing the patient for bariatric surgery b. Informing the patient to continue diet therapy alone for few more days c. Informing the patient that mortality rate is high with bariatric surgery d. Encouraging the patient to do physical activity and undergo behavior therapy
d. Encouraging the patient to do physical activity and undergo behavior therapy Rationale: A BMI of 28 kg/m2 is in the overweight category. If diet therapy is unsuccessful, physical activity and behavior therapy should be encouraged along with diet therapy.
A patient reports a sore and burning sensation in the mouth and tongue. The nurse finds red, macular lesions that are velvety in appearance. The patient is a chronic alcoholic and smoker. Which condition does the patient most likely have? a. Stomatitis b. Xerostomia c. Leukoplakia d. Erythroplakia
d. Erythroplakia
Which symptom indicates the need for Nissen fundoplication surgery? a. Chest pain b. Regurgitation c. Belching d. Feeling of suffocation
d. Feeling of suffocation Rationale: Nissen fundoplication is a surgical treatment that is frequently used for type II hiatal hernia. A feeling of suffocation is a symptom of type II hiatal hernia. Therefore, a patient with feelings of suffocation may indicate the need for Nissen fundoplication.
A nurse is caring for a client who is receiving TPN and develops referring syndrome. The nurse should expect which of the following laboratory findings? a. Hyperglycemia b. Hyperkalemia c. Hyponatremia d. Hypophosphatemia
d. Hypophosphatemia
Which is true regarding the usefulness of the diagnostic test esophageal manometry? a. It is useful in evaluating esophagitis and monitoring Barrett's esophagitis. b. It is useful in monitoring gastric pH. c. It is useful in obtaining a sample of the esophagus for biopsy. d. It is useful in measuring esophageal motor activity.
d. It is useful in measuring esophageal motor activity.
Which is true regarding leukoplakia? a. It is a malignant lesion found commonly on the mandibular mucosa. b. It occurs mostly in newborns. c. It is more prevalent in women than men. d. It looks like nonremovable, slightly raised, sharply rounded white plaques.
d. It looks like nonremovable, slightly raised, sharply rounded white plaques.
A nurse receives in report that a male patient who had Billroth II procedure a few weeks ago is now experiencing dumping syndrome. Which of the following statements most accurately explains the pathophysiology associated with the patient's symptoms. a. Distention of the stomach due to too much food and fluid intake b. Hyperglycemia caused by uncontrolled gastric emptying into the small intestines c. Irritation of the stomach lining by reflux of bile salts because of the removal of the pyloric sphincter d. Movement of fluid into the small bowel because food and fluids move rapidly into the intestines.
d. Movement of fluid into the small bowel because food and fluids move rapidly into the intestines.
Which type of infection or inflammation of the mouth can occur as a result of chemotherapy, renal disease, or liver disease? a. Canker sores b. Oral Candidiasis c. Parotitis d. Mucositis
d. Mucositis
A patient is admitted to the hospital with left upper quadrant (LUQ) pain. What may be a possible source of the pain? a. Appendix b. Gallbladder c. Liver d. Pancreas
d. Pancreas
Which is a short-term complication of bariatric surgery? a. Hernia b. Anemia c. Band slippage d. Pulmonary embolism
d. Pulmonary embolism Rationale: The other options are long-term complications
A patient is hospitalized to rule out peptic ulcer disease (PUD). He asks the nurse what types of noninvasive tests the provider will perform. Which test should the nurse say is most commonly performed? a. Upper-endoscopy test b. Liver function test c. Esophagogastroduodenoscopy (EGD) d. Stool antigen test
d. Stool antigen test Rationale: This is the only noninvasive test answer choice
In working with clients who have been diagnosed with gastroesophageal reflux disease, which statement is accurate related to the use of proton pump inhibitors as therapeutic treatment? a. It is also useful in the treatment of H. pylori. b. The client is encouraged to increase fluid intake while taking this therapy to prevent dehydration from occurring. c. It leads to resolution of clinical condition after two months of therapy. d. Tolerance is unlikely.
d. Tolerance is unlikely.
