GI/Nutrition

Which statement made by the client demonstrates a correct understanding of the home care of an ascending colostomy? 1. "I will avoid eating foods such as broccoli and cauliflower." 2. "I will empty the pouch when it is one-half full of stool." 3. "I will irrigate the colostomy to promote regular bowel movements." 4. "I will restrict my fluid intake to 2,000 mL of fluid a day."

1 Proper care of the stoma and pouch appliance that should be taught to the client or caregiver includes: -Ensure sufficient fluid intake (at least 3,000mL/day) to prevent dehydration -Identify and eliminate foods that cause gas and odor (broccoli, cauliflower, dried beans, brussel sprouts) -Empty the pouch when it becomes one-third full to prevent leak due to increasing pouch weight Option 3: Stool produced in the ascending and transverse colon is semiliquid, which eliminates the need for irrigation. Irrigation to promote a bowel regimen may be useful for descending or sigmoid colostomies as the stool is more formed

The nurse is teaching the home health client how to perform colostomy irrigation. Which client action reveals that further teaching is required? 1. Attaches an enema set to the irrigation bag, lubricates it, gently inserts it into the stoma, and holds it in places 2. Fills irrigation contained with 500-1000 mL of lukewarm tap water and flushes the irrigation tubing 3. Hangs the irrigation container on a hook at the level of the shoulder approximately 22 inches above the stoma 4. Slowly opens the roller clamp, allowing the irrigation solution to flow, but clamps the tubing when cramping occurs

1 A colostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall for the passage of stool to bypass an obstructed or diseased portion of the colon. Stool drains through the intestinal stoma into a pouch device secured to the skin Clients with a descending or sigmoid colostomy drain stool that is more formed and similar to a normal bowel movement. Although less common, some clients choose to irrigate their colostomy in order to create a bowel regimen that allows them to wear a smaller pouch or a dressing over the stoma. When irrigated daily, the client gains increased control over the passage of stool The procedure for bowel irrigation is as follows: -Fill the irrigation container with 500-1000ML OF LUKEWARM WATER, flush irrigation tubing, and reclamp; hang the container on a hook or IV pole -Instruct the client to sit on the toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet, and place the irrigation container approximately 18-24 inches above the stoma -LUBRICATE CONE-TIPPED IRRIGATOR, insert cone and attached catheter gently into the stoma, and hold in place -Slowly open the roller clamp, allowing irrigation solution to flow for 5-10 min -Clamp the tubing if cramping occurs, unit it subsides -Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet Option 1: A cone-tip applicator is used to instill the irrigation solution into the stoma. An enema set should never be used to irrigate a colostomy

The nurse who is caring for a client with acute diverticulitis will immediately report which finding to the HCP? 1. Abdominal pain has progressed to the left upper quadrant 2. Hemoglobin of 11.2 g/dL 3. Lying on side with knees drawn up to abdomen and trunk flexed 4. White blood cell count of 12,000/mm

1 Diverticula are saclike protrusions or outpouchings of the intestinal mucosa of the large intestine caused by increased intraluminal pressure (chronic constipation). The left (descending, sigmoid) colon is the most common area for diverticula to develop When these diverticula become inflamed (diverticulitis), the client may experience acute pain (usually in the left lower quadrant) and systemic signs of infection (fever, tachycardia, nausea, leukocytosis). Complications that can occur in some clients are ABSCESS FORMATION (continuous fever despite antibiotics and palpable mass) and INTESTINAL PERFORATION resulting in diffuse PERITONITIS (progressive pain in other quadrants of the abdomen, rigidity, guarding, rebound tenderness) The client with peritonitis prefers to lie still and take shallow breaths to avoid stretching the inflamed peritoneum. Peritonitis is a potentially lethal complication and should be reported immediately Option 2: Clients with acute diverticulitis can bleed. Usually this bleeding is quite obvious, often with a large amount of bright red blood seen in the stool. This client's mild anemia is nonspecific and should not be given reporting priority Option 4: Leukocytosis is expected with acute diverticulitis. However this client's white blood cell count is only minimally elevated (upper limit of normal is 11,000) and is not a priority

