GI Cancers and IBD Canvas Quiz

The nurse and a licensed practical/vocational nurse (LPN/LVN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/LVN requires that the nurse intervene? A. The LPN/LVN positions the head of the bed in the flat position. B. The LPN/LVN uses soft swabs to provide oral care. C. The LPN/LVN encourages the patient to use pain medications before coughing. D. The LPN/LVN includes the enteral feeding volume when calculating intake.

A. The patient's bed should be in Fowler's position to prevent reflux and aspiration of gastric contents. The other actions by the LPN/LVN are appropriate.

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching? (Picture transverese colon with a double barrel stoma) A. This type of colostomy is usually temporary. B. Soft, formed stool can be expected as drainage. C. Irrigations can regulate drainage from the stomas. D. Stool will be expelled from both stomas.

A. A loop, or double-barrel stoma, is usually temporary. Stool will be expelled from the proximal stoma only. The stool from the transverse colon will be liquid and regulation through irrigations will not be possible.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to A. discontinue the patient's oral food intake. B. administer IV metoclopramide (Reglan). C. administer cobalamin (vitamin B12) injections. D. teach the patient about total colectomy surgery.

A. An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate.

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for A. cobalamin (B12) supplements. B. routine blood transfusions. C. iron dextran infusions D. oral ferrous sulfate tablets.

A. Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. Cobalamin must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions.

A patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months. The nurse will plan to teach about A. medication use. B. activity restrictions. C. enteral nutrition. D. fluid restriction.

A. Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.

A nurse cares for a patient with a new ileostomy. The patient states, "I don't think my friends will accept me with this ostomy." How would the nurse respond? A. "Tell me more about your concerns." B. "A therapist can help you resolve your concerns." C. "Your friends will be happy that you are alive." D. "With time you will accept your new body."

A. Social anxiety and apprehension are common in patients with a new ileostomy. The nurse would encourage the patient to discuss concerns. The nurse would not minimize the patient's concerns or provide false reassurance.

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer? A. Painful blisters at the lip border B. Red, velvety patches on the buccal mucosa C. Bleeding during tooth brushing D. White, curdlike plaques on the posterior tongue

B. A red, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes simplex).

After teaching a patient who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the patient's understanding. Which statement made by the patient indicates a need for additional teaching? A. "I must wash my hands after I play with my dog." B. "I will take this medication with my breakfast each morning." C. "I will avoid large crowds and people who are sick." D. "Nausea and vomiting are common side effects of this drug."

B. Adalimumab (Humira) is an immune modulator that must be given via subcutaneous injection. It does not need to be given with food or milk. Nausea and vomiting are two common side effects. Adalimumab can cause immune suppression, so patients receiving the medication should avoid large crowds and people who are sick, and should practice good handwashing

A patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups daily. A. 3 B. 4 C. 2 D. 5

C. After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

The nurse preparing for the annual physical exam of a 50-yr-old man will plan to teach the patient about A. endoscopy. B. computerized tomography screening. C. colonoscopy. D. carcinoembryonic antigen (CEA) testing.

C. At age 50 years, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 50 years.

A 71-yr-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? A. Encourage acceptance of the colostomy stoma. B. Monitor output from the stoma. C. Assess the perineal drainage and incision. D. Teach about a low-residue diet.

C. Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider? A. The patient smokes a pack/day of cigarettes. B. The patient has a history of constipation. C. The patient has noticed blood in the stools. D. The patient had an appendectomy at age 27.

C. Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further assessment by the health care provider. The other patient information will also be communicated to the health care provider, but does not indicate an urgent need for further testing or intervention.

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all these changes. I don't want to look at the stoma." What is the best action by the nurse? A. Reassure the patient that ileostomy care will become easier. B. Develop a detailed written list of ostomy care tasks for the patient. C. Ask the patient about the concerns with stoma management. D. Postpone any teaching until the patient adjusts to the ileostomy.

C. Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching may be postponed, the nurse should offer teaching about some aspects of living with an ostomy.

A nurse assesses a patient who is recovering from an ileostomy placement. Which clinical manifestation would alert the nurse to urgently contact the health care provider? A. Liquid stool B. Blood-smeared output C. Pale and bluish stoma D. Ostomy pouch intact

C. The nurse would assess the stoma for color and contact the health care provider if the stoma is pale, bluish, or dark. The nurse would expect the patient to have an intact ostomy pouch with dark green liquid stool that may contain some blood.

A 26-yr-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid A. emotionally stressful situations. B. foods that cause distention or bloating. C. chronic use of H2 blocking medications. D. smoked foods such as ham and bacon.

D. Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.

After teaching a patient who has a new colostomy, the nurse provides feedback based on the patient's ability to complete self-care activities. Which statement would the nurse include in this feedback? A. "You cleaned the stoma well. Now you need to practice putting on the appliance." B. "You seem to understand what I taught you today. What else can I help you with?" C. "I realize that you had a tough time today, but it will get easier with practice." D. "You seem uncomfortable. Do you want your daughter to care for your ostomy?"

A. The nurse would provide both approval and room for improvement in feedback after a teaching session. Feedback would be objective and constructive, and not evaluative. Reassuring the patient that things will improve does not offer anything concrete for the patient to work on, nor does it let him or her know what was done well. The nurse would not make the patient convey learning needs because the patient may not know what else he or she needs to understand. The patient needs to become the expert in self-management of the ostomy, and the nurse would not offer to teach the daughter instead of the patient.

A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? A. Joint pain B. Fever C. Headache D. Nausea

B. Since infliximab suppresses the immune response, rapid treatment of infection is essential. The other patient complaints are common side effects of the medication, but they do not indicate any potentially life-threatening complications.

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? A. Place a pouching system over the ostomy. B. Drain and measure the output from the ostomy. C. Check the skin around the stoma for breakdown. D. Document the appearance of the stoma.

B. Draining and measuring the output from the ostomy is included in UAP education and scope of practice. The other actions should be implemented by LPNs or RNs.

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102°F (38.3°C), pulse 120 beats/min, respiration 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first? A. Administer IV ketorolac 15 mg for pain relief. B. Infuse a liter of lactated Ringer's solution over 30 minutes. C. Draw a blood sample for a complete blood count (CBC). D. Send the patient for an abdominal computed tomography (CT) scan.

B. The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should A. place ice packs around the stoma. B. document stoma assessment findings. C. notify the surgeon about the stoma. D. monitor the stoma every 30 minutes.

B. The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed.

Which nursing action will the nurse include in the plan of care for a 35-yr-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? A. Ambulate six times daily. B. Monitor stools for blood. C. Increase dietary fiber intake. D. Restrict oral fluid intake.

B. Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? A. Draw blood for typing and crossmatching. B. Administer 1 L of lactated Ringer's solution. C. Insert a nasogastric (NG) tube and connect to suction. D. Give an IV H2 receptor antagonist.

B. Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly, but are not the highest priorities.

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to A. identify any metastasis of the cancer. B. monitor the tumor status after surgery. C. determine the need for postoperative chemotherapy. D. confirm the diagnosis of a specific type of cancer.

B. CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made on the basis of biopsy. Chemotherapy use is based on factors other than CEA.

The nurse will anticipate preparing an older patient who is vomiting "coffee-ground" emesis for A. gastric analysis. B. endoscopy. C. barium studies. D. angiography.

B. Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.

A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? A. Skin is dry with poor turgor on all extremities. B. Crackles are heard halfway up the posterior chest. C. Patient has had 5 loose stools over the previous 6 hours. D. Patient has not voided for the last 4 hours.

B. The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. The other data will also be reported but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? A. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. B. Restrict fluid intake to prevent constant liquid drainage from the stoma. C. Use care when eating high-fiber foods to avoid obstruction of the ileum. D. Change the pouch every day to prevent leakage of contents onto the skin.

C. High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

A nurse plans care for a patient with Crohn's disease who has a heavily draining fistula. Which intervention would the nurse indicate as the priority action in this patient's plan of care? A. Antibiotic administration B. Intravenous glucocorticoids C. Skin protection D. Low-fiber diet

C. Protecting the patient's skin is the priority action for a patient who has a heavily draining fistula. Intestinal fluid enzymes are caustic and can cause skin breakdown or fungal infections if the skin is not protected. The plan of care for a patient who has Crohn's disease includes adequate nutrition focused on high-calorie, high-protein, high-vitamin, and low-fiber meals, antibiotic administration, and glucocorticoids.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? A. Palpating the abdomen for distention B. Measuring the quantity of emesis C. Taking the blood pressure (BP) and pulse D. Auscultating the chest for breath sounds

C. The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? A. The patient cleans the perianal area with soap after each stool. B. The patient asks for antidiarrheal medication after each stool. C. The patient uses witch hazel compresses to soothe irritation. D. The patient uses incontinence briefs to contain loose stools.

C. Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with plain water or pH balanced cleanser after each stool.

A nurse cares for a patient who is prescribed mesalamine (Rowasa) for ulcerative colitis. The patient states, "I am having trouble swallowing this pill." Which action would the nurse take? A. Contact the clinical pharmacist and request the medication in suspension form. B. Crush the pill carefully and administer it in applesauce or pudding. C. Ask the health care provider to prescribe the medication as an enema instead. D. Empty the contents of the capsule into applesauce or pudding for administration.

C. Asacol is the oral formula for mesalamine and is produced as an enteric-coated pill that should not be crushed, chewed, or broken. Asacol is not available as a suspension or elixir. If the patient is unable to swallow the Asacol pill, a mesalamine enema (Rowasa) may be administered instead, with a provider's prescription.

Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? A. Notify the doctor for any bloody nasogastric (NG) drainage. B. Start oral fluids when the patient has active bowel sounds. C. Elevate the head of the bed to at least 30 degrees. D. Reposition the NG tube if drainage stops.

C. Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). The nurse will explain that the medication will A.lower the risk for H. pylori infection. B. decrease nausea and vomiting. C. inhibit development of stress ulcers. D. prevent aspiration of gastric contents.

C. Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent Helicobacter pylori infection.

A nurse cares for a patient with ulcerative colitis. The patient states, "I feel like I am tied to the toilet. This disease is controlling my life." How would the nurse respond? A. "To decrease distress, do not eat anything before you go out." B. "You must retake control of your life. I will consult a therapist to help." C. "Let's discuss potential factors that increase your symptoms." D. "If you take the prescribed medications, you will no longer have diarrhea."

C. Patients with ulcerative colitis often express that the disorder is disruptive to their lives. Stress factors can increase symptoms. These factors would be identified so that the patient will have more control over his or her condition. Prescription medications and anorexia will not eliminate exacerbations. Although a therapist may assist the patient, this is not an appropriate response.

A nurse assesses a patient who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation would the nurse expect to find? A. Positive Murphy's sign with rebound tenderness to palpitation B. Reports of abdominal cramping that is worse at night C. High-pitched, rushing bowel sounds in the right lower quadrant D. Dull, hypoactive bowel sounds in the lower abdominal quadrants

C. The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohn's disease. A positive Murphy's sign is indicative of gallbladder disease, and rebound tenderness often indicates peritonitis. Dullness in the lower abdominal quadrants and hypoactive bowel sounds is not commonly found with Crohn's disease. Nightly worsening of abdominal cramping is not consistent with Crohn's disease.

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include? A. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria. B. The patient will begin sitting in a chair at the bedside on the first postoperative day. C. An additional surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. D. The site where the stoma will be located will be marked on the abdomen preoperatively.

D. A WOCN should select the site where the ostomy will be positioned and mark the abdomen preoperatively. The site should be within the rectus muscle, on a flat surface, and in a place that the patient is able to see. A permanent colostomy is created with this surgery. Sitting is contraindicated after an abdominal-perineal resection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria.

A nurse assesses a patient who has ulcerative colitis and severe diarrhea. Which assessment would the nurse complete first? A. Inspection of oral mucosa B. Recent dietary intake C. Percussion of abdomen D. Heart rate and rhythm

D. Although the patient with severe diarrhea may experience skin irritation and hypovolemia, the patient is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea. The patient would have her or his electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, recent dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this patient than heart rate and rhythm.

A young woman who has Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? A. Drink adequate fluids to maintain normal hydration. B. Bacteria in the perianal area can enter the urethra. C. Empty the bladder before and after sexual intercourse. D. Fistulas can form between the bowel and bladder.

D. Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse.

A nurse reviews the chart of a patient who has Crohn's disease and a draining fistula. Which documentation would alert the nurse to urgently contact the provider for additional prescriptions? A. Patient ate 20% of breakfast meal B. Patient's weight decreased by 3 lbs (1.4 kg) C. White blood cell count of 8200/mm3 (8.2 × 109/L) D. Serum potassium of 2.6 mEq/L (2.6 mmol/L)

D. Fistulas place the patient with Crohn's disease at risk for hypokalemia which can lead to serious dysrhythmias. This potassium level is low and would cause the nurse to intervene. The white blood cell count is normal. The other two findings are abnormal and also warrant intervention, but the potassium level takes priority.

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? A. "The medication will be tapered if I need surgery." B. "I will need to avoid contact with people who are sick." C. "The medication prevents the infections that cause diarrhea." D. "I will need to use a sunscreen when I am outdoors."

D. Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed.

A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care? A. Teach the patient about antiemetic therapy. B. Infuse IV fluids through a central line. C. Refer the patient for hospice services. D. Offer supplemental feedings between meals.

D. The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.

A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate? A."Thinking about dying will only make you feel worse." B."You may have quite a few years still left to live." C."It is important that you be realistic about your prognosis." D."Having this new diagnosis must be very hard for you."

D. This response is open ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have a low survival rate, so the response "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. The response beginning, "It is important that you be realistic" discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.

A patient complains of gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take? A. Offer the prescribed promethazine (Phenergan). B. Instill a mineral oil retention enema. C. Administer the prescribed IV morphine sulfate. D. Encourage the patient to ambulate.

D. Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention.

Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? A."Persistent heartburn is common after surgery." B."I should choose high carbohydrate foods." C."I will drink more liquids with my meals." D."Vitamin supplements may prevent anemia."

D. Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome.

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to A. remove the tube and replace it with a new one. B. auscultate for hypotonic bowel sounds. C. notify the patient's health care provider. D. check for tube placement and reposition it.

D. Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded.

A nurse cares for a teenage girl with a new ileostomy. The patient states, "I cannot go to prom with an ostomy." How would the nurse respond? A. "You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable." B. "Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance." C. "The pouch won't be as noticeable if you avoid broccoli and carbonated drinks prior to the prom." D. "Let's talk to the enterostomal therapist about options for ostomy supplies and dress styles."

D. The ostomy nurse is a valuable resource for patients, providing suggestions for supplies and methods to manage the ostomy. A larger dress size will not necessarily help hide the ostomy appliance. Avoiding broccoli and carbonated drinks does not offer reassurance for the patient. Ileostomies have an almost constant liquid effluent, so pouch removal during the prom is not feasible.

Which patient should the nurse assess first after receiving change-of-shift report? A. A 40-yr-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours B. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool C. A 60-yr-old patient whose new ileostomy has drained 800 mL over the previous 8 hours D. A 30-yr-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

D. The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients should also be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.

Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa? A. Complete antibiotic courses used to treat throat infections. B. Use sunscreen when outside even on cloudy days. C. Use antivirals to treat herpes simplex virus (HSV) infections. D. Avoid use of cigarettes and smokeless tobacco.

D. Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer.