COTAC Exam 5 PP ?s

Clinical manifestations of esophageal cancer include dysphagia, painful swallowing, halitosis and hiccups. T/F

T Symptoms include dysphagia, initially with solid foods and eventually with liquids, a sensation of a mass in the throat; painful swallowing; substernal pain and later, regurgitation of undigested food with halitosis and hiccups.

Pain from a gastric ulcer is exacerbated by the ingestion of food. T/F

T The food directly irritates the stomach lining and causes increased secretion of acid into the stomach

Clients with dry-mouth are at greater risk for developing dental caries as the normal flow of saliva is a natural tooth-cleaning process?

T The normal flow of saliva aids greatly in keeping the teeth clean. Nursing consideration: Many medications can cause dry mouth and increase the risk for oral infection. Anticholinergic drugs

The primary risk factors for the development of laryngeal cancer are tobacco use combined with regular alcohol consumption. T/F

T Using alcohol and tobacco together greatly increase the risk of developing cancer of the larynx.

Both ulcerative colitis and Crohn disease put the client at risk for developing colon cancer. T/F

T While colon cancer is more common with ulcerative colitis, it can be a risk if Crohn disease affects the colon.

Which statement indicates that a client with esophageal reflux disorder understands the dietary teaching? "I WON'T DRINK ANY CARBONATED DRINKS." "I WILL DRINK HOT TEA BEFORE BED." "I CAN HAVE LEMONADE AFTER MEALS." "I CAN DRINK TWO CUPS OF COFFEE A DAY."

"I WON'T DRINK ANY CARBONATED DRINKS."

Which of the following dietary instructions are appropriate for a client recovering from acute pancreatitis? Select all that apply. "I will eat smaller meals more frequently." "I will switch from 2% milk to skim (non-fat) milk." "I will only have 2 cups of coffee with my breakfast." "I will reduce my alcohol consumption to 2 drinks daily." "I will have easily digestible food that is low in fat."

"I will eat smaller meals more frequently." "I will switch from 2% milk to skim (non-fat) milk." "I will have easily digestible food that is low in fat."

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further questioning and teaching? "My partner had an affair years ago that caused us a lot of problems." "I'll be sure to wash my fresh fruits and vegetables more carefully." "Sometimes I forget to wash my hands when I help in my child's preschool classroom." "I'll be sure to take all my medications as ordered."

"My partner had an affair years ago that caused us a lot of problems."

The client was recently diagnosed with a hiatal hernia. The healthcare provider orders an antacid that has reduced adverse effects. What should the nurse include in the client's teaching about the side effects of antacids? "A SIDE EFFECT OF AN ANTACID IS FAST BREATHING." "THE MAJOR SIDE EFFECT OF AN ANTACID IS DIARRHEA." "A SIDE EFFECT OF AN ANTACID IS A DECREASED URGE TO URINATE." "THE MAJOR SIDE EFFECT OF AN ANTACID IS PROFUSE SWEATING."

"THE MAJOR SIDE EFFECT OF AN ANTACID IS DIARRHEA." Major side effects of antacids include diarrhea, constipation, dry mouth, gas, nausea, and stomach pain. These should be explained to the client. Side effects do not include profuse sweating, decreased urge to urinate, or fast breathing. Some antacids, depending on the type, can cause dry mouth, increased urge to urinate, and slow breathing.

The nurse is preparing to discontinue a client's nasogastric tube. The client is positioned properly, and the tube has been flushed with 15 mL of air to clear secretions. Before removing the tube, the nurse should make which statement to the client? "Take a deep breath when I tell you and hold it while I remove the tube." "Take a deep breath when I tell you, and bear down while I remove the tube." "Take a deep breath when I tell you, and slowly exhale while I remove the tube." "Take a deep breath when I tell you and breathe normally while I remove the tube."

"Take a deep breath when I tell you and hold it while I remove the tube." Rationale: The client should take a deep breath because the client's airway will be temporarily obstructed during tube removal. The client is then told to hold the breath and the tube is withdrawn slowly and evenly over the course of 3 to 6 seconds (coil the tube around the hand while removing it) while the breath is held. Bearing down could inhibit the removal of the tube. Exhaling is not possible during removal because the airway is temporarily obstructed during removal. Breathing normally could result in aspiration of gastric secretions during inhalation.

__ Protein manufactured by the liver; low levels lead to ascites

ALBUMIN

__ Sensitive measure of biliary obstruction

ALKALINE PHOSPHATASE

__ Alanine aminotransferase: levels increase in primary liver disorders; used to the course of liver disease

ALT

__ Liver converts this substance to urea. It is elevated in liver failure and is a primary cause of hepatic encephalopathy

AMMONIA

A client with a history of a hiatal hernia presents to the clinic with reports of worsening pain, and the health care provider orders an endoscopy. Which nursing actions will be provided after upper endoscopy? Select all that apply. ASSESS FOR SUDDEN PAIN. ASSESS FOR DECREASED BLOOD PRESSURE. ASSESS FOR INCREASED OXYGEN SATURATION LEVELS. ASSESS FOR RAPID PULSE. ASSESS FOR SHOCK.

ASSESS FOR SUDDEN PAIN. ASSESS FOR DECREASED BLOOD PRESSURE. ASSESS FOR RAPID PULSE. ASSESS FOR SHOCK. The nurse should watch for sudden pain, decreased blood pressure, rapid pulse, and shock after endoscopy; these are all signs of perforation and blood loss. Increased oxygen saturation levels are not a sign of perforation and blood loss.

__ Aspartate aminotransferase: present in tissues with high metabolic activity; not specfic to liver disease, but elevated with liver damage

AST

A client undergoes a barium swallow fluoroscopy that confirms gastroesophageal reflux disease (GERD). Based on this diagnosis, the client should be instructed to take which action? Select all that apply. FOLLOW A HIGH-FAT, LOW-FIBER DIET. AVOID CAFFEINE AND CARBONATED BEVERAGES. SLEEP WITH THE HEAD OF THE BED FLAT. STOP SMOKING. TAKE ANTACIDS ONE HOUR AND THREE HOURS AFTER MEALS. LIMIT ALCOHOL CONSUMPTION TO ONE DRINK PER DAY.

AVOID CAFFEINE AND CARBONATED BEVERAGES. STOP SMOKING. TAKE ANTACIDS ONE HOUR AND THREE HOURS AFTER MEALS.

A nurse is caring for a client with a hiatal hernia who states that abdominal and sternal pain occurs after eating and when lying down. Which instructions would the nurse recommend when teaching this client? Select all that apply. AVOID CONSTRICTIVE CLOTHING AROUND THE ABDOMEN. LIE DOWN FOR 30 MINUTES AFTER EATING. DECREASE INTAKE OF CAFFEINE AND SPICY FOODS. EAT THREE MEALS PER DAY. SLEEP IN SEMI-FOWLER'S POSITION. MAINTAIN A NORMAL BODY WEIGHT.

AVOID CONSTRICTIVE CLOTHING AROUND THE ABDOMEN. DECREASE INTAKE OF CAFFEINE AND SPICY FOODS. SLEEP IN SEMI-FOWLER'S POSITION. MAINTAIN A NORMAL BODY WEIGHT.

Which of the following symptoms or signs should the nurse expect with a perforated peptic ulcer? (Select all that apply) Abdominal rigidity Hypertension Tachycardia Rebound tenderness Cyanosis of the lips

Abdominal rigidity Tachycardia Rebound tenderness

A client has received a prescription for sulfasalazine. Which of the following should be included in the client teaching? (Select all that apply) Avoid direct sunlight if possible Drink with a large glass of water Report any new rash to the HCP Contact the HCP with a fever or cough Black stools are a side effect of the medication Report yellow, orange-tinged urine color A folate supplement may be needed

Avoid direct sunlight if possible Drink with a large glass of water Report any new rash to the HCP Contact the HCP with a fever or cough Report yellow, orange-tinged urine color A folate supplement may be needed Photosensitivity Drink a lot since can crystalize in the urine SJS rash can occur with any sulpha drug Myelosuppression can occur with this drug Can cause jaundice from a hepatitis Effects and lowers folic acid in the body, but rarely leads to folate deficiency

A client is receiving an aluminum-based antacid for acute gastritis. Which information topic should the nurse include? Monitor for diarrhea Avoid consuming fiber Avoid medication for 1 hour Take the antacid with food

Avoid medication for 1 hour

Hepatitis B

Blood-borne, body fluids Vaccine

Hepatitis C

Blood-borne, body fluids about 80% of people develop chronic hepatitis

A client reports ongoing episodes of "heartburn." Which food will the nurse recommend that the client eliminate from the diet? STEAK CARROTS CHOCOLATE POPCORN

CHOCOLATE Foods that decrease esophageal sphincter pressure, such as fatty foods, caffeine, and chocolate, should be avoided. Steak, carrots, and popcorn do not decrease esophageal sphincter pressure.

The nurse is preparing to administer medication using a client's nasogastric tube. Which actions should the nurse take before administering the medication? Select all that apply. Check the residual volume. Aspirate the stomach contents. Turn off the suction to the nasogastric tube. Remove the tube and place it in the other nostril. Test the stomach contents for a pH indicating acidity.

Check the residual volume. Aspirate the stomach contents. Turn off the suction to the nasogastric tube. Test the stomach contents for a pH indicating acidity. Rationale: By aspirating stomach contents, the residual volume can be determined and the pH checked. A pH less than 3.5 verifies gastric placement. The suction should be turned off before the tubing is disconnected to check for residual volume; in addition, suction should remain off for 30 to 60 minutes following medication administration to allow for medication absorption. There is no need to remove the tube and place it in the other nostril in order to administer a feeding; in fact, this is an invasive procedure and is unnecessary.

A client with a large bowel obstruction from fecal impaction is being assessed by the nurse. Which finding is most consistent with this scenario? Client had a normal bowel movement yesterday Client is having small liquid stools frequently The client has had excessive gas all week The client had an episode of vomiting yesterday

Client is having small liquid stools frequently

While undergoing radiation treatment for oral cancer, a client develops xerostomia. What collaborative resource does the nurse suggest for this client's care? DENTIST OCCUPATIONAL THERAPIST SPEECH THERAPIST PSYCHIATRIST

DENTIST Xerostomia is the subjective feeling of oral dryness. It is a long-term effect of radiation therapy and requires ongoing oral care such as the use of saliva substitutes and follow-up dental visits.Occupational therapists, psychiatrists, and speech therapists are not the appropriate resource for a client with xerostomia.

The nurse checks the gastric residual of an unconscious client receiving nasogastric tube feedings continuously at 50 mL/hr. The nurse notes that the residual is 250 mL at 0800 and 300 mL at 0900. The nurse determines that the client is experiencing which complication? Air in the stomach Too slow an infusion rate Delayed gastric emptying Early signs of peptic ulcer

Delayed gastric emptying Rationale: If the gastric residual is greater than 200 mL for 2 consecutive hours, the client may be experiencing delayed gastric emptying. If this occurs, the feeding is stopped, and the health care provider should be notified. The nurse should assess whether abdominal girth is enlarged and should auscultate bowel sounds to rule out intestinal obstruction. Some clients benefit from administration of metoclopramide to stimulate gastric emptying. Air in the stomach would be accompanied by abdominal distention and increased abdominal girth. The infusion rate cannot be too slow if the client is not tolerating the rate. Early peptic ulcer could be detected by a Hematest-positive gastric aspirate. In addition, agency procedures should be followed regarding gastric residuals.

A nurse is caring for a client with a recent diagnosis of a duodenal ulcer. Which of the following statements are correct? (Select all that apply) Discontinue using ibuprofen. H. pylori is the most common cause. Black, tarry stools may indicate intestinal bleeding. Yellow, jaundiced eyes occur with this condition. Prednisone is a safe medication to administer.

Discontinue using ibuprofen. H. pylori is the most common cause. Black, tarry stools may indicate intestinal bleeding.

A client is prescribed pancrelipase for chronic pancreatitis. Select the correct education for administering the medication. Educate the client to chew the capsules prior to the meals Educate to drinks a glass of water after taking the capsules Take the capsules only with the large meals of the day Sprinkle the capsules on protein-based foods like meat

Educate to drinks a glass of water after taking the capsules Pancrelipase: enzyme replacement since pancreas may not be producing digestive enzymes. Capsules can be sprinkled on non-protein food, drink water following the medication, rinse mouth to eliminate the enzyme from mouth or skin. Take with all meals & snacks to aid digestion

A nurse is administering oral prednisone to a client with an exacerbation of ulcerative colitis. Which of the following is the priority assessment finding? Elevated body temperature Insomnia and restlessness Glucose positive urinalysis Weight gain of 5 pounds in 2 weeks Buffalo hump to upper back Purple stretch marks to the side of abdomen

Elevated body temperature

Select the most likely clinical finding in a client with acute pancreatitis. Right upper quadrant tenderness Hyperactive bowel sounds Abdominal pain that worsens with leaning forward Epigastric pain radiating through to the back

Epigastric pain radiating through to the back

Two days after the donation of the right lobe of the liver to a parent, a client tells the nurse, "I was pressured by my family to donate a piece of my liver." What is the nurse's priority intervention in this situation? Provide written documentation of the conversation to the ethics committee. Inform all the surgeons who harvested and transplanted the liver. Explore the client's statement to obtain additional, detailed information. Notify the supervisor to determine if a psychiatric evaluation is necessary.

Explore the client's statement to obtain additional, detailed information. This powerful statement by the client needs to be explored and the client requires support. This is the first step in an ethical analysis. The donor's advocate team needs to be informed. Only after collecting the information on this client situation and completing the steps of an ethical analysis can it be determined if a report should go to the hospital's ethics committee. A possible outcome based on the nurse's assessment may be to offer psychiatric support in the form of a consultation or therapy.

In a large bowel obstruction, the abdomen will be distended, and bowel sounds will be hyperactive. T/F

F In a large bowel obstruction, bowel sounds may be normal or tympanic early in the obstruction, but later they will be hypoactive to absent.

The nurse recognizes that an increasing aspartate aminotransferase (AST) is an expected outcome in a client recovering from viral hepatitis. T/F

F Serum transaminase levels such as AST decrease as liver cells heal and regenerate.

Ulcerative colitis and Crohn disease share several symptoms including severe bleeding, narrowing of the bowel lumen and mucosal edema. T/F

F Symptoms of ulcerative colitis include severe bleeding, but there is no narrowing of the colon or mucosal edema. Symptoms of Crohn disease rarely include bleeding but if it occurs it is mild. There will be a narrowing of the colon and mucosal edema.

The usual wearing time of an ostomy appliance before it begins to leak and needs to be changed is 2-3 days. T/F

F The amount of time a person can keep the appliance sealed to the body surface depends on the location of the stoma and on body structure, as well as the type of skin barrier used. However, the usual wearing time of an ostomy appliance before leakage occurs and it needs to be changed is 5-10 days.

The nurse should encourage a high-calorie, high-protein diet for a client with liver cirrhosis and an ammonia level of 85mcg/dL. T/F

F The liver breaks down protein, which results in the formation of ammonia. Foods high in protein should be avoided since the client's ammonia level is elevated above the normal range.

Alcohol abuse is the most common cause of hepatitis. T/F

F Viral hepatitis is the most common type of hepatitis, although toxic and drug-induced hepatitis can occur secondary to an exposure (alcohol, industrial toxins, acetaminophen).

The route of transmission for Hepatitis A, B, and C is through the blood. T/F

F While the route of transmission for hepatitis B&C is the blood, hepatitis A and E are transmitted via fecal-oral route.

After the symptoms of acute gastritis subside, the nurse should introduce solid foods right away to provide adequate oral nutrition and decrease the need for IV therapy. T/F

False. Soft, low acidity

Hepatitis A

Fecal-oral route Vaccine Least severe form

A nurse is managing the care of a client 10 days after a liver transplant. What assessments may indicate organ rejection? Select all that apply. Fever Tachycardia Elevated liver enzymes Amber urine Brown stool

Fever Tachycardia Elevated liver enzymes Transplant rejection is a Type IV hypersensitivity cell-mediated immune response. Elevated temperature, tachycardia, and elevated liver enzymes are signs of liver transplant rejection. Because the rejected liver is not processing bilirubin, the urine will be tea colored and stool will be clay colored with rejection.

Which of the following findings would the nurse expect with a gastric ulcer? (Select all that apply) Food aggravates the abdominal pain Abdominal pain is often at night-time Increased bloating and indigestion Pain occurs 2-3 hours after a meal Pain is in the epigastric area of abdomen

Food aggravates the abdominal pain Increased bloating and indigestion Pain is in the epigastric area of abdomen

__ Values are elevated in ETOH abuse & are markers for biliary cholestasis

GGT

A nurse is caring for a client who has just returned from surgery to treat a fractured mandible. The jaws are wired. What should the nurse do if the client begins to vomit? ADMINISTER AN ANTIEMETIC AS ORDERED. CUT THE WIRES AND ASSIST THE CLIENT TO EXPECTORATE. HAVE CLIENT SIT UP, BEND OVER, AND SPIT INTO AN EMESIS BASIN. INSERT A SUCTION TUBE TO CLEAR THE VOMITUS FROM THE ORAL CAVITY.

HAVE CLIENT SIT UP, BEND OVER, AND SPIT INTO AN EMESIS BASIN. Following surgery for a fractured mandible, the client's jaws will be wired. The nurse should be prepared to intervene quickly in case the client develops respiratory distress or begins to choke or vomit. If the client begins to vomit, the nurse should assist the client to a sitting position and have the client bend over and expectorate the emesis into an emesis basin. Wire cutters or scissors should always be available in case the wires need to be cut in a medical emergency but are only used if the client cannot breathe or is choking. Suction equipment should be available to help clear the client's airway, if necessary, but this is not the first course of action. The nurse should administer the antiemetic if the client reports nausea, but the drug will not be effective if the client is already vomiting.

A client with severe inflammatory bowel disease is receiving total parenteral nutrition (TPN). When administering TPN, the nurse must take care to maintain the ordered flow rate because giving TPN too rapidly may cause which of the following complications? Hyperglycemia Air embolism Constipation Dumping syndrome

Hyperglycemia Hyperglycemia may occur if TPN is administered too rapidly, exceeding the client's glucose metabolism rate. With hyperglycemia, the renal threshold for glucose reabsorption is exceeded and osmotic diuresis occurs, leading to dehydration and electrolyte depletion. Although air embolism may occur during TPN administration, this problem results from faulty catheter placement, not overly rapid administration. TPN may cause diarrhea, not constipation, especially if administered too rapidly. Dumping syndrome results from food moving through the GI tract too quickly; because TPN is given I.V., it can't cause dumping syndrome.

Which of the following laboratory results should the nurse expect to be abnormal in a client with acute pancreatitis? Select all that apply. Hyperglycemia Hypercalcemia Increased lipase Decreased amylase Reduced ESR or CRP

Hyperglycemia Increased lipase

The health care provider prescribes metoclopramide hydrochloride for the client with hiatal hernia. The nurse should assess the client to determine which expected outcome? INCREASE TONE OF THE ESOPHAGEAL SPHINCTER. NEUTRALIZE GASTRIC SECRETIONS. DELAY GASTRIC EMPTYING. REDUCE SECRETION OF DIGESTIVE JUICES.

INCREASE TONE OF THE ESOPHAGEAL SPHINCTER.

__ Prolonged in hepatic dysfunction; will not return to baseline with administration of vitamin K

INR

Liver transplant: _________ for life to reduce risk of rejection

Immunosuppressives for life to reduce risk of rejection

Which of the following lab tests would the nurse expect in a client with a persistent exacerbation of Crohn disease? (Select all that apply). Increased hematocrit Decreased ESR Increased WBC count Reduced serum albumin Reduced serum folate

Increased WBC count Reduced serum albumin Reduced serum folate

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? REQUEST A PRESCRIPTION FOR AN OPIOID TO MANAGE PAIN. RESTRICT FLUIDS. APPLY COLD COMPRESSES. MASSAGE THE SALIVARY GLAND.

MASSAGE THE SALIVARY GLAND. Sialadenitis is inflammation of a salivary gland. The salivary gland is massaged to stimulate the flow of saliva. This is done by milking the edematous gland with the fingertips toward the ductal opening. To promote the flow of saliva, warm (not cold) compresses are applied to the affected salivary gland. Pain from this condition is managed with NSAIDs, not opioids. Hydration promotes salivary flow.

A nurse is caring for a client with acute gastritis receiving oral clear fluids. Which of the following should be included in the plan of care? (Select all that apply) Monitor electrolyte lab values Monitor fluid input and output Encourage smaller meals Indomethacin for pain or headaches Monitor stools for blood

Monitor electrolyte lab values Monitor fluid input and output Encourage smaller meals Monitor stools for blood

Liver transplant: Most significant complications post-op are ________ and ________.

Most significant complications post-op are bleeding and infection

List the priority nursing interventions for a client experiencing a bowel obstruction.

NGT, IVF, F&E, pain management Functional: NPO and bowel rest Assess for the return of bowel sounds, it means the bowel is waking up again, so can try sips of fluids IV fluids until able to start po fluids and hydration Increase activity/walking by the client Keep client in semi-Fowler position in case of vomiting and to keep GI secretions down Mechanical: Depends on the cause of the obstruction Adhesions: bowel rest, IV fluids, analgesia, serial x-rays, anti-nausea medicaitons

Which of the following are considered risk factors for developing gallstones? Select all that apply. Obesity Use of estrogen products Male sex Multiple pregnancies Family history of gallstones Peptic ulcer disease

Obesity Use of estrogen products Multiple pregnancies Family history of gallstones

A nurse is caring for a client with a small bowel obstruction requiring an NGT insertion. Which of the following interventions are appropriate by the nurse? (Select all that apply) Obtain a chest x-ray following NGT insertion Document the output of gastric secretions from NGT Irrigate the NGT every 8-12 hours to prevent occlusion Provide oral hygiene every 2 hours for the client Auscultate the bowel sounds for the quality of the sound

Obtain a chest x-ray following NGT insertion Document the output of gastric secretions from NGT Provide oral hygiene every 2 hours for the client Auscultate the bowel sounds for the quality of the sound

The nurse is caring for a client diagnosed with aphthous ulcers. Which food will the nurse recommend that the client avoid? (Select all that apply.) APPLES PASTA BAKED POTATO NUTS CHEESE

PASTA BAKED POTATO NUTS CHEESE Aphthous ulcers (canker sores) are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. The nurse tells the client that certain foods such as cheese, nuts, potatoes, and foods containing gluten (like pasta) may trigger allergic responses that cause aphthous ulcers and should be avoided.Apples and bananas are not acidic and do not trigger allergic responses that cause aphthous ulcers

Which practice does the nurse include when teaching a client about proper oral hygiene? PERFORM SELF-EXAMINATION OF THE MOUTH EVERY WEEK AND REPORT ANY UNUSUAL FINDINGS. BRUSH THE TEETH DAILY AND FLOSS AS NEEDED. WEAR DENTURES THAT FIT A BIT LOOSELY FOR MOVEMENT WHEN CHEWING. USE MOUTHWASH WITH ALCOHOL UNLESS LESIONS ARE PRESENT.

PERFORM SELF-EXAMINATION OF THE MOUTH EVERY WEEK AND REPORT ANY UNUSUAL FINDINGS. The nurse will teach the client that proper oral care involves self-examination of the mouth every week and to report any unusual findings to the healthcare provider. Clients need to brush teeth and floss every day—not just as needed. Clients are taught to avoid contact with agents that may cause inflammation of the mouth (such as alcohol-based mouthwashes). Dentures should fit snugly, not loosely.

The nurse is caring for a client with cirrhosis of the liver. Which laboratory results are consistent with the disease process? (Select all that apply). PT = 22 seconds (range 11-13 seconds) K+ = 4.0 mEq/L (range 3.5-5.0 mEq/L) Albumin 7.2 g/dL (range 3.5-5.2 g/dL) Ammonia 96 mg/dL (range 15-60 mcg/dL) Platelets 75,000 cells/mm3 (range 140,000-400,000/mcL)

PT = 22 seconds (range 11-13 seconds) Ammonia 96 mg/dL (range 15-60 mcg/dL) Platelets 75,000 cells/mm3 (range 140,000-400,000/mcL)

The nurse should recognize which of the following as manifestations of hiatal hernia? (Select all that apply). PYROSIS REGURGITATION ASYMPTOMATIC DYSPHAGIA FULLNESS AFTER EATING

PYROSIS REGURGITATION ASYMPTOMATIC DYSPHAGIA FULLNESS AFTER EATING

Which of the following are potential findings or complications of acute pancreatitis? Select all that apply. Pancreatic pseudocysts Biliary flow obstruction Chvostek's sign Respiratory failure Hyperkalemia Bruising of flanks Periumbilical bruising

Pancreatic pseudocysts Biliary flow obstruction Chvostek's sign Respiratory failure Bruising of flanks Periumbilical bruising

A client with a flare-up of ulcerative colitis is diagnosed with toxic megacolon. Which of the following is of greatest concern with this condition? Perforation of bowel Profuse bleeding Bowel obstruction Anal abscesses

Perforation of bowel

The nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to cough and has difficulty breathing. What is the most appropriate action? Insert the tube quickly. Notify the health care provider immediately. Remove the tube and reinsert it when the respiratory distress subsides. Pull back on the tube and wait until the respiratory distress subsides.

Pull back on the tube and wait until the respiratory distress subsides. Rationale: During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides. It is not necessary to notify the health care provider immediately or remove the tube completely. Quickly inserting the tube is not an appropriate action because, in this situation, it is likely that the tube has entered the bronchus.

The nurse is teaching a client how to maintain effective oral health. Which measure does the nurse include in the teaching plan? (Select all that apply.) REGULAR DENTAL CHECKUPS. EATING A BALANCED DIET. USE OF MOUTHWASHES CONTAINING ALCOHOL. MANAGING STRESS AS MUCH AS POSSIBLE. ENSURING THAT DENTURES ARE SLIGHTLY LOOSE-FITTING.

REGULAR DENTAL CHECKUPS. EATING A BALANCED DIET. MANAGING STRESS AS MUCH AS POSSIBLE. Regular dental checkups are important, so potential problems can be prevented or attended to promptly. Stress suppresses the immune system, which can increase the client's risk for infections such as Candida albicans. Eating a balanced diet can reduce the risk for dental caries and infections such as C. albicans or stomatitis.Mouthwashes that contain alcohol may irritate tissues and cause inflammation and should be avoided. Dentures must be in good repair and need to fit properly, not loosely.

A client with a small bowel obstruction is being assessed by a nurse. Which of the following would be consistent with a small bowel obstruction? (Select all that apply) Recurrent vomiting with a fecal odor Episodic crampy abdominal pain High-pitched abdominal sounds Rigid flat abdomen with rebound tenderness A lab test showing a K+ of 3.2 mg/dl Metabolic alkalosis on ABG testing

Recurrent vomiting with a fecal odor Episodic crampy abdominal pain High-pitched abdominal sounds A lab test showing a K+ of 3.2 mg/dl Metabolic alkalosis on ABG testing

A client with chronic gastritis is being educated about pernicious anemia. Which of the following educational topics should be included? (Select all that apply) Caused by loss of acid production in the stomach Requirement for monthly vitamin B12 injections Results in neurological symptoms like ataxia and confusion Vitamin B12 is needed for production of platelets Caused by a loss of intrinsic factor production

Requirement for monthly vitamin B12 injections Results in neurological symptoms like ataxia and confusion Caused by a loss of intrinsic factor production

List complications that may occur because of portal HTN.

Resulting in: Ascites (accumulation of fluid in peritoneal cavity): causes severe distension of abdomen, sometimes needing a paracentesis, IV albumin, and diuretics like spironolactone Esophageal varices (fragile engorged veins in esophagus): can result in severe GI bleeding.

Which of the following should the nurse teach to a client following a laparoscopic cholecystectomy? (Select all that apply) Take a bath instead of showers for a week. Resume your regular diet when discharged. Clean the wound puncture sites with a mild soap. Remove the steri-strips and bandage the next day. Report any fevers or increasing abdominal pain.

Resume your regular diet when discharged. Clean the wound puncture sites with a mild soap. Report any fevers or increasing abdominal pain.

A client is receiving education prior to a laparoscopic cholecystectomy. Which of the following should be included in the teaching? Select all that apply. A scope will be inserted into your stomach A 1-2-day hospitalization will be required Right shoulder pain may occur after the surgery A Jackson Pratt drain will be inserted during the surgery Mobilization can occur immediately after surgery

Right shoulder pain may occur after the surgery Mobilization can occur immediately after surgery

The nurse is caring for a client with gastroesophageal reflux disease (GERD). The nurse knows that breakfast is served for clients at 0800. Which prescribed medication will the nurse administer at 0730? LANSOPRAZOLE CIMETIDINE ACETAMINOPHEN SUCRALFATE

SUCRALFATE

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? SWEATING AND PALLOR BRADYCARDIA AND INDIGESTION DOUBLE VISION AND CHEST PAIN ABDOMINAL CRAMPING AND PAIN

SWEATING AND PALLOR Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. These manifestations include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. Delayed gastric emptying occurs in 15-39% of patient after esophagectomy, which increases the risk for dumping syndrome.

An appropriate nursing intervention for a client with xerostomia (dryness of the mouth) is to provide the client with sipping water and saliva substitutes. T/F

T Xerostomia is common in clients with oral cancer, particularly if the salivary glands were exposed to radiation or surgery. Current recommendations include sipping water, oral mucosal lubricants (saliva substitutes topically applied), incorporating the use of newer edible saliva substitutes such as oral moisturizing jelly and taking medications that stimulate saliva production.

A hiatal hernia occurs when the upper part of the stomach is displaced upward into the esophagus. T/F

T A hiatal hernia occurs when the upper part of the stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax.

Clients with Crohn disease can develop an anal fistula which is a tunnel or canal from the anus to the perianal skin. T/F

T An anal fistula is a complication of Crohn disease. Purulent drainage or stool may leak constantly from this cutaneous opening. These rarely heal spontaneously and usually require surgery to prevent systemic infections.

Liver damage can cause up to 20 liters or more of albumin-rich fluid to accumulate in the peritoneal cavity. T/F

T Ascites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs. Ascites results from portal hypertension and low serum albumin levels.

Clients with inflammatory bowel disease (IBD) should follow a low-residue, high-protein, high-calorie diet; especially during an acute phase. T/F

T Dietary modifications can control but do not cure the disease. The client should also be encouraged to keep a record of foods that irritate the bowel and to avoid them. The client should also drink at least eight glasses of water each day.

The pain associated with a duodenal ulcer is relieved by ingestion of food. T/F

T Duodenal pain is relieved by the ingestion of food or antacids. Pain typically occurs 90 min to 3 hours after a meal.

The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. T/F

T Early symptoms include forgetfulness, anxiety, irritability, short attention span and coordination and balance problems.

A client with an esophageal diverticulum is at risk for aspiration. T/F

T If the diverticulum becomes filled with food or fluid, and the client assumes a recumbent position, undigested food is regurgitated, and can cause aspiration.

Sialolithiasis (salivary calculi) can be asymptomatic unless they become infected or obstruct the gland's duct. T/F

T If the stone obstructs the gland's duct there will be swelling and sudden, local, and often colicky pain, which is abruptly relieved by a gush of saliva.

The nurse should educate clients with Celiac disease to avoid food products that contain gluten, such as wheat, barley and rye; as well as non-food items such as toothpastes, communion wafers, cosmetics and art supplies that may also contain gluten. T/F

T It is important that the nurse include non-food gluten items in his/her client teaching. Many generic and over-the-counter drugs can be prepared with gluten gels. Toothpastes, communion wafers and some cosmetics (e.g., lipsticks) and art supplies (e.g., modeling clay) can also contain gluten.

Cancerous tumors in the liver are more likely to be metastases from other primary sites such as breast and lung, than to be primary liver cancer. T/F

T Metastases from other primary sites are found in the liver 2.5 times more frequently than tumors due to primary liver cancers. Often, the first evidence of cancer in an abdominal organ is the appearance of liver metastases.

Abdominal pain, enlarged liver, intermittent mild fever and ankle edema are all signs of compensated cirrhosis of the liver. T/F

T Other signs of compensated cirrhosis include flatulent dyspepsia, palmar erythema, unexplained epistaxis and vascular spiders. Decompensated cirrhosis results when the damage to the liver has progressed to the point where functionality is significantly compromised, as evidenced by ascites, jaundice, hypotension, weight loss and spontaneous bruising.

Varices in the upper stomach and esophagus are caused by collateral circulation due to portal hypertension. T/F

T Portal hypertension is caused by impaired circulation of blood through the liver. Collateral circulation is subsequently developed, creating varices in the upper stomach and esophagus. Varices are fragile and can bleed easily.

A client with a surgical repair of a perforated esophagus will require enteral or parenteral nutritional supplementation for at least 7 days post-operatively. T/F

T Postoperative nutritional status is a major concern. The post-op client remains NPO for approximately 7 days so enteral or parenteral nutrition is started on postoperative day 2 or 3.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention? SEROSANGUINOUS DRAINAGE ON THE DRESSING FOLEY CATHETER BAG CONTAINING 500ML OF AMBER URINE A PIGGYBACK INFUSION OF LEVOFLOXACIN THE CLIENT LYING IN A LATERAL POSITION, WITH THE HEAD OF BED FLAT

THE CLIENT LYING IN A LATERAL POSITION, WITH THE HEAD OF BED FLAT A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing are not causes for concern.

Which assessment in a client that has just returned from having a modified radical neck dissection with skin flap would require a nurse to take immediate action? THE SKIN FLAP APPEARS WHITE. THE CLIENT'S VOICE IS HOARSE. SUTURES ARE VISIBLE ON THE CLIENT'S FACE. THERE IS AN ABSENCE OF BOWEL SOUNDS.

THE SKIN FLAP APPEARS WHITE. A white skin flap indicates lack of perfusion and the healthcare provider should be notified immediately. Hoarseness may be due to trauma from the endotracheal tube that is inserted during surgery. Sutures may be visible after this surgery. An absence of bowel sounds is a normal finding immediately post surgery with general anesthesia.

_Substance produced during the normal breakdown of red blood cells that passes through the liver and is excreted in stool

TOTAL BILIRUBIN

A physician orders lactulose 30 ml three times daily for a client with cirrhosis. The nurse will know that this medication is effective by which finding? The client will have an increase in urine output. The client's abdominal girth would decrease. The client would develop diarrhea. The client's level of consciousness (LOC) would improve.

The client's level of consciousness (LOC) would improve.

The nurse is caring for a client who is receiving parenteral nutrition. Which assessment is most important for the nurse to make to detect early signs of metabolic complications? Breath sounds Daily weights Urine output Vital signs

Urine output

A nurse has been exposed to hepatitis B through a needlestick injury. Which actions should be included in the postexposure management plan? Select all that apply. Wash the injection site with soap and water Wipe the site with undiluted bleach solution Administer hepatitis B immune globulin Administer hepatitis B vaccine Notify the nurse's supervisor

Wash the injection site with soap and water Administer hepatitis B immune globulin Administer hepatitis B vaccine Notify the nurse's supervisor The postexposure management plan following a needlestick injury when the client has hepatitis B must be instituted immediately. The nurse should first wash the site of the needlestick with soap and water. An antiseptic agent may be used following washing the site, but a strong bleach solution is too caustic. The nurse should then receive both hepatitis B immune globulin and the hepatitis B vaccine. The incident must be reported to the nurse's supervisor and other departments within the health care organization as required.