A nurse is caring for a client who developed paralytic ileus after a stroke. The client reports nausea, abdominal discomfort, and distension; bowel sounds are absent. Which prescription does the nurse question? 1. Hydrocodone 5/325mg 1 tab every 4 hours prn for moderate pain 2. Increase continuous IV normal saline rate from 75 to 100mL/hr 3. Insert NG tube and attach to wall suction 4. Ondansetron 4mg IVP every 4 hours prn for nausea

1 Paralytic ileus is characterized by temporary paralysis of a portion of the bowel, which affects peristalsis and bowel motility. Signs and symptoms include abdominal discomfort, distension, and N/V. Risk factors for paralytic ileus include: -Abdominal surgery -Perioperative medications (anesthesia, analgesics) -Immobility (stroke) To prevent further abdominal distension and resulting nausea, the client should remain NPO. NG tube to wall suction may be necessary to decompress the stomach. IV fluid and electrolyte replacement may be necessary to correct losses that occur from nasogastric suction. Nausea can be treated with prescribed antiemetics (Zofran, promethazine) Option 1: The client should not take medications by mouth (due to NPO status) and opioid medications should be avoided as they prolong paralytic ileus

A client with diabetes receiving peritoneal dialysis experiences chills and abdominal discomfort. The nurse assess the client's abdomen by pressing one hand firmly into the abdominal wall. The client experiences pain when the nurse quickly withdraws the hand. The client's blood glucose level is 210 mg/dL. What is the priority action by nurse? 1. Collect peritoneal fluid for culture and sensitivity 2. Heat the remaining dialysate fluid and increase the dwell time 3. Place the client in high Fowler's position 4. Prepare to administer regular insulin IV

1 Peritonitis is a common but serious complication of peritoneal dialysis that typically occurs as a result of contamination during infusion connects or disconnections. Typically, the earliest indication of peritonitis is the presence of cloudy peritoneal effluent. Later manifestations include low-grade fever, chills, generalized abdominal pain, and rebound tenderness

The nurse assessing a client with an upper GI bleed would expect the client's stool to have which appearance? 1. Black tarry 2. Bright red bloody 3. Light gray "clay-colored" 4. Small, dry, rocky-hard masses

1 The nurse would expect a client experiencing an upper GI bleed to have black tarry stools (melena). As blood passes through the GI tract, digestion of the blood ensues, producing the black tarry appearance Option 2: Bright red bloody stool (hematochezia) would indicate a lower GI hemorrhage Option 3: Decreased bile flow into the intestine due to biliary obstruction would produce a light gray clay colored stool Option 4: Small, dry, rocky hard masses are an indication of constipation

During assessment of a client who had major abdominal surgery a week ago, the nurse notes that the incision has dehisced and evisceration has occurred. The nurse stays with the client while another staff member gets sterile gauze and saline. How should the nurse position the client while waiting to cover the wound? 1. Low Fowler's position with knees bent 2. Prone to prevent further evisceration 3. Side-lying lateral position 4. Supine with head of the bed flat

1 Wound evisceration is the protrusion of internal organs through the wall of an incision. It typically occurs 6-8 days after surgery and is more common in clients who have had abdominal surgery, those with poor wound healing, and those who are obese. It is considered a medical emergency. The nurse should remain with the client while calling for help. The wound should be covered with STERILE NORMAL SALINE DRESSINGS. The client should be positioned in LOW FOWLER'S POSITION WITH THE KNEES BENT. This position lessons abdominal tension on the suture line and can prevent further evisceration. The client should be prepared for immediate return to surgery

The nurse is caring for a client with liver cirrhosis who was admitted for cellulitis of the leg. Which assessments would the nurse perform to determine if the client's condition has progressed to hepatic encephalopathy? Select all that apply. 1. Ask if the client knows what day it is 2. Ask the client to extend the arms 3. Assess for telangiectasia (spider nevi) 4. Determine if the conjunctiva is jaundiced 5. Note amylase and lipase serum levels

1, 2 Hepatic encephalopathy is a frequent complication of liver cirrhosis. Precipitating factors include hypokalemia, constipation, GI hemorrhage, and infection. It results from accumulation of ammonia and other toxic substances in blood Clinical manifestations of HE range from sleep disturbances (early) to lethargy and coma. MENTAL STATUS IS ALTERED, and clients are not oriented to time, place, or person. A characteristic clinical finding of HE is presence of ASTERIXIS (flapping tremors of the hands). It is assessed by having the client extend the arms and dorsiflex the wrists. Another sign is fetor hepaticus (musty, sweet odor of the breath) from accumulated digestive byproducts Option 3: Spider angiomas (small, dilated blood vessels with bright red centers), gynecomastia, testicular atrophy, and palmar erythema are expected findings in cirrhosis due to altered metabolism of hormone in the liver Option 4: Jaundice occurs when bilirubin is 2-3 times the normal value. Jaundice can occur in hepatitis and tends to worsen in cirrhosis due to increasing functional derangement. It is not related specifically to encephalopathy Option 5: Amylase and lipase are enzymes from pancreatic tissue. ALT/AST are liver enzymes. They would be elevated with hepatitis and are not unique to cirrhosis or HE. Elevated ammonia levels would be more specific to cirrhosis

The nurse is caring for a client in the postanesthesia care unit following a gastroduodenostomy. Which of the following nursing interventions are appropriate? Select all that apply 1. Applying bilateral SCDs 2. Encouraging splinting of the incision with a pillow when coughing 3. Keeping the client NPO until bowel sounds return 4. Maintaining supine positioning at all times 5. Repositioning and irrigating a clogged NG tube prn

1, 2, 3 A gastroduodenostomy (Billroth I) involves removing the distal two-thirds of the stomach with anastomosis of the remaining stomach to the duodenum. Following partial gastrectomy, clients should remain NPO until bowel sounds return. Once tolerated, consumption of small, frequent meals will help prevent the occurrence of dumping syndrome Postoperative clients are at risk for developing venous thromboembolism due to reduced mobility levels and require VTE prophylaxis (SCDs, compression hose). Clients are also at risk for hypoventilation and respiratory compromise due to sedation, pain, immobility. Encourage clients to turn, cough, and deep breathe while splinting the surgical site to prevent development of atelectasis Option 4: In the postoperative period, the nurse should elevate the HOB to improve ventilation and reduce the risk of aspiration. Only clients who experience dumping syndrome should lay supine for a short period after eating Option 5: Clients may have an NG tube postoperatively for gastric decompression. Clogged NG tubes should be reported to the surgeon. Attempting to manipulate or flush the device may disrupt the surgical site, causing hemorrhage or gastric perforation

During morning rounds, the nurse notices that a client admitted 3 days ago with hepatic encephalopathy is sleepy and confused. The client is scheduled for discharge later today. Which interventions are appropriate for the nurse to implement? Select all that apply 1. Assess the client's hand movements with the arms extended 2. Compare current mental status findings with those from previous shifts 3. Contact the HCP to request a blood draw for ammonia level 4. Encourage the client to ambulate in the hallway 5. Hold the client's morning dose of lactulose

1, 2, 3 Hepatic encephalopathy is a serious complication of end-stage liver disease that results from inadequate detoxification of ammonia from the blood. Symptoms include lethargy, confusion, and slurred speech; coma can occur if this condition remains untreated. ASTERIXIS, or flapping tremor of the hands when the arms are extended with the hands facing forward, may also be noted in the client with encephalopathy If encephalopathy continues to worsen, medical treatment should include higher doses of LACTULOSE and RIFAXIMIN, and discharge should be delayed until the client is stable Option 4: The client with lethargy and confusion is at risk for falling. Ambulation is not an appropriate intervention at this point Option 5: Lactulose is the primary drug used for hepatic encephalopathy treatment. It helps to excrete ammonia through the bowels as soft or loose stools

The nurse is reinforcing teaching about ulcer prevention with a client newly diagnosed with peptic ulcer disease. Which of the following client statements indicate appropriate understanding of teaching? Select all that apply 1. "I need to avoid taking medicines like ibuprofen without a prescription." 2. "I should avoid drinking excess coffee or cola." 3. "I should enroll in a smoking cessation program." 4. "I should reduce or eliminate my intake of alcoholic beverages." 5. "I will eliminate whole wheat foods, like breads and cereals, from my diet."

1, 2, 3, 4 Peptic ulcer disease is characterized by ulceration of the protective layers (mucosa) of the esophagus, stomach, and/or duodenum. Mucosal "breaks" allow digestive enzymes and stomach acid to digest underlying tissues, leading to potential GI BLEEDING and PERFORATION Risk factors for PUD include H. Pylori infections, genetic predisposition, chronic NSAID (aspirin, ibuprofen, naproxen) use, stress, diet and lifestyle choices Nurses educating clients with PUD about ulcer prevention should focus on modifiable risk factors: -NSAIDs: Chronic use can damage the gastric mucosa and delay ulcer healing -Caffeine: Cola, tea, and coffee should be avoided as they stimulate stomach acid secretion -Smoking: Tobacco increases secretion of stomach acid and delays ulcer healing -Alcohol: Should be avoided as it stimulates stomach acid secretion and impairs ulcer healing -Meal timing: Eating multiple meals throughout the day or eating shortly before sleeping may actually worsen PUD by increasing stomach acid secretion

Which instructions should the nurse include when providing discharge teaching to a client with peptic ulcer disease due to Helicobacter pylori infection? Select all that apply 1. "Avoid foods that may cause epigastric distress such as spicy or acidic foods" 2. "It is best if you refrain from consuming alcohol products" 3. "Report black tarry stools to your HCP immediately" 4. "Take your amoxicillin, clarithromycin, and omeprazole for the next 14 days" 5. "You may take OTC drugs such as aspirin if you have mild epigastric pain"

1, 2, 3, 4 Discharge instructions for PUD include: Lifestyle modifications --> -Avoid spicy foods, acidic foods, black pepper -Avoid substances that may stimulate acid secretion and delay healing (NSAIDs, alcohol, caffeine, chocolate, tobacco) -Reduce stress and obtain sufficient rest Complications--> Call HCP if signs of these complications are present: -GI bleeding: Orthostatic hypotension, lightheadedness, dizziness, tachycardia, and melena/black stools -Perforation: increased epigastric pain, nausea, vomiting, fever Medications --> -Take prescribed triple-drug therapy to avoid relapse Client teaching related to PUD includes lifestyle changes (dietary modifications, stress reduction), PUD complications, and medication administration H. Pylori infection and treatment with NSAIDs are risk factors for complicated PUD H. Pylori treatment includes antibiotics and proton-pump inhibitors for acid suppression. The recommended initial treatment is 7-14 days of triple-drug therapy with omeprazole (Prilosec), amoxicillin, and clarithromycin (Biaxin) Option 5: Clients with PUD should AVOID NSAIDS as they inhibit prostaglandin synthesis, increase gastric secretion, and reduce the integrity of the mucosal barrier

The nurse is teaching about the importance of dietary fiber at a community health fair. Which health benefits of consuming a fiber-rich diet should the nurse include in the teaching plan? Select all that apply 1. Helps prevent colorectal cancer 2. Improves glycemic control 3. Promotes weight loss 4. Reduces risk of vascular disease 5. Regulates bowel movements

1, 2, 3, 4, 5 Dietary fiber is composed of indigestible complex carbohydrates that absorb and retain water which increases stool bulk and makes stool softer and easier to pass. Consuming a diet high in fiber-rich foods (fruits, veggies, legumes, whole grains) improves stool elimination, which helps prevent constipation and decreases the risk of colorectal cancer Fiber-rich foods tend to have a LOW GLYCEMIC LOAD (less sugar per serving) and are nutrient dense, yet they have lower caloric density. Clients may also experience increased satiety as fiber absorbs water and produces fullness. This may help reduce caloric intake, improve blood glucose control, and promote weight loss Fiber binds to cholesterol in the intestines, which REDUCES SERUM CHOLESTEROL levels by decreasing the amount of dietary cholesterol that enters the bloodstream. Decreasing serum cholesterol levels helps reduce vascular plaque buildup and atherosclerosis. A high intake of fiber-rich foods directly correlates with a reduced risk of vascular diseases, including coronary artery disease and stroke

The nurse cares for a client with ulcerative colitis who is having abdominal pain and > 10 bloody stools per day. Which of the following interventions should be included in the client's plan of care? Select all that apply 1. Administer prescribed analgesic medications as needed 2. Encourage the client to discuss feelings about illness 3. Initiate strict, hourly intake and output monitoring 4. Investigate the client's compliance with the medication regimen 5. Offer the client high-protein foods during meals and snacks

1, 2, 3, 4, 5 Ulcerative colitis is a chronic inflammatory bowel disease characterized by INFLAMMATION AND ULCERATION of the large intestine (colon) that results in abdominal pain, frequent bouts of BLOODY DIARRHEA, anorexia, and anemia. The nurse planning care for a client with UC should: -Manage pain: Intestinal inflammation often produces severe abdominal pain that limits treatment compliance. Provide prescribed analgesics to promote comfort and treatment adherence -Address psychosocial needs: Chronic illness may increase the risk of hopelessness and or depression due to prolonged treatment and frustration over lack of improvement or symptom control. Encourage clients to discuss emotions and feelings -Assess fluid balance: Diarrhea, blood loss, and poor oral intake contribute to dehydration. Strict intake and output monitoring helps ensure adequate fluid intake and prevent dehydration -Evaluate treatment adherence: UC exacerbations may be spontaneous or may be precipitated by certain foods or lack of adherence to prescribed treatments. Assess compliance with prescribed treatments and provide education as needed to promote adherence -Promote nutrition: Pain after eating may lead to anorexia, and intestinal inflammation decreases nutrient absorption; both result in nutritional deficiency. Help client select nutrient-dense, HIGH-PROTEIN FOODS to promote and meet nutritional needs

The nurse is providing discharge teaching to a client newly diagnosed with ulcerative colitis. Which of the following statements by the client indicate that teaching has been effective? Select all that apply 1. "I need to eat a diet high in calories and protein so that I avoid losing weight" 2. "I need to take multivitamins containing calcium daily." 3. "I should avoid consuming alcoholic beverages." 4. "I should drink at least 2 liters of water daily and more when I have diarrhea." 5. "I will keep a symptom journal to note what I eat and drink during the day."

1, 2, 3, 4, 5 Ulcerative colitis is a form of IBD characterized by remitting periods of mucosal irritation in the large intestine, resulting in profuse, bloody diarrhea. Nutrition and hydration management: -Diets consisting of high calorie, high protein foods are recommended to prevent weight loss and muscle wasting -Multivitamins containing calcium are often prescribed to supplement nutrition -Oral hydration is critical in UC as >10 liquid stools may occur daily during flares, placing clients at risk for dehydration -Dietary triggers for UC vary between individuals and may include dairy, nuts/legumes, cereal, alcohol, caffeine, and fatty and processed foods. Diet journaling is recommended to assist with identifying triggers

The nurse is teaching a client with newly diagnosed lactase deficiency about dietary management. Which statements by the client indicate a correct understanding of this condition? Select all that apply 1. "I can still eat cheese and yogurt as long as they don't make me feel sick" 2. I should take a daily calcium and vitamin D supplement 3. "Most dairy products should eliminated from my diet, but ice cream is okay" 4. "My lactase enzyme supplement should be taken with meals containing dairy" 5. "This means that I have developed an allergy to milk"

1, 2, 4 Clients with lactase deficiency (lactose intolerance) experience varying degrees of GI symptoms after ingesting milk products, including flatulence, diarrhea, bloating, and cramping. This is due to a deficiency of the enzyme lactase, which is required for digestion of lactose. Treatment includes RESTRICTING LACTOSE-CONTAINING FOODS in the diet. These clients may also take LACTASE ENZYME REPLACEMENTS (Lactaid) to decrease symptoms. Supplementation of CALCIUM AND VITAMIN D is recommended due to insufficient intake of fortified milk Milk and ice cream contain the highest amounts of lactose and should be restricted depending on the client's individual tolerance. Some dairy products, including aged cheeses and live-culture yogurts, contain little to no lactose and can be tolerated by most clients with lactase deficiency Option 5: Lactase deficiency is not an immune reaction (allergy) to milk products. Rather the GI symptoms are due to a deficiency of the enzyme lactase and the resultant inability to digest lactose

A client with a history of diverticular disease is being discharged after an episode of acute diverticulitis. Which instructions should be included in the discharge teaching plan to reduce the risk of future episodes? Select all that apply 1. Drink plenty of fluids 2. Exercise regularly 3. Follow a low-residue diet 4. Include whole grains, fruits, and vegetables in the diet 5. Increase intake of red meat

1, 2, 4 Preventing constipation may help reduce the risk of diverticula forming and becoming inflamed Measures to prevent constipation include a diet high in fiber, daily intake of at least 8 glasses of water or other fluids, and exercise. A fiber supplement such as psyllium or bran may be advised. Option 3: A low-residue diet, which avoids all high fiber foods, may be used in treating acute diverticulitis. However, after symptoms have resolved, a high-fiber diet is resumed to prevent future episodes

A client diagnosed with cirrhosis is experiencing pruritus. Which strategies are appropriate for the nurse to teach the client to promote comfort and skin integrity? Select all that apply 1. Apply cool, moist washcloths to the affected areas 2. Keep the fingernails trimmed short to minimize skin scratching 3. Take a hot bath or shower to alleviate itching sensations 4. Use skin protectant or moisturizing cream over unbroken skin 5. Wear cotton gloves or long-sleeved clothing to avoid scratching

1, 2, 4, 5 A client with cirrhosis may experience pruritus due to buildup of bile salts beneath the skin. Clients with cirrhosis are also at an increased risk for skin breakdown due to the development of edema Cholestyramine (Questran) may be prescribed to increase the excretion of bile salts in feces, thereby decreasing pruritus. It is packaged in powered form, must be mixed with food (applesauce) or juice (apple juice) and should be given 1 HOUR AFTER ALL OTHER MEDICATIONS Option 3: Temperature extremes (hot showers) may intensify pruritus

A nurse is precepting a new graduate nurse who is caring for a client with a paralytic ileus and a Salem sump tube attached to continuous suction. The preceptor should intervene when the graduate nurse performs which interventions? Select all that apply 1. Checks for residual every 4 hours 2. Places client in semi-Fowler's position 3. Plugs the air vent if gastric content refluxes 4. Provides mouth care every 4 hours 5. Turns off suction when auscultating bowel sounds

1, 3 CONTINUOUS SUCTION can be applied to decompress the stomach if a double lumen Salem sump tube is in place. The larger lumen is attached to suction and the smaller lumen (within the larger one) is open to the atmosphere Checking for residual volume is not an appropriate intervention because the Salem sump is attached to continuous suction for decompression and is not being used to administer enteral feeding The AIR VENT MUST REMAIN OPEN as it provides a continuous flow of atmospheric air through the drainage tube at its distal end (to prevent excessive suction force). This prevents damage to the gastric mucosa. If gastric content refluxes, 10-20 mL of air can be injected into the air vent. However, the air vent is kept above the level of the client's stomach to prevent reflux General interventions to maintain gastric suction using a Salem sump tube include: -Place the client in SEMI FOWLER'S POSITION to help keep the tube from lying against the stomach wall; this is done to prevent gastric reflux -Provide MOUTH CARE EVERY 4 HOURS as this helps to maintain moisture of oral mucosa and promote comfort -TURN OFF SUCTION BRIEFLY DURING AUSCULTATION as the suction sound can be mistaken for bowel sounds -Inspect the drainage system for patency

The nurse is caring for a client with acute diverticulitis who has nausea, vomiting, and rates pain as 8 on a scale of 0-10. Which of the following interventions should be included in the plan of care? Select all that apply 1. Administer morphine as prescribed for pain 2. Insert a rectal tube to protect the client's skin from diarrhea 3. Instruct the client to avoid straining 4. Maintain NPO status 5. Start IV infusion of normal saline

1, 3, 4, 5 Diverticulosis is a condition in which saclike protrusions develop in the large intestine, caused by increased intraabdominal pressure (straining, lifting, tight clothing) and/or chronic constipation. When diverticula become infected and inflamed, the individual has diverticulitis Acute care for diverticulitis focuses on allowing the colon to rest and the inflammation to resolve. This includes: -NPO status: More acute cases require complete rest of the bowel; less severe cases may be handled at home, and clients may tolerate a low-fiber or clear liquid diet -IV fluids to prevent dehydration when NPO -Pain relief with IV medications to maintain NPO status -Preventing increased intraabdominal pressure (straining, coughing, lifting) to avoid perforation and rupture -Preventing increased intestinal motility by avoiding laxatives and enemas

A client admitted 3 days ago with upper gastrointestinal bleeding underwent an endoscopic procedure to stop the bleeding. The client is started on a clear liquid diet today. Which foods are appropriate for the nurse to offer the client? Select all that apply 1. Apple juice 2. Cherry popsicle 3. Chicken broth 4. Frozen yogurt 5. Unsweetened tea 6. Vanilla ice cream

1, 3, 5 A client recovering from abdominal surgery first consumes ice chips after demonstrating adequate bowel function (return of bowel sounds and passing flatus). After ice chips, postoperative diet progression continues to clear liquids, full liquids, soft diet, and then regular diet Unsweetened tea, chicken broth, and apple juice are appropriate food choices for a client on a clear liquid diet Option 2: Popsicles are part of clear liquid diet. However, RED DYES IN CLEAR LIQUIDS should not be given to clients with RECENT GI BLEEDING. If a client vomits, the vomitus may appear red and falsely lead the nurse to believe that the client is bleeding. It is important to implement prudent nursing judgement and fully consider the client's condition when making care decisions; for this client, a green or yellow popsicle would be more appropriate Options 4 and 6: Frozen yogurt and vanilla ice cream are appropriate food choices for a client on a full liquid diet

The nurse is reinforcing discharge instructions with a client following a partial gastrectomy. Which of the following instructions should the nurse include to prevent dumping syndrome? Select all that apply 1. Add high protein foods to diet 2. Consume high carbohydrate meals 3. Eat small, frequent meals 4. Increase intake of fluids with meals 5. Lie down after eating

1, 3, 5 Following a partial gastrectomy, many clients experience dumping syndrome, which occurs when gastric contents empty too rapidly into the duodenum, causing a fluid shift into the small intestine. This results in HYPOTENSION, abdominal pain, N/V, dizziness, generalized SWEATING and TACHYCARDIA. The symptoms usually diminish over time Recommendations to delay gastric emptying include: -Consume meals HIGH IN FAT, PROTEIN, and fiber, which take more time to digest and remain in the stomach longer than carbohydrates. -Avoid consuming FLUIDS WITH MEALS because this causes stomach contents to pass faster into the jejunum, which worsens symptoms. Fluid intake should occur up to 30 minutes before or after meals -Slowly consume SMALL, FREQUENT MEALS to reduce the amount of food in the stomach -AVOID MEALS HIGH IN SIMPLE CARBS (sugar, syrup) because these may trigger symptoms when the carbs break down into simple sugars -Avoid sitting up after a meal because gravity increases gastric emptying. Instead, lying down after meals in encouraged

The clinic nurse educator is developing a teaching plan for the following 6 clients. The nurse should instruct which client to avoid the Valsalva maneuver when defecating? Select all that apply 1. 22 year old man with a head injury sustained during a college football game 2. 30 year old woman recently hospitalized for reconstructive augmentation mammoplasty 3. 56 year old man two weeks post myocardial infarction 4. 68 year old woman recently diagnosed with pancreatic cancer 5. 74 year old man with portal hypertension related to alcohol-induced cirrhosis 6. 82 year old woman 1 week post cataract surgery

1, 3, 5, 6 The Valsalva maneuver (straining during defecation) involves holding the breath while bearing down on the perineum to pass a stool. Straining to have a bowel movement is to be avoided in clients recently diagnosed with increased ICP, stroke, or head injury as straining increases intra-abdominal and intra-thoracic pressure, which raises the intracranial pressure The vagus nerve is stimulated when bearing down; this temporarily slows the heart and decreases cardiac output, leading to potential cardiac complications in clients with heart disease Straining increases intra-abdominal and intra-thoracic pressure and should be avoided in clients diagnosed with portal HTN related to cirrhosis due to the risk of variceal bleeding The maneuver increases intraocular pressure and is contraindicated in clients with glaucoma and recent eye surgery Option 2: The otherwise healthy client recovering from reconstructive augmentation mammoplasty is not at risk for complications related to the Valsalva maneuver Option 4: The client recently diagnosed with pancreatic cancer is not at risk for complications related to the Valsalva maneuver

A healthy 50 year old client asks the nurse, "What must I do in preparation for my screening colonoscopy?" Which statements by the nurse correctly answer the client's questions? Select all that apply 1. "No food or drink is allowed 8 hours prior to the test." 2. "Prophylactic antibiotics are taken as prescribed." 3. "Smoking must be avoided after midnight." 4. "The day prior to the procedure your diet will be clear liquids." 5. "You will drink polyethylene glycol as directed the day before."

1, 4, 5 Colonoscopy evaluates colonic mucosa. Therefore, clients should follow instructions to keep the colon clean with no stool left for better visualization during the procedure. These instructions include: 1. Clear liquid diet the day before 2. Nothing by mouth 8-12 hours prior to the exam 3. The HCP prescribes a bowel-cleansing agent such as a cathartic, enema, or polyethylene glycol the day before the test Option 3: The instructions prior to a nuclear gastric emptying scan include teaching the client to avoid smoking the day of the exam as delay of gastric emptying occurs with tobacco use

The nurse is caring for a client with a balloon tamponade tube in place due to bleeding esophageal varices. The client suddenly develops respiratory distress, and the nurse finds that the tube has been partially pulled out. Which intervention should be the nurse's priority? 1. Contact the HCP 2. Cut the tube with scissors 3. Increase gastric suction level 4. Place the client in high Fowlers position

2 A balloon tamponade tube (Sengstaken-Blakemroe, Minnesota) is used to temporarily control bleeding from esophageal varices. Airway obstruction can occur if the balloon tamponade tube becomes displaced and a balloon migrates into the oropharynx. SCISSORS ARE KEPT AT THE BEDSIDE as a precaution; in the event of airway obstruction, the nurse can emergently cut the tube for rapid balloon deflation and tube removal

The RN is developing a nursing care plan for a client who has just undergone surgery for treatment of ulcerative colitis with the creation of a permanent ileostomy. What is the priority outcome for this client? 1. The client will contact the United Ostomy Association of America 2. The client will look at and touch the stoma 3. The client will read the materials provided on ostomy care 4. The client will verbalize methods to control gas and odor

2 A client who has undergone ostomy surgery must become independent in self-care. This requires adaptation to a significant alteration in body image and dealing with a number of psychosocial issues that are associated with a change in appearance and the loss of bowel control. It is not uncommon for a client to cope with this loss by refusing to look at or participate in the care of the stoma

During the immediate postoperative period after a colostomy, which stoma appearance requires the nurse to contact the HCP immediately? 1. Brick red with slight moisture noted 2. Dusky with moderate edema present 3. Pink with slight oozing of blood 4. Rosy with no stool produced

2 A colostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall for