Adult Care Exam 4

1. X-rays - What can they reveal/detect? 2. Chest X-rays - What can they reveal?

1. Can reveal masses, tumors, and strictures or obstructions - patterns of bowel gas appear light on the fim and can be useful in detecting an obstruction (ileus) 2. Can reveal a hiatal hernia

What age do we typically see physiological changes in the GI system?

65 and >

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate? Arrange a dietary consult Increase fluid intake Limit the client's foods Make the client NPO

ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian nutritionist will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.

To promote comfort and the passage of flatus after a colonoscopy, in what position does the nurse place the client? A. Left lateral B. Prone C. Right lateral D. Supine

ANS: A After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.

An older adult has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best? A. "Changes in your liver cause drugs to be metabolized differently." B. "Perhaps you don't need as high a dose of the drug as before." C. "Stomach muscles atrophy with age and you digest more slowly." D. "Your body probably can't tolerate as much medication anymore."

ANS: A Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels. The other options do not accurately explain this age-related change.

A nurse is preparing to administer pantoprazole intravenously to prevent stress ulcers during surgery. What action(s) by the nurse is (are) most appropriate? (Select all that apply.) A. Administer the drug through a separate IV line B. Infuse pantoprazole using an IV pump C. Keep the drug in its original brown container D. Take vital signs frequently during infusion E. Use an in-line IV filter when infusing

ANS: A, B, E When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.

A nurse assesses a client who is prescribed alosetron. Which assessment question would the nurse ask this client before starting the drug? A. "Have you been experiencing any constipation?" B. "Are you eating a diet high in fiber and fluids?" C. "Do you have a history of high blood pressure?" D. "What vitamins and supplements are you taking?"

ANS: A Ischemic colitis is a life-threatening complication of alosetron. The nurse would assess the client for constipation because it places the client at risk for this complication. The other questions do not identify the risk for complications related to alosetron.

A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? A. "It's a good thing I love orange and cherry gelatin." B. "My spouse will be here to drive me home." C. "I'll avoid ibuprofen for several days before the test." D. "I'll buy a case of clear Gatorade before the prep."

ANS: A The client would be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show an understanding of the preparation for the procedure.

The nurse is caring for a client who has frequent gastric pain and dyspepsia. Which procedure would the nurse expect for the client to make an accurate diagnosis? A. Esophagogastroduodenoscopy (EGD) B. Abdominal arteriogram C. Nuclear medicine scan D. Magnetic resonance imaging (MRI)

ANS: A The gold standard for diagnosing disorders of the stomach is an EGD which allows direct visualization by the endoscopist into the esophagus, stomach, and duodenum.

The nurse is caring for a client with probable colorectal cancer (CRC). What assessment findings would the nurse expect? (Select all that apply.) A. Weight gain B. Rectal bleeding C. Anemia D. Change in stool shape E. Electrolyte imbalances F. Abdominal discomfort

ANS: B, C, D, F The client who has CRC usually experiences unintentional weight loss and rectal bleeding, either gross or occult. As a result of bleeding, the client has anemia and fatigue. Electrolyte imbalances are not common, but the client may note that the shape or consistency of stool has changed.

The nurse is teaching a client how to avoid the formation of hemorrhoids. What lifestyle change would the nurse include? A. Avoiding alcohol B. Quitting smoking C. Decreasing fluid intake D. Increasing dietary fiber

ANS: C The major cause of hemorrhoid formation is constipation. Therefore, the nurse teaches the client ways to prevent constipation, which include increasing dietary fiber, increasing exercise and fluid intake, and avoiding straining when have a stool.

A nurse is assessing a client who has a complete intestinal obstruction. which of the following findings should the nurse expect? A. Absence of bowel sounds in all 4 abd quadrants B. Passage of blood tinged liquid stool C. Presence of flatus D. Hyperactive bowel sounds above the obstruction

D. Hyperactive bowel sounds above the obstruction With a complete intestinal obstruction, there are NO bowel sounds below the obstruction

What does the nurse need to instruct the patient to do BEFORE assessing the abdomen?

Ask patient to empty bladder and lie in a supine position with knees bent, keeping arms at sides to prevent tensing of abdominal muscles

A nurse is assisting to plan teaching about secondary prevention actions for colorectal cancer for a health fair for adults in the community. Which of the following topics should the nurse recommend to include? A. Smoking cessation B. Benefits of a diet high in cruciferous veggies C. New types of ostomy appliances D. Importance of colonoscopy screening starting at age 50 years old

D. Importance of colonoscopy screening starting at age 50 years old

A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse teach the client to perform? Select all that apply A. Use antimicrobial ointment on the peristomal skin B. Empty the bag when it is one-third to one-half full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water E. Apply the skin barrier while the skin is slightly moist

B. Empty the bag when it is one-third to one-half full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water Empty the bag when it is one-third to one-half full; Cut the skin barrier opening a little larger than the ostomy; Wash the peristomal skin with mild soap and water

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? A. Elevated BP B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

C. Rigid abdomen Abdominal tenderness and rigidity indicate a bowel perforation. As fluid escapes into the peritoneal cavity, a reduction in circulating blood volume occurs, lowering BP

Many electrolytes are altered in GI tract dysfunction. What are the 3 usually affected?

Calcium = Absorbed in the GI tract and may be measured to detect malabsorption Excessive vomiting or diarrhea causes sodium or potassium depletion

Chapter 48

Chapter 48

A nurse is caring for a client who is postoperative following a laparotomy and has an indwelling urinary catheter and a Jackson Pratt drain in place. Which of the following findings should indicate that the client is developing a postoperative complication? A. Pain scale score of 5 out of 10 B. Urine output of 65 mL/hr C. 20 mL of bright red drainage from the drain D. Pulse oximetry of 85%

D. Pulse oximetry of 85%

In adults, GI bleeding is the most frequent cause of anemia. Which disorders is it associated with?

GI cancer; PUD; Diverticulitis; IBD

What GI disorders is alcohol and caffeine consumption associated with?

Gastritis and peptic ulcer disease

Where does abdominal examination usually begin?

Starts on the right side = RUQ > LUQ > LLQ > RLQ

Why would an endoscopy be prescribed?

To evaluate bleeding, ulceration, inflammation, tumors, and cancer of the esophagus, stomach, biliary system, or bowel

Changes in the GI system associated with age: 1. Atrophy of the gastric mucosa leads to decreased hydrochloric acid levels - What disorders can occur r/t to this change? 2. Peristalsis decreases and nerve impulses are dulled - What disorders can occur r/t to this change? 3. Distension and dilation of pancreatic ducts change. Calcification of pancreatic vessels occur with a decrease in lipase production - What disorders can occur r/t to this change? 4. A decrease in the number and size of hepatic cells leads to decreased liver weight and mass. This change and an increase in fibrous tissue lead to decreased protein synthesis and changes in liver enzymes. Enzyme activity and cholesterol synthesis or diminished - What disorders can occur r/t to this change? 5. The delicate microbial balance of good anaerobic and aerobic flora is disrupted over time, negatively affecting the immune response - What disorders can occur r/t to this change?

1. Decreased absorption of iron and B12 and proliferation of bacteria; Atrophic gastritis occurs as a consequence of bacterial overgrowth 2. Decreased sensation to defecate can result in postponement of bowel movements, which leads to constipation and impaction 3. Decreased lipase levels result in decreased fat absorption and digestion; Steatorrhea (fatty stool) occurs bc of decreased fat digestion 4. Decreased enzyme activity depresses drug metabolism, which leads to accumulation of drugs - possibly to toxic levels 5. Dysfunctional microbial activity contributes to obesity, inflammatory disease, and reduced immunity

Hiatal hernia: 1. How do symptoms present? 2. What is the major concern for a sliding hernia? What are the S/S? 3. What are the S/S for paraesophageal or rolling hernias? 4. What is the most specific diagnostic test?

1. Usually asymptomatic but some experience S/S similar to GERD 2. Development of esophageal reflux and associated complications - heartburn - regurgitation - chest pain - dysphagia - belching 3. Rolling: - feeling of fullness after eating - breathlessness after eating - feeling of suffocation after eating - chest pain that mimics angina - worsening of S/S in a recumbent position 4. Barium swallow study with fluoroscopy

EGD: 1. What does it examine? 2. What happens if GI bleeding is found during the examine? 3. What drugs are to be avoided several days before? 4. What should the nurse teach the patient B4? 5. What drugs are given prior and why? What should one caution? 6. Why would Atropine be given? 7. How/why is the throat prepared for insertion of the tube? What does the nurse need to explain to the patient? 8. Once drugs are given, what position is the patient placed? 9. How long does it take?

1. Esophagus, stomach, and duodenum by means of a fiberoptic endoscope 2. The HCP can use clips, thermocoagulation, injection therapy, or topical hemostatic agent 3. Avoid anticoagulants, aspirin, or other NSAIDs 4. To remain NPO 6-8 hrs B4 5. Midazolam, fentanyl, or propofol are commonly used for sedation - THEY CAN DEPRESS THE RATE AND DEPTH OF THE PATIENT'S RESPIRATIONS 6. Atropine may be given to dry secretions 7. Local anesthetic is sprayed to inactivate the gag reflex and facilitate passage of the tube - EXPLAIN THAT THE ANESTHETIC WILL DEPRESS GAG REFLEX AND SWALLOWING MAY BE DIFFICULT!! - Before giving pt something to drink, ASSESS GAG REFLEX!! 8. Position the patient with the HOB elevated - a bite block is inserted to prevent biting on endoscope/protect teeth 9. 20-30 min

ERCP: 1. What does it include/identify? 2. Once the cannula is inserted into the common bile duct, what is instilled? 3. Prepare pt in same manner as for an EGD. But what would be different? 4. What is a tilt table? 5. What position is the patient placed in? 6. How long does it take? 7. What is done AFTER? 8. What complications can occur AFTER?

1. Includes visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify the cause and location of obstruction 2. Radiopaque dye is instilled and several x-ray images are obtained - biopsy samples are frequently taken during this test 3. Ask about prior exposure to x-ray contrast media and any sensitivities/allergies; Ask if the pt has a cardiac pacemaker; The endoscope is advanced farther into the duodenum and into the biliary tract (unlike EGD) 4. Assists in distributing the contrast medium to all areas 5. Left lateral position for viewing the common bile duct - Once the cannula is placed, place patient in prone position 6. 30 min to 2 hours 7. AFTER: - Assess VS every 15 min - Check to see if the gag reflex has returned B4 offering fluids/fluid so aspiration doesn't occur - Discontinue IV fluids that were started before when pt is able to tolerate oral fluids without N/V - Do not drive for 12-18 hours after 8. Colicky abd pain and flatulence can result due to air instilled during procedure - REPORT abd pain, fever, N/V that fails to resolve after returning home - Cholangitis; Pancreatitis; Perforation; Sepsis; Bleeding = Complications

GI problems: Which enzymes are associated with the following organs? 1. Liver 2. Pancreas * in other words, if someone has a GI issue, the liver and pancreas can be a way to determine what is wrong. the liver and pancreas are associated with certain enzymes and when there is a GI issue, the enzymes become altered. what are those enzymes associated with the liver/pancreas?*

1. Liver = ALT and ammonia 2. Pancreas = Amylase and lipase

GERD: 1. Who is at the highest risk? 2. How does helicobacter pylori play part? 3. What are S/S? 4. What complications can occur if not managed?

1. Overweight or obese - increased weight increases intra-abdominal pressure, which contributes to reflux 2. Helicobacter pylori may contribute to reflux by causing gastritis and thus poor gastric emptying - This increases frequency of GER events and acid exposure to the esophagus 3. S/S: - Dyspepsia - Regurgitation - Belching - Coughing - Chest discomfort - Dysphagia 4. Complications: - Asthma - Laryngitis - Dental caries - Cardiac disease - Cancer

Esophageal Tumors: Esophagectomy 1. What should the nurse instruct the pt to do PREOP/B4? 2. What should the nurse instruct the pt to do POSTOP/AFTER?

1. PREOP: - Stop smoking 2-4 weeks before - Respiratory rehab - Nutrition support = Supplement is given PO but some require tubes - Monitor weight and I/O - Eval to treat dental disease - Practice meticulous oral care 4 times daily 2. POSTOP: - RESPIRATORY CARE = HIGHEST PRIORITY!!! - Keep pt in semi-fowler or high-fowler - Ensure patency of chest tube drainage system and monitor changes in volume or color - Hypotension can occur - Carefully monitor cardio and pulmonary status - Monitor for symptoms of fluid volume overload, especially in older adults (edema, crackles, increased jugular venous pressure) - Observe for atrial fibrillation - Provide meticulous oral and nasal hygiene every 2-4 hours r/t NG tubes - Recognize fever, fluid accumulation, signs of inflammation, and symptoms of early shock (tachycardia, tachypnea)

Colonoscopy: 1. What beverages should be avoided B4? 2. How is the patient positioned? 3. What might be instilled and why? What does it indicate? 4. How is the patient positioned AFTER and why? 5. You should always assess for S/S of hypovolemic shock. What are the S/S? 6. What should the nurse instruct the client to do if they notice a spot of bright red blood on the toilet paper after having a colonoscopy and biopsy? 7. What should the nurse do/assess AFTER?

1. Red, orange, or purple beverages or gelatin 2. On left side with knees drawn up while the endoscope is placed into the rectum and moved to the cecum 3. Air or CO2 may be instilled for better visualization - Research indicates that use of CO2 is associated with decreased pain and distention 4. Lie on the left side = promotes comfort and encourages passing flatus 5. Hypovolemic shock = dizzy, light-headed, decreased BP, tachycardia, pallor, and altered mental status 6. Remind the client that a small amount is normal 7. Obtain VS every 15-30 min; Assess for rectal bleeding/severe pain; Confirm pt has a ride home/plans to rest

Esophageal Tumors: 1. What are the primary risk factors? 2. What is the most common S/S? 3. What are the rest of the key features?

1. Risk factors: - alcohol - diets chronically deficient in fresh fruits/veggies - diets high in nitrates and nitrosamines (pickled/fermented foods) - malnutrition - obesity - smoking - untreated GERD 2. Dysphagia - may not be present until the esophageal opening has narrowed - Weight loss often accompanies progressive dysphagia and can exceed 20 lbs over several months 3. Key features: - Feeling of food sticking in the throat - Odynophagia - Halitosis - Chronic hiccups - Chronic cough with increasing secretions - Hoarseness - Severe, persistent chest/abd pain/discomfort - Anorexia - Regurgitation - N/V - Weight loss (> 20 lbs) - Diarrhea, constipation, bleeding r/t the bowel

EGD: 10. What does the nurse monitor DURING? What happens if the patient begins to have shallow respirations? 11. What should the nurse do/teach AFTER?

10. Monitor the patient's respirations for rate and depth - shallow respirations decrease the amount of carbon dioxide that the patient exhales - if the patient's RR is BELOW 10 or exhaled CO2 falls BELOW 20%, the nurse typically uses a stimulus such a sternal rub to encourage deeper and faster respirations 11. AFTER: - Monitor VS every 15-30 min until sedation wears off - Keep side rails raised during this time; Keep patient NPO until the gag reflex returns (30-60 min) - IV fluids started before can be discontinued when pt is able to tolerate oral fluids without N/V - Remind pt to not drive for 12-18 hrs - Teach that a hoarse voice or sore throat may persist for several days; Use of lozenges can relieve discomfort

GERD: 13. What are the two PPIs used and why? What can long-term use of these do? 14. What is the standard surgical approach for severe GERD?

13. Esomeprazole and pantoprazole = IV for short-term use to treat/prevent stress ulcers - long-term use may mask reflux symptoms - long-term use can cause community-acquired pneumonia, C. diff, bone fractures chronic kidney injury, and vitamin/mineral deficiencies 14. Laparoscopic Nissen fundoplication (LNF) - minimally invasive surgery (MIS)

GERD: 4. What should the nurse teach the pt r/t eating? 5. What type of history would the nurse ask about? 6. If indigestion is severe, where is pain felt? 7. Why are older adults at an increased risk for developing severe GERD? What are the complications? 8. What foods should one avoid?

4. Teach pt to consume SMALL, FREQUENT meals; Limit fried, fatty, spicy foods, and caffeine; Sit upright for AT LEAST 1 hour after eating 5. History of newly diagnosed asthma, has experienced morning hoarseness, or has coughing/wheezing at night = Severe reflux or pulmonary aspiration 6. The pain may be felt in the chest and radiate to the neck, jaw, or back, mimicking cardiac pain 7. Due to age-related changes, comborbities, increased prevalence of obesity, and polypharmacy - atypical chest pain - ear, nose, and throat infections - aspiration pneumonia - sleep apnea - asthma - Barrett esophagus and esophageal erosions 8. Avoid: - peppermint - chocolate - fatty foods (fried) - caffeine - carbonated drinks - spicy foods - acidic foods (OJ and tomatoes)

Hiatal hernia: 5. Rolling are usually clearly visible but sliding is not. How does one visualize sliding hernias? 6. What does fundoplication mean? 7. What can the LNF put a patient at risk for? Explain post op instructions for LNF

5. EGD may be performed to view both the esophagus and gastric lining 6. The stomach fundus is wrapped around the distal esophagus - the wrap is then closed with sutures to anchor the lower esophagus below the diaphragm 7. LNF: - Risks = Bleeding and infection - Consume a soft diet for about a week; Avoid carbonated drinks, tough foods, and raw veggies - Remain on antireflux meds for at least a month - Do not drive for a week after - Walk every day but no heavy lifting - Remove small dressings 2 days after and shower; Do not remove wound closure strips until day 10 - Wash incisions with soap and water, rinse well, and pat dry; Report any redness/drainage - Report fever above 101, N/V, or uncontrollable bloating/pain; Older adults > 65 report temp above 100 - Keep follow-up appointment, usually 3-4 weeks after

GERD: 8. What diagnostic assessment is used for patients who have atypical S/S? 9. What is the most accurate method of diagnosing? How is it done? What should the patient do? 10. Besides foods, what else should the nurse teach the client? 11. What should the nurse discourage/encourage the pt to do? 12. What 3 major types of drugs help with managing?

8. EGD 9. pH monitoring - a transnasally placed catheter or wireless, capsule-like device is affixed to the distal esophageal mucosa - pt is asked to keep a diary of activities/symptoms over 24 to 48 hrs and the pH is continuously monitored/recorded 10. Eat 4-6 meals/day; Eat slow and thorough; Avoid eating 3 hours before bed; Prop head up when sleeping; Avoid alcohol and tobacco 11. Discourage heavy lifting, straining, and working in a position in which the patient bends at the abdomen; Encourage comfy, nonrestrictive clothes 12. Antacids; Antihistamines; PPIs

A nurse is performing discharge teaching about ostomy care while at home for a client who has a newly placed ileostomy. Which of the following instructions should the nurse include in the teaching? A. "Empty your ostomy pouch when it becomes half full." B. "Place an aspirin in the ostomy pouch to eliminate odor." C. "Change the ostomy appliance every week." D. "Cleanse the site around the stoma with hydrogen peroxide and water."

A. "Empty your ostomy pouch when it becomes half full."

A nurse is teaching a client who has a colostomy about ways to reduce flatus and odor. which of the following strategies should the nurse include? A. Eat crackers and yogurt regularly B. Chew minty gum throughout the day C. Drink orange juice everyday D. Put an aspirin in the pouch

A. Eat crackers and yogurt regularly Crackers, toast, and yogurt can help reduce flatus, which contributes to odor

A nurse cares for a client who states, "My husband is repulsed by my colostomy and refuses to be intimate with me." How would the nurse respond? A. "Let's talk to the ostomy nurse to help you and your husband work through this." B. "You could try to wear longer lingerie that will better hide the ostomyappliance." C. "You should empty the pouch first so it will be less noticeable for your husband." D. "If you are not careful, you can hurt the stoma if you engage in sexual activity."

ANS: A The nurse would collaborate with the ostomy nurse to help the client and her husband work through intimacy issues. The nurse would not minimize the client's concern about her husband with ways to hide the ostomy. The client will not hurt the stoma by engaging in sexual activity.

A nurse cares for a client who has a new colostomy. Which action would the nurse take? A. Empty the pouch frequently to remove excess gas collection B. Change the ostomy pouch and barrier every morning C. Allow the pouch to completely fill with stool prior to emptying it D. Use surgical tape to secure the pouch and prevent leakage

ANS: A The nurse would empty the new ostomy pouch frequently because of excess gas collection, and empty the pouch when it is one-third to one-half full of stool. The ostomy pouch does not need to be changed every morning. Ostomy barriers would be used to secure and seal the ostomy appliance; surgical tape would not be used.

The nurse is caring for a client experiencing upper gastrointestinal (GI) bleeding. What is the priority action for the client's care? A. Maintain airway, breathing, and circulation B. Monitor vital signs, including orthostatic blood pressures C. Draw blood for hemoglobin and hematocrit immediately Insert a nasogastric (NG) tube and connect to intermittent suction.

ANS: A The priority action for any client experiencing deterioration or an emergent situation is monitor and maintain airway, breathing, and circulation (ABCs). Taking orthostatic blood pressures would not be appropriate, but the nurse would monitor vital signs carefully and draw blood for hemoglobin and hematocrit. An NG tube would also need to be inserted and connected to gastric suction to rest the GI tract. However, none of these actions take priority over maintaining ABCs.

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, "The stool in my pouch is still liquid." How would the nurse respond? A. "The stool will always be liquid with this type of colostomy." B. "Eating additional fiber will bulk up your stool and decrease diarrhea." C. "Your stool will become firmer over the next couple of weeks." D. "This is abnormal. I will contact your primary health care provider."

ANS: A The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool. This finding is not abnormal. Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client's diet or with the passage of time.

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to which organ functions or dysfunctions? (Select all that apply.) A. Alanine aminotransferase: biliary system B. Ammonia: liver C. Amylase: liver D. Lipase: pancreas E.Urine urobilinogen: stomach

ANS: B, D Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions would the nurse include in this client's assessment? (Select all that apply.) A. "Which food types cause an exacerbation of symptoms?" B. "Where is your pain or discomfort and what does it feel like?" C. "Have you lost a significant amount of weight lately?" D. "Are your stools soft, watery, and black?" E. "Do you often experience nausea and vomiting"

ANS: A, B The nurse would ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse would also assess the location, intensity, and quality of the patient's pain or discomfort. Clients who have IBS do not usually lose weight, have nausea and vomiting, or have stools that are black.

During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect? A. Hematemesis B. Pain when eating C. Melena D. Weight loss

ANS: C All of the other assessment findings are more commonly seen in clients who have gastric ulcers rather than duodenal ulcers.

The nurse is teaching a client about risk factors for esophageal cancer. Which risk factors would the nurse include? (Select all that apply.) A. Alcohol intake B. Obesity C. Smoking D. Lack of fresh fruits and vegetables E. Untreated GERD F. Use of NSAIDs

ANS: A, B, C, D, E All of these factors increase the risk of esophageal cancer except for the use of NSAIDs. Untreated GERD causes damage to esophageal tissue which may develop into Barrett esophagus, or precancerous cells.

The nurse is teaching a client about the risk of uncontrolled or untreated the client's gastroesophageal reflux disease (GERD). What complication(s) may occur if the GERD is not successfully managed? (Select all that apply.) A. Asthma B. Laryngitis C. Dental caries D. Cardiac disease E. Cancer

ANS: A, B, C, D, E Any of these complications may occur in clients who have uncontrolled or untreated GERD.

The nurse is caring for a client who just had a minimally invasive inguinal hernia repair. Which nursing actions would the nurse implement? (Select all that apply.) A. Apply ice to the surgical area for the first 24 hours after surgery B. Encourage ambulation with assistance within the first few hours after surgery C. Encourage deep breathing after surgery but teach the client to avoid coughing D. Assess vital signs frequently for the first few hours after surgery E. Teach the client to rest for several days after surgery when at home F. Teach the client not to lift more than 10 lb (4.5 kg) until allowed by the surgeon

ANS: A, B, C, D, E, F All of these nursing actions are appropriate for the client having MIS for inguinal hernia repair.

The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease (GERD). What assessment finding(s) would the nurse expect? (Select all that apply.) A. Dyspepsia B. Regurgitation C. Belching D. Coughing E. Chest discomfort F. Dysphagia

ANS: A, B, C, D, E, F All of these signs and symptoms are commonly seen in clients who have GERD.

Which of the following is (are) (a) risk factor(s) for gastric cancer? (Select all that apply.) A. Achlorhydria B. Chronic atrophic gastritis C. H. pylori infection D. Iron deficiency anemia E. Pernicious anemia

ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.

The nurse assists the wound care/ostomy nurse assess a client prior to ostomy surgery. Which assessments would the nurse complete before marking the placement for the ostomy? (Select all that apply.) A. Contour of the abdomen when standing B. Location of the client's belt line C. Contour of the abdomen when lying D. Location of abdominal muscles E. Contour of the abdomen when sitting

ANS: A, B, C, E Before marking the placement for the ostomy, the nurse would consider the contour of the abdomen in lying, sitting, and standing positions, the location of the belt line and possible location in the rectus muscle. The location of abdominal muscles is not considered.

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse teaches the client and family about the signs of potential complications which include what problems? (Select all that apply.) A. Cholangitis B. Pancreatitis C. Perforation D. Renal lithiasis E. Sepsis

ANS: A, B, C, E Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.

The nurse recalls that the risk factors for acute gastritis include which of the following? (Select all that apply.) A. Alcohol B. Caffeine C. Corticosteroids D. Fruit juice E. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A, B, C, E Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.

The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.) A. Decreased hydrochloric acid production B. Diminished sensation that can lead to constipation C. Fat not digested as well in older adults D. Increased peristalsis in the large intestine E. Pancreatic vessels become calcified

ANS: A, B, C, E Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.

The assistive personnel note that a client had a dark stool. What stool test would the nurse obtain for this client? A. Culture and sensitivity B. Parasites and ova C. Occult blood test D. Total fat content

ANS: C Dark stools are typical in clients who have lower GI bleeding. Therefore, an fecal occult blood test would be the most appropriate test as a follow-up.

What action(s) by the nurse is (are) appropriate to promote nutrition in a client who had a partial gastrectomy? (Select all that apply.) A. Administer vitamin B12 injections B. Ask the primary health care provider about folic acid replacement C. Educate the client on enteral feedings D. Obtain consent for total parenteral nutrition E. Provide iron supplements for the client

ANS: A, B, E After a partial or total gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse would provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.

A nurse cares for a client who is recovering from a colonoscopy. Which actions would the nurse take? (Select all that apply.) A. Obtain vital signs every 15 to 30 minutes until alert B. Assess the client for rectal bleeding and severe pain C. Administer prescribed pain medications as needed D. Monitor the client's serum and urine glucose levels E. Confirm the client has a ride home and plans to rest

ANS: A, B, E During the recovery phase after a colonoscopy, the nurse would obtain vital signs every 15 to 30 minutes until the client is alert, assess for rectal bleeding or severe pain, and confirm the client has arranged for another person to drive home to get rest. Pain medications are not necessary after the procedure, and neither is glucose monitoring.

A nurse is caring for a client who has been diagnosed with a small bowel obstruction. Which assessment findings would the nurse correlate with this diagnosis? (Select all that apply.) A. Serum potassium of 2.8 mEq/L (2.8 mmol/L) B. Loss of 15 lb (6.8 kg) without dieting C. Abdominal pain in upper quadrants D. Low-pitched bowel sounds E. Serum sodium of 121 mEq/L (121 mmol/L)

ANS: A, C, E Small bowel obstructions often lead to severe fluid and electrolyte imbalances. The client is hypokalemic (normal range is 3.5 to 5.0 mEq/L [3.5 to 5.0 mmol/L]) and hyponatremic (normal range is 136 to 145 mEq/L [136 to 145 mmol/L]). Abdominal pain across the upper quadrants is associated with small bowel obstruction. Dramatic weight loss without dieting followed by bowel obstruction leads to the probable development of colon cancer. High-pitched sounds may be noted with small bowel obstructions.

The nurse is caring for a client who has perineal surgical wound. Which actions would the nurse take to promote comfort and wound healing? (Select all that apply.) A. Assist the client into a side-lying position B. Use a rubber donut device when sitting up C. Apply warm compresses three to four times a day D. Instruct the client to wear boxer shorts E. Place an absorbent dressing over the wound

ANS: A, C, E The nurse would place an absorbent pad over the wound and apply warm compresses to the wound area. The nurse would also instruct the male client to wear jockey-type shorts for support rather than boxers, assume a side-lying position in bed, avoid sitting for long periods, and use foam pads or soft pillows whenever in a sitting position. The patient should avoid the use of air rings or rubber donut devices.

The nurse is aware of the most recent American Cancer Society Screening Guidelines for colon cancer, which include which accepted testing modalities for people over the age of 50? (Select all that apply.) A. Colonoscopy every 10 years B. Endoscopy every 5 years C. Computed tomography (CT) colonography every 5 years D. Double-contrast barium enema every 10 years E. Flexible sigmoidoscopy every 5 years

ANS: A, C, E The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) A. Apricots B. Coffee cake C. Milk shake D. Potato soup E. Steamed broccoli

ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, and low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

The nurse is caring for a client who has a nasogastric tube (NGT). Which actions would the nurse take for client care? (Select all that apply.) A. Assess for proper placement of the tube every 4 hours or per agency policy B. Flush the tube with water every hour to ensure patency C. Secure the NG tube to the client's chin D. Disconnect suction when auscultating bowel peristalsis E. Monitor the client's skin around the tube site for irritation

ANS: A, D, E The nurse would frequently assess for NGT placement, patency, and output (drainage) every 4 hours or per agency policy. The nurse would also monitor the skin around the tube for irritation and secure the tube to the client's nose. When auscultating bowel sounds for peristalsis, the nurse would disconnect suction. NGT irrigation may or may not be prescribed. If it is prescribed, hourly irrigation is not appropriate.

The primary health care provider documents that a client has a bruit over the abdominal aorta. What teaching will the nurse provide for assistive personnel (AP) based on this assessment finding? A. "Use warm compresses on the client's abdomen continuously." B. "Avoid washing the client's abdomen too aggressively." C. "Apply ice to the client's abdomen every 4 hours." D. "Massage the client's abdomen to help reduce pain."

ANS: B A bruit heard over the abdominal aorta possible indicates stenosis or an aneurysm which should not be palpated or percussed. Therefore, the AP should wash the client's abdomen very gently.

The nurse is caring for a client who is planning to have a laparoscopic colon resection for colorectal cancer tomorrow. Which statement by the client indicates a need for further teaching? A. "I should have less pain after this surgery compared to having a large incision." B. "I will probably be in the hospital for 3 to 4 days after surgery." C. "I will be able to walk around a little on the same day as the surgery." D. "I will be able to return to work in a week or two depending on how I do."

ANS: B All of these statements are correct about having minimally invasive laparoscopic surgery except that the hospital stay will likely be only 1 or 2 days.

The nurse is caring for a client who has a postoperative paralytic ileus following abdominal surgery. What drug is appropriate to manage this nonmechanical bowel obstruction? A. Alosetron B. Alvimopan C. Amitriptyline D. Amlodipine

ANS: B Alvimopan is the appropriate drug to promote peristalsis for clients who have a paralytic ileus. The other drugs do not affect intestinal activity.

A client who has peptic ulcer disease is prescribed quadruple drug therapy for Helicobacter pylori infection. What health teaching related to bismuth would the nurse include? A. "Report stool changes to your primary health care provider immediately." B. "Do not take aspirin or aspirin products of any kind while on bismuth." C. "Take bismuth about 30 minutes before each meal and at bedtime." D. "Be aware that bismuth can cause frequent vomiting and diarrhea."

ANS: B Bismuth is a salicylate drug and causes stool discoloration but not vomiting and diarrhea. It does not have to be taken at a specific time relative to meals. Clients taking bismuth should not take other salicylates, such as aspirin or aspirin-containing products.

A client has a nasogastric (NG) tube as a result of an upper gastrointestinal (GI) hemorrhage. What comfort measure would the nurse remind assistive personnel (AP) to provide? Lavaging the tube with ice water Performing frequent oral care Re-positioning the tube every 4 hours Taking and recording vital signs

ANS: B Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Repositioning the tube, if needed, is also done by the nurse. The can take vital signs, but this is not a comfort measure.

A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspect? A. Pyloric obstruction B. Dumping syndrome C. Delayed gastric emptying D. Pernicious anemia

ANS: B Dumping syndrome causes autonomic symptoms as food quickly leaves the stomach due to its decreased size after surgery.

The nurse is caring for a client who has been prescribed lubiprostone for irritable bowel syndrome (IBS-C). What health teaching will the nurse include about taking this drug? A. "This drug will make you very dry because it will decrease your diarrhea." B. "Be sure to take this drug with food and water to help manage constipation." C. "Avoid people who have infection as this drug will suppress your immune system." D. "Include high-fiber foods in your diet to help produce more solid stools."

ANS: B Lubiprostone is an oral laxative approved for women who have IBS with constipation (IBS-C). Water and food will also help to improve constipation. The drug is not used for clients who have diarrhea and does not affect the immune system. Although high-fiber foods are important for clients who have IBS, this client does not need fiber to help make stool more solid. Instead the fiber will help prevent constipation.

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching? A. Ham sandwich on white bread, cup of applesauce, carbonated beverage B. Broiled chicken with brown rice, steamed broccoli, glass of apple juice C. Grilled cheese sandwich, small banana, cup of hot tea with lemon D. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

ANS: B Patients with IBS are advised to eat a high-fiber diet. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. Clients should avoid alcohol, caffeine, and other gastric irritants.

The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ? A. Kidneys B. Liver C. Spleen D. Stomach

ANS: B Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.

A client is preparing to have a fecal occult blood test (FOBT). What health teaching would the nurse include prior to the test? A. "This test will determine whether you have colorectal cancer." B. "You need to avoid red meat and NSAIDs for 48 hours before the test." C. "You don't need to have this test because you can have a virtual colonoscopy." D. "This test can determine your genetic risk for developing colorectal cancer."

ANS: B The FOBT is a screening test that is sometimes used to assess for microscopic lower GI bleeding. To help prevent false positive results, the client needs to avoid red meat, Vitamin C, and NSAIDs. The test is not diagnostic nor does it determine a client's genetic risk for colorectal cancer.

A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is appropriate? A. Allow the client cool liquids only B. Assess the client's gag reflex C. Remind the client to remain NPO D. Tell the client to wait 4 hours

ANS: B The local anesthetic used during this procedure depresses the client's gag reflex. After the procedure, the nurse would ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the client's readiness for them.

A client has a recurrence of gastric cancer and is crying. What response by the nurse is most appropriate? A. "Do you have family or friends for support?" B. "Would you tell me what you are feeling now." C. "Well, we knew this would probably happen." D. "Would you like me to refer you to hospice?"

ANS: B The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and "yes-or-no" questions are not therapeutic. Stating that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.

The nursing is teaching a client diagnosed with gastroesophageal reflux disease (GERD) who is planning to have an endoscopic radiofrequency (Stretta) procedure. What preprocedure health teaching would the nurse include? (Select all that apply.) A. "You will need to be on a liquid diet for the first week after the procedure." B. "Avoid taking any NSAIDs like ibuprofen for 10 days before the procedure." C. "Contact the primary health care provider after the procedure if you have increased pain." D. "You will need a nasogastric tube for a few days after the procedure." E. "You will have a small incision in your stomach area that will have a wound closure.

ANS: B, C The client having this procedure does not have an incision and will not require a nasogastric tube (NGT). The client should avoid an NGT placement for at least a month after the procedure. A liquid diet is required for only 24 hours after the procedure and then the client should progress to include soft floods like custard and applesauce.

The nurse is caring for a client who had an open traditional esophagectomy. Which assessment findings would the nurse report immediately to the primary health care provider? (Select all that apply.) A. Nausea B. Wound dehiscence C. Fever D. Tachycardia E. Moderate pain F. Fatigue

ANS: B, C, D Wound dehiscence is a serious, potentially life-threatening problem that needs immediate attention of the primary health care provider, typically the surgeon. Fever and tachycardia may indicate that the client has a postoperative infection, another serious, potentially life-threatening complication. Indications of both of these problems need to be documented and reported by the nurse. Nausea, fatigue, and moderate pain are expected postoperative assessment findings.

The nurse is teaching a client who had a descending colostomy 2 days ago about the ostomy stoma. Which changes in the stoma would the nurse teach the client to report to the primary health care provider? (Select all that apply.) A. Stool consistency is similar to paste B. Stoma becomes dark and dull C. Skin around the stoma becomes excoriated D. Skin around stoma becomes protruded E. Stoma becomes retracted into the abdomen

ANS: B, C, D, E A colostomy placed in the descending colon would be expect to have a paste-like stool consistency. However, if the stoma becomes retracted or discolored, the client should report those changes to the primary health care provider. Skin around the stoma that becomes protruded would suggest the formation of a peristomal hernia, and skin excoriation needs appropriate management. Therefore, both of those skin changes would need to be reported to the primary health care provider.

The nurse is caring for a client with a long history of peptic ulcer disease. What assessment findings would the nurse anticipate if the client experiences upper gastrointestinal (GI) bleeding? (Select all that apply.) A. Decreased heart rate B. Decreased blood pressure C. Bounding radial pulse D. Dizziness E. Hematemesis F. Decreased urinary output

ANS: B, D, E, F The client who has upper GI bleeding would likely have vomiting that contains blood (hematemesis), and would have signs and symptoms of dehydration such as a decreased blood pressure, dizziness, and/or decreased urinary output. The heart rate increases rather than decreases and the pulse is weak rather than bounding in clients who are dehydrated.

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is appropriate? A. Ask the client to call back if this happens again today B. Instruct the client to go to the emergency department C. Remind the client that a small amount of bleeding is possible D. Tell the client to come to the clinic this afternoon

ANS: C After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse would remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride. The client's respiratory rate is 8 breaths/min. What action by the nurse is appropriate? A. Administer naloxone B. Call the Rapid Response Team C. Provide physical stimulation D. Ventilate with a bag-valve-mask

ANS: C For an EGD, clients are given mild sedation but would still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse's most appropriate action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for midazolam HCl. The Rapid Response Team is not needed at this point. The client does not need manual ventilation.

A nurse cares for a client with colorectal cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How would the nurse respond? A. "I have a good friend with a colostomy who would be willing to talk with you." B. "The ostomy nurse will be able to answer all of your questions." C. "I will make a referral to the United Ostomy Associations of America." D. "You'll find that most people with colostomies don't want to talk about them."

ANS: C Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including ostomates (specially trained visitors who also have ostomies). The nurse would not suggest that the client speak with a personal contact of the nurse. Although the ostomy nurse is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse would not brush aside the client's request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.

The nurse is caring for a client who has been diagnosed with peptic ulcer disease. For which complication would the nurse monitor? A. Large bowel obstruction B. Dyspepsia C. Upper gastrointestinal (GI) bleeding D. Gastric cancer

ANS: C Peptic ulcer disease (PUD) can cause gastric mucosal damage or perforation, which causes upper GI bleeding. Dyspepsia is a symptom of PUD, gastritis, and gastric cancer. PUD affects the stomach and/or duodenum, not the colon.

The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk? A. Abdominal distention B. Nausea C. Electrolyte imbalance D. Obstipation

ANS: C The client who has a small bowel obstruction is at the highest risk for fluid and electrolyte imbalances, especially dehydration and hypokalemia due to profuse vomiting. Nausea, abdominal distention, and obstipation are also usually present, but these problems are not as life threatening as the imbalances in electrolytes.

A client is admitted with a diagnosis of possible strangulated inguinal hernia. For which complication would the nurse monitor? A. Paralytic ileus B. Bowel volvulus C. Sepsis D. Colitis

ANS: C The client who has a strangulated inguinal hernia would likely develop bowel necrosis which can lead to sepsis. The nurse would observe for early signs and symptoms of sepsis such as fever, tachypnea, and tachycardia. If the client's condition is not promptly managed, bowel perforation, septic shock, and death can result.

A client has an open traditional hiatal hernia repair this morning. What is the nurse's priority for client care at this time? A. Managing surgical pain B. Ambulating the client early C. Preventing respiratory complications D. Managing the nasogastric tube

ANS: C The client who has traditional surgery (rather than minimally invasive surgery) is at risk for respiratory complications such as atelectasis and pneumonia because he or she has an incision that may prevent the client from taking deep breaths or using an incentive spirometer. Therefore, the nurse's priority is to prevent these potentially life-threatening respiratory problems.

A nurse teaches a client who is at risk for colorectal cancer. Which dietary recommendation would the nurse teach the client? A. "Eat low-fiber and low-residual foods." B. "White rice and bread are easier to digest." C. "Add vegetables such as broccoli and cauliflower to your diet." D. "Foods high in animal fat help to protect the intestinal mucosa."

ANS: C The client would be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action would the nurse take? A. Ask if the client is experiencing pain in the right shoulder B. Perform a rectal examination and assess for polyps C. Recommend that the client have computed tomography D. Administer a laxative to increase bowel movement activity

ANS: C The presence of visible peristaltic waves, accompanied by high-pitched or high-pitched bowel sounds, is indicative of bowel obstruction caused by the tumor. The nurse would contact the primary health care provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The nurse generalist is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

A client with peptic ulcer disease is in the emergency department and reports gastric pain that has gotten much worse over the last 24 hours. The client's blood pressure when lying down is 112/68 mm Hg and when standing is 98/52 mm Hg. What action by the nurse is most appropriate? A. Administer a proton pump inhibitor (PPI) B. Call the Rapid Response Team C. Start a large-bore IV with normal saline D. Tell the patient to remain lying down

ANS: C This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse would start a large-bore IV with isotonic solution. PPIs are not a treatment for an ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the most appropriate action at this time.

The nurse assesses a client who has possible gastritis. Which assessment finding(s) indicate(s) that the client has chronic gastritis? (Select all that apply.) A. Anorexia B. Dyspepsia C. Intolerance of fatty foods D. Pernicious anemia E. Nausea and vomiting

ANS: C, D Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.

After teaching a client who is recovering from a colon resection to treat early-stage colorectal cancer (CRC), the nurse assesses the client's understanding. Which statements by the client indicate understanding of the teaching? (Select all that apply.) A. "I must change the ostomy appliance daily and as needed." B. "I will use warm water and a soft washcloth to clean around the stoma." C. "I might start bicycling and swimming again once my incision has healed." D. "I will make sure that I make lifestyle changes to prevent constipation." E. "I will be sure to have the recommended colonoscopies."

ANS: C, D, E The client has had a colon resection for early CRC and there is no indication that the client also had a colostomy. Follow up with recommended colonoscopies are essential to monitor for CRC recurrence. Avoiding constipation will help improve intestinal motility which helps to decrease the risk for CRC recurrence. Exercise and other activities do not need to be restricted after the client has healed.

A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer? A. A 37-year-old who drinks eight cups of coffee daily B. A 44-year-old with irritable bowel syndrome (IBS) C. A 60-year-old lawyer who works 65 hours per week D. A 72-year-old who eats fast food frequently

ANS: D Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed? A. Prone B. Supine C. Recumbent D. Semi-Fowler

ANS: D Having the client in a semi-sitting position helps to decrease the pressure caused by abdominal distention and promotes thoracic expansion to facilitate breathing.

A nurse is assessing a client reporting right upper quadrant (RUQ) abdominal pain. What technique would the nurse use to assess this client's abdomen? A. Auscultate after palpating B. Avoid any type of palpation C. Lightly palpate the RUQ first D. Lightly palpate the RUQ last

ANS: D If pain is present in a certain area of the abdomen, that area would be palpated last to keep the client from tensing which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.

The nurse caring for clients with gastrointestinal disorders would recall that omeprazole is a drug in which classification? A. Gastric acid inhibitor B. Histamine receptor blocker C. Mucosal barrier fortifier D. Proton pump inhibitor

ANS: D Omeprazole is a proton pump inhibitor.

The nurse is interviewing a client who reports having abdominal cramping, bloating, and diarrhea after drinking milk or ingesting other dairy products. What health problem does the client most likely have? A. Steatorrhea B. Ulcerative colitis C. Crohn disease D. Lactose intolerance

ANS: D The client is demonstrating signs and symptoms of lactose intolerance because they occur after the client eats or drinks dairy products which contain lactose

A nurse cares for a client who has a family history of colorectal cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer?" How would the nurse respond? A. "If you eat a low-fat and low-fiber diet, your chances decrease significantly." B. "You are safe. This is an autosomal dominant disorder that skips generations." C. "Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer." D. "You should have a colonoscopy more frequently to identify abnormal polyps early."

ANS: D The nurse would encourage the patient to have frequent colonoscopies to identify abnormal polyps and cancerous cells early. The abnormal gene associated with colon cancer is an autosomal dominant gene mutation that does not skip a generation and places the client at high risk for cancer. Changing the client's diet to more high-fiber (not low-fiber) and preemptive chemotherapy may decrease the client's risk of colon cancer but will not prevent it.

The nurse is teaching a client who has been treated for acute gastritis. What statement by the client indicates a need for further teaching? A. "I need to cut down on drinking martinis every might." B. "I should decrease my intake of caffeinated drinks, especially coffee." C. "I will only take ibuprofen once in a while when I really need it." D. "I can continue smoking cigarettes which is better than chewing tobacco."

ANS: D To prevent another episode of acute gastritis, alcohol, caffeinated drinks, and NSAIDs should be avoided or kept at a minimum. Smoking and all forms of tobacco should also be avoided.

Chapter 49

Chapter 49

Chapter 50

Chapter 50

Chapter 51

Chapter 51

What happens when the LES does not properly work?

Reflux of gastric contents into the esophagus occurs = GERD