Nurse 225: Ch. 36

Which statement by a client with a new diagnosis of hepatitis A alerts the nurse to the need for more education? "I may feel tired for about a week." "My skin may turn yellow in the next few weeks." "I am going to have flare-ups for the rest of my life." "I need to wash my hands after using the restroom."

"I am going to have flare-ups for the rest of my life." -Hepatitis A does not have chronic flare-ups; therefore the nurse should realize the client needs teaching to correct this misinformation. A method of preventing the transmission of hepatitis A is handwashing, because the most common transmission route is fecal-oral. The prodromal phase of hepatitis is characterized by fatigue and malaise. The icteric phase begins about 1 month after exposure and is characterized by jaundice.

Which statement by the client about the modifiable risk factors for pancreatitis requires follow-up by the nurse? "I can only drink beer now." "I need to stop smoking now." "I need to try to lose weight." "I need to take my antiulcer medications daily."

"I can only drink beer now." -All alcohol should be eliminated from the client's diet for pancreatitis; therefore, the nurse should realize the client needs follow-up to correct the misinformation. Clients should be educated on the need to stop drinking, stop smoking, lose weight, and prevent peptic ulcers. Smoking, peptic ulcer disease, obesity, and alcoholism are all risk factors in developing pancreatitis.

Which statement by the client about the manifestations of cirrhosis requires follow-up by the nurse? "If I stop drinking, I will be cured." "I am at increased risk of bleeding." "I may develop swelling in my ankles." "I may have to have fluid removed from my abdomen."

"If I stop drinking, I will be cured." -Cirrhosis is an irreversible disease of the liver. Stopping drinking will not cure the disease; therefore, the nurse should realize the client needs follow-up to correct this misinformation. Clients with cirrhosis may develop ascites and require the fluid to be removed. Because the liver normally produces clotting factors, clients with cirrhosis are at an increased risk of bleeding. Edema (swelling) is caused by decreased albumin production by the liver.

Which client is predisposed to a paralytic ileus? A client with diarrhea A client with vomiting A client after abdominal surgery A client after gastroesophageal reflux

A client after abdominal surgery -Paralytic ileus is a functional bowel obstruction caused by failure of intestinal motility that often occurs after abdominal surgery. Paralytic ileus is not a result of diarrhea, vomiting, or gastroesophageal reflux.

Which assessment finding should a nurse report most urgently to a primary healthcare provider? A client previously diagnosed with hepatitis B is very tired again this morning. A client previously diagnosed with duodenal ulcer developed hematemesis this morning. A client previously diagnosed with cirrhosis has laboratory test results this morning that show hypoalbuminemia. A client previously diagnosed with dysphagia is having difficulty swallowing this morning.

A client previously diagnosed with duodenal ulcer developed hematemesis this morning. -Hematemesis is a sign of upper gastrointestinal tract bleeding and needs immediate attention. People who have dysphagia have difficulty swallowing; this is expected. Hepatitis typically causes fatigue that lasts a long time; this is not an emergency. Hypoalbuminemia is an expected sign of cirrhosis and does not indicate an emergency.

A client with which disease should be assessed for ascites because it is common with the disease? A client who has gastritis A client who has cirrhosis A client who has pancreatitis A client who has acute hepatitis

A client who has cirrhosis -Cirrhosis commonly causes ascites. Gastritis does not cause ascites. Ascites is not common with pancreatitis or acute hepatitis.

A client has jaundice due to increased unconjugated bilirubin. The nurse is caring for which client? A client with gallstones A client with hypertension A client with blocked bile duct A client with hemolytic anemia

A client with hemolytic anemia -With hemolytic anemia, unconjugated bilirubin accumulates faster than the liver is able to conjugate it. Gallstones do not cause jaundice unless the stones cause a blockage leading to jaundice from conjugated bilirubin. Hypertension is not associated with jaundice. With bile duct obstruction, the liver conjugates bilirubin but is unable to excrete it in the backed-up bile. The conjugated bilirubin accumulates, causing jaundice.

Which client is most predisposed to acute fulminating hepatitis? A client with hepatitis A A client with hepatitis B A client with hepatitis D A client with hepatitis E

A client with hepatitis B -Acute fulminating hepatitis is a rare condition observed with hepatitis B and can occur as a complication with hepatitis C. It is not associated with hepatitis A or E.

Which client is predisposed to developing colon cancer? A client with hiatal hernia A client with duodenal ulcers A client with ulcerative colitis A client with dumping syndrome

A client with ulcerative colitis -Ulcerative colitis is associated with increased risk of developing bowel cancer. Hiatal hernia, duodenal ulcers, and dumping syndrome are not risk factors for cancer.

A client has diverticulosis. Which pathophysiologic process should the nurse consider when planning care? Polyps or growths of the colon wall mucosa and submucosa Acquired herniations of the colon wall mucosa and submucosa Congenital outpouchings of the colon wall mucosa and submucosa Inflammation of small pockets in the colon wall mucosa and submucosa

Acquired herniations of the colon wall mucosa and submucosa -Diverticula are herniations or saclike outpouchings of the mucosa and submucosa through the muscle layers, usually in the wall of the sigmoid colon. Diverticulosis is characterized not by growths but rather by herniations or pouches; cancer usually produces polyps or growths. Diverticulitis is an inflammation of the herniations. Diverticulosis is not a congenital disorde

A client has chronic pancreatitis. Which common cause of chronic pancreatitis should the nurse consider when planning care for this client? Gallstones Viral infection Alcohol abuse Bacterial infection

Alcohol abuse -Chronic pancreatitis commonly is associated with chronic alcohol abuse. Gallstones often cause acute pancreatitis. Bacterial and viral infections are not commonly the cause of chronic pancreatitis.

Which assessment finding should the nurse expect to find in a client with cirrhosis of the liver? Ascites Hyperglycemia Pain radiating to the back Difficulty digesting starch and fats

Ascites -Cirrhosis is the most common cause of ascites. Hypoglycemia occurs in cirrhosis. Hyperglycemia, pain radiating to the back, and difficulty digesting starch and fats indicate pancreatitis, not cirrhosis of the liver.

A client has acute pancreatitis. When the nurse is planning care, which pathophysiologic process should the nurse remember? Destruction of hepatocytes Autodigestion of the pancreas Decreased serum lipase levels Walled-off cysts in the pancreas

Autodigestion of the pancreas -The pathophysiology of pancreatitis is autodigestion of the pancreas. Walled-off cysts occur in chronic hepatitis. Elevated serum lipase level, not decreased, is the primary diagnostic marker for acute pancreatitis. Hepatocytes are found in the liver, not in the pancreas

Which information should the nurse consider when planning care for a client with ulcerative colitis? It generally appears in childhood. Black people are more commonly affected. It extends throughout the entire gastrointestinal tract. Autoimmune disorders may accompany ulcerative colitis

Autoimmune disorders may accompany ulcerative colitis -Autoimmune disorders, such as systemic lupus erythematosus and erythema nodosum, may accompany ulcerative colitis. The lesions usually begin appearing between 20 and 40 years of age and are located from the rectum to the colon proximally. Ulcerative colitis is a chronic inflammatory condition that is common in Jewish or white populations

A client has acute pancreatitis. Which findings will the nurse typically observe? Select all that apply. Fever Tetany Jaundice Bradycardia Bowel hypomotility Pain radiating to the groin

Bowel hypomotility, Jaundice, Tetany, Fever -Jaundice can occur from obstruction of the bile duct (e.g., a gallstone) or from pancreatic edema pressing on the duct. Fever and leukocytosis accompany the inflammatory response. Abdominal distention accompanies bowel hypomotility and the accumulation of fluids in the peritoneal cavity. Tetany may develop as a result of hypocalcemia when calcium is deposited in areas of fat necrosis or as a decreased response to parathormone. The cardinal manifestation of acute pancreatitis is epigastric or midabdominal constant pain ranging from mild abdominal discomfort to severe, incapacitating pain. The pain may radiate to the back, not the groin. Tachycardia occurs, not bradycardia.

A client is diagnosed with hematochezia. Which assessment finding confirms this diagnosis? Bloody vomitus Bright red stools Presence of tarry stools Low urine output that is cloud

Bright red stools -Hematochezia is bright red stools. Hematemesis is blood in the vomitus. Melena is dark or tarry stools. Oliguria is low urine output; cloudy urine usually indicates an infection.

A client is diagnosed with hepatitis B. How is this disease transmitted? By sneezing By coughing By sexual contact By the fecal-oral route

By sexual contact -Hepatitis B is transmitted by parenteral routes, especially sexually. Hepatitis A is transmitted by the fecal-oral route, as is hepatitis E. Sneezing and coughing do not transmit hepatitis B but can transmit certain respiratory disorders (for example, tuberculosis).

Chart Info.: Prescriptions (Orders) -NPO -Nasogastric Suction Vital Signs -Pulse- 90 -Resp.- 18 -BP- 110/60 Medication Record -Only IV meds prescribed A client has pancreatitis with pain and is nauseated and vomiting. Which action by the nursing assistant will cause the nurse to intervene? Talking to the client and family Carrying a food tray into the room Making sure the water pitcher is empty Taking a blood pressure cuff into the room

Carrying a food tray into the room -The client is supposed to have nothing by mouth. A food tray should not be taken into the room, and such action must be stopped by the nurse. A blood pressure cuff would be needed for vital signs. Making sure the water pitcher is empty is appropriate, because the client can have nothing by mouth. Talking to the family and client is appropriate.

A client asks what causes portal hypertension. What is the nurse's best response? Varices Pancreatitis Cirrhosis of the liver Protein-energy malnutrition

Cirrhosis of the liver -The most common cause of portal hypertension is fibrosis and obstruction caused by cirrhosis of the liver. Protein-energy malnutrition in the presence of carbohydrate intake is called kwashiorkor. Pancreatitis is inflammation of the pancreas and does not cause portal hypertension. Varices are a consequence of portal hypertension, not the cause.

A client experiences chronic intermittent pain in the epigastric area when the stomach is empty and in the middle of the night. Which diagnosis will the nurse most likely see documented on the chart? Gastric ulcer Acute gastritis Duodenal ulcer Chronic gastritis

Duodenal ulcer -These symptoms support a diagnosis of a duodenal ulcer. Gastric ulcer symptoms include epigastric pain that may occur immediately after eating. Acute gastritis often has vague abdominal discomfort, epigastric tenderness, and bleeding. Chronic gastritis has symptoms that include anorexia, fullness, nausea, vomiting, and pain

A client has cirrhosis. Which assessment findings will the nurse expect to observe? Select all that apply. Dark urine Spider angiomas Light-colored stools Increased body hair Bleeding tendency

Dark urine, Spider angiomas, Light-colored stools, Bleeding tendency -Hepatic failure causes dark urine, spider angiomas, light-colored stools, and bleeding tendencies. There is loss of body hair in cirrhosis, not increased body hair.

A client has suspected appendicitis. Which assessment findings would help confirm the diagnosis? Select all that apply. Fever Nausea Vertigo Diarrhea Rebound tenderness present Elevated white blood cell count

Diarrhea, Rebound tenderness present, Elevated white blood cell count Fever, Nausea -Manifestations of appendicitis include pain followed by nausea, vomiting, anorexia, low-grade fever, and, in some cases, diarrhea. Elevated white blood cell count with rebound tenderness usually referred to the right lower quadrant are characteristic of appendicitis. Vertigo is not a symptom of appendicitis.

A client has esophageal carcinoma. Which clinical manifestation should the nurse expect to find upon assessment? Jaundice Dysphagia Bloody stool Abdominal pain

Dysphagia -The two frequent symptoms of esophageal carcinoma are chest pain and dysphagia. Jaundice occurs with hepatic, biliary, or hemolytic disorders. Bloody stool can occur with colorectal cancer, not esophageal cancer. A person with esophageal cancer has chest pain, not abdominal pain.

"The amylase is sky-high," says a nurse in morning report. "Better go see this client first to check the pain level." Pain management is likely an issue for this client because of which pathophysiologic process? Elevated amylase is a false neurotransmitter that indicates end-stage cirrhosis with hepatic encephalopathy. Elevated amylase indicates pancreatic enzymes are autodigesting the pancreas. Elevated amylase is an enzyme that normally is secreted as an inactive proenzyme and digests fat, causing pain. Elevated amylase leads to secretion of histamine that causes itching and severe burning.

Elevated amylase indicates pancreatic enzymes are autodigesting the pancreas. -Elevation of amylase is characteristic of acute pancreatitis, which causes pancreatic enzymes to autodigest the pancreas. Amylase does not cause histamine release. Amylase is not a false neurotransmitter. Amylase does not digest fat, nor is it secreted as a proenzyme.

A client has chronic pancreatitis. Which actions will the nurse take? Select all that apply. Offer pain relief Drain biliary tree secretions Reduce pancreatic enzyme Encourage cessation of alcohol intake Administer oral enzyme replacements

Encourage cessation of alcohol intake, Administer oral enzyme replacements, Offer pain relief -The treatment of acute pancreatitis includes the cessation of alcohol intake, the replacement of oral enzymes, and pain control. Pancreatic enzyme replacement, not reduction, is a component of care. Biliary tree drainage is not a component of care for this condition.

A nurse is preparing a presentation on disorders commonly associated with damage from alcohol overuse. What disorders should be included? Select all that apply. Gastritis Cirrhosis Pancreatitis Appendicitis Cholecystitis Esophageal cancer

Esophageal cancer,Pancreatitis, Cirrhosis, Gastritis -Overuse of alcohol causes damage that can lead to gastritis, cirrhosis, esophageal cancer, and pancreatitis. Appendicitis and cholecystitis are not commonly associated with alcohol overuse.

A client has cholelithiasis. Which findings will the nurse typically find upon assessment? Select all that apply. Jaundice Biliary colic Bloody diarrhea Left lower quadrant pain Fatty meals causing pain

Fatty meals causing pain, Biliary colic, Jaundice -Abdominal pain and jaundice are the cardinal manifestations of cholelithiasis. Vague symptoms include heartburn, flatulence, epigastric discomfort, and food intolerances, particularly to fats and cabbage. The pain (biliary colic) occurs 30 minutes to several hours after a fatty meal is eaten. Cholelithiasis pain usually occurs in the right upper quadrant, not the left lower.

Which finding will alert the nurse that the client with diverticulosis has developed diverticulitis? Fever Diarrhea Flatulence Constipation

Fever -If the diverticula become inflamed or abscesses form, the individual develops fever, leukocytosis (increased white blood cell count), and tenderness of the lower left quadrant. Diarrhea, constipation, distention, or flatulence may occur during diverticulosis.

A client with hepatic encephalopathy has asterixis. What will the nurse observe upon assessment? Jaundice Biliary colic Flapping hand tremors Abdominal fluid accumulation

Flapping hand tremors -Asterixis is a flapping tremor of the hands. Jaundice, or icterus, is a yellow or greenish pigmentation of the skin caused by hyperbilirubinemia. Ascites is accumulation of fluid in the peritoneal cavity (abdomen). Biliary colic is pain that occurs 30 minutes to several hours after a client with cholelithiasis eats a fatty meal.

Helicobacter pylori is discovered in the gastrointestinal tract of a client experiencing an inflammation of the gastric mucosa. Which term should the nurse use to describe the inflammation of the gastric mucosa? Ileus Diarrhea Gastritis Obstruction

Gastritis -Gastritis is an inflammatory disorder of the gastric mucosa. Helicobacter pylori infection is associated with gastritis. Ileus is loss of peristaltic motor activity in the intestines. Diarrhea is an increase in the frequency of defecation and in the fluid content and volume of feces, with more than three stools per day. Obstruction is blockage of a passage.

Which assessment findings are common in a client with erosive reflux esophagitis? Select all that apply. Ascites Anorexia Heartburn Dysphagia Chronic cough

Heartburn, Dysphagia, Chronic cough -Heartburn, dysphagia, and chronic dry cough are all common manifestations of erosive reflux esophagitis. Ascites and anorexia are not common manifestations of gastroesophageal reflux disease but can occur in liver disease.

A nurse is talking about a hepatitis that can be acquired from ingesting contaminated food or water and may cause acute fever, abdominal pain, and jaundice but does not lead to chronic hepatitis. Which hepatitis is the nurse describing? Hepatitis A Hepatitis B Hepatitis C Hepatitis D

Hepatitis A -Hepatitis A is acquired from ingesting contaminated food or water and may cause acute fever, abdominal pain, and jaundice. Individuals with hepatitis A generally make a full recovery. Hepatitis B, C, and D can cause chronic liver disease.

A nurse is teaching a health class about the risk factors for nonalcoholic fatty liver disease. Which information should the nurse include in the teaching session? Select all that apply. Obesity Alcohol intake Metabolic syndrome Low levels of cholesterol High levels of triglycerides

High levels of triglycerides, Metabolic syndrome, Obesity -Nonalcoholic fatty liver disease is associated with obesity (including in obese children), high levels of cholesterol and triglycerides, metabolic syndrome, and type 2 diabetes mellitus. It is the most common chronic liver disease in the United States. This condition occurs in the absence of alcohol intake, thus its name (nonalcoholic).

When a client reports jaundice, dark urine, and clay-colored stools, a diagnosis of hepatitis is made. The nurse is caring for the client in which stage of the disease process? Icteric phase Recovery phase Prodromal phase Chronic active hepatitis phase

Icteric phase -The icteric phase begins 1 to 2 weeks after the prodromal phase and includes jaundice, dark urine, clay-colored stools, and hepatomegaly. The prodromal phase begins about 2 weeks after exposure and includes fatigue, anorexia, malaise, low-grade fever, and nausea/vomiting; it ends with the appearance of jaundice. The recovery phase begins with resolution of jaundice and other symptoms. Chronic active hepatitis is persistence of clinical manifestations and liver inflammation after acute infection.

A nurse is teaching about the most common causes of cirrhosis. Which information should the nurse include? Select all that apply. Idiopathy Alcoholism Hepatitis C Hemachromatosis Antibiotic overdose

Idiopathy, Alcoholism, Hepatitis C -Chronic alcoholism, idiopathy, and hepatitis C are common causes of cirrhosis. Hemachromatosis and antibiotic overdose are not common causes of cirrhosis.

Where should the nurse observe for ascites in a client? In the face In the feet In the ankles In the abdomen

In the abdomen -Ascites is the accumulation of fluid in the peritoneal (abdominal) cavity. Ascites does not involve fluid accumulation in the face, ankles, or feet.

Which information indicates the nurse has an accurate understanding of the pathophysiologic mechanisms that cause blood ammonia levels to increase in a client with hepatic encephalopathy? Inability of liver to produce albumin Inability of liver to break down aldosterone Inability of liver to secrete C-reactive protein Inability of liver to convert digested proteins to urea

Inability of liver to convert digested proteins to urea -The most hazardous substances in this situation are end products of intestinal protein digestion, particularly ammonia, which cannot be converted to urea by the diseased liver. Albumin synthesis, aldosterone, and C-reactive protein do not influence blood ammonia levels.

Which information indicates the nurse has a correct understanding of the pathophysiologic process or processes that cause tissue damage in a client with acute pancreatitis? Insulin toxicity and beta cell hyperplasia Autoimmune destruction of the pancreas inappropriate activation of pancreatic enzymes Hydrochloric acid reflux into the pancreatic duct

Inappropriate activation of pancreatic enzymes -Tissue damage in acute pancreatitis is caused by inappropriate activation of pancreatic enzymes in the pancreas and the resulting autodigestion of the gland. Insulin toxicity and beta cell hyperplasia do not cause the tissue damage in acute pancreatitis. Autoimmune destruction of the pancreas does not cause the tissue damage in acute pancreatitis. Hydrochloric acid reflux into the pancreatic duct is not associated with acute pancreatitis.

Which clinical manifestation should the nurse expect to observe in a client with ascites? Soft abdomen Hematemesis Increased abdominal girth Decreased respiratory rate

Increased abdominal girth -With ascites, the nurse would see increased abdominal girth, tight or hard abdominal tissue, abdominal distention, and weight gain. Large volumes of fluid (10 to 20 L) displace the diaphragm and cause dyspnea by decreasing lung capacity. Respiratory rate increases, and the individual assumes a semi-Fowler position to relieve the dyspnea. Hematemesis occurs with portal hypertension and esophageal varices

A client with hepatic encephalopathy is exhibiting confusion and asterixis. Which laboratory finding is most indicative of this disorder? Increased vitamin K Increased ammonia Increased creatinine Increased potassium

Increased ammonia

A client experiences a large hematoma from a motor vehicle accident. The client develops jaundice due to increased breakdown of red blood cells (hemolysis). Which pathophysiologic process should the nurse remember when planning care for this client? Bilirubin is excreted in the urine. There is an increase in conjugated bilirubin. Hemolysis is identical to obstructive jaundice. Increased amounts of unconjugated bilirubin occur.

Increased amounts of unconjugated bilirubin occur. -Excessive hemolysis (destruction of red blood cells) can cause hemolytic jaundice (prehepatic jaundice). Increased unconjugated bilirubin is formed through metabolism of the heme component of destroyed red blood cells and exceeds the conjugation ability of the liver, causing blood levels of unconjugated bilirubin to rise. Bilirubin excretion in the urine occurs with extrahepatic obstructive jaundice. Unconjugated bilirubin is not water soluble, so it cannot be excreted in the urine. Conjugated bilirubin increases in extra- and intrahepatic obstructive jaundice, not in hemolytic jaundice. Obstructive (blockage) jaundice is not the same as hemolysis (red blood cell destruction).

A client has an intestinal obstruction. The nurse closely monitors the client for a perforated bowel. What is the rationale for the nurse's actions? Atelectasis causes severe inflammation, release of cytokines, and loss of bowel wall integrity. Stasis of chyme allows bacterial overgrowth, causing inflammation and loss of bowel wall integrity. Increased intraluminal pressure causes tissue hypoxia, ischemia, and loss of bowel wall integrity. Osmotic forces from high particle content of static chyme draw extracellular fluid into the bowel wall.

Increased intraluminal pressure causes tissue hypoxia, ischemia, and loss of bowel wall integrity. -An intestinal obstruction leads to perforation of the bowel when increased intraluminal pressure causes occlusion of the arterial circulation, leading to ischemia, necrosis, and perforation. Osmosis does not cause perforation of the bowel. Atelectasis can lead to pneumonia, not bowel perforation. Peritonitis or sepsis, not bowel perforation, can be directly caused by bacteria.

Which laboratory value should the nurse expect to see in a client with cirrhosis? Increased albumin Increased prothrombin time Decreased partial thromboplastin time Decreased aspartate aminotransferase

Increased prothrombin time -Prothrombin time is increased in cirrhosis. Partial thromboplastin time is increased, not decreased. With cirrhosis, albumin levels are decreased, not increased. Aspartate aminotransferase is increased, not decreased.

Which medication would be given to decrease a client's confusion associated with hepatic encephalopathy? Haloperidol (Haldol) Lorazepam (Ativan) Diazepam (Valium) Lactulose (Cephulac)

Lactulose (Cephulac) -Lactulose decreases ammonia absorption in the colon. Haloperidol, lorazepam, and diazepam are used as antianxiety/antipsychotic medications but are not used to decrease hepatic encephalopathy.

A client is admitted with suspected acute pancreatitis. Which elevated laboratory result is most diagnostic for acute pancreatitis? Lipase Amylase Aminotransferase Alanine transaminase

Lipase -Elevated serum lipase level is the primary diagnostic marker for acute pancreatitis. Although amylase rises in response to pancreatitis, it is less specific. Aminotransferase and alanine transaminase levels are more diagnostic for hepatic (liver) disease.

Which information from a client indicates teaching was successful by the nurse for risk factors of peptic ulcers? Select all that apply. Advanced age History of alcohol abuse Following a strict vegetarian diet Presence of Helicobacter pylori in the duodenum Long-term use of nonsteroidal anti-inflammatory drugs

Long-term use of nonsteroidal anti-inflammatory drugs, History of alcohol abuse, Advanced age, Presence of Helicobacter pylori in the duodenum -Advanced age, alcohol consumption, presence of Helicobacter pylori, and long-term use of nonsteroidal anti-inflammatory drugs are viewed as risk factors for the development of this disorder. A vegetarian diet is not currently related to the development of peptic ulcers.

