GI Evolve
A client develops peritonitis and sepsis after the surgical repair of a ruptured diverticulum. What signs should the nurse expect when assessing the client? (Select all that apply.) 1 Fever 2 Tachypnea 3 Hypertension 4 Abdominal rigidity 5 Increased bowel sounds
Fever Tachypnea Abdominal rigidity
The mother of a large family asks the home health nurse for inexpensive sources of B vitamins. What suggestion should the nurse make? 1 "Eat more red meat." 2 "Bake with whole-wheat flour." 3 "Include more eggs in the diet." 4 "Sprinkle wheat germ on casseroles.
"Bake with whole-wheat flour."
A client is to be discharged after a laparoscopic cholecystectomy. What statement indicates to the nurse that the client understands the discharge instructions? 1 "The bandages must be changed every day." 2 "I may have mild shoulder pain for about a week." 3 "The surgical sites should not be bathed for a week." 4 "I will remain on a full liquid diet for two more days."
"I may have mild shoulder pain for about a week."
A client is to be discharged after a laser laparoscopic cholecystectomy. The nurse evaluates that the discharge instructions are understood when the client states: 1 "I should stay on a full liquid diet for three days." 2 "The sites will have a moderate amount of bloody drainage for about three days." 3 "I should change the dressings once a day for one week." 4 "I may have mild shoulder pain for about a week."
"I may have mild shoulder pain for about a week."
Which client statement indicates to the nurse that a client who is receiving cyanocobalamin (vitamin B12) therapy for an intrinsic factor deficiency understands the treatment? 1 "I should have a vitamin B12 injection every month." 2 "I'll take my B12 vitamin every morning with my breakfast." 3 "I'll have a salad every day because Vitamin B12 is in green vegetables." 4 "I should feel better because my vitamin B12 treatments will improve my aplastic anemia."
"I should have a vitamin B12 injection every month."
A female client who had a colostomy recently is asking questions about how normal her life will be now that she has a colostomy. The statement by the client that indicates a need for further teaching is: 1 "I wanted another child, and now pregnancy is not an option for me." 2 "I must allow extra time for irrigating my colostomy when traveling." 3 "It is good to know that I can swim every day after my incision heals." 4 "I'm glad I won't have to have special clothing and I can wear what I have."
"I wanted another child, and now pregnancy is not an option for me."
A home care nurse is teaching a client of the Orthodox Jewish faith about food supplements that can promote weight gain. Which client statement supports the nurse's conclusion that the teaching is successful? 1 "Supper is the best time to add caffeine to my diet." 2 "I should put a slice of cheese on my turkey sandwich." 3 "Dinner should include both beef or veal and a glass of milk." 4 "I will have cookies and a milkshake as a midafternoon snack.
"I will have cookies and a milkshake as a midafternoon snack.
A client who had a transurethral resection of the prostate is to be discharged from the outpatient surgical department. Which client statement indicates to the nurse that discharge teaching about self-care is understood? 1 "I am going to drive myself home today." 2 "I am looking forward to a bowl of hot chili for supper." 3 "I will drink four to five glasses of water during the day." 4 "I will notify my health care provider if persistent bleeding occurs.
"I will notify my health care provider if persistent bleeding occurs.
A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse? 1 "Sedatives can be given to help you relax." 2 "We can give you immune serum globulin." 3 "Vitamin supplements are frequently helpful and hasten recovery." 4 "There are medications to help reduce viral load and liver inflammation."
"There are medications to help reduce viral load and liver inflammation."
Which statement made by a client after attending a class on nutrition indicates an understanding of the importance of essential amino acids? 1 "Amino acids can be made by the body because they are essential to life." 2 "They come from the diet because they cannot be synthesized in the body." 3 "They are used in key processes essential for growth once they are synthesized by the body." 4 "Essential amino acids are required for metabolism, whereas the other amino acids are not
"They come from the diet because they cannot be synthesized in the body."
A client has a permanent sigmoid colostomy, and colostomy irrigations are prescribed. The client asks the nurse why they are needed. How should the nurse respond? 1 "Less fluid is lost from the intestine." 2 "They help establish an elimination schedule." 3 "They decrease the amount of flatus in the bowel." 4 "Straining is minimized during a bowel movement.
"They help establish an elimination schedule."
A client with a parotid tumor expresses anxiety about the surgery to remove the tumor. The client states that perhaps surgery should be performed soon, even if the preoperative radiotherapy is not completed. The best response by the nurse is: 1 "You are concerned about the delay of surgery?" 2 "You are anxious about the effects of radiotherapy?" 3 "I think you do not have confidence in your health care provider's decisions." 4 "I can understand your anxiety concerning the delay of your surgery.
"You are concerned about the delay of surgery?"
The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase (Viokase). The nurse evaluates that teaching is understood when the client states, "I will take them: 1 At bedtime." 2 With meals." 3 One hour before meals." 4 On arising each morning."
.With meals."
