Exam 3: Endocrine and GI
The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client? 1. Explain it will take up to a month for symptoms of hyperthyroidism to subside. 2. Teach the iodine therapy will have to be tapered slowly over one (1) week. 3. Discuss the client will have to be hospitalized during the radioactive therapy. 4. Inform the client after therapy the client will not have to take any medication.
1. Radioactive iodine therapy is used to destroy the overactive thyroid cells. After treatment, the client is followed closely for three (3) to four (4) weeks until the euthyroid state is reached. Rationales for other answer options: 2. A single dose of radioactive iodine therapy is administered; the dosage is based on the client's weight. 3. The colorless, tasteless radioiodine is administered by the radiologist, and the client may have to stay up to two (2) hours after the treatment in the office. 4. If too much of the thyroid gland is destroyed by the radioactive iodine therapy, the client may develop hypothyroidism and have to take thyroid hormone the rest of his or her life.
The client diagnosed with IBD is prescribed total parenteral nutrition (TPN). Which intervention should the nurse implement? 1. Check the client's glucose level. 2. Administer an oral hypoglycemic. 3. Assess the peripheral intravenous site. 4. Monitor the client's oral food intake.
1. Check the client's glucose level. TPN is high in dextrose, which is glucose; therefore, the client's blood glucose level must be monitored closely.
Which oral medication should the nurse question before administering to the client with peptic ulcer disease? 1. E-mycin, an antibiotic. 2. Prilosec, a proton pump inhibitor. 3. Flagyl, an antimicrobial agent. 4. Tylenol, a nonnarcotic analgesic.
1. E-mycin, an antibiotic. E-mycin is irritating to the stomach, and its use in a client with peptic ulcer disease should be questioned. Rationale for other choices: 2. Prilosec, a proton pump inhibitor, decreases gastric acid production, and its use should not be questioned by the nurse. 3. Flagyl, an antimicrobial, is administered to treat peptic ulcer disease secondary to H. pylori bacteria. 4. Tylenol can be safely administered to a client with peptic ulcer disease.
Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? 1. Serum sodium. 2. Serum calcium 3. Urine glucose. 4. Urine white blood cells
1. Serum sodium The client will have an elevated sodium level as a result of low circulating blood volume. The fluid is being lost through the urine. Rationales for other answer options: 2. Serum calcium is not affected by diabetes insipidus. 3. Urine glucose is monitored for diabetes mellitus. 4. White blood cells in the urine indicate the presence of a urinary tract infection
Which assessment data indicate to the nurse the client's gastric ulcer has perforated? 1. Complaints of sudden, sharp, substernal pain. 2. Rigid, board like abdomen with rebound tenderness. 3. Frequent, clay-colored, liquid stool. 4. Complaints of vague abdominal pain in the right upper quadrant. A rigid, boardlike abdomen with rebound tenderness is the classic sign/symptom of peritonitis, which is a complication of a perforated gastric ulcer. Sudden sharp pain felt in the substernal area indicates angina or myocardial infarction. Clay-colored stools indicate liver disorders, such as hepatitis. 4. Clients with gallbladder disease report vague to sharp abdominal pain in the right upper quadrant.
2. A rigid, board like abdomen with rebound tenderness is the classic sign/symptom of peritonitis, which is a complication of a perforated gastric ulcer. Rationale for other answer options: 1. Sudden sharp pain felt in the substernal area indicates angina or myocardial infarction. 3. Clay-colored stools indicate liver disorders, such as hepatitis. 4. Clients with gallbladder disease report vague to sharp abdominal pain in the right upper quadrant.
The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement? 1. Assess for dehydration and monitor blood glucose levels. 2. Assess for nausea and vomiting and weigh daily. 3. Monitor potassium levels and encourage fluid intake. 4. Administer vasopressin IV and conduct a fluid deprivation test.
2. Early signs and symptoms are nausea and vomiting. Rationales for other options: 1. The client has excess fluid and is not dehydrated, and blood glucose levels are not affected. 3. The client experiences dilutional hyponatremia, and the body has too much fluid already. 4. Vasopressin is the name of the antidiuretic hormone. Giving more increases the client's problem. Also, a water challenge test is performed, not a fluid deprivation test.
The client with a history of peptic ulcer disease is admitted into the intensive care department with frank gastric bleeding. Which priority intervention should the nurse implement? 1. Maintain a strict record of intake and output. 2. Insert a nasogastric (N/G) tube and begin saline lavage. 3. Assist the client with keeping a detailed calorie count. 4. Provide a quiet environment to promote rest.
2. Inserting a nasogastric tube and lavaging the stomach with saline is the most important intervention because this directly stops the bleeding. Raionales for other answers: 1. Maintaining a strict record of intake and output is important to evaluate the progression of the client's condition, but it is not the most important intervention. 3. A calorie count is important information assisting in the prevention and treatment of a nutritional deficit, but this intervention does not address the client's immediate and life-threatening problem. 4. Promoting a quiet environment aids in the reduction of stress, which can cause further bleeding, but this will not stop the bleeding.
Which expected outcome should the nurse include for a client diagnosed with peptic ulcer disease? 1. The client's pain is controlled with the use of NSAIDs. 2. The client maintains lifestyle modifications. 3. The client has no signs and symptoms of hemoptysis. 4. The client takes antacids with each meal
2. Maintaining lifestyle changes such as following an appropriate diet and reducing stress indicate the client is complying with the medical regimen. Compliance is the goal of treatment to prevent complications. Rationales for other answers: 1. Use of NSAIDs increases and causes problems associated with peptic ulcer disease. 3. Hemoptysis is coughing up blood, which is not a sign or symptom of peptic ulcer disease. This would not be an expected outcome. 4. Antacids should be taken one (1) to three (3) hours after meals, not with each meal.
The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? 1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?"
2. Most clients with GERD have been self-medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. Rationales for other answers: 1. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss but not weight gain. 3. Milk and dairy products contain lactose, which are important if considering lactose intolerance but are not important for "heartburn." 4. Heartburn is not a symptom of a viral illness.
The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1. Provide a low-residue diet. 2. Rest the client's bowel. 3. Assess vital signs daily. 4. Administer antacids orally
2. Whenever a client has an acute exacerbation of a gastrointestinal disorder, the first intervention is to place the bowel on rest. The client should be NPO with intravenous fluids to prevent dehydration. Rationales for other answers: 1. The client's bowel should be placed on rest and no foods or fluids should be introduced into the bowel. 3. The vital signs must be taken more often than daily in a client who is having an acute exacerbation of ulcerative colitis. 4. The client will receive anti-inflammatory and antidiarrheal medications, not antacids, which are used for gastroenteritis.
Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer.
3. Barrett's esophagus results from long term erosion of the esophagus as a result of reflux of stomach contents secondary to GERD. This is a precursor to esophageal cancer.
The nurse is caring for clients on a medical floor. Which client should be assessed first? 1. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday. 2. The client diagnosed with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1,500 mL and an output of 1,600 mL in the last 8 hours. 3. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching. 4. The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night.
3. Muscle twitching is a sign of early sodium imbalance. If an immediate intervention is not made, the client could begin to seize. Rationales for other answer options: 1. Clients with SIADH have a problem with retaining fluid. This is expected. 2. This client's intake and output are relatively the same. Nothing alerting or immediate that needs attention. 4. The client has to get up all night to urinate, so the client feeling tired is expected
The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test? 1. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours. 2. The client will be administered an injection of antidiuretic hormone (ADH), and urine output will be measured for four (4) to six (6) hours. 3. The client will have nothing by mouth (NPO), and vital signs and weights will be done hourly until the end of the test. 4. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done.
3. The client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and weights are taken every hour to determine circulatory status. If a marked decrease in weight or vital signs occurs, the test is immediately terminated.
The unlicensed assistive personnel (UAP) complains to the nurse she has filled the water pitcher four (4) times during the shift for a client diagnosed with a closed head injury and the client has asked for the pitcher to be filled again. Which intervention should the nurse implement first? 1. Tell the UAP to fill the pitcher with ice cold water. 2. Instruct the UAP to start measuring the client's I&O. 3. Assess the client for polyuria and polydipsia. 4. Check the client's BUN and creatinine levels.
3. The first action should be to determine if the client is experiencing polyuria and polydipsia as a result of developing diabetes insipidus, a complication of the head trauma. Rationales for other answer options: 1. The client should have the water pitcher filled, but this is not the first action. 2. This should be done but not before assessing the problem. 4. This could be done, but it will not give the nurse information about DI.
The client presents with a complete blockage of the large intestine from a tumor. Which healthcare provider's order would the nurse question? 1. Obtain consent for a colonoscopy and biopsy. 2. Start an IV of 0.9% saline at 125 mL/hr. 3. Administer 3 liters of GoLYTELY. 4. Give tap water enemas until it is clear.
3. This client has an intestinal blockage from a solid tumor blocking the colon. Although the client needs to be cleaned Chapter 7 Gastrointestinal Disorders 275 out for the colonoscopy, GoLYTELY could cause severe cramping without a reasonable benefit to the client and could cause a medical emergency. Rationales for other answers: 1. The client will need to have diagnostic tests, so this is an appropriate intervention. 2. The client who has an intestinal blockage will need to be hydrated. 4. Tap water enemas until clear would be instilling water from below the tumor to try to rid the colon of any feces. The client can expel this water.
Which medication order should the nurse question in the client diagnosed with untreated hypothyroidism? 1. Thyroid hormones. 2. Oxygen. 3. Sedatives. 4. Laxatives.
3. Untreated hypothyroidism is characterized by an increased susceptibility to the effects of most hypnotic and sedative agents; therefore, the nurse should question this medication. Rationales for other answer options: 1. Thyroid hormones are the treatment of choice for the client diagnosed with hypothyroidism; therefore, the nurse should not question this medication. 2. In untreated hypothyroidism, the medical management is aimed at supporting vital functions, so administering oxygen is an appropriate medication. 4. Clients with hypothyroidism become constipated as a result of decreased metabolism, so laxatives should not be questioned by the nurse
The client is two hours post colonoscopy. Which assessment data warrant intermediate intervention by the nurse? 1. The client has a soft, nontender abdomen. 2. The client has a loose, watery stool. 3. The client has hyperactive bowel sounds. 4. The client's pulse is 104 and BP is 98/60.
4. Bowel perforation is a potential complication of a colonoscopy. Therefore, signs of hypotension—decreased BP and increased pulse—warrant immediate intervention from the nurse. Rationales for other answers: 1. The client's abdomen should be soft and nontender; therefore, this finding would not require immediate intervention. 2. The client had to clean the bowel prior to the colonoscopy; therefore, watery stool is expected. 3. The client was NPO and received bowel preparation prior to the colonoscopy; therefore, hyperactive bowel sounds might occur and do not warrant immediate intervention.
The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? 1. Discuss the importance of drinking 1,000 mL of water daily. 2. Instruct the client to exercise at least three (3) times a week. 3. Teach the client about eating a low-residue diet. 4. Explain the need to have daily bowel movements.
4. The client should have regular bowel movements, preferably daily. Constipation may cause diverticulitis, which is a potentially life-threatening complication of diverticulosis. Rationales for other answers: 1. The client should drink at least 3,000 mL of water daily to help prevent constipation. 2. The client should exercise daily to help prevent constipation. 3. The client should eat a high-fiber diet to help prevent constipation.
Which nursing intervention should be included in the plan of care for the client diagnosed with hyperthyroidism? 1. Increase the amount of fiber in the diet. 2. Encourage a low-calorie, low-protein diet. 3. Decrease the client's fluid intake to 1,000 mL/day. 4. Provide six (6) small, well-balanced meals a day.
4. The client with hyperthyroidism has an increased appetite; therefore, well-balanced meals served several times throughout the day will help with the client's constant hunger. Rationales for other answers: 1. Fiber should be increased in the client diagnosed with hypothyroidism because the client experiences constipation secondary to decreased metabolism. 2. The client with hyperthyroidism should have a high-calorie, high-protein diet. 3. The client's fluid intake should be increased to replace fluids lost through diarrhea and excessive sweating.
The client diagnosed with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temperature of 100.6°F. Which intervention should the nurse implement first? 1. Notify the health-care provider. 2. Document the findings in the chart. 3. Administer an oral antipyretic. 4. Assess the client's abdomen.
4. The nurse should assess the client to determine if the abdomen is soft and nontender. A rigid tender abdomen may indicate peritonitis. Rationales for other answers: 1. These are classic signs/symptoms of diverticulitis; therefore, the HCP does not need to be notified. 2. These are normal findings for a client diagnosed with diverticulitis, but on admission the nurse should assess the client and document the findings in the client's chart. 3. The nurse should not administer any food or medications
The client who has had an abdominal perineal resection is being discharged. Which discharge information should the nurse teach? 1. The stoma should be a white, blue, or purple color. 2. Limit ambulation to prevent the pouch from coming off. 3. Take pain medication when the pain level is at an "8." 4. Empty the pouch when it is one-third to one-half full.
4. The pouch should be emptied when it is one-third to one-half full to prevent the contents from becoming too heavy for the seal to hold and to prevent leakage from occurring. Rationales for other answers: 1. The stoma should be light to a medium pink, the color of the intestines. A blue or purple color indicates a lack of circulation to the stoma and is a medical emergency. 2. The stoma should be pouched securely for the client to be able to participate in normal daily activities. The client should be encouraged to ambulate to aid in recovery. 3. Pain medication should be taken before the pain level reaches a "5." Delaying taking medication will delay the onset of pain relief and the client will not receive full benefit from the medication.
Scenario: An otherwise healthy 60-year-old male, with diverticulosis that was diagnosed during a colonoscopy 5 years ago, arrives to the hospital today with reports of extreme left lower abdominal pain, bloating, and nausea. The nurse documents the following assessment findings: ·Reports abdominal pain of 9/10 on a 0-10 pain intensity scale ·Blood pressure 142/70 ·Heart rate 115 bpm ·Temperature 101.3*F orally ·Bowel sounds tinkling in the LLQ. Abdomen slightly distended. LLQ tender with palpable mass. ·Reports he has only had clear liquids in the last 12 hours. ·Reports a history of excess flatulence What findings would require immediate follow up by the nurse?
Abdominal Pain 9/10 Temperature 101.3 orally LLQ tender with palpable mass
A nurse is assessing a client who has a history of a bleeding peptic ulcer. What assessment findings should the nurse report immediately?
Abdominal distension; cool, clammy skin; weak, thready pulse. Rationale: These are signs of internal bleeding. Abdominal distension results from the increased blood in the stomach. Cool, clammy skin and a weak, thready pulse are signs of the body compensating after hemorrhage.
A nurse is caring for a client with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to prevent?
Aspiration. Rationale: Checking tube placement and checking for residual volume protects the client from aspiration, which can cause pneumonia.
A patient with aldosteronism would be expected to exhibit all of the following symptoms except: A: Alkalosis B: Hypokalemia C: Hyponatremia D: Increased pH
C
Laboratory findings suggestive of Addison's Disease include all of the following except: A: A relative lymphocytosis B: Hyperkalemia and Hyponatremia C: Hypertension D: Hypoglycemia
C
If peptic ulcer hemorrhage were suspected, an immediate nursing action would be to: A: place the patient in a recumbent position with the legs elevated B: prepare for a peripheral and central line for IV infusions C: assess vital signs D: accomplish all of the above
D
Nursing interventions associated with peptic ulcers include: A: Checking the BP and HR every 15-20 mins B: Frequently monitoring H&H C: Observing stools and emesis for color, consistency, and volume D: All of the above
D
Patients with hyperthyroidism are characteristically: A: Anorexic B: Calm C: Emotionally stable D: Insensitive to Heat
D
The goal of medical management for hypoparathyroidism is to: A: achieve a serum calcium level of 9-10mg/dl B: eliminate clinical symptoms C: reverse symptoms of hypocalcemia D: all of the above
D
The preferred medication for treating hypothyroidism is: A: Lithium B: Propranolol C: Propylthiouracil D: Levothyroxine
D
Tetany is suspected when either of these signs are positive:
Trousseau Sign and Chvostek's Sign
T or F: Crohn's disease can cause malabsorption of nutrients
True
The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying
1. Of adult-onset asthma cases, 80% to 90% are caused by gastroesophageal reflux disease (GERD). Rationales for other answer options: 2. Pancreatitis is not related to GERD. 3. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levels of gastric acid, but it is not related to reflux. 4. GERD is not related to increased gastric emptying. Increased gastric emptying would be a benefit to a client with decreased functioning of the lower esophageal sphincter
One of the most important and frequently occurring complications of hyperparathyroidism is: A: kidney stones B: pancreatitis C: pathologic fractures D: peptic ulcer
A
The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena.
1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD. Rationales for other answers: 2. Gastroesophageal reflux disease does not cause weight loss. 3. There is no change in abdominal fat, no proteinuria (the result of a filtration problem in the kidney), and no alteration in bowel elimination for the client diagnosed with GERD. 4. Midepigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease.
The most common complication of peptic ulcer disease is: A: Hemorrhage B: Intractable ulcer C: Perforation D: Pyloric Obstruction
A
The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit? 1. Complaints of extreme fatigue and hair loss. 2. Exophthalmos and complaints of nervousness. 3. Complaints of profuse sweating and flushed skin. 4. Tetany and complaints of stiffness of the hands.
1. A decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss. Rationales for other answer options: 2. These are signs of hyperthyroidism. 3. These are signs of hyperthyroidism. 4. These are signs of hypoparathyroidism.
The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the health-care provider? 1. Serum sodium of 112 mEq/L and a headache. 2. Serum potassium of 5.0 mEq/L and a heightened awareness. 3. Serum calcium of 10 mg/dL and tented tissue turgor. 4. Serum magnesium of 1.2 mg/dL and large urinary output.
1. A serum sodium level of 112 mEq/L is dangerously low, and the client is at risk for seizures. A headache is a symptom of a low-sodium level. Rationales for other answers: 2. This is a normal potassium level, and a heightened level of awareness indicates drug usage. 3. This is a normal calcium level and the client is fluid overloaded, not dehydrated, so there would not be tented tissue turgor. 4. This is a normal magnesium level, and a large urinary output is desired.
The most common site for peptic ulcer formation is the: A: Duodenum B: Esophagus C: Pylorus D: Stomach
A
When thyroid hormone is administered for prolonged hypothyroidism, the nurse knows to monitor the patient for? A: Angina B: Depression C: Mental confusion D: Hypoglycemia
A
The nurse is caring for a client diagnosed with rule-out peptic ulcer disease. Which test confirms this diagnosis? 1. Esophagogastroduodenoscopy. 2. Magnetic resonance imaging (MRI). 3. Occult blood test. 4. Gastric acid stimulation.
1. The esophagogastroduodenoscopy (EGD) is an invasive diagnostic test that visualizes the esophagus, stomach, and duodenum to accurately diagnose an ulcer and evaluate the effectiveness of the client's treatment. Rationales for other answers: 2. Magnetic resonance imaging (MRI) shows cross-sectional images of tissue or blood flow. 3. An occult blood test shows the presence of blood but not the source. 4. A gastric acid stimulation test is used to understand the pathophysiology of ulcer disease, but it has limited usefulness.
What are some treatments for a c.diff infection? Select all that apply A: Fluids B: Vancomycin IV C: Fecal transplant D: Miconazole
A & C Rationales for other answers: B: is incorrect because c.diff is treated with PO vancomycin D: Miconazole is an antifungal. Metronidazole is another antibiotic that treats c.diff
The client is admitted to the intensive care department diagnosed with myxedema coma. Which assessment data warrant immediate intervention by the nurse? 1. Serum blood glucose level of 74 mg/dL. 2. Pulse oximeter reading of 90%. 3. Telemetry reading showing sinus bradycardia. 4. The client is lethargic and sleeps all the time.
2. A pulse oximeter reading of less than 93% is significant. This is a sign of hypoxemia and requires immediate intervention. Rationales for other answer options: 1. Hypoglycemia is expected in a client with myxedema; therefore, a 74-mg/dL blood glucose level is expected. 3. The client with myxedema coma is in an exaggerated hypothyroid state; a low pulse is expected in a client with hypothyroidism. 4. Lethargy is an expected symptom in a client diagnosed with myxedema; therefore, this does not warrant immediate intervention.
Which signs/symptoms should make the nurse suspect the client is experiencing a thyroid storm? 1. Constipation and hypoactive bowel sounds. 2. Hyperpyrexia and extreme tachycardia. 3. Hypotension and bradycardia. 4. Decreased respirations and hypoxia.
2. Hyperpyrexia and extreme tachycardia.
What are signs and symptoms of an small bowel obstruction? Select all that apply A: Acute, rapid onset B: Abdominal distension C: Obstipation D: Ribbon-like stools
A and C B and D are signs and symptoms of a large bowel obstruction
The charge nurse has just received the shift report. Which client should the nurse see first? 1. The client diagnosed with Crohn's disease who had two (2) semi formed stools on the previous shift. 2. The elderly client admitted from another facility who is complaining of constipation. 3. The client diagnosed with AIDS who had a 200-mL diarrhea stool and has elastic skin tissue turgor. 4. The client diagnosed with hemorrhoids who had some spotting of bright red blood on the toilet tissue.
2. This client has just arrived, so the nurse does not know if the complaint is valid and needs intervention unless assessed. The elderly have difficulty with constipation as a result of decreased gastric motility, medications, poor diet, and immobility. Rationales for other answers: 1. This client is improving; semiformed stools are better than diarrhea. 3. The client has diarrhea, but only 200 mL, and has elastic tissue turgor, indicating the client is not dehydrated. 4. This is not normal, but it is expected for a client with hemorrhoids
A client who is recovering from gastric surgery is receiving IV fluids to be infused at 100 mL/hour. The IV tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? Record your answer using a whole number.
25gtt/min
The nurse is caring for clients in an outpatient clinic. Which information should the nurse teach regarding the American Cancer Society's recommendations for the early detection of colon cancer? 1. Beginning at age 60, a digital rectal examination should be done yearly. 2. After reaching middle age, a yearly fecal occult blood test should be done. 3. Have a colonoscopy at age 50 and then once every five (5) to 10 years. 4. A flexible sigmoidoscopy should be done yearly after age 40.
3. The American Cancer Society recommends a colonoscopy at age 50 and every five (5) to 10 years thereafter, and a flexible sigmoidoscopy and a barium enema every five (5) years. Rationales for other answers: 1. A digital rectal examination is done to detect prostate cancer and should be started at age 40 years. 2. "Middle age" is a relative term; specific ages are used for recommendation. 4. A flexible sigmoidoscopy should be done at five (5)-year intervals between the colonoscopy
The patho of hypoparathyroidism is associated with all of the following except: A: a decrease in serum calcium B: an elevation of blood phosphate C: an increase of the renal excretion of phosphate D: a lowered renal excretion of calcium
C
The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? 1. Grilled hamburger on a wheat bun and fried potatoes. 2. A chicken salad sandwich and lettuce and tomato salad. 3. Roast pork, white rice, and plain custard. 4. Fried fish, whole grain pasta, and fruit salad
3. A low-residue diet is a low-fiber diet. Products made of refined flour or finely milled grains, along with roasted, baked, or broiled meats, are recommended. Rationales for other answers: 1. Fried potatoes, along with pastries and pies, should be avoided. 2. Raw vegetables should be avoided because this is roughage. 4. Fried foods should be avoided, and whole grain is high in fiber. Nuts and fruits with peels should be avoided.
What complications are patient's with UC and Crohn's at risk for?
Colorectal Cancer Perforation Dehydration
The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess? 1. Moon face, buffalo hump, and hyperglycemia. 2. Hirsutism, fever, and irritability. 3. Bronze pigmentation, hypotension, and anorexia. 4. Tachycardia, bulging eyes, and goiter.
3. Bronze pigmentation, hypotension, and anorexia.
The client being admitted from the emergency department is diagnosed with a fecal impaction. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication every day and prn. 2. Perform bowel training every two (2) hours. 3. Administer an oil retention enema. 4. Prepare for an upper gastrointestinal (UGI) series x-ray
3. Oil retention enemas will help to soften the feces and evacuate the stool. Rationales for other answers: 1. An antidiarrheal medication would slow down the peristalsis in the colon, worsening the problem. 2. The client has an immediate need to evacuate the bowel, not a need for bowel training. 4. A UGI series adds barium to the already hardened stool in the colon. Barium enemas x-ray the colon; a UGI series x-rays the stomach and jejunum.
The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side-lying position and take antacids before meals. 4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client.
4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client. Rationale: The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux.
The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective? 1. A decrease in alcohol intake. 2. Maintaining a bland diet. 3. A return to previous activities. 4. A decrease in gastric distress.
4. Antibiotics, proton pump inhibitors, and Pepto-Bismol are administered to decrease the irritation of the ulcerative area and cure the ulcer. A decrease in gastric distress indicates the medication is effective. Rationales for other answers: 1. Decreasing the alcohol intake indicates the client is making some lifestyle changes. 2. The client with peptic ulcer disease (PUD) is prescribed a regular diet, but the type of diet does not determine if the medication is effective. 3. The return to previous activities indicates the client has not adapted to the lifestyle changes and has returned to the previous behaviors which precipitated the peptic ulcer disease.
The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions? 1. "I should not eat for at least one (1) day following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid orange juice and eating tomatoes until my esophagus heals."
4. Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal. Rationales for other answers: 1. The client is allowed to eat as soon as the gag reflex has returned. 2. An esophagogastroduodenoscopy is a diagnostic procedure, not a cure. Therefore, the client still has GERD and should be instructed to stay in an upright position for two (2) to three (3) hours after eating. 3. Stomach contents are acidic and will erode the esophageal lining.
Which assessment data supports the client's diagnosis of gastric ulcer to the nurse? 1. Presence of blood in the client's stool for the past month. 2. Reports of a burning sensation moving like a wave. 3. Sharp pain in the upper abdomen after eating a heavy meal. 4. Complaints of epigastric pain 30 to 60 minutes after ingesting food.
4. Complaints of epigastric pain 30 to 60 minutes after ingesting food. In a client diagnosed with a gastric ulcer, pain usually occurs 30 to 60 minutes after eating but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating food. Pain occurs one (1) to three (3) hours after meals.
The nurse is preparing to administer 250 mL of intravenous antibiotic to the client. The medication must infuse in one (1) hour. An intravenous pump is not available and the nurse must administer the medication via gravity with IV tubing at 10 gtts/min. At what rate should the nurse infuse the medication? _________
42 gtts/min. The nurse must use the formula: (amount to be infused) × (drops per minute) / minutes for infusion 250 mL × 10 gtts /60 minutes or, 2,500 ÷ 60 minutes = 41.66 gtts/min, which should be rounded up to 42 gtts/min
The client diagnosed with Cushing's disease has developed 1++ peripheral edema. The client has received intravenous fluids at 100 mL/hr via IV pump for the past 79 hours. The client received intravenous piggyback (IVPB) medication in 50 mL of fluid every six (6) hours for 15 doses. How many mL of fluid did the client receive?
8,650ml
The nurse is preparing to hang a new bag of total parenteral nutrition for a client with an abdominal perineal resection. The bag has 1,500 mL of 50% dextrose, 10 mL of trace elements, 20 mL of multivitamins, 20 mL of potassium chloride, and 500 mL of lipids. The bag is to infuse over the next 24 hours. At what rate should the nurse set the pump?
85 mL/hr. First determine the total amount to be infused over 24 hours: 1500 + 500 + 20 + 20 = 2,040 mL over 24 hours Then, determine the rate per hour: 2,040 ÷ 24 = 85 mL/hr
A diagnosis of hyperparathyroidism can be established by all of the following signs except: A: a negative reading on a Sulkowitch test B: a serum calcium level of 12mg/dl C: an elevated level of parathyroid hormone D: bone demineralization seen on radiographic film
A
A pheochromocytoma is an adrenal medulla tumor that causes arterial hypertension by increasing the level of circulating: A: Catacholamines B: Enzymes C: Hormones D: Glucocorticoids
A
A recommended breakfast for a hyperparathyroid patient would be: A: cereal with milk and bananas B: fried eggs and bacon C: orange juice and toast D: pork sausage and cranberry juice
A
Clinical manifestation not commonly associated with hyperthyroidism is: A: HR slower than 90bpm B: Elevated systolic BP C: Muscular fatiguability D: Weight loss
A
Iodine and iodide compounds are used for hyperthyroidism because they do all of the following except: A: decrease the basal metabolic rate B: increase the vascularity of the gland C: lessen the release of thyroid hormones D: reduce the size of the gland
B
The objectives of pharmacotherapy for hypothyroidism include: A: destroying overactive thyroid cells B: preventing thyroid hormonal synthesis C: increasing the amount of thyroid tissue D: all of the above
B
Select the correct characteristics of ulcerative colitis: A: Cobblestone ulcers B: Diarrhea with bright red blood C: Fistula formation D: Toxic megacolon E: Adequate absorption of nutrients
B, D, E
Teaching points to help a patient after a total gastric resection to avoid dumping syndrome include all of the following except: A: eating small, frequent meals B: increasing the carb content of the diet to supply needed calories for energy C: lying down after meals D: taking fluid between meals to decrease the total volume of the stomach at one time.
B.
Because of religious beliefs, a client, who is an Orthodox Jew, refuses to eat hospital food. Hospital policy discourages food from outside the hospital. What should the nurse do next? A: Encourage the client's family to bring food for the client because of the special circumstances. B: Discuss the situation and possible courses of action with the dietitian and the client. C: Explain alternatives to food such as intravenous fluids that can provide nutrition during hospitalization. D: Teach the client that it is important to eat the food served.
B: Discuss the situation and possible courses of action with the dietitian and the client. The best course of action when a client is not able to eat food that is contrary to religious beliefs is to discuss the situation with the client and the dietitian. Health team members may need to confer about this client's needs.
A characteristic associated with peptic ulcer pain is a: A: burning sensation localized in the back or midepigastrium B: Feeling of emptiness that precedes meals from 1-3 hours C: severe gnawing pain that increases in severity as the day progresses D: combination of all of the above
D
A client who had a splenectomy yesterday has a nasogastric (NG) tube. What should the nurse assess to determine the effectiveness of the NG tube? A: depth of diaphragmatic breathing B: amount of blood draining from the tube C: normal pH of gastric contents D: absence of abdominal distention
D: absence of abdominal distention An NG tube is placed to decrease abdominal distention in the immediate postoperative phase. The NG tube does not affect the depth of diaphragmatic breathing. The NG tube drains gastric contents and air in the stomach; it is not in the operative site and therefore cannot be used to irrigate it, and there should not be bloody drainage. The gastric juices are not checked as an indicator that peristalsis has returned, and the pH should be normal; instead, bowel sounds are auscultated in all four quadrants to indicate the return of peristalsis.
What are possible triggers of inflammatory bowel disease?
Diet Smoking Stress Genetics Other autoimmune conditions
T or F: Crohn's can cause toxic megacolon
F. UC is the disorder that causes toxic megacolon
What diet would a provider recommend for a patient that has a new diagnosis of IBS?
FODMAP
T or F: Ulcerative colitis can affect the entire GI tract
False. Ulcerative colitis only affects the colon. Crohn's can affect a patient from mouth to anus.
A client underwent insertion of a nasogastric (NG) tube for partial bowel obstruction the previous evening. The nurse notes that the tube is not secured to the client's face. How will the nurse proceed? 1. Call the healthcare provider immediately. 2. Verify placement of the tube. 3. Securely tape the tube in place. 4. Note the findings on the client's flow sheet.
The NG tube placement should be verified prior to re-taping the NG tube; the other options require verification of the NG tube placement first and the healthcare provider will need to know.
The client diagnosed with acute diverticulitis is complaining of severe abdominal pain. On assessment, the nurse finds a hard, rigid abdomen and T 102°F. Which intervention should the nurse implement? 1. Notify the health-care provider. 2. Prepare to administer a Fleet's enema. 3. Administer an antipyretic suppository. 4. Continue to monitor the client closely.
1. These are signs of peritonitis, which is life threatening. The health-care provider should be notified immediately. Rationales for other answers: 2. A Fleet's enema will not help a life-threatening complication of diverticulitis. 3. A medication administered to help decrease the client's temperature will not help a life-threatening complication. 4. These are signs/symptoms indicating a possible life-threatening situation and require immediate intervention.
Which physical examination should the nurse implement first when assessing the client diagnosed with peptic ulcer disease? 1. Auscultate the client's bowel sounds in all four quadrants. 2. Palpate the abdominal area for tenderness. 3. Percuss the abdominal borders to identify organs. 4. Assess the tender area progressing to nontender.
1. Auscultation should be used prior to palpation or percussion when assessing the abdomen. Manipulation of the abdomen can alter bowel sounds and give false information. Rationales for other answers: 2. Palpation gives appropriate information the nurse needs to collect, but if done prior to auscultation, the sounds will be altered. 3. Percussion of the abdomen does not give specific information about peptic ulcer disease. 4. Tender areas should be assessed last to prevent guarding and altering the assessment. This includes palpation, which should be done after auscultation
The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client supports this diagnosis? 1. "My pain goes away when I have a bowel movement." 2. "I have bright red blood in my stool all the time." 3. "I have episodes of diarrhea and constipation." 4. "My abdomen is hard and rigid and I have a fever."
1. The terminal ileum is the most common site for regional enteritis, which causes right lower quadrant pain that is relieved by defecation. Rationales for other answers: 2. Stools are liquid or semiformed and usually do not contain blood. 3. Episodes of diarrhea and constipation may be a sign/symptom of colon cancer, not Crohn's disease. 4. A fever and hard, rigid abdomen are signs/ symptoms of peritonitis, a complication of Crohn's disease.
The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when teaching ways to prevent an acute exacerbation of diverticulosis? Select all that apply. 1. Eat a high-fiber diet. 2. Increase fluid intake. 3. Elevate the HOB after eating. 4. Walk 30 minutes a day. 5. Take an antacid every two (2) hours.
1. A high-fiber diet will help to prevent constipation, which is the primary reason for diverticulitis. 2. Increased fluids will help keep the stool soft and prevent constipation. 4. Exercise will help prevent constipation. Rationales for other answers: 3. This will not do anything to help prevent diverticulitis. 5. No medications are prescribed to prevent an acute exacerbation of diverticulitis. Antacids are used to neutralize hydrochloric acid in the stomach
Which problems should the nurse include in the plan of care for the client diagnosed with peptic ulcer disease to observe for physiological complications? 1. Alteration in bowel elimination patterns. 2. Knowledge deficit in the causes of ulcers. 3. Inability to cope with changing family roles. 4. Potential for alteration in gastric emptying.
4. Potential for alteration in gastric emptying is caused by edema or scarring associated with an ulcer, which may cause a feeling of "fullness," vomiting of undigested food, or abdominal distention. Rationales for other answers: 1. There is no indication from the question there is a problem or potential problem with bowel elimination. 2. Knowledge deficit does not address physiological complications. 3. This client may have problems from changing roles within the family, but the question asks for potential physiological complications, not psychosocial problems.
The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented? 1. Administer sliding-scale insulin as ordered. 2. Restrict caffeinated beverages. 3. Check urine ketones if blood glucose is >250. 4. Assess tissue turgor every four (4) hours
4. The client is excreting large amounts of dilute urine. If the client is unable to drink enough fluids, the client will quickly become dehydrated, so tissue turgor should be assessed frequently. Rationales for other answer options: 1. Diabetes insipidus is not diabetes mellitus; sliding-scale insulin is not administered to the client. 2. There is no caffeine restriction for DI. 3. Checking urine ketones is not indicated.
To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? A: "Avoid coffee and alcoholic beverages." B: "Take antacids with meals." C: "Limit fluid intake with meals." D: "Lie down after meals to promote digestion."
A: "Avoid coffee and alcoholic beverages."
Match the religion with the common diet restriction. Note that these are generalizations and not every person who practices that religion will restrict. A. Muslim B. Judaism C. Seventh Day Adventists D. Catholic 1. Lacto-Ovo Vegetarians/Avoid Alcohol 2. Meat is not allowed on Fridays during Lent 3. All blood must be drained from the meat or cooked out of it before it is eaten 4. Fasts from sunrise to sunset during Ramadan
A: 4 B: 3 C: 1 D: 2
What is an appropriate nursing goal for a client who has ulcerative colitis? A: verbalizes the importance of small, frequent feedings B: maintains a daily record of intake and output C: uses a heating pad to decrease abdominal cramping D: accepts that a colostomy is inevitable at some time in his life
A: verbalizes the importance of small, frequent feedings Small, frequent feedings are better tolerated by clients with ulcerative colitis as they lessen the amount of fecal material present in the gastrointestinal tract and decrease stimulation.
The best time to administer an antacid is: A: with the meal B: 30 mins. before the meal C: 1-3 hours after a meal D: immediately after the meal
C
The nurse is administering medication to a group of clients. Which of the following would be an appropriate action for the nurse to take. Select All that Apply A. Instructs the client taking prednisone that their blood sugar and blood pressure could drop if stopped suddenly. B. Holds the tolvaptan and notifies the provider when the client's sodium level increases from 115 mEq/L to 129 mEq/L in 24 hours. C. Before giving propylthiouracil, notes the thyroid-stimulating hormone (TSH) and holds/notifies provider if the TSH is decreased. D. Instructs the client receiving levothyroxine to take the medication in the morning 1 hour before breakfast. E. Places the client on their right side when preparing to administer a mineral oil enema. F. Instruct the client with GERD to chew the calcium carbonate 2-4 hours after taking other medications.
Correct: A, B, C, D, F
A positive diagnosis of Cushing's Syndrome is associated with: A: The disappearance of lymphoid tissues B: A reduction in circulating eosinophils C: An elevated cortisol level D: All of the above
D
Clinical manifestations of Cushing's Syndrome may be modified with a diet that is: A: High in protein B: Low in Carbs C: Low in Sodium D: All of the above
D
DI is a disorder related to a deficiency of: A: Growth Hormone B: Prolactin C: Oxytocin D: Vasopressin
D
True or False: Diverticulosis exhibits symptoms such as fever, LLQ pain, and elevated WBCs.
False. Diverticulosis consists of abnormal pouches on the intestinal wall but are asymptomatic. Diverticulosis is the inflammation/infection of these pouches, which exhibit the symptoms listed.
The bacillus that is commonly associated with gastric and peptic ulcers is:
H. Pylori
What class of medications might a patient with Crohn's or Colitis be taking to prevent further flare-ups?
Immunosuppressants
What are some shared common symptoms of Crohn's and Colitis?
Inflammation Diarrhea Abdominal pain and cramping Fever Weight loss Fatigue Blood in stool (UC will have more visible red blood, Crohn's will likely be occult)
What supplements would you provide to a patient experiencing an IBD flare-up?
Iron B12 Folic Acid Electrolytes
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube on low continuous suction. Which acid-base imbalance is most likely to occur?
Metabolic Alkalosis. Suctioning the gastric juices too much or too often will cause the stomach to become alkaline in nature.
Name three major complications of a peptic ulcer
Perforation, leading to peritonitis Bowel necrosis Pyloric obstruction Hemorrhage
Describe the clinical manifestations associated with peptic ulcer perforation
Rigid abdomen Absent bowel sounds Increased lactic acid Extreme pain Vomiting
A client is diagnosed with peptic ulcer disease caused Helicobacter pylori infection. The client is following a 2-week drug regimen that includes clarithromycin along with omeprazole and amoxicillin. How should the nurse instruct the client to take these medications?
Take the drugs for the entire 2 week period.
