GI

What are the s/s of Dumping syndrome that can be seen following bariatric surgery?

-Abdominal cramping -Tachycardia -N/D -Diaphoresis

If a patient has an intestinal obstruction, how can you expect the bowel sounds to be?

-Absent DISTAL to obstruction

What is the patient teaching after a patient has had an ostomy?

-Assess stoma regularly, should be pink & moist (pale/blue= ischemia) -Empty bag when it is 1/3 to 1/2 full (but change immediately for leaking) -Cut opening in skin barrier ≤1/8" bigger than measured stoma size to prevent skin damage from contact with ostomy output -Chew food thoroughly -Consume low fiber diet for first 6-8wks -Avoid foods that cause gas/odor

What are the RF for Ulcerative Colitis?

-Autoimmune disorders -Genetics -Jewish descent -Stress

What are the medications given for esophageal varices?

-BETA BLOCKERS (non-selective) -Vasoconstrictors

What are the LATE clinical mainfestations of Cirrhosis?

-Bleeding/bruising (no clotting factors) -Jaundice -Ascites -Esophageal varices -Portal HTN -Peripheral edema -Fetor hepaticus (sweet musty breath odor) -Asterixis (hand flapping) -Hepatic encephalopathy -Pruritus -Petechiae -Spider angiomas -Palmar erythema -Dark urine -Clay-colored stool

What is the patient teaching for a patient with Crohn's?

-Bowel REST (NPO) with TPN during severe exacerbations -Ongoing, consume high-calorie, low fiber diet -Eat small, frequent meals

What do patients with dumping syndrome need to be taught to minimize exacerbations?

-Chew food slowly & completely -Eat 6 small meals a day -Do NOT consume liquids with meals -RECLINE/lie down after meals to slow gastric emptying -Avoid foods high in sugar, fat, CHO -Eat more high protein foods (delays gastric emptying) -Take a vitamin/mineral supplement as directed

What labs will be decreased with pancreatitis?

-Decreased calcium, magnesium, platelets

What are the s/s of Crohn's disease?

-Diarrhea of 5-6 loose stools/day -Steatorrhea -RLQ pain -Weight loss -Anemia -Fever -Fatigue

What are the s/s of Ulcerative Colitis?

-Diarrhea with BLOOD or pus (10-20 liquid stools/day) -Abdominal pain -Fecal urgency -Weakness -Weight loss -Fever -Anemia -Dehydration

What are the s/s of GERD?

-Dyspepsia (heartburn) -Regurgitation -Dysphagia/throat irritation -BITTER TASTE -Burning pain in esophagus (worse when lying down, better when upright) -CHRONIC COUGH

Besides diet modifications, what are the patient teachings for GERD?

-Eat smaller meals -Remain upright after meals -Do not eat right before bedtime -Avoid tight fitting clothing -Lose weight, if applicable -Quit smoking -Reduce alcohol intake -Elevate HOB at home with blocks

What lab values will be elevated with pancreatitis?

-Elevated amylase, lipase, WBCs, bilirubin and glucose

What are the procedures used for esophageal varices?

-Endoscopic sclerotherapy (EST) -Band ligation -Balloon tamponade -Esophageal stent -Transjugular stent

What are the EARLY clinical manifestations of Cirrhosis?

-Fatigue -Hepatomegaly -N/V -Abdominal pain

What foods do patient with GERD need to avoid?

-Fried/fatty foods -Citrus -Spicy foods -Caffeine

What are the RF for gastritis?

-H. pylori (just like PUD) -Long term NSAID use -Smoking -Stress -Heavy alcohol consumption -Radiation -Vitamin B 12 deficiency

What are the risk factors for PUD?

-H. pylori (just like gastritis) -Chronic NSAID use -Corticosteroids -Potassium chloride -Increased stress -Radiation therapy -Chemotherapy -Malignancy

What causes diverticulitis?

-High intraluminal pressure, possibly from a low fiber diet (risk factor)

What s/s might you see in a patient with bleeding esophageal varices?

-Hypotension -Tachycardia -Decreased Hgb/Hct (give blood transfusion)

What are the pertinent labs in Cirrhosis to look at?

-Increased AST/ALT, bilirubin and ammonia -Decreased serum protein, albumin, RBCs, Hgb/Hct, platelets

What labs will be increased/decreased in diverticulitis?

-Increased WBCs and ESR -Decreased Hgb/Hct with bleeding

What are the s/s of diverticulitis?

-LLQ abdominal pain -Bloating -Fever -N/V

What is the recommended diet for a patient with Cirrhosis?

-LOW SODIUM -Small, frequent meals -NO alcohol (encourage alcohol recovery program)

What is the treatment for PUD?

-MULTIPLE ABX (for H. pylori) -H2 blockers -PPIs -Antacids -Sucralfate

What are the treatments for Crohn's disease?

-Medications: Sulfasalazine, corticosteroids, immunosuppressants, antidiarrheals -Surgery: small bowel resection, colectomy, ileostomy

What is the nursing care for Cirrhosis?

-Monitor I&O -Restrict fluid & sodium as ordered -Measure abdominal girth daily -Monitor for complications (encephalopathy, portal HTN, esophageal varices, hemorrhage)

What is the postoperative care after a patient has had a paracentesis?

-Monitor for hypovolemia (peritoneal fluid is high in protein, causing fluid shift) -Administer albumin as prescribed -Take VS, weight -Measure abd girth

What is the patient teaching prior to a GI series?

-NPO -No smoking/chewing gum 8hr prior

What is the teaching for a patient who has Diverticulitis?

-NPO or clear liquid diet during exacerbations, THEN progress to LOW FIBER diet -Ongoing, eat a HIGH FIBER diet

What are the teachings for a patient with pancreatitis?

-No smoking -LOW FAT diet -No alcohol (encourage recovery program)

What are the medications used to treat Gastritis?

-PPI's -H2 receptor blockers -Antacids -Abx if H. pylori

What is the patho behind pancreatitis?

-Pancreatic digestive enzymes are activated prematurely, resulting in autodigestion and fibrosis of the pancreas

What is the characteristic finding of Crohn's disease?

-Patchy ulcerations ("skips in lesions"); causes scarring and narrowing of the intestinal lumen, and places the patient at risk for fistulas

What is the preoperative teaching for a paracentesis?

-Patient needs EMPTY BLADDER -Ensure consent has been provided -Take VS, weight -MEASURE ABD GIRTH

What are the RF for esophageal varices?

-Portal HTN -Portal vein obstruction

What are the s/s of peritonitis?

-RIGID, BOARDLIKE ABDOMEN -Abdominal pain -N/V -Rebound tenderness -Fever -Tachycardia

What are the s/s of Appendicitis?

-RLQ pain (McBurney's point) -Rebound tenderness -Loss of appetite -N/V -Fever

What are the s/s of pancreatitis?

-Severe LUQ/epigastric pain radiating to back/left shoulder -CULLEN'S SIGN (umbilicus) -TURNERS SIGN (flanks) -Ascites -Jaundice -Tetany -N/V

What is the difference in s/s if there is a small vs a large bowel obstruction?

-Small: profuse vomiting, severe F&E imbalances, metabolic alkalosis -Large: Minimal/no vomiting, no major F&E imbalances

What are patients who have an abdominal hernia at risk for?

-Strangulation -Obstruction -Bowel necrosis

What is the normal albumin level ?

3.5-5 (same as K+)

What is the total protein normal range?

6.4-8.3

What 2 Hepatitis types have a vaccine?

A and B

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

A. "Empty your ostomy pouch when it becomes half full" RATIONALE: should be emptied when 1/3 to 1/2 full B- this could cause irritation & ulceration of the stoma; a BREATH MINT can be placed in the stoma to assist with odor C- change the ostomy appliance every 2 weeks; changing too frequently can irritate the clients skin D- cleanse the site around the stoma with mild soap and water prior to placing the appliance

A nurse is developing a plan of care for a client who has GERD. The nurse should plan to monitor for which of the following complications? A. Aspiration B. Infection C. Anemia D. Weight loss

A. Aspiration

A nurse is admitting a client who has cirrhosis. Which of the following prescriptions should the nurse anticipate? SATA A. Obtain the clients PT/INT measurements B. Administer lactulose 30mL po 4 times daily C. Obtain daily weights and abdominal girth measurements D. Administer a daily multivitamin E. Place the client on a low protein diet

A. Obtain the clients PT/INT measurements B. Administer lactulose 30mL po 4 times daily C. Obtain daily weights and abdominal girth measurements D. Administer a daily multivitamin

A nurse is recommending dietary modification for a client who has GERD. The nurse should suggest eliminating which of the following foods from the client's diet? A. Oranges and tomatoes B. Carrots and bananas C. Potatoes and squash D. Whole wheat and beans

A. Oranges and tomatoes RATIONALE: Eliminate alcohol, caffeine, nicotine, chocolate, fatty foods, citrus fruits, tomatoes and peppermint

Which enzyme begins the digestion of carbohydrates?

Amylase

What is the indication for paracentesis?

Ascites from cirrhosis that is causing respiratory distress

A nurse is preparing a community education program about Hepatitis B. Which of the following statements should the nurse include in the teaching? A "A hepatitis B immunization is recommended for those who travel, especially military personnel" B. "A hepatitis B immunization is given to infants and children" C. "Hepatitis B is acquired by eating foods that are contaminated during handling" D. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation"

B. "A hepatitis B immunization is given to infants and children" RATIONALE: can be administered as early as birth and second dose is between 1 and 4 months of age A- this is Hep A C- this is referring to Hep A; hep B is acquired through blood/bodily fluids D- This is hep A

A nurse is presenting an in-service training about nutrition. How many of the amino acids must be obtained from dietary intake? A. 6 B. 9 C. 11 D. 15

B. 9

A nurse in a provider's office is assessing a client who has GERD. When documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions? A. Stair-climbing B. Bending over C. Sitting D. Walking

B. Bending over

A nurse is obtaining a guaiac test from a client. This test is performed to detect which of the following? A. Fecal material in vomit B. Blood in stool C. Infestations of parasites D. Microorganisms in urine

B. Blood in stool

A nurse is caring for a client who has recovered from acute diverticulitis. The nurse should instruct the client to increase his intake of which of the following foods when the inflammation subsides? A. Cucumbers & tomatoes B. Cabbage and peaches C. Strawberries and corn D. Figs and nuts

B. Cabbage and peaches RATIONALE: High fiber foods, such as wheat bran, whole-grain bread and fresh fruits/vegetables that do not contain seeds should be taken after recovery from acute diverticulitis

A nurse is teaching a client who has diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include? SATA A. Bradycardia B. Diaphoresis C. Deep, rapid respirations D. Palpitations E. Shakiness

B. Diaphoresis D. Palpitations E. Shakiness

A nurse is caring for a client who has a percutaneous (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? A. Flush the tube with water B. Place the client in a semi-Fowler's position C. Cleanse the skin around the tube site D. Aspirate the tube for residual contents

B. Place the client in a semi-Fowler's position

A nurse is providing dietary teaching to a client who has ulcerative colitis. Which of the following food selections by the client indicates an understanding of the teaching? A. Raw vegetable salad with low fat dressing B. Roast chicken with white rice C. Fresh fruit salad with milk D. Peanut butter on whole wheat bread

B. Roast chicken with white rice RATIONALE: This offers low fiber; raw fruits should be avoided because they are high fiber; lactose (milk) should be avoided

What is the route of transmission of Hepatitis C?

Blood/bodily fluids

A nurse is providing preoperative teaching to a client who will undergo a surgery to create a temporary colostomy. The client asks the nurse about the difference between colostomies and ileostomies. Which of the following responses should the nurse make? A. "A colostomy drains stool, and an ileostomy drains urine" B. "A colostomy is temporary and an ileostomy is permanent" C. "A colostomy is from the large intestine, and an ileostomy is from the small intestine" D. "An ileostomy requires dietary restrictions, while a colostomy does not"

C. "A colostomy is from the large intestine, and an ileostomy is from the small intestine" RATIONALE: A- both involve the GI system B- can both be either temporary or permanent D- both require dietary changes

A nurse is providing teaching about nutrients to a client. Which of the following statements should the nurse include? A. "Carbohydrates transport nutrients throughout the body" B. "Fats prevent ketosis" C. "Protein builds and repairs body tissue" D. "Carbohydrates help regulate body temperature"

C. "Protein builds and repairs body tissue" RATIONALE: A- Proteins do this B- Carbohydrates do this D- Fats do this

A nurse is caring for a client who is 2 days post operative following gastric surgery and has an NGT inserted. Which of the following findings should the nurse report to the provider? A. Dryness of the mucous membranes B. Hypoactive bowel sounds C. 200mL of bright red drainage from the NGT D. Suction set at continuous low suction

C. 200mL of bright red drainage from the NGT RATIONALE: Drainage should be either yellow-green color or clear; bright red indicates blood loss and can be a disrupted suture line or other internal bleeding

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should return to the expected reference range within 72hr of treatment beginning? A. Aldolase B. Lipase C. Amylase D. Lactic dehydrogenase

C. Amylase RATIONALE: Amylase begins to increase about 3-6hr following the onset of acute pancreatitis; amylase levels peak 20-30hr and returns to the expected reference range within 2-3 days A- not affected by pancreatic disorders B- Lipase levels stay elevated for 14 days or Longer D- LDH are seen in patients with anemia, leukemia or liver damage

A nurse is caring for a client from the Middle East who has celiac disease. Which of the following actions should the nurse perform regarding the client's diet? A. Provide foods prepared according to kosher dietary law B. Ask the kitchen to prepare grits to meet the clients dietary need for grains C. Determine the client's dietary preferences D. Prepare a diet tray that includes vegetables and barely soup

C. Determine the client's dietary preferences

A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for this client? A. Endoscopic sclerotherapy B. Liver lobectomy C. Liver transplant D. Transjugular intrahepatic portal-systemic shunt placement

C. Liver transplant RATIONALE: Liver transplant is the treatment of choice since mortality is so high for fulminant hepatitis, caused by viral hepatitis D- for esophageal varices

What type of ulcerations are present in Ulcerative colitis?

CONTINUOUS ulcerations (vs Crohns, where there are "skips")

What causes Laennec's Cirrhosis?

Chronic alcoholism

A nurse is providing postoperative teaching about the management of dumping syndrome to a client who had a partial gastrectomy. Which of the following instructions should the nurse include in the teaching? A. "Consume at least 4oz of fluid with meals" B. "Take a short walk after each meal" C. "Use honey to flavor foods such as cereal" D. "Eat protein with each meal"

D. "Eat protein with each meal"

A nurse is providing teaching to a client who is scheduled for a sigmoid colon resection with colostomy. Which of the following statements by the client indicates a need for further teaching? A. "Because most of my colon is still intact and functioning, my stool will be formed" B. "My stoma will appear large at first, but it will shrink over the next several weeks" C. "My colostomy will begin to function in 2 to 6 days after surgery" D. "I'll have to consume a soft diet after surgery"

D. "I'll have to consume a soft diet after surgery" RATIONALE: after surgery, the client can quickly return to a regular diet

A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Increased BP B. Decreased HR C. Yellowing of the skin D. Boardlike abdomen

D. Boardlike abdomen

A nurse is caring for a client who is 2 days post operative following gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding? A. Vanilla pudding B. Apply juice C. Diet ginger ale D. Clear liquids

D. Clear liquids RATIONALE: Should be limited to only 30mL (1oz) per feeding; water does not contain sugar, which could cause diarrhea due to hyperosmolarity

A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw

D. Coleslaw RATIONALE: Coleslaw= cabbage A- fresh fruits contain a low more fiber

A nurse is performing a GI assessment of a client who has liver cirrhosis with abdominal distention. Which of the following actions should the nurse take to assess for changes in the clients abdominal distention? A. Percuss the abdomen for tympanic sounds B. Inspect the contour of the abdominal wall C. Instruct the client to report increased abdominal discomfort D. Take serial measurements of the abdomen with a tape measure

D. Take serial measurements of the abdomen with a tape measure

A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75mL/hr. When the nurse assesses the client at 0800, which of the following findings requires an intervention? A. A full pitcher of water is sitting on the client's bedside table within the client's reach B. The disposable feeding bag is from the previous day at 1000 and contains 200mL of feeding C. The client is lying on the right side with a visible dependent loop in the feeding tube D. The head of the bed is elevated at 20 degrees

D. The head of the bed is elevated at 20 degrees RATIONALE: Should be at least 30 degrees

A nurse is providing teaching to the guardian of a child who has celiac disease. Which of the following foods should the nurse instruct the guardian to omit from the child's diet? A. Cornflakes B. Reduced fat milk C. Canned fruits D. Wheat bread

D. Wheat bread

What is the difference in pain in a gastric vs duodenal ulcer?

Gastric- pain 15-30min after meal, worse in the day time, worse with EATING (think location) Duodenal- pain 2-3hr after meal, worse at NIGHT, BETTER with eating

What type of Hepatitis is self limiting and presents as an acute infection?

Hep A

What type of Hepatitis can present as either acute OR chornic, is spread by blood/bodily fluids, and HC workers are at risk?

Hep B

What other type of Hepatitis MUST be present in order to have Hepatitis D?

Hep B (so get vaccinated for Hep B to protect against Hep D)

What type of Hepatitis is frequently transmitted by contaminated water or undercooked meat (fecal/oral)?

Hep E

What is the patho behind cirrhosis?

Inflammation of the liver results in destruction & replacement of hepatocytes with scar tissue; this impairs BF in the liver and decreases liver function

What medication is used for Cirrhosis to remove excess ammonia?

Lactulose

What are bowel movements with an ileostomy?

Loose/watery (created from small intestine)

Identify the following type of prevention: An action that prevents the DEVELOPMENT of a disease-

Primary prevention

If a patient has dysphagia, what specialist do they need to see?

Speech language pathologist

What are the complications of pancreatitis?

Type 1 DM Chronic pancreatitis Pseudocyst

What are bowel movements with a colostomy?

Vary in consistency Ascending- liquid Transverse- semi-solid Descending/Sigmoid- formed (created from large intestine)

What are risk factors for Cholecystitis (inflammation of gallbladder)?

-High fat diet -Older age -Female -Obesity -Genetics

What is the patient teaching post op from a GI series?

-Increase fluid intake to flush out the barium -Stools may be white for several days until the barium is cleared out

A nurse is teaching a newly licensed nurse about caring for a client who is scheduled for an esophagogastric balloon tamponade tube to treat bleeding esophageal varices. Which of the following pieces of information should the nurse include in the teaching? A. The client will be placed on mechanical ventilation prior to this procedure B. The tube will be inserted into the clients trachea C. The client will receive a bowel preparation with cathartics prior to this procedure D. The tube allows the application of a ligation band to the bleeding varices

A. The client will be placed on mechanical ventilation prior to this procedure

A nurse is caring for a client who has an acute exacerbation of Crohn's disease. Which of the following actions should the nurse take? A. Ensure bowel rest B. Offer sparkling water frequently C. Administer a stool softener D. Offer plain warm tea frequently

A. Ensure bowel rest RATIONALE: Clients who have an exacerbation of Crohn's disease usually require NPO status to ensure bowel rest and promote healing & recovery

A nurse is caring for a client who has an indwelling urinary catheter. Which of the following actions should the nurse take? A. Place the drainage bag on the clients abdomen when transferring from a bed to a cart B. Empty the drainage bag when half-full of urine C. Rest the drainage bag on the floor when closing the drainage spigot during emptying D. Disconnect the drainage bag when obtaining a urine specimen

B. Empty the drainage bag when half-full of urine RATIONALE: A- always below level of the client's bladder C- do not allow it to touch the floor; maintain it in a hanging position D- Use the collection port to prevent contamination and maintain asepsis

A nurse is monitoring the laboratory results of a client who has end-stage liver failure. which of the following results should the nurse expect? A. Decreased lactate dehydrogenase B. Increased serum albumin C. Decreased serum ammonia D. Increased prothrombin time

D. Increased prothrombin time RATIONALE: not making clotting factors -A- would be increased -B- would be decreased (liver not making proteins) C- would be increased

A nurse is planning an in-service training session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes plays a role in the digestion of protein? A. Amylase B. Lipase C. Steapsin D. Pepsin

D. Pepsin RATIONALE: Pepsin breaks down protein into polypeptides

If a patient has appendicitis, what may a sudden relief of pain indicate?

Rupture of the appendix!

Identify the following type of prevention: An action that promotes early detection of a disease

Secondary prevention

Identify the following type of prevention: An action that minimizes the effects of a long-term disease or disability-

Tertiary prevention

A nurse is caring for a client who has colitis and reported increased exacerbations due to stress at work. Which of the following responses should the nurse make? A. "I will contact the social worked so you can discuss career alternatives" B. "Have you thought about discussing the possibility of a part-time assignment with your employer?" C. "Why don't you ask your employer to relieve you of some work until you are stronger?" D. "Perhaps we should review your coping mechanisms and talk about other alternatives"

D. "Perhaps we should review your coping mechanisms and talk about other alternatives"

A nurse is providing dietary teaching to a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? A. Avoid foods containing protein B. Drink liquids during each meal C. Eat foods that contain simple sugars D. Maintain a supine position after meals

D. Maintain a supine position after meals

A nurse is caring for a client who is 3 days postoperative following abdominal surgery. The client states "Something just popped when I coughed". Which of the following actions should the nurse take first? A. Cover the client's wound with a sterile, moist dressing B. Flex the client's knees C. Reassure the client D. Instruct the client to avoid coughing

A. Cover the client's wound with a sterile, moist dressing

A nurse is teaching a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? A. Digesting fat B. Producing chyme C. Stimulating gastric acid secretion D. Providing energy

A. Digesting fat

A nurse is caring for a child who had her spleen removed following a bicycle accident. The child's parent asks the nurse about the role of the spleen in the body. The nurse should explain that the spleen performs which of the following functions? A. Maintains fluid balance B. Regulates calcium in the blood C. Destroys old blood cells D. Produces prothrombin

C. Destroys old blood cells RATIONALE: also filters antigens and stores platelets; a client without a spleen is at an increased risk of infection & sepsis d/t reduced immune function

A nurse is providing teaching to a client who has constipation. Which of the following instructions should the nurse include? A. Use bismuth subsalicylate regularly B. Consume a low fiber diet C. Eat yogurt with live cultures D. Use bisacodyl suppositories regularly

C. Eat yogurt with live cultures

A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? A. Foods high in Vitamin C B. Foods low in fat C. Foods high in fiber D. Foods low in calories

C. Foods high in fiber RATIONALE: Long-term low-fiber eating habits and increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula

A nurse is updating the plan of care for a client who has dumping syndrome. Which of the following instructions should the nurse include? A. Consume beverages with meals B. Eat 3 large meals per day C. Include high-fiber foods in the diet D. Eat a source of protein with each meal

D. Eat a source of protein with each meal RATIONALE: Delays gastric emptying

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

D. Hyperactive bowel sounds above the obstruction RATIONALE: A- this is paralytic ileus B- regarding partial intestinal obstruction

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

D. Pulse oximetry of 85% RATIONALE: this indicates hypoxemia A- expected B- expected C- expected

A nurse enters a client's room and notes smoke coming from a wastebasket in the adjacent bathroom. Which of the following actions should the nurse take FIRST? A. Close the door to the client's room B. Attempt to extinguish the fire C. Activate the facility's alarm system D. Transport the client to an area away from the smoke

D. Transport the client to an area away from the smoke

A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet? A. White bread and plain yogurt B. Shredded wheat cereal and blueberries C. Broccoli and kidney beans D. Oatmeal and fresh pears

A. White bread and plain yogurt RATIONALE: Maintain a low fiber diet during acute inflammation (low fat milk, poached eggs, canned soft fruit)

A nurse is assisting a provider with performing a paracentesis on a client. Which of the following actions should the nurse take? A. Ask the client to empty his bladder before the procedure B. Place the client leaning forward over the bedside table for the procedure C. Inform the client he will be sedated during the procedure D. Instruct the client to fast for 6hr prior to the procedure

A. Ask the client to empty his bladder before the procedure RATIONALE: To prevent injury to the bladder B- this is for thoracentesis C- not required D- can eat/drink beforehand

A nurse is assessing a client who has cholecystitis. Which of the following findings should the nurse expect? A. Blumberg's sign B. Ascites C. GI bleeding D. Kehr's sign

A. Blumberg's sign RATIONALE: This is rebound tenderness and can be an indication of peritoneal inflammation

A community health nurse is planning an educational program about Hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing Hepatitis A? A. Children B. Older adults C. Women who are pregnant D. Middle-aged men

A. Children RATIONALE: Hep A is by fecal-oral route (poor hygiene, at school, hand-to-mouth contact, etc.)

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

A. Eat crackers and yogurt regularly

A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A. Emesis with a coffee ground appearance B. Increased BP C. Decreased HR D. Bright green stools

A. Emesis with a coffee ground appearance

A nurse is caring for a client with a history of cirrhosis who has been admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? A. Gamma-glutamyl transferase (GGT) B. Alkaline phosphatase (ALP) C. Serum bilirubin D. Alanine aminotransferase (ALT)

A. Gamma-glutamyl transferase (GGT) RATIONALE: The GGT lab test is specific to the hepatobiliary system in which levels can be raised by alcohol & hepatotoxic drugs B- ALP is elevated in biliary obstruction but does not detect alcohol C- Serum bilirubin is used to detect function of the liver & its ability to excrete bilirubin D- Not specific only to the liver

A nurse is teaching dietary modification strategies to a client who has been newly diagnosed with cirrhosis. Which of the following foods should the nurse recommend? A. Grilled chicken B. Potato soup C. Fish sticks D. Baked ham

A. Grilled chicken RATIONALE: Needs protein for recovery and to compensate for disease- related weight loss -D- avoid high sodium d/t ascites

A nurse is caring for a client who is NPO and has an NGT to suction. When the client reports nausea, which of the following actions should the nurse take? A. Irrigate the tube with normal saline solution B. Provide oral hygiene C. Clamp the tube for 30min D. Increase the amount of suction

A. Irrigate the tube with normal saline solution RATIONALE: This is to determine patency

A nurse is caring for a client who had a gastric resection to treat adenocarcinoma of the stomach. The client tells the nurse in the PACU that he does not remember why the surgeon said he had to have a tube in his nose. The nurse should explain that the NG tube serves which of the following purposes? A. Prevents excessive pressure on suture lines B. Allows gastric lavage after surgery C. Allows postoperative feedings D. Facilitates obtaining gastric specimens for testing

A. Prevents excessive pressure on suture lines RATIONALE: B- not necessary for gastric resection, only for upper GI bleeding

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure? A. Prothrombin time B. Serum lipase C. Bilirubin D. Calcium

A. Prothrombin time

A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report which of the following manifestations? SATA A. Regurgitation B. Nausea C. Belching D. Heartburn E. Weight loss

A. Regurgitation B. Nausea C. Belching D. Heartburn

A nurse is caring for a client who is 4hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? A. Right shoulder pain B. Urine output 20mL/hr C. Temp of 101.1F D. Oxygen saturation of 92%

A. Right shoulder pain RATIONALE: d/t gas (CO2)

A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray? A. Wheat toast B. Tapioca pudding C. Hard-boiled egg D. Mashed potatoes

A. Wheat toast

A nurse is providing discharge teaching to a client who has a new diagnosis of Hepatitis A. Which of the following instructions should the nurse include in the teaching? A. "During this illness, she may take acetaminophen for fevers or discomfort" B. "Encourage her to eat foods that are high in CHO" C. The provider will prescribe a medication to help her liver heal faster" D. "Have her perform moderate exercise to restore her strength more quickly""

B. "Encourage her to eat foods that are high in CHO" RATIONALE: A- Do not take because they are METABOLIZED BY THE LIVER C- No approved med to treat Hep A D- alternate rest with activity

A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client asks the nurse why he has to stay in bed, which of the following responses should the nurse provide? A. "You need to conserve energy at this time" B. "Lying down quietly in bed helps slow down the activity in your intestines" C. "Staying in bed promotes the rest and comfort you need" D. "Staying in bed will help prevent injury and minimize your risk for falls"

B. "Lying down quietly in bed helps slow down the activity in your intestines"

A nurse is teaching a client with Barrett's esophagus who is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? A. "This procedure is performed to measure the presence of acid in your esophagus" B. "This procedure can determine how well the lower part of your esophagus works" C. "This procedure is performed while you are under general anesthesia" D. "This procedure can determine if you have colon cancer"

B. "This procedure can determine how well the lower part of your esophagus works"

A nurse is assessing a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect? A. Jaundice B. Anorexia C. Dark urine D. Pale feces

B. Anorexia RATIONALE: All of the other manifestations are LATE manifestations

A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse teach the client to perform? SATA A. Use antimicrobial ointment on the peristomal skin B. Empty the bag when it is 1/3 to 1/2 full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the periostomal skin with mild soap and water E. Apply the skin barrier while the skin is slightly moist

B. Empty the bag when it is 1/3 to 1/2 full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the periostomal skin with mild soap and water

A nurse is assessing a client who is 12hr postoperative following an open cholecystectomy. Which of the following findings should the nurse report to the provider? A. Hypoactive bowel sounds B. Indwelling urinary catheter output of 25mL/hr C. Heart rate of 96/min D. Serous drainage at the surgical incision site

B. Indwelling urinary catheter output of 25mL/hr

A nurse is planning an in-service training session regarding nutrition. Which of the following minerals should the nurse identify as involved in gas transportation? A. Zinc B. Iron C. Phosphorus D. Magnesium

B. Iron

A nurse is caring for a client who is schedueld to undergo an EGD. The nurse should identify that this procedure is for which of the following reasons? A. To visualize polyps in the colon B. To detect an ulceration in the stomach C. To identify an obstruction to the biliary tract D. To determine the presence of free air in the abdomen

B. To detect an ulceration in the stomach RATIONALE: EGD is used to visualize the esophagus, stomach & duodenum with a lighted tube to detect a tumor, ulceration or obstruction

A nurse is planning discharge teaching for a client who is postoperative following a traditional open cholecystectomy. Which of the following learning needs of the client is the nurse's priority? A. Dietary recommendations B. Incision care C. Coughing and deep breathing exercises D. Pain management

C. Coughing and deep breathing exercises

A nurse is planning care for a client who has cholelithiasis. Which of the following interventions should the nurse include in the plan? A. Restrict the client's fluid intake B. Restrict the client's calcium intake C. Decreased the client's fat intake D. Decrease the client's potassium intake

C. Decreased the client's fat intake

A nurse is caring for a client who has abdominal pain and possible pancreatitis. Which of the following laboratory results should the nurse identify as an indication of pancreatitis? A. Decreased WBC count B. Increased albumin level C. Increased serum lipase level D. Decreased blood glucose level

C. Increased serum lipase level

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

C. Rigid abdomen

A nurse is caring for a client who has cholelithiasis and will undergo a cholecystectomy. The client states that she does not understand how she will be alright without a gallbladder. The nurse should explain to the client that which of the following is the main function of the gallbladder? A. Producing bile B. Adding digestive enzymes to bile C. Storing bile D. Eliminating bile

C. Storing bile

A nurse in the emergency department is caring for a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A. Famotidine B. Esomeprazole C. Vasopressin D. Omeprazole

C. Vasopressin RATIONALE: Vasopressin constricts the spanchnic bed and decreases portal pressure; it also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varices

A nurse is completing a history and physical for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High calorie diet B. Prior GI illness C. Tobacco use D. Alcohol use

D. Alcohol use

A nurse is caring for a client who has GI bleeding. The provider suspects a bleeding lesion in the colon. The initial approach to treatment likely will involve which of the following procedures? A. Exploratory laparotomy B. Double-contrast barium enema C. MRI D. Colonoscopy

D. Colonoscopy RATIONALE: This will help identify the exact location and cause of bleeding A- something exploratory is more risky

A nurse is teaching a client who has cirrhosis of the liver and a history of alcohol consumption. The nurse should explain that alcohol can cause liver cirrhosis through which of the following actions? A. Increasing the workload of the liver by releasing stored glycogen B. Causing ulceration of liver tissue that can lead to bleeding C. Dilating veins in the portal circulation D. Destroying liver cells that are later replaced with scar tissue

D. Destroying liver cells that are later replaced with scar tissue

A nurse is caring for a client who is receiving TPN therapy and has just returned to the room following PT. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis

D. Diaphoresis RATIONALE: This client has the potential to develop hypoglycemia due to the sudden withdrawal of TPN solution

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

D. Importance of colonoscopy screening starting at age 50 RATIONALE: this is secondary prevention; an action that promotes early detection of a disease A- primary prevention B- primary prevention (prevents DEVELOPMENT of a disease) C- Tertiary prevention