Saunders CH.45 & 46 Questions

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic would the nurse expect to see documented in the record? 1. Diarrhea 2. Constipation 3. Bloody stools 4. Stool constantly oozing from the rectum

1 Rationale: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four or five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and 4 are not characteristics of Crohn's disease.

It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

1 Rationale: Hepatitis A virus (HAV) is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B virus, hepatitis C virus, and hepatitis D virus are most commonly transmitted via infected blood or body fluids.

A client with hiatal hernia chronically experiences heartburn after meals. Which would the nurse teach the client to avoid? 1. Lying recumbent after meals 2. Eating small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking histamine receptor antagonist medication, as prescribed

1 Rationale: Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm, where the esophagus usually is positioned. The client generally experiences pain caused by reflux resulting from ingestion of irritating foods, lying flat following meals or at night, and consuming large or fatty meals. Relief is obtained by eating small, frequent, and bland meals; histamine antagonists and antacids; and elevation of the thorax after meals and during sleep.

The nurse is reinforcing teaching to a client about an upcoming colonoscopy procedure. The nurse would include in the instructions that the client will be placed in which position for the procedure? 1. Modified left lateral recumbent position 2. Lithotomy position 3. Knee-chest position 4. Fowler's position

1 Rationale: The client is placed in the modified left lateral recumbent position for the procedure. This position takes the best advantage of the client's anatomy for ease with introducing the colonoscope. The other options are incorrect.

A client with ascites is scheduled for a paracentesis. The nurse is assisting the primary health care provider (PHCP) with performing the procedure. Which position would the nurse assist the client into for this procedure? 1. Flat 2. Upright 3. Left side-lying 4. Right side-lying

2 Rationale: An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration during catheter insertion. Options 1, 3, and 4 are incorrect positions.

The client has an as needed prescription for loperamide hydrochloride. For which condition would the nurse administer this medication? 1. Constipation 2. Acute diarrhea 3. Abdominal pain 4. Hematest-positive nasogastric tube drainage

2 Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 3, and 4.

An older client has recently been taking cimetidine. The nurse needs to monitor the client for which most frequent central nervous system side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3 Rationale: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to the central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

The client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3 Rationale: Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication reduces the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but would not result in weight loss if it is aiding in digestion.

An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. Which would the nurse explain to the client about this test? 1. The test is uncomfortable. 2. The test requires that the client be NPO. 3. The test requires the client to lie still for short intervals. 4. The test is preceded by the administration of oral tablets.

3 Rationale: Ultrasound of the gallbladder is a noninvasive procedure and is frequently used for emergency diagnosis of acute cholecystitis. The client may need to lie still during the procedure for short intervals of time while visualization of the gallbladder is done. The client may or may not need to be NPO (per PHCP preference), but may be instructed to avoid carbonated beverages for 48 hours before the test to help decrease intestinal gas. It is a painless test and does not require the administration of oral tablets as preparation.

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation would indicate that a prolapse has occurred? 1. Dark and bluish 2. Sunken and hidden 3. Narrowed and flattened 4. Protruding and swollen

4 Rationale: A prolapsed stoma is one in which bowel protrudes through the stoma, with an elongated and swollen appearance. A stoma retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with a dusky or bluish color. A stoma with a narrowed opening, either at the level of the skin or fascia, is said to be stenosed.

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency? 1. Vitamin A 2. Vitamin C 3. Vitamin E 4. Vitamin B12

4 Rationale: Deterioration and atrophy of the lining of the stomach lead to the loss of function of the parietal cells. When the acid secretion decreases, the source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. Options 1, 2, and 3 are incorrect.

The client has an as needed prescription for ondansetron. For which condition would the nurse administer this medication? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4 Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.

The nurse reinforces postoperative liver biopsy instructions to a client. Which would the nurse tell the client? 1. Avoid alcohol for 8 hours. 2. Remain NPO for 24 hours. 3. Lie on the right side for 2 hours. 4. Save all stools to be checked for blood.

3 Rationale: To splint the puncture site, the client is kept on the right side for a minimum of 2 hours. It is not necessary to remain NPO for 24 hours. Permission regarding the consumption of alcohol needs to be obtained from the primary health care provider (PHCP). It is not necessary to save all stools.

The client has been taking omeprazole for 4 weeks. The nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

2 Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called "heartburn" by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

The nurse is preparing to perform an abdominal examination. Which step would be taken first? 1. Palpation 2. Inspection 3. Percussion 4. Auscultation

2 Rationale: The appropriate technique for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection and before percussion and palpation to ensure that the motility of the bowel and bowel sounds are not altered. The sequence of maneuvers is inspect, auscultate, percuss, and palpate.

The client who frequently uses nonsteroidal anti-inflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that this medication is having the intended therapeutic effect if which is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased white blood cell count

2 Rationale: The client who frequently uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Options 3 and 4 are incorrect.

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. During review of the postoperative prescriptions, which would the nurse clarify? 1. Leg exercises 2. Early ambulation 3. Irrigating the nasogastric (NG) tube 4. Coughing and deep-breathing exercises

3 Rationale: In a Billroth II resection, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric (NG) tube is critical for preventing the retention of gastric secretions. However, the nurse would not irrigate or reposition the NG tube after gastric surgery unless specifically prescribed by the primary health care provider (PHCP). In this situation, the nurse would clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure would the nurse include during client teaching to help prevent dumping syndrome? 1. Ambulate after a meal. 2. Eat high-carbohydrate foods. 3. Limit the fluids taken with meals. 4. Sit in a high Fowler's position during meals.

3 Rationale: The client would be instructed to decrease the amount of fluid taken at meals. The client would also be instructed to avoid high-carbohydrate foods, including fluids such as fruit nectars; assume a low-Fowler's position during meals; lie down for 30 minutes after eating to delay gastric emptying; and take antispasmodics as prescribed.

The nurse is reviewing the primary health care provider's (PHCP's) prescriptions written for a client admitted with acute pancreatitis. Which PHCP prescription would the nurse verify if noted in the client's chart? 1. NPO status 2. An anticholinergic medication 3. Position the client supine and flat 4. Prepare to insert a nasogastric (NG) tube

3 Rationale: The pain associated with acute pancreatitis is aggravated when the client lies in a supine and flat position. Therefore, the nurse would verify this prescription. Options 1, 2, and 4 are appropriate interventions for the client with acute pancreatitis.

The client with a gastric ulcer has a prescription for sucralfate 1 g by mouth four times daily. The nurse would schedule the medication to be administered at which times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4 Rationale: Sucralfate is a gastric protectant. The medication needs to be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client with Crohn's disease is scheduled to receive an infusion of infliximab. The nurse assisting with caring for the client would take which action to monitor the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

2 Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.

The nurse is monitoring a client for the early signs/symptoms of dumping syndrome. Which indicates this occurrence? 1. Sweating and pallor 2. Dry skin and stomach pain 3. Bradycardia and indigestion 4. Double vision and chest pain

1 Rationale: Early manifestations occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. 1. Nizatidine 2. Famotidine 3. Cimetidine 4. Esomeprazole 5. Lansoprazole

1, 2, 3 Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist with preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed? Select all that apply. 1. Administer antacids, as prescribed. 2. Encourage coughing and deep breathing. 3. Administer anticholinergics, as prescribed. 4. Maintain the client in a supine and flat position. 5. Encourage small, frequent, high-calorie feedings.

1, 2, 3 Rationale: The client with acute pancreatitis is normally placed on an NPO status to rest the pancreas and suppress gastrointestinal (GI) secretions. Because abdominal pain is a prominent symptom of pancreatitis, pain medication will be prescribed. Some clients experience lessened pain by assuming positions that flex the trunk and draw the knees up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may also help ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted. Antacids and anticholinergics may be prescribed to suppress GI secretions.

A client with a peptic ulcer is diagnosed with a H. pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3 Rationale: Triple therapy for H. pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.