A client on a low-residue diet asks the nurse about foods that must be avoided. Which foods should the nurse instruct the client to avoid? (Select all that apply.) 1 1. Fresh fruit 2 Broiled fish 3 Poached eggs 4 Buttered white rice 5 Whole wheat bread
1. Fresh fruit
A client eats a meal that contains 13 g of fat, 31 g of carbohydrates, and 5 g of protein. What is this client's total caloric intake for this meal? Record your answer using a whole number. ______ kilocalories
2
A client is admitted via the emergency department with the tentative diagnosis of diverticulitis. Which test commonly is prescribed to assess for this problem? 1 Computed tomography (CT) scan 2 Gastroscopy 3 Colonoscopy 4 Barium enema
Computed tomography (CT) scan
A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease? 1 An ache radiating to the left side 2 An intermittent colicky flank pain 3 A gnawing sensation relieved by food 4 A generalized abdominal pain intensified by moving
A gnawing sensation relieved by food
The nurse is caring for a client with a 25-year history of excessive alcohol use. The nurse expects that assessment findings will indicate: 1 Signs of liver infection 2 A low blood ammonia level 3 A small liver with a rough surface 4 An elevated temperature and a generalized rash
A small liver with a rough surface
A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? (Select all that apply.) 1 Provide a low fat diet. 2 Administer analgesics. 3 Teach relaxation exercises. 4 Encourage walking in the hall. 5 Monitor cardiac rate and rhythm. 6 Observe for signs of hypercalcemia
Administer analgesics. Teach relaxation exercises. Monitor cardiac rate and rhythm.
A client is diagnosed as having colitis. Which clinical findings should the nurse expect the client to report? (Select all that apply.) 1 Fever 2 Diarrhea 3 Gain in weight 4 Spitting up blood 5 Abdominal cramps
Abdominal cramps
Which clinical indicators identified by the nurse support the probable presence of a fecal impaction in a client? (Select all that apply.) 1 Abdominal cramps 2 Fecal liquid seepage 3 Hyperactive bowel sounds 4 Bright red blood in the stool 5 Decreased number of bowel movements
Abdominal cramps Fecal liquid seepage Hyperactive bowel sounds
A nurse is caring for a client who had a gastroscopy. What response indicates a major concern associated with this surgery? 1 Projectile vomiting 2 Increased gastrointestinal (GI) motility 3 Abdominal distention 4 Difficulty swallowing
Abdominal distention
A client with cholelithiasis has a laser laparoscopic cholecystectomy. Postoperatively it is most appropriate for the nurse to: 1 Maintain the client's nothing by moth status for the first 24 hours 2 Monitor the client's abdominal incision for bleeding 3 Offer clear carbonated beverages to the client 4 Ambulate the client when the client is alert and oriented
Ambulate the client when the client is alert and oriented
A client has a diagnosis of hemorrhoids. Which signs and symptoms does the nurse expect the client to report? (Select all that apply.) 1 Flatulence 2 Anal itching 3 Blood in stool 4 Rectal pressure 5 Pain when defecating
Anal itching Blood in stool Rectal pressure Pain when defecating
For the last three days, the client has expressed a complete lack of interest in food. How should the nurse document this in the client's record? 1 Apathy 2 Aphasia 3 Adactyly 4 Anorexia
Anorexia
What should the nurse do when caring for a client with an ileostomy? 1 Teach the client to eat foods high in residue. 2 Explain that drainage can be controlled with daily irrigations. 3 Expect the stoma to start draining on the third postoperative day. 4 Anticipate that any emotional stress can increase intestinal peristalsis
Anticipate that any emotional stress can increase intestinal peristalsis
A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, the nurse reinforces that antacid tablets: 1 Are as effective as the liquid form 2 Should be taken one hour before meals 3 Should be taken only at four-hour intervals 4 Are known to interfere with the absorption of other drugs
Are known to interfere with the absorption of other drugs
An abdominal cholecystectomy is performed on a client with gangrene of the gallbladder. During the first 24 hours postoperatively, analgesics should be administered: 1 If repositioning is ineffective 2 When the pain becomes severe 3 In gradually increasing dosages 4 As prescribed by the health care provider
As prescribed by the health care provider
Three days after admission to the hospital for a brain attack (cerebrovascular accident [CVA]), a client has a nasogastric tube inserted and is receiving continuous tube feedings. What should the nurse do to best evaluate whether the feeding is being absorbed? 1 Aspirate for a residual volume. 2 Evaluate the intake in relation to the output. 3 Instill air into the client's stomach while auscultating. 4 Compare the client's body weight with the baseline data
Aspirate for a residual volume.
A client is admitted to the hospital after two days of painful abdominal spasms and severe diarrhea. The nurse uses an appropriate sequence to examine the client's abdomen, starting with "inspection" followed by: 1 Percussion, palpation, auscultation 2 Palpation, percussion, auscultation 3 Auscultation, palpation, percussion 4 Auscultation, percussion, palpation
Auscultation, palpation, percussion
A nurse is concerned that a client with a diagnosis of cirrhosis of the liver may experience the complication of hepatic coma. For which clinical indicator should the nurse assess this client? 1 Icterus 2 Urticaria 3 Uremic frost 4 Hemangioma
Icterus
A client was diagnosed with cancer of the head of the pancreas two months ago. The client is admitted to the hospital with weight loss, severe epigastric pain, and jaundice. When performing the client's assessment, the nurse expects the client's stool to be what color? 1 Green 2 Brown 3 Red-tinged 4 Clay-colored
Clay-colored
A nurse is providing education about excellent food sources of vitamin A for a client who is deficient in this vitamin. Which foods should the nurse include in the teaching? (Select all that apply.) 1 Carrots 2 Oranges 3 Tomatoes 4 Skim milk 5 Leafy greens
Carrots Leafy greens
A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question? 1 Blood clotting 2 Bone formation 3 Muscle contraction 4 Cellular membranes
Cellular membranes
A client has a large open abdominal wound. The health care provider's prescription states to cleanse the wound with normal saline, pack the wound with damp gauze, cover with abdominal pads, and secure with Montgomery straps twice a day. What should the nurse do to maintain sterility when changing the dressing? 1 Use a separate square gauze to cleanse each half of the wound. 2 Apply new Montgomery straps each time the dressing is changed. 3 Hold the wet gauze with the tips of the forceps higher than the wrist. 4 Cleanse the wound with wet sterile gauze from the center of the wound outward
Cleanse the wound with wet sterile gauze from the center of the wound outward
A nurse is administering an enema to a client who is scheduled for gastrointestinal surgery. What should the nurse do when the client complains of abdominal cramps during the enema? 1 Reduce the rate of flow of the infusion. 2 Discontinue the enema and try again later. 3 Lower the container below the level of the rectum. 4 Close the lumen of the tubing and wait until the discomfort subsides
Close the lumen of the tubing and wait until the discomfort subsides
A financially struggling, large family is instructed by the home health nurse about ways to increase the dietary intake of calcium. Which suggestion should the nurse make? 1 Collards or kale in one meal a day 2 Fruit-flavored yogurt every other day 3 Eight ounces of milk with every meal 4 Bread made with cornmeal each morning
Collards or kale in one meal a day
Which response should the nurse expect when assessing a client who is dehydrated? (Select all that apply.) 1 Confusion 2 Bounding pulse 3 Sunken eyeballs 4 Dependent edema 5 Decreased blood pressure
Confusion Sunken eyeballs Decreased blood pressure
A client asks the nurse to review a list of the foods the client has been choosing to combat constipation. Upon review, the nurse identifies that the food item that has the least amount of fiber content is: 1 Stewed prunes 2 Whole-bran cereal 2 Grapefruit sections 4 Cream of wheat cereal
Cream of wheat cereal
A low-residue diet is recommended for a client. Which food should the nurse encourage the client to select from a menu? 1 Steamed broccoli 2 Creamed potatoes 3 Raw spinach salad 4 Baked sweet potato
Creamed potatoes
A nurse is caring for a client with hepatic cirrhosis. Which elements are important to include in this client's diet? (Select all that apply.) 1 High fat 2 Low protein 3 Low sodium 4 High vitamins 5 Low carbohydrates
Low protein Low sodium High vitamins
The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. What would be appropriate to include in the dietary plan? 1 Soft-textured foods to reduce the digestive burden 2 Low-cholesterol foods to avoid further formation of gallstones 3 Increased protein intake to promote tissue healing and improve energy reserves 4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release
Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release
Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is bright red. What should the nurse do first? 1 Notify the health care provider. 2 Clamp the nasogastric tube for one hour. 3 Determine that this is an expected finding. 4 Irrigate the nasogastric tube with iced saline
Determine that this is an expected finding.
Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? (Select all that apply.) 1 Irritability 2 Dysrhythmias 3 Muscle weakness 4 Abdominal cramps 5 Tingling of the fingertips
Dysrhythmias Muscle weakness
A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care? 1 Encouraging expression of concerns 2 Administering antibiotics as prescribed 3 Teaching the importance of getting rest 4 Explaining that everything will be all right
Encouraging expression of concerns
A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? (Select all that apply.) 1 Ecchymosis 2 Yellow sclera 3 Dark brown stool 4 Straw-colored urine 5 Pain in right upper quadrant
Ecchymosis Yellow sclera Pain in right upper quadrant
A client is admitted to the hospital with a diagnosis of acute salmonellosis. What does the nurse expect the health care provider to prescribe? 1 Cathartics 2 Electrolytes 3 Antidiarrheals 4 Antispasmodics
Electrolytes
A client is scheduled for a barium swallow. How should the nurse prepare the client for this test? (Select all that apply.) 1 Ask about allergies to iodine before the test. 2 Administer cleansing enemas before the test. 3 Suggest a light breakfast on the day of the test. 4 Ensure that a laxative is prescribed after the test. 5 Instruct to withhold prescribed opioids for one day before the test.
Ensure that a laxative is prescribed after the test. Instruct to withhold prescribed opioids for one day before the test.
A client has a diagnosis of hemorrhoids. Which signs and symptoms does the nurse expect the client to report? (Select all that apply.) 1 Flatulence 2 Anal itching 3 Blood in stool 4 Rectal pressure 5 Pain when defecating
Everything except Flatulence
A paracentesis is prescribed for a client recently admitted to a medical unit. The nurse recalls that the procedure is performed for what reasons? (Select all that apply.) 1 Extract peritoneal fluid 2 Improve respiratory status 3 Decrease intrapleural fluid 4 Increase intraabdominal tension 5 Obtain peritoneal fluid for culture
Extract peritoneal fluid Improve respiratory status Obtain peritoneal fluid for culture
A nurse is planning a community health program about screening for cancer. Which information recommended by the American Cancer Society (ACS) should the nurse include? 1 Mammography should be performed annually after age 35 years for women. 2 Fecal occult blood testing should be performed yearly beginning at age 50 years. 3 Breast self-examination should be performed monthly beginning at age 30 years. 4 Digital rectal exams and Prostate-Specific Antigen (PSA) testing should be done yearly after age 40 for men.
Fecal occult blood testing should be performed yearly beginning at age 50 years.
A client who had surgery for a ruptured appendix develops peritonitis. What clinical findings related to peritonitis should the nurse expect the client to exhibit? (Select all that apply.) 1 Fever 2 Hyperactivity 3 Extreme hunger 4 Urinary retention 5 Abdominal muscle rigidity
Fever Abdominal muscle rigidity
An active adolescent is admitted to the hospital for surgery for an ileostomy. When planning a teaching session about self-care, the nurse includes sports that should be avoided by a client with an ileostomy. Which should be included on the list of sports to be avoided? (Select all that apply.) 1 Football 2 Swimming 3 Ice hockey 4 Track events 5 Cross-country skiing
Football Ice hockey
A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn's disease. Which expected outcome is most important for this client? 1 Does skin care 2 Takes oral fluids 3 Gains a half pound per week 4 Experiences less abdominal cramping
Gains a half pound per week
When advising a college student about dietary choices, the nurse should consider the caloric value of the most commonly ordered fast foods eaten by active young adults. List the following foods in order from the one with the least number of calories to the one with the most number of calories. 1. Hamburger with cheese 2. Six pieces of chicken tenders 3. French fries 4. One slice of French toast 5. Garden salad
Garden salad One slice of French toast Six pieces of chicken tenders French fries Hamburger with cheese
A health care provider prescribes an upper gastrointestinal (GI) series and a barium enema. The client asks, "Why do I have to have barium for these tests?" The nurse's best response is "Barium: 1 Gives off visible light, illuminating the alimentary tract." 2 Provides fluorescence, thereby lighting up the alimentary tract." 3 Dyes the structures of the alimentary tract, making them more visible." 4 Gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays.
Gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays.
When performing the initial history and physical examination of a client with a tentative diagnosis of peptic ulcer, the nurse expects the client to describe the pain as: 1 Gnawing epigastric pain or boring pain in the back 2 Located in the right shoulder and preceded by nausea 3 Sudden, sharp abdominal pain, increasing in intensity 4 Heartburn and substernal discomfort when lying down
Gnawing epigastric pain or boring pain in the back
A client had a bypass graft because of an abdominal aortic aneurysm. Postoperative prescriptions include measurements of the client's abdominal girth. Which serious problem may be indicated by an increasing abdominal girth? 1 Graft leakage 2 Bowel puncture 3 Abdominal infection 4 Postoperative flatulence
Graft leakage
Which food selections by a client with malabsorption syndrome indicate that the nurse's dietary teaching was successful? (Select all that apply.) 1 Green beans 2 Baked potato 3 Noodle pudding 4 Turkey sandwich 5 Whole wheat cerea
Green beans Baked potato
The nurse teaches the client about foods to help prevent constipation after pelvic surgery. Which foods selected by the client indicate that the teaching is understood? (Select all that apply.) 1 Ripe bananas 2 Milk products 3 Green vegetables 4 Creamed potatoes 5 Whole grain bread
Green vegetables Whole grain bread
A client is instructed to avoid straining on defecation postoperatively. The nurse evaluates that the related teaching is understood when the client states, "I must increase my intake of: 1 Ripe bananas." 2 Milk products." 3 Green vegetables." 4 Creamed potatoes."
Green vegetables."
A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care? 1 Empty feeding bag stays attached to the tubing. 2 Tube is flushed with air after medication is given. 3 Replacement of the tube is done on a weekly basis. 4 Head of the bed remains elevated after the feeding.
Head of the bed remains elevated after the feeding.
An underweight client has autoimmune hemolytic anemia that has been unresponsive to corticosteroids, and a splenectomy is scheduled. For what complication should the nurse assess the client in the immediate postoperative period? 1 Dehiscence 2 Hemorrhage 3 Wound infection 4 Abscess formation
Hemorrhage
For which clinical indicator associated with a complication of portal hypertension should the nurse assess the client? 1 Liver abscess 2 Intestinal obstruction 3 Perforation of the duodenum 4 Hemorrhage from esophageal varices
Hemorrhage from esophageal varices
A client is being discharged after an acute episode of hepatitis. The nurse expects the primary health care provider to prescribe which type of diet for this client? 1 Low calorie, high protein, low carbohydrate, low fat 2 High calorie, low protein, high carbohydrate, high fat 3 Low calorie, low protein, low carbohydrate, moderate fat 4 High calorie, high protein, high carbohydrate, moderate fat
High calorie, high protein, high carbohydrate, moderate fat
A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone (Aldactone).What should the nurse monitor the client for? 1 Bruising 2 Tachycardia 3 Hyperkalemia 4 Hypoglycemia
Hyperkalemia
A nurse is reviewing a list of current medications with an 80-year-old client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the health care provider because it is contraindicated for a person who is experiencing gastrointestinal bleeding? 1 Ibuprofen (Advil) 2 Digoxin (Lanoxin) 3 Furosemide (Lasix) 4 Spironolactone (Aldactone)
Ibuprofen (Advil)
The nurse provides education related to the relationship between aerobic exercise and weight loss to an obese client. The nurse evaluates that this teaching is effective when the client states, "I know that exercise will: 1 Decrease my appetite." 2 Lower my metabolic rate." 3 Increase my resting heart rate." 4 Increase my lean body mass.
Increase my lean body mass.
A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? 1 Promotes the formation of calculi in the cystic duct 2 Stimulates the pancreas to secrete more insulin than it can immediately produce 3 Alters the composition of enzymes so they are capable of damaging the pancreas 4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas
Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas
A nurse provides dietary teaching for a client with an acute exacerbation of colitis, and afterward the client makes a list of foods that can be included on the diet. Which food choices indicate that the teaching was effective? (Select all that apply.) 1 Orange juice 2 Creamed soup 3 Jelly sandwich 4 Lean roast beef 5 Scrambled eggs
Jelly sandwich Lean roast beef Scrambled eggs
Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. The nurse responds, "It: 1 Increases gastric motility. 2 Neutralizes gastric acidity. 3 Facilitates histamine release. 4 Inhibits gastric acid secretion
Inhibits gastric acid secretion
A client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. A nursing priority is to: 1 Institute fall prevention/safety measures 2 Monitor respiratory status 3 Measure abdominal girth daily 4 Test stool specimens for blood
Institute fall prevention/safety measures
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse should monitor the client for which complications? (Select all that apply.) 1 Phlebitis 2 Infection 3 Hepatitis 4 Anorexia 5 Dysrhythmias
Phlebitis Infection
A day after surgery to create an ileostomy, a 68-year-old male client remarks to the nurse, "It will be difficult for my wife to care for a helpless old man." Which conflict of Erikson's developmental stages is reflected by this comment? 1 Trust versus mistrust 2 Integrity versus despair 3 Industry versus inferiority 4 Generativity versus stagnation
Integrity versus despair
A client who recently immigrated to the United States has a chronic vitamin A deficiency. What information about vitamin A should the nurse consider when assessing this client for clinical indicators of this deficiency? 1 Vitamin A is an integral part of the retina's pigment called melanin. 2 It is a component of the rods and cones, which control color visualization. 3 Vitamin A is the material in the cornea that prevents the formation of cataracts. 4 It is a necessary element of rhodopsin, which controls responses to light and dark environments.
It is a necessary element of rhodopsin, which controls responses to light and dark environments.
A client is admitted with the diagnosis of acute pancreatitis. For which clinical manifestations should a nurse assess the client? (Select all that apply.) 1 Jaundice 2 Acute pain 3 Hypertension 4 Hypoglycemia 5 Increased amylase
Jaundice Acute pain Increased amylase
A client with liver dysfunction states, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs additional Vitamin: 1 D 2 E 3 A 4 K
K
A nurse administers several vitamins as part of a client's medical regimen. Which prescribed vitamin is essential for the synthesis of prothrombin by the liver? 1 B12 2 C 3 D 4 K
K
A nurse is assisting a health care provider to perform a sigmoidoscopy. In which position should the nurse place the client for this procedure? 1 Sims 2 Prone 3 Lithotomy 4 Knee-chest
Knee-chest
A client is admitted to the hospital for surgery for a total abdominoperineal resection. What position should the nurse encourage the client to maintain when in bed to promote perineal wound healing after surgery? 1 Knee-chest 2 Dorsal recumbent 3 Left or right Sims 4 Left or right side-lying
Left or right side-lying
A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client? 1 Prone 2 Supine 3 Left Sims 4 Right side-lying
Left Sims
A client with a history of ulcerative colitis has a large portion of the large intestine removed and the creation of an ileostomy. For which potential life-threatening complication should the nurse assess the client after this surgery? 1 Infection caused by the excretion of feces 2 Injury caused by exposed intestinal mucosa 3 Altered bowel elimination caused by the ostomy 4 Limited water reabsorption caused by removal of intestine
Limited water reabsorption caused by removal of intestine
A client reports experiencing nausea, dyspnea, and right upper quadrant pain unrelieved by antacids. The pain occurs most often after eating in fast-food restaurants. Which diet should the nurse instruct the client to follow? 1 Low fat 2 Low carbohydrate 3 Soft textured and bland 4 High protein and kilocalories
Low fat
A health care provider prescribes daily docusate sodium (Colace) for a client. The nurse determines that the action of this drug in the gastrointestinal (GI) tract is to: 1 Lubricate the feces 2 Create an osmotic effect 3 Stimulate motor activity 4 Lower the surface tension of feces
Lower the surface tension of feces
A client has an excision of a thrombosed external hemorrhoid. What should the nurse teach the client to use when cleaning the anus after a bowel movement? 1 Betadine pads 2 Soft facial tissue 3 Medicated pads (Tucks) 4 Sterile 4×4-inch gauze pads
Medicated pads (Tucks)
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which classic signs of hepatic coma should the nurse assess this client? (Select all that apply.) 1 Mental confusion 2 Increased cholesterol 3 Brown-colored stools 4 Flapping hand tremors 5 Hyperactive deep tendon reflexes
Mental confusion Flapping hand tremors
Which medication should the nurse question when it is prescribed for a client with acute pancreatitis? 1 Ranitidine (Zantac) 2 Cimetidine (Tagamet) 3 Meperidine (Demerol) 4 Promethazine HCl (Phenergan
Meperidine
A client arrives in the emergency department with complaints of epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Based on the client's database, the primary nursing concern is: 1 Acute pain 2 Risk for injury 3 Metabolic alkalosis 4 Ineffective breathing
Metabolic alkalosis
A nurse is caring for a client on the second day after an abdominoperineal resection. How does the nurse expect the stoma to appear? 1 Dry, pale pink, and flush with the skin 2 Moist, skin-colored, and flush with the skin 3 Moist, red, and raised above the skin surface 4 Dry, purple, and depressed below the skin surface
Moist, red, and raised above the skin surface
What client factor does the nurse consider to have the greatest impact on the effectiveness of bariatric surgery? 1 Freedom from concurrent high-risk conditions. 2 Motivation to cooperate with required lifestyle changes. 3 Willingness to have a panniculectomy a year after weight is stabilized. 4 Ability to tolerate the large abdominal incision necessary for this surgery
Motivation to cooperate with required lifestyle changes.
A client with a 20-year history of excessive alcohol use is admitted to the hospital with jaundice and ascites. A priority nursing action during the first 48 hours after the client's admission is to: 1 Monitor the client's vital signs 2 Increase the client's fluid intake 3 Improve the client's nutritional status 4 Determine the client's reasons for drinking
Monitor the client's vital signs
A client is diagnosed with Crohn's disease, and parenteral vitamins are prescribed. The client asks why the vitamins have to be given intravenously (IV) rather than by mouth. What rationales for this route should the nurse include in a response to the question? (Select all that apply.) 1 More rapid action results. 2 They are ineffective orally. 3 They decrease colon irritability. 4 Intestinal absorption may be inadequate. 5 Allergic responses are less likely to occur
More rapid action results. They are ineffective orally. Intestinal absorption may be inadequate.
A client complains of pain four hours after a liver biopsy. The nurse identifies that there is a leakage of a large amount of bile on the dressing over the biopsy site. What should the nurse do first? 1 Tell the client to remain flat on the back. 2 Medicate the client for pain as prescribed. 3 Notify the client's health care provider immediately. 4 Monitor the client's vital signs every 10 minutes
Notify the client's health care provider immediately.
A client is diagnosed with sprue (adult celiac disease). What should the nurse teach the client to avoid when providing dietary teaching? (Select all that apply.) 1 Meat 2 Oranges 3 Oatmeal 4 Spaghetti 5 Tomatoes
Oatmeal Spaghetti
When comparing ulcerative colitis and Crohn's disease, a nurse considers that they are similar yet dissimilar in many ways. What clinical manifestation is common to clients with Crohn's disease and not to clients with ulcerative colitis? 1 Diarrhea 2 Weight loss 3 Right lower quadrant pain 4 Decreased hematocri
Right lower quadrant pain
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. The priority nursing intervention is to: 1 Weigh the client daily 2 Restrict the client's oral fluid intake 3 Measure the client's urine specific gravity 4 Observe the client for increasing confusion
Observe the client for increasing confusion
A client has a nasogastric feeding tube inserted, and the health care provider prescribes the feeding to be instituted immediately. What should the nurse do first? 1 Instill normal saline into the tube to maintain patency. 2 Obtain an x-ray to verify that the tube is in the stomach. 3 Auscultate the epigastric area while instilling 15 mL of air. 4 Withdraw 30 mL of stomach contents to verify tube placement.
Obtain an x-ray to verify that the tube is in the stomach.
A client with cholecystitis is placed on a low fat, high protein diet. What nutrient should the nurse teach the client is included with this diet? 1 Skim milk 2 Boiled beef 3 Poached eggs 4 Steamed broccoli
Skim milk
A client is diagnosed with gastric cancer, and a subtotal gastrectomy is performed. After surgery the client begins to hemorrhage. What clinical findings support the nurse's conclusion that the client is experiencing hypovolemic shock? (Select all that apply.) 1 Oliguria 2 Bradypnea 3 Diaphoresis 4 Tachycardia 5 Hypertension
Oliguria Diaphoresis Tachycardia
A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply. 1 Oliguria 2 Lethargy 3 Irritability 4 Irritability 5 Slurred speech
Oliguria Irritability Irritability
A client follows a vegetarian diet and must compensate for the lack of vitamin B12 found in food of animal origin. Which food should the nurse encourage the client to consume each day? 1 One orange 2 One glass of soy milk 3 Two handfuls of nuts 4 Two servings of green vegetables
One glass of soy milk
A client who recently had an abdominoperineal resection and colostomy accuses the nurse of being uncomfortable during a dressing change because the "wound looks terrible." Which defense mechanism does the nurse conclude the client is using as a form of self-protection? Correct 1 Projection 2 Sublimation 3 Intellectualization 4 Reaction formation
Projection
A nurse is assisting a client to plan a therapeutic diet that is high in vitamin C. What excellent sources of vitamin C should be included in the plan? (Select all that apply.) 1. Lettuce 2 Oranges 3 Broccoli 4 Apricots 5 Strawberries
Oranges Broccoli Strawberries
A client has circumgastric banding, a bariatric surgical procedure. The nurse provides discharge teaching about signs and symptoms of dumping syndrome and includes what physiological response? 1 Fever 2 Vomiting 3 Palpitations 5 Constipation
Palpitations
When caring for a client who is recovering from a gastrectomy, a nurse is concerned about the potential development of pernicious anemia. What should the nurse conclude may be the cause of this complication? 1 Vitamin B12 is just absorbed in the stomach. 2 Hemopoietic factor is secreted in the stomach. 3 Parietal cells of the stomach secrete the intrinsic factor. 4 Chief cells in the stomach promote the secretion of the extrinsic factor
Parietal cells of the stomach secrete the intrinsic factor.
A client in a debilitated state is admitted for palliative treatment of cancer of the liver. Which objective information collected by the nurse is most helpful for future monitoring of the client's condition? 1 Diet history 2 Bowel sounds 3 Present weight 4 Pain description
Present weight
A client with a history of alcoholism and cirrhosis is admitted with severe dyspnea as a result of ascites. The nurse concludes that the ascites is most likely the result of increased: 1 Secretion of bile salts 2 Pressure in the portal vein 3 Interstitial osmotic pressure 4 Production of serum albumin
Pressure in the portal vein
A client with Crohn's disease is admitted to the hospital with a history of chronic, bloody diarrhea, weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level, and signs of negative nitrogen balance. The nurse concludes that the client's health status is related to a major deficiency of: 1 Iron 2 Protein 3 Vitamin C 4 Linoleic acid
Protein
A nurse assists a client who had bariatric surgery to be more mobile. What complication is the nurse attempting to prevent? 1 Incisional pain 2 Wound dehiscence 3 Anastomosis leakage 4 Pulmonary embolism
Pulmonary embolism
After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The client says, "What does it mean when the health care provider said that I am experiencing dumping syndrome?" What information should the nurse include in a response to this question? 1 Nausea resulting from a full stomach 2 Reflux of gastric contents into the esophagus 3 Buildup of flatulence within the large intestine 4 Rapid passage of concentrated fluid into the small intestine
Rapid passage of concentrated fluid into the small intestine
An 18-year-old is admitted with an acute onset of right lower quadrant pain at McBurney's point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis? 1 Urinary retention 2 Gastric hyperacidity 3 Rebound tenderness 4 Increased lower bowel motility
Rebound tenderness
A client is admitted to the hospital for surgery for recto-sigmoid colon cancer, and the nurse is obtaining a health history as part of the admission process. What clinical findings associated with recto-sigmoid colon cancer does the nurse expect the client to report? (Select all that apply.) 1 Rectal bleeding 2 Inability to digest fat 3 Change in the shape of stools 4 Feeling of abdominal bloating
Rectal bleeding Change in the shape of stools Feeling of abdominal bloating
A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. What is the priority expected client outcome in response to therapy at this time? 1 Report decreased pain. 2 Remain in fluid balance. 3 Lose four pounds a week. 4 Join Alcoholics Anonymous
Report decreased pain.
A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition? 1 Avoid foods high in vitamin K. 2 Check the pulse several times a day. 3 Drink a glass of milk when taking aspirin. 4 Report signs of bleeding no matter how slight
Report signs of bleeding no matter how slight
A nurse concludes that a client understands the teaching about limiting the discomfort associated with a hiatal hernia when the client states, "After meals I will: 1 Drink 8 oz of water." 2 Take a 10-minute walk." 3 Rest in a sitting position for one hour." 4 Lie down in bed for at least 20 minutes."
Rest in a sitting position for one hour."
Which intervention helps prevent hepatic coma in a client with liver dysfunction? 1 Restrict dietary protein. 2 Prepare for emergency surgery. 3 Eliminate carbohydrates from the diet. 4 Give hypertonic small volume enemas
Restrict dietary protein.
A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? (Select all that apply.) 1 Preventing constipation 2 Screening of blood donors 3 Avoiding shellfish in the diet 4 Limiting hepatotoxic drug therapy 5 Maintaining a monogamous sexual relationship
Screening of blood donors Maintaining a monogamous sexual relationship
A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for signs that strangulation of the intestine may have occurred. What is an early sign of strangulation? 1 Increased flatus 2 Projectile vomiting 3 Sharp abdominal pain 4 Decreased bowel sounds
Sharp abdominal pain
A client is admitted to the ambulatory surgery unit for a liver biopsy. The nurse recalls that which assessment finding will be a cause for the biopsy to be postponed? 1 Signs of bruising 2 Visible hyperactivity 3 Lethargy on the morning of the test 4 Foods high in vitamin K consumed on the day before the test
Signs of bruising
A client with a diagnosis of cancer of the stomach expresses a lack of interest in food and eats only small amounts. What should the nurse provide? 1 Nourishment between meals 2 Small portions more frequently 3 Supplementary vitamins to stimulate the client's appetite 4 Only foods the client likes in small portions at mealtimes
Small portions more frequently
A client is recovering from an acute episode of alcoholism that included esophageal involvement. What are the components of a therapeutic diet that are most appropriate for the nurse to include in the teaching plan for this client? (Select all that apply.) 1 Soft diet 2 Regular diet 3 Low protein diet 4 High protein diet 5 Low carbohydrate diet 6 High carbohydrate die
Soft diet High protein diet High carbohydrate die
A client with Crohn's disease is admitted to the hospital with abdominal pain, fever, poor skin turgor, and diarrhea, with 10 stools in the past 24 hours. Which signs are evidence that the client probably is dehydrated? (Select all that apply.) 1 Moist skin 2 Sunken eyes 3 Decreased apical pulse 4 Dry mucous membranes 5 Increased blood pressure
Sunken eyes
After many years of coping with colitis, a client makes the decision to have a colectomy as advised by the health care provider. Which is most likely the significant factor that impacted on the client's decision? 1 It is temporary until the colon heals. 2 Surgical treatment cures ulcerative colitis. 3 Ulcerative colitis can progress to Crohn's disease. 4 Without surgery, eating table foods is contraindicated
Surgical treatment cures ulcerative colitis.
A client develops acute appendicitis. Prior to arrival to the hospital, the client attempted self-care at home. Which self-care measures could potentially lead to rupture of the appendix? 1 Refusing food and liquids 2 Applying an ice pack to the abdomen 3 Taking a small volume enema 4 Taking acetaminophen (Tylenol) for pain
Taking a small volume enema
After abdominal surgery a client is to receive a progressive postsurgical diet. The nurse explains to the client that this diet is characterized by progressive alterations in the: 1 Caloric content of food 2 Nutritional value of food 3 Texture and digestibility of food 4 Variety of fluids and food
Texture and digestibility of food
Megadoses of vitamin A are taken by a client. Why should the nurse question this practice? 1 Vitamin A is highly toxic, even in small amounts. 2 The liver has a great storage capacity for vitamin A, even to toxic amounts. 3 Vitamin A cannot be stored; therefore excess amounts will saturate the general body tissues. 4 Although the body's requirement for vitamin A is great, the cells can synthesize more as needed
The liver has a great storage capacity for vitamin A, even to toxic amounts.
The nurse is caring for a client with ascites who is scheduled for a paracentesis. The client teaching will include: 1 The need to empty the bladder immediately before the procedure 2 The importance of a low fat diet after the procedure to aid in healing 3 The importance of staying in a supine position throughout the procedure 4 The need to consume only liquids for 24 hours after the procedure
The need to empty the bladder immediately before the procedure
An older adult is hospitalized for weight loss and dehydration because of nutritional deficits. What should the nurse consider when caring for this client? 1 Financial resources usually are unrelated to nutritional status. 2 An older adult's daily fluid intake must be markedly increased. 3 The client's diet should be high in carbohydrates and low in proteins. 4 The nutritional needs of an older adult are unchanged except for a decreased need for calories
The nutritional needs of an older adult are unchanged except for a decreased need for calories
When discussing a scheduled liver biopsy with a client, the nurse explains that for several hours after the biopsy the client will have to remain in what position? 1 The left side-lying position with the head of the bed elevated 2 A high Fowler position with both arms supported on several pillows 3 The right side-lying position with pillows placed under the costal margin 4 Any comfortable recumbent position as long as the client remains immobile
The right side-lying position with pillows placed under the costal margin
A nurse identifies that clients with cancer often lose weight and may become cachectic. What common response do clients with cancer experience regardless of the site of the cancer that accounts for this weight loss? 1 Depression precipitates anorexia. 2 Tumor necrosis factor affects the satiety center. 3 Decreased saliva impedes chewing and swallowing. 4 Nutrients are not absorbed through the gastrointestinal mucosa.
Tumor necrosis factor affects the satiety center.
A client is transferred to the postanesthesia care unit after abdominal surgery. The client begins vomiting. What nursing action is most important when caring for this client? 1 Turning the client onto the side 2 Measuring the amount of vomitus 3 Checking the wound for dehiscence 4 Administering the prescribed antiemetic to the client
Turning the client onto the side
After a bilateral inguinal hernia repair (herniorrhaphy) the nurse should assess the client for the development of: 1 Hydrocele 2 Paralytic ileus 3 Urinary retention 4 Thrombophlebitis
Urinary retention
A client reports pain as a result of a gastric ulcer. What clinical findings is the nurse most likely to identify during an assessment of the client's pain? (Select all that apply.) 1 Vomiting relieves pain. 2 Eating food prevents pain. 3 Pain described as gnawing. 4 Flatulence accompanies pain. 5 Pain occurs a half hour after meals
Vomiting relieves pain. Pain described as gnawing. Pain occurs a half hour after meals
A client is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver. The nurse suspects what type of toxicity? 1 Thiamine 2 Vitamin A 3 Vitamin C 4 Pyridoxine
Vitamin A
A nurse is preparing to administer a nasogastric tube feeding. List the steps of the procedure in the order in which they should be performed. 1. Wash the hands. 2. Aspirate the contents of the stomach. 3. Verify the solution to be administered. 4. Instill the prescribed solution. 5. Document the client's response to the procedure
Wash the hands. Verify the solution to be administered. Aspirate the contents of the stomach. Instill the prescribed solution. Document the client's response to the procedure
A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery? 1 Vitamins 2 Whole bran 3 Cod liver oil 4 Amino acids
Whole bran
Discharge teaching for a client with hypercholesterolemia includes nutritional instructions for a diet low in saturated fat. Which items included by the client on a list of foods to avoid supports the nurse's conclusion that teaching has been effective? 1 High fiber foods 2 Canned vegetables 3 Citrus fruits and juices 4 Whole milk and hard cheeses
Whole milk and hard cheeses
A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice? 1 Yellow sclera 2 Pain on urination 3 Dark brown stools 4 Coffee-ground emesis
Yellow sclera
