EAQ GI

A client with a recent colostomy expresses concern about the inability to control the passage of gas. Which recommendation would the nurse make? Eliminate foods high in cellulose. • Decrease fluid intake at mealtimes. • Avoid foods that in the past caused flatus. • Adhere to a bland diet before social events.

Avoid foods that in the past caused flatus.

Which finding is an indication of ulcer perforation in a client with peptic ulcer disease (PUD)? Select all that apply. One, some, or all responses may be correct.

Back and shoulder pain, Nausea and vomiting, Rigid abdomen, Hypotension, Tachycardia Reason: Perforation of an ulcer can cause tachycardia and hypotension (both caused by fluid volume shifts from the vascular compartment to the abdominal cavity). A client with a perforated ulcer would have a hard, rigid abdomen (caused by tensed muscles) and nausea and vomiting. Back and shoulder pain can occur as a result of irritation of the phrenic nerve.

the nurse is caring for a client admitted with peritonitis. Which finding in the medical record is most likely the cause?

Bowel Obstruction Causes: Bowel obstruction, appendicitis, external penetrating wound, peritoneal dialysis

Which food or drink would the nurse instruct a client with a new colostomy to avoid because it produces large amounts of gas? • Milk © Cheese • Coffee • Cabbage

Cabbage R:Cabbage is a gas-producing food that can cause a client with a colostomy problems with odor control and ballooning of the ostomy bag, which may break the device seal and allow leakage. Milk, cheese, and coffee should not cause excessive gas problems in moderation. The client with a new colostomy should slowly introduce new foods into the diet to test toleration.

An in-home babysitter phones a health clinic, stating that a child swallowed dish soap. Which advice would the nurse give? • Call a Poison Control Center. • Induce vomiting immediately. • Give syrup of ipecac, 1 tablespoon. Give activated charcoal and expect black stools for 24 hours.

Call a Poison Control Center.

Six hours after major abdominal surgery, a client reports severe abdominal pain and faintness. The nurse identifies a thready, rapid pulse. The nurse checks the medication administration record (MAR) and determines that the client can receive another injection of pain medication in an hour. Which action would the nurse take? Notify the health care provider about the client's symptoms. Explain to the client that it is too early to have an injection for pain. Reposition the client for greater comfort and turn on the television as a distraction. • Prepare the injection to administer it to the client early because of the severe pain.

Call the health care provider, report the clients symptoms, and obtain further prescriptions because the clients signs and symptoms suggest the possibility of shock.

which information would the nurse provide a client with a new colostomy about managing the appliance?

Cut opening 1/8- to 1/16-inch larger than stoma.

The nurse provides teaching for a client with gastrosophageal reflux disease. The nurse should recommend that the client take which action after meals? O Drink 8 oz (240 mL) of water. • Take a walk for 30 minutes. • Lie down for at least 20 minutes. © Rest in a sitting position for 1 hour.

D) Rest in a sitting position for 1 hour ***gravity facilitates digestion and prevents reflux of stomach contents into the esophagus

The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. Which is an important nursing intervention? Weigh the client daily. Restrict the client's oral fluid intake. • Measure the client's urine specific gravity. • Observe the client for increasing confusion.

D. Observe the client for increasing confusion Increased serum ammonia level impairs the central nervous system

A client has a body mass index (BMI) of 35 and verbalizes the need to lose weight. The nurse encourages the client to lose weight safely by changing which dietary habits?

Decrease portion size and fat intake

Which recommendation would the nurse provide to a client with gastrosophageal reflux disease (GERD) who asks how to reduce heartburn and pain without taking medication?

Elevate head of the bed 5 inches

A health care provider prescribes a sigmoidoscopy for one client and a barium enema for another client. Which is a nursing responsibility common to preparing both of the clients for these procedures? • Withholding food for several hours O Giving castor oil the afternoon before • Administering soapsuds enemas until clear • Ensuring an understanding of the procedure

Ensuring an understanding of the procedure

A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease?

Esophageal pain may imitate the symptoms of a heart attack.

which factor can be used to determine the source of infection in a client who test positive for Giardia lamblia?

Giardia is found in freshwater lakes and rivers. Clients who test positive for the bacteria should be asked about recent travel and activity history including outings like camping or hiking. Giardiasis is associated with anal intercourse regardless of sexual orientation. Antibiotic use can cause Clostridium difficile infection. Raw eggs can carry Salmonella. Botulism is associate with improperly canned foods.

Which assessment parameter is used to determine the severity of blood loss in a client with an upper GI bleed?

Hemocrat, hemoglobin, platelet count, oxygen saturation, and blood, urea and nitrogen (BUN)

A client is prescribed gastric lavage after an overdose of acetaminophen. In which position would the nurse place the client when the nasogastric tube is being inserted? • Supine O Semi-Fowler's © High-Fowler's • Trendelenburg

High-Fowler's

a client has been diagnosed with cholelithiasis. which fact about the condition would the nurse recall when assessing this client for risk factors?

Individuals who are obese are more prone to this condition than those who are thin.

A client is scheduled for a pyloroplasty and vagotomy because of strictures caused by ulcers unresponsive to medical therapy. Which information about the purpose of a vagotomy would the nurse include in the client's education? • It increases the heart rate. • It hastens gastric emptying. • It eliminates pain sensations. • It decreases acid in the stomach.

It decreases acid in the stomach. The vagus nerve stimulates the stomach to secrete hydrochloric acid. When it is severed, this neural pathway is interrupted and stomach acid is decreased. The portion of the vagus nerve that is severed innervates the stomach, not the heart; therefore, the heart rate is not affected. The vagus nerve controls hydrochloric acid secretion, not gastric emptying; emptying is determined by the nature of foods being digested. The vagus nerve is not a sensory nerve.

The nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "How does my drinking relate to my diagnosis?" Which effect of alcohol would the nurse include when responding? • It promotes the formation of calculi in the cystic duct. • It stimulates the pancreas to secrete more insulin than it can immediately produce. © It alters the composition of enzymes so they are capable of damaging the pancreas. • It increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas.

It increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas. Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct. The backflow of enzymes into the pancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Although blockage of the bile duct with calculi may precipitate pancreatitis, this is not associated with alcohol. Alcohol does not deplete insulin stores; the demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged.

The nurse provides education related to the relationship between aerobic exercise and weight loss to a client who is obese. The nurse evaluates that teaching is effective when the client states which effect of exercise? O 'it will decrease my appetite." • "It will decrease my metabolic rate." • 'It will increase my lean body mass." • 'It will increase my resting heart rate."

It will increase my lean body mass."

A health care provider informs a client that a T-tube will be in place after an abdominal cholecystectomy and a choledochostomy. Which would the nurse include in the preoperative teaching for this client regarding the primary reason why a T-tube is necessary? O Drain bile from the cystic duct • Keep the common bile duct patent Prevent abscess formation at the surgical site • Provide a port for contrast dye in a cholangiogram

Keep the common bile duct patent

Which finding would the nurse document as normal for a second, postabdominoperineal resection stoma?

Moist, red, and raised above the skin surface

The nurse provides postoperative teaching to a client who is scheduled for a bilateral herniorrhaphy. Which client statement indicates correct understanding of the teaching? • "I will have a nasogastric tube in place." O "I should cough and deep breathe regularly." O "I will need to be on bed rest for several days." O "I will have a portable wound drainage system in place."

O "I should cough and deep breathe regularly."

on the third postoperative day after a subtotal gastrectomy, a client reports severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. Which action would the nurse perform first?

Obtain vital signs

The nurse is caring for a client who has cancer of the rectum and is scheduled for an abdominoperineal resection with creation of a colostomy. For which type of surgery would the nurse prepare the client? Permanent sigmoid colostomy Permanent ascending colostomy • Temporary double-barrel colostomy • Temporary transverse loop colostomy

Permanent sigmoid colostomy

A client recently had an abdominoperineal resection and colostomy. While the nurse changes the dressing, the client states, "You think that it looks repulsive." The nurse identifies that the client as using which defense mechanism? Projection • Sublimation • Compensation • Intellectualization

Projection is the attribution of unacceptable feelings and emotions onto others. Sublimation is the substitution of socially acceptable feelings or instincts to replace those that are threatening to the ego. Compensation is overachievement in a more comfortable area, thereby covering up a weakness. Intellectualization is the use of mental reasoning processes to deny facing emotions and feelings involved in a situation

A client with Laënnec cirrhosis experiences ascites, jaundice, and confusion. Which is a nursing priority when caring for this client? • Correcting nutritional deficiencies O Measuring abdominal girth every day O Providing for the client's physical safety Placing the client in the high-Fowler position

Providing for the client's physical safety Hepatic encephalopathy, related to high ammonia levels, results in central nervous system derangement; physical safety is the priority. Although correcting nutritional deficiencies is important, it is not the priority. Although measuring abdominal girth is important, it is not the priority. The high-Fowler position will be uncomfortable because of the pressure of the distended abdomen against the legs; the semi-Fowler position is more appropriate, and it promotes respiration.

After a subtotal gastrectomy (Billroth I), the client begins eating a variety of food textures and forms. After meals, the client reports cramping discomfort, rapid pulse, and waves of weakness, often followed by nausea and vomiting. Which physiological response does the nurse suspect occurs after the client eats? • Slow movement of food from the stomach into the small intestine Rapid routing of diluted food mixture into the small intestine • Quick passage of hyperosmolar food solution into the small intestine Entry of less concentrated food than the surrounding fluid into the small intestine

Quick passage of hyperosmolar food solution into the small intestine

The nurse is caring for a client with a new colostomy. Which client outcome is most important for achievement of long-range goals associated with adjusting to a new colostomy? • Mastery of techniques of colostomy care Readiness to accept an altered body function Awareness of available community resources • Knowledge of necessary dietary modifications

Readiness to accept an altered body function

the nurse is caring for a client with a bowel obstruction. which assessment findings indicate the possible onset of peritonitis?

Rebound tenderness Diminished bowel sounds Rigid, board-like abdomen Constipation and tachycardia

A health care provider discusses with a client the need for an abdominoperineal resection and a colostomy. After the health care provider leaves the room, the client tells the nurse about being relieved that only minor surgery is necessary. Which psychological process explains this client's reaction? O Reflection • Regression • Repudiation • Reconciliation

Repudiation A refusal to recognize anticipated loss in an attempt to protect oneself against the overpowering stress of illness is called repudiation.

which dietary selections made by the client indicate understanding of previously taught dietary principles associated with having viral hepatitis?

Salad, sliced chicken sandwich, gelatin dessert

the nurse is preparing to insert a nasogastric (NG) tube for a client to allow continuous suction. Which tube would the nurse select?

Salem sump

During history-taking, the nurse discovers that a client takes megadoses of vitamin A. How would the nurse interpret this finding? © Vitamin A is highly toxic, even in small amounts. • The body stores excess vitamin A, even in toxic amounts. O Vitamin A cannot be stored; therefore, excess amounts will saturate body tissues. O Although the body's requirement for vitamin A is great, cells can synthesize more as needed.

The body stores excess vitamin A, even in toxic amounts.

Which pain-related clinical manifestation would the nurse expect in a client who had received a diagnosis of a peptic ulcer?

The pain occurs 1 to 2 hours after having a meal. Reason: Pain occurs after the stomach empties; eating stimulates gastric secretions, which act on the gastric mucosa of an empty stomach, causing gnawing pain. Vomiting temporarily alleviates pain because acid secretions are removed. There is no intolerance of fats, and eating generally alleviates pain. Pain associated with the ingestion of fatty foods is associated with cholecystitis. Pain is localized in the epigastrium; however, it only radiates to the abdomen if the ulcer has perforated

Transmission-based precautions are implemented for a client with salmonellosis and would include which component? • Wearing a gown if soiling is likely • Providing isolation in a private room Wearing a mask when emptying the bedpan • Limiting visiting hours during the acute phase

Transmission-based precautions are implemented for a client with salmonellosis and would include which component?

A client with esophageal varices experiences severe hematemesis, and a Sengstaken-Blakemore tube is inserted. Which design and purpose does the tube have? O Single-lumen, for gastric lavage O Double-lumen; for intestinal decompression • Triple-lumen; for esophageal compression • Multi-lumen; for gastric and intestinal decompression

Triple-lumen; for esophageal compression

Which recommendation is important for the nurse to include in a teaching program for a client who has been placed on a 2-gram sodium diet? • Use lemon juice to season meat. • Put condiments on food to add flavor. • Include canned vegetables in meal preparation. • Drink carbonated beverages instead of decaffeinated coffee.

Use lemon juice to season meat.

Which action would the nurse include in the plan of care to prevent oral infections in a client preparing to undergo surgical resection for esophageal cancer? Select all that apply. One, some, or all responses may be correct. Soaking dentures every night Providing Yankauer suctioning Swishing and spitting with chlorhexidine Administering intravenous (IV) fluids Offering sugar-free candies to moisten the mouth

all

the nurse provides education to a client about colostomy care. To be effective when providing the teaching, the nurse would start with which step?

assess barriers to learn

A client is admitted to the hospital with a diagnosis of Crohn disease. What is most important for the nurse to include in the teaching plan for this client? a. Controlling constipation b. Meeting nutritional needs c. Preventing increased weakness d. Anticipating a sexual alteration

b. Meeting nutritional needs To avoid gastrointestinal pain and diarrhea, these clients often refuse to eat and become malnourished. The consumption of a high-calorie, high-protein diet is advised. Diarrhea, not constipation, is a problem with Crohn disease. Preventing an increase in weakness is a secondary concern that results from malnutrition; correcting the malnutrition will increase strength. Anticipating a sexual alteration generally is not a problem with Crohn disease.

Which information to promote self-management would the nurse provide to a client being discharged with a new ileostomy?

change the appliance every 4 to 7 days

Which client response during the insertion of a nasogastric tube indicates to the nurse that the client is experiencing serious difficulty with the insertion? O Choking O Redness • Gagging • Cyanosis

cyanosis

Which priority medication will the nurse prepare to administer to the client admitted with acute salmonellosis? • Opioids • Antacids • Electrolytes • Antidiarrheals

electrolytes Fluids of dextrose and normal saline and electrolytes are administered to prevent profound dehydration caused by an excessive loss of water and electrolytes through diarrhea output.

The nurse is teaching a client about a sodium-restricted diet. Which foods should the nurse encourage the client to consume? Select all that apply. One, some, or all responses may be correct. Fruits deli meats condiments fresh vegetables processed meats

fruits fresh vegetables

A client is diagnosed with cancer of the stomach and is scheduled for a partial gastrectomy. Which topic would the nurse include in the postoperative care teaching? • Gastric suction • Oxygen therapy • Fluid restriction • Urinary catheter

gastric suction

A client is scheduled to receive total parenteral nutrition (TPN). To administer TPN, which piece of equipment is important for the nurse to obtain? O Infusion pump • Tall intravenous (IV) pole Clamp that will be taped at the bedside • Infusion set that delivers 60 drops/mL

infusion pump Hypertonic solution should be administered in an infusion pump for continuous and uniform infusion to prevent hyperosmolar diuresis or fluctuations in glucose. The height of the IV pole is not as significant as the stability needed to safely support the infusion pump. There is no reason to keep a clamp at the bedside. The tubing set should be appropriate for the type of infusion pump being used.

A client is diagnosed with cancer of the rectum and has surgery for an abdominoperineal resection and colostomy. Which nursing care would be implemented during the postoperative period?

keeping clean

The nurse is assisting a health care provider to perform a sigmoidoscopy. In which position would the nurse place the client for this procedure? • Left lateral recumbent • Prone • Lithotomy • Knee-chest

knee-chest The proctologic (knee-chest or prone jackknife) position is the preferred position in which to examine the perineum and rectum properly. In this position, the patient can easily undergo further studies such as anoscopy and sigmoidoscopy because of easier access to the anorectum

A client is scheduled for a colonoscopy, and the health care provider prescribes a tap water enema. In which position should the nurse place the client during the enema? O Left lateral recumbent • Back lying • Knee-chest • Mid-Fowler

left sims

a client with hepatic cirrhosis begins to exhibit slurred speech, confusion, drowsiness, and a flapping tremor. Based upon this assessment, which prescribed diet would the nurse anticipate?

moderate protein

The nurse identifies which weight category as reflective of a client's body mass index (BMI) of 25.5 kg/m^2?

overweight

the nurse is caring for a client with suspected appendicitis. Which assessment finding would the nurse determine would further support the diagnosis?

pain in the right lower quadrant

The nurse is caring for a client with chronic inflammation of the bowel. For which most serious complication would the nurse monitor in this client? • Ileus • Pain • Perforation • Obstruction

perforation

A client with an acute attack of cholecystitis has a cholecystectomy with a choledochostomy. The client returns from surgery with a T-tube connected to a drainage bag. What would the nurse conclude is the purpose of the T-tube? Decrease edema Permit drainage of bile • Insert antibiotic medication • Provide for irrigation of the gallbladder

permit drainage of bile

The nurse is providing dietary teaching to a client receiving a high-protein diet while recovering from an acute episode of colitis. Which would the nurse include in the rationale for this diet? O Repairs tissues • Slows peristalsis • Corrects anemia • Improves muscle tone

repairs tissues

When caring for a client in the early postoperative period after a hemorrhoidectomy, the nurse will place the client in which position? • Supine • Side-lying O High-Fowler • Trendelenburg

side-lying

a client is scheduled for a cholecystectomy and asks the primary nurse about the function of the gall bladder

stores and concentrates bile

obstrutive jaundice symptom O Yellow sclera • Pain on urination • Dark brown stools O Coffee-ground emesis

yellow sclera

Discharge planning for a client with chronic pancreatitis includes dietary education. Which client statement indicates to the nurse that further teaching is needed? • "I must eat foods high in calories." O "I should avoid alcoholic beverages." • "I will eat more often but in smaller amounts." • "I can eat foods high in fat now that the acute stage is over."

• "I can eat foods high in fat now that the acute stage is over."

A client with invasive carcinoma of the bladder is scheduled for a cystectomy and an ileal conduit. The client expresses worries about the possibility of offensive odors associated with the urinary diversion. How would the nurse respond? • "Tell me more about your concerns." • "Products are available to limit this problem." "This is a problem, but the surgery is necessary." • "Most people who have this surgery share this same concern."

• "Tell me more about your concerns." Rationale: The response "Tell me more about what you are thinking" is an open-ended statement that focuses on the client's concerns and allows further verbalization of feelings. Although true, the response "This is a problem, but the surgery is necessary" may increase anxiety and cut off communication. The responses "Products are available to limit this problem" and "Most people who have this surgery share this same concern" move the focus away from the client and minimize the client's concerns.

After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The client asks the nurse, "What does that mean?" How would the nurse explain dumping syndrome? • It is nausea resulting from a full stomach. • It is the reflux of gastric contents into the esophagus. • It is the buildup of flatulence within the large intestine. • It is the rapid passage of concentrated fluid into the small intestine.

• It is the rapid passage of concentrated fluid into the small intestine. When high-osmotic fluid passes rapidly into the small intestine, it causes hypovolemia; this results in a sympathetic response of tachycardia, diaphoresis, and dizziness. The symptoms also are attributed to a sudden increase and subsequent decrease in blood glucose level. The stomach is not full; its contents rapidly empty into the jejunum. Reflux of gastric contents into the esophagus may occur with gastroesophageal reflux disease;dumping syndromeis associated with increased motility, involving the stomach and the jejunum. Buildup of flatulence within the large intestine usually is

An older adult is hospitalized for weight loss and dehydration due to nutritional deficit. Which factor would the nurse consider when planning care for this client? • Financial resources usually are unrelated to nutritional status. • An older adult's daily fluid intake must be markedly increased. • The client's diet should be high in carbohydrates and low in proteins. • The nutritional needs of an older adult are basically unchanged except for a decreased need for calories.

• The nutritional needs of an older adult are basically unchanged except for a decreased need for calories.

An older client with diarrhea is admitted to the hospital from a nursing home. A stool specimen confirms a diagnosis of a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse making room assignments asks if it is possible to place the new client with another client that also has MRSA in the same isolation room. How should the nurse respond?

"It is safe to place people with the same infection in one room."

during a health symposium the nurse teaches the group how to prevent food poisoning. Which statement by one of the participants indicates the teaching is understood.

"Meats and cream-based foods need to be refrigerated."

The client with a permanent sigmoid colostomy has colostomy irrigations prescribed and inquires as to why they are prescribed. Which response would the nurse use? O 'The irrigations provide electrolytes and lessen intestinal fluid loss." O "The irrigations help establish an elimination schedule." © "The irrigations decrease the amount of flatus in the bowel." • "The irrigations assist in minimizing bowel movement straining.

"The irrigations help establish an elimination schedule." Irrigations regulate the bowel to function at a specific time for the convenience of the client.

A client who had a severe weight loss is told the importance of eating more protein to provide the essential amino acids. The client asks the nurse why these substances in protein foods are essential. How should the nurse respond? • "They will give you the added energy you need." "They contain the necessary nitrogen you need for healing. © "They are essential for rebuilding your body tissue protein." "They must come from your food because your body cannot make them."

"They must come from your food because your body cannot make them All amino acids are needed for the synthesis of various proteins, but the term "essential" refers to those amino acids that the body cannot make and that are indispensable in the diet. All amino acids in a protein contribute the same number of calories for energy. All amino acids, not just essential amino acids, contain nitrogen. All amino acids, not just essential amino acids, are necessary for rebuilding body tissue.

Which finding indicates that a client is at an increased risk for colorectal cancer (CRC)? Select all that apply. One, some, or all responses may be correct.

- Dark and tarry stools, a family history of polyposis, a 20-year history of ulcerative colitis, unintentional weight loss of 20 pounds and a change in bowel patterns lasting 3 months are all findings that would warrant further evaluation for CRC. All of these clients are at higher risk for CRC. Dark, tarry stools occur from occult blood loss. A client who reports a longstanding change in bowel pattern should be tested for CRC. Familial polyposis is a precursor to CRC. Ulcerative colitis is an inflammatory bowel disease that increases the client's risk for CRC. Any client who experiences an unexplained and unintentional weight loss should be evaluated for cancer. The use of coffee, caffeine, or alcohol increase an individual's risk for gastritis. Long-term use of NSAIDS such as ibuprofen is a risk factor for both gastritis and peptic ulcer disease. Bacterial infection with H. pylori is also a risk factor for peptic ulcer disease.

The nurse is reviewing discharge plans with a client who is hospitalized with hepatitis A. The nurse concludes that the client understands preventive measures to reduce the risk of spreading the disease when the client makes which statement? O "I should wash my hands frequently." • "I should launder my clothes separately." • "I should put used tissues in the garbage." O "I should wear a mask when leaving the house."

1. "I should wash my hands frequently." Rationale: Hepatitis A microorganisms are transmitted via the anal-oral route; hand washing, particularly after toileting, is the most important precaution. The response "I should launder my clothes separately" will not deter the spread of the virus; hand washing is necessary. Putting used tissue in the garbage is important, but hand washing is the most important precaution. Hepatitis A microorganisms exit through the rectum, not the respiratory tract.

A client, readmitted for exacerbation of ulcerative colitis, is weak, thin, and irritable. The client states, "I am now ready for the surgery to create an ileostomy. Which nursing intervention best meets the client's needs at this time? Parenterally replace the client's fluids and electrolytes. • Adjust client's diet to promote weight gain. • Provide anticipatory teaching on the use of ileostomy appliances. • Encourage client interaction with other clients who have an ileostory.

1. Parenterally replace the client's fluids and electrolytes. Rationale: When a client has an ulcerative colitis exacerbation, the client may have more than 10 stools per day, and the stools are bloody and full of mucus. The client can become dehydrated and lose vital electrolytes. Parenterally replacing fluids and electrolytes is a life-saving strategy; replacement occurs before performing the surgery to stabilize the client. Helping the client regain former body weight is not the priority at this time. The client is neither physically nor cognitively ready to learn the psychomotor skill of how to manage an ileostomy. The client is not demonstrating a readiness for contact with other persons with ileostomies at this time.

A client with jaundice associated with hepatitis expresses concern over the change in skin color. The nurse explains that this color change is a result of: 1 Stimulation of the liver to produce an excess quantity of bile pigments 2 Inability of the liver to remove normal amounts of bilirubin from the blood 3 Increased destruction of red blood cells during the acute phase of the disease 4 Decreased prothrombin levels, leading to multiple sites of intradermal bleeding

2 Damage to liver cells affects the ability to facilitate removal of bilirubin from the blood, with resulting deposition in the skin and sclera. 1 With hepatitis, the liver does not secrete excess bile. 3 Destruction of red blood cells does not increase in hepatitis. 4 Decreased prothrombin levels cause spontaneous bleeding, not jaundice.

A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question? 1 Blood clotting 2 Bone formation 3 Muscle contraction 4 Cellular membranes

4 Cellular membranes Cholesterol is an essential structural and functional component of most cellular membranes. That it is associated with atherosclerotic plaques does not detract from its essential functions. Cholesterol is not necessary for blood clotting; calcium and vitamin K are necessary. Cholesterol is not essential for bone formation; calcium, phosphorus, and calciferol are necessary. Cholesterol is not involved in muscle contraction; potassium, sodium, and calcium are necessary.

A health care provider prescribes an upper gastrointestinal (Gl) series and a barium enema. The client asks, "Why do I need barium for these tests?" Which explanation would the nurse give? • 'It gives off visible light, illuminating the alimentary tract." • "It provides fluorescence, thereby lighting up the alimentary tract." O "It dyes the structures of the alimentary tract, making them more visible. "It gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays."

55Rationale Barium salts used in a GI series and barium enemas coat the inner lining of the GI tract and then absorb x-rays passing through. Thus they outline the surface features of the tract on a photographic plate. Barium has no light-emitting properties. Barium does not give off visible light or provide fluorescence. Barium does not have the properties of a dye.

Which pain description would the nurse expect a client to report when describing pain associated with a suspected duodenal peptic ulcer? © An ache radiating to McBurney point • An intermittent, colicky right-flank pain • A gnawing sensation in the epigastric area • A generalized abdominal pain intensified by movement

A gnawing sensation in the epigastric area

A client with a diagnosis of incarcerated hernia asks the nurse for an explanation of the condition. Which description should the nurse give? The bowel has twisted upon itself. • A piece of the intestine has become stuck in a hole in the abdominal wall. O The intestinal blood supply has been out off. • The involved intestine has developed an erosion.

A piece of the intestine has become stuck in a hole in the abdominal wall.

A client is admitted to the hospital with Laënnec cirrhosis and chronic pancreatitis. Bile salts (bile acid factor) are prescribed, and the client asks why they are needed. How would the nurse respond? • "They stimulate prothrombin production." • 'They aid in the absorption of fat-soluble vitamins." • "They promote bilirubin secretion in the urine." • "They help the common bile duct contract stronger."

Ans: 2 Bile salts are used to aid digestion of fats and absorption of the fat-soluble vitamins A, D, E, and K. Bile salts are not involved in stimulating prothrombin production, in promoting bilirubin secretion in the urine, or in stimulating contraction of the common bile duct.

A nurse is caring for a client who is vomiting. When caring for this client, the nurse considers the fact that the vomiting reflex follows a set pattern. List the following steps in the order that they occur. 1. Contraction of abdominal muscles 2. Closure of the trachea to prevent aspiration 3. Initiation of reverse peristalsis in the stomach 4. Relaxation of the upper esophageal sphincter

Ans: 3, 1, 2, 4 Reverse peristalsis starts the sequence; with contraction of the abdominal muscles, gastric contents are propelled into the esophagus, and the upper esophageal sphincter relaxes so vomiting can occur. Finally, the trachea closes to prevent aspiration.