A client has diverticulosis. When the nurse takes the history, which dietary situation may be expected? Low residue Iron deficiency Lactose deficiency High intake of dietary fiber

Low residue -Habitual consumption of a low-residue diet reduces fecal bulk, thus reducing the diameter of the colon and promoting diverticulosis. Iron deficiency can lead to anemia, not diverticulosis. There is no such clinical or dietary condition as "lactose deficiency," because lactose (a sugar found in milk) is not a mandatory component of a healthy diet. Lactase deficiency, on the other hand (lack of the enzyme that enables the digestion of lactose), is the cause of lactose intolerance. But it is not associated with diverticulosis. The treatment for diverticulosis is a high intake of dietary fiber; therefore a diet high in fiber would not lead to diverticulosis.

A nurse is teaching an adult community group about the risk factors for esophageal cancer. Which information should the nurse include? Select all that apply. Cirrhosis Male gender Low-fiber diet Tobacco use Chronic alcohol intake

Male gender,Chronic alcohol intake, Tobacco use -The male gender, tobacco use, and chronic alcohol intake all increase the risk of esophageal cancer. Cirrhosis and a low-fiber diet are not risk factors for esophageal cancer.

A client has black, sticky, tarry, foul-smelling stools from digested dark blood. Which term should the nurse use in report to describe this finding? Melena Coffee ground Hematochezia Occult bleeding

Melena -Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract. Coffee ground is an emesis description for upper gastrointestinal bleeding that has been affected by stomach acids. Hematochezia refers to fresh red blood in the stool. Occult gastrointestinal bleeding produces no visible stool changes.

A nurse is preparing educational pamphlets about the differences between Crohn disease and ulcerative colitis. Which characteristics should be placed in a section that is specific to ulcerative colitis? Select all that apply. Mucosal layer involved Lesions usually continuous High risk for fistula formation Lesions usually discontinuous Caused by Helicobacter pylori infection Deep lesions involving the entire intestinal wall

Mucosal layer involved, Lesions usually continuous -Characteristics specific to ulcerative colitis include involvement of the mucosal layer and shallow lesions that are usually continuous. Characteristics specific to Crohn disease are a high risk of fistula formation, discontinuous lesions, and deep lesions involving the entire intestinal wall. Helicobacter pylori infection is not pertinent to ulcerative colitis or Crohn disease but to peptic ulcer disease.

A client has severe acute pancreatitis. Which complication should the nurse closely monitor for in this client? Cerebral edema Bowel obstruction Diabetes with neuropathy Multisystem organ dysfunction

Multisystem organ dysfunction -Multiple organ failure or the systemic inflammatory response syndrome accounts for most deaths in persons who have severe acute pancreatitis. Impaired function of the pancreas, not pancreatitis, can result in diabetes. Bowel obstructions and cerebral edema are not related to pancreatitis

A nurse is asked by a client to describe diverticula. What is the nurse's best response? Ulcers that form in the colon Perforations of the colon wall Outpouchings of the colon mucosa Areas of muscle hypertrophy in the colon

Outpouchings of the colon mucosa -Diverticula are herniations or saclike outpouchings of the mucosa and submucosa through the muscle layers, usually in the wall of the sigmoid colon. Diverticula are not ulcers (breaks in the protective mucosal lining), perforations of the colon wall (breaks through the entire gastrointestinal wall), or areas of hypertrophy (enlargement).

A client has a duodenal ulcer. What should a nurse expect to find in an assessment? Pain at night Constant pain Pain in the lower abdomen Pain immediately after eating

Pain at night -Duodenal ulcer causes pain at night. Pain is intermittent in the upper abdomen with duodenal ulcers. Pain that occurs immediately after eating is associated with gastric ulcers, not duodenal ulcers. In duodenal ulcer pain occurs when the stomach is empty.

A nurse is assessing a client with suspected appendicitis. Which assessment finding would support the diagnosis? Pain starting in the periumbilical area and then recurring in the left lower quadrant Pain starting in the periumbilical area and then recurring in the left upper quadrant Pain starting in the periumbilical area and then recurring in the right lower quadrant Pain starting in the periumbilical area and then recurring in the right upper quadrant

Pain starting in the periumbilical area and then recurring in the right lower quadrant -Appendicitis usually begins with periumbilical pain that increases in intensity over several hours and then recurs in the right lower quadrant. Appendicitis pain does not generally occur on the left or in the upper quadrants.

A client has esophageal varices. While planning care, the nurse should focus interventions on which cause of esophageal villustarices? Biliary obstruction Portal hypertension Systemic hypotension Weakness of esophageal walls

Portal hypertension -Vomiting of blood (hematemesis) from bleeding esophageal varices is the most common clinical manifestation of portal hypertension. Biliary obstruction could result in jaundice. Systemic hypotension would not result in esophageal varices. Esophageal vessels, not the esophageal wall itself, are affected.

A client with viral hepatitis presents with fatigue, nausea, and vomiting. The nurse will report that the client is in which phase? Acute phase Icteric period Recovery phase Prodromal phase

Prodromal phase -The prodromal phase of viral hepatitis is the first stage and is marked by fatigue, anorexia, nausea, vomiting, headache, hyperalgia, cough, and low-grade fever. The second phase is the icteric phase and is marked by symptoms such as dark urine and clay-colored stools. The recovery phase is when jaundice is resolved, though the liver may remain enlarged for several weeks. The acute phase is not a phase of viral hepatitis.

A client with an inflamed gallbladder (cholecystitis) presents with pain in the right scapula. What type of pain will the nurse report the client is experiencing? Motility Parietal Referred Secretory

Referred -Referred pain is visceral pain felt at some distance from a diseased or affected organ. For example, acute cholecystitis may have pain referred to the right shoulder or scapula. Parietal pain, from the parietal peritoneum, is more localized and intense than visceral pain, which arises from the organs themselves. The terms motility and secretory are not used in reference to pain; a common context of their use is in classifying types of diarrhea.

Current Vital Signs -P= 100 bpm, reg. -Resp.=28 -BP= 152/84 -Temp.=99/4 degrees F Abd. Assessment -Skin intact w/ no visible lesions -Epigastric pain, 7 on a 10-point scale Lab. Report -Serum bilirubin elevated -serum amylase and lipase elevated A nurse is caring for a client who has acute cholecystitis. Which information in the current medical record does the nurse recognize as most likely indicating an additional problem and should be brought to the attention of a primary health care provider? Serum bilirubin elevated Temperature: 99.4 degrees F Serum amylase and lipase elevated Epigastric pain, 7 on a 10-point scale

Serum amylase and lipase elevated -Amylase and lipase are pancreatic enzymes; elevation of these enzymes in the blood occurs with acute pancreatitis, and the primary health care provider must be notified of this complication. Cholecystitis can lead to obstruction, which may also lead to reflux of bile into the pancreatic duct, causing acute pancreatitis. Fever may accompany cholecystitis. Both cholecystitis and acute pancreatitis can cause epigastric pain. Elevated serum bilirubin occurs with cholecystitis.

A client has pancreatic insufficiency. Which assessment finding is typical for this client? Steatorrhea Curling ulcer Bloody stools Cushing ulcer

Steatorrhea -A large amount of fat in the stool (steatorrhea) is the most common sign of pancreatic insufficiency. Bloody stools occur in individuals with ulcerative colitis. Curling ulcers are stress ulcers that occur in individuals that are severely burned. Cushing ulcers are stress ulcers that occur in individuals that have severe head trauma or brain surgery.

Which term should the nurse use to describe a client's fatty stool? Motility Osmotic Bloating Steatorrhea

Steatorrhea -Steatorrhea is fat in the stools. Bloating is gas within the abdomen that can cause the abdomen to distend. Motility diarrhea is caused by resection of the small intestine and is usually small-volume diarrhea. This is often found after bypass surgery (bariatric surgery). Osmotic diarrhea is due to a nonabsorbable substance in the intestine that draws water into the lumen by osmosis and produces large-volume diarrhea; an example is lactase deficiency.

What clinical manifestations should the nurse expect to observe in a client with chronic pancreatitis? Select all that apply. Weight gain Steatorrhea Odynophagia Abdominal pain Hyperglycemia

Steatorrhea,Abdominal pain, Hyperglycemia -Abdominal pain is seen with chronic pancreatitis and may be intermittent or continuous. Hyperglycemia is seen with destruction of the islet of Langerhans cells, leading to insulin-dependent diabetes that requires treatment. Steatorrhea is seen in late-stage chronic pancreatitis. Weight loss, not weight gain, is seen in chronic pancreatitis. Odynophagia (pain on swallowing) may be initiated from cancer of the esophagus, not chronic pancreatitis.

A nurse is caring for a client with acute pancreatitis. Which is the primary treatment goal? Maintain oral intake Preserve enzyme secretion Prevent a fall in blood glucose Stop the process of autodigestion

Stop the process of autodigestion -The goal of treatment for acute pancreatitis is to stop the process of autodigestion and prevent systemic complications. Stabilizing blood glucose levels is important but is not the primary aim of treatment of acute pancreatitis. Preserving enzyme secretion is not the primary aim of treatment of acute pancreatitis. Oral intake is contraindicated in the treatment of acute pancreatitis.

The nurse will teach a client with cancer of the colon about which type of treatment that is most common? Surgery Radiation Herbal therapy Chemotherapy

Surgery -Treatment for cancer of the colon is surgical resection or removal of the rectum with formation of a permanent colostomy. Radiation and chemotherapy are of less use, although they can be adjuvant or neoadjuvant. Herbal therapy is not a common treatment for colon cancer

A client with bile duct obstruction has jaundice. How should the nurse interpret this assessment finding? The client has increased conjugated bilirubin. The client has decreased conjugated bilirubin. The client has increased unconjugated bilirubin. The client has decreased unconjugated bilirubin.

The client has increased conjugated bilirubin. -With bile duct obstruction, the liver conjugates bilirubin but is unable to excrete it. The conjugated bilirubin accumulates in the blood and deposits in skin and other tissues, causing jaundice. Decreased bilirubin does not cause jaundice; hyperbilirubinemia does. The liver is still able to conjugate bilirubin, so unconjugated bilirubin levels do not change with bile duct obstruction.

A client with a hiatal hernia is confused about where the stomach herniates. How should the nurse respond? The stomach protrudes into the rectum. The stomach protrudes through the diaphragm. The stomach protrudes into the pyloric sphincter. The stomach protrudes through the inguinal canal

The stomach protrudes through the diaphragm -Hiatal hernia is protrusion of a portion of the stomach through the esophageal hiatus of the diaphragm. There is not a type of hernia where the stomach protrudes through the rectum, inguinal canal, or pyloric sphincter.

The nurse is assessing a client with suspected congestive splenomegaly caused by portal hypertension. Which clinical manifestation would be consistent with this condition? Flatulence Encephalopathy Thrombocytopenia Elevated serum lipase

Thrombocytopenia -Thrombocytopenia is the most common symptom of congestive splenomegaly. Flatulence occurs with cholelithiasis. Elevated serum lipase level is the primary diagnostic marker for acute pancreatitis. Encephalopathy results from a combination of biochemical alterations that affect neurotransmission from toxins altering cerebral energy metabolism.

A nurse is teaching about Crohn disease. Which information should the nurse include? Select all that apply. Weight loss Increased cancer risk Presence of "skip" lesions Involvement of only the mucosal layer Cobblestone appearance of the gastrointestinal tract Common stool pattern of bloody diarrhea about 4 times per day

Weight loss, Increased cancer risk, Presence of "skip" lesions, Cobblestone appearance of the gastrointestinal tract -In Crohn disease, there is a cobblestone appearance of the gastrointestinal tract; the entire intestinal wall is involved; there are "skip" lesions involved; there is an increased cancer risk; and there is weight loss. Bloody diarrhea and involvement of only the mucosal layer occur with ulcerative colitis. In Crohn disease, diarrhea is common but blood therein is not.

A client with cholelithiasis asks the nurse what cholelithiasis means. Which information is best for the nurse to share with the client? You have gallstones. You have atrophy of the gallbladder. You have inflammation of the gallbladder. You have hypersecretion of bile by the liver

You have gallstones. -Cholelithiasis is formation of gallstones. Cholelithiasis is not atrophy. Cholecystitis is inflammation of the gallbladder. Cholelithiasis is not hypersecretion of bile by the liver.

A client with stage IV colon cancer is receiving chemotherapy today and asks the nurse to explain what stage IV means. What is the nurse's best response? Your cancer has spread to distant lymph nodes and is growing in other locations that are far from where it began. Your cancer is invading local tissues near where it began, but it has not spread far away in your body. Your cancer cells are highly aggressive and look similar to the normal cells that they are killing. Your cancer cells look so undeveloped that the pathologist cannot tell where they originated.

Your cancer has spread to distant lymph nodes and is growing in other locations that are far from where it began. -Stage IV tumors have evidence of distant lymph node spread and distant metastasis. Cancer staging progresses from 0, the most local, to IV, the most widespread. Degree of cell abnormality describes cancer grading rather than staging.

Which information indicates the nurse has a correct understanding of the pathophysiologic mechanisms that lead to peptic ulcer formation from chronic infection with Helicobacter pylori ( H. pylori )? pylori inhibits the proton pumps in the gastric lining. pylori produces toxins and enzymes that promote inflammation and ulceration. pylori inhibits prostaglandins, which causes decreased mucus production. pylori causes the pyloric sphincter to open prematurely, releasing acid into the duodenum.

pylori produces toxins and enzymes that promote inflammation and ulceration. -H. pylori releases toxins and enzymes that promote inflammation and ulceration as well as causing death of mucosal epithelial cells and elevated levels of gastrin and pepsinogen. Inhibition of proton pumps would decrease secretion of gastric acid and protect against peptic ulcers. Long-term use of nonsteroidal anti-inflammatory drugs inhibits prostaglandins and results in reduced maintenance of the mucosal barrier and decreased bicarbonate secretion. Cigarette smoking stimulates acid production. Presence of H. pylori does not cause premature release of acid.

A nurse is teaching a client about intestinal obstructions. Which diagram should the nurse choose to illustrate a volvulus? A volvulus is a __________ of the intestines. A hernia is best illustrated in the picture with the intestines in a pouch. Intussusception is best illustrated in the picture where the intestine telescopes into itself. Adhesion is best illustrated in the picture where scar tissue is constricting the intestines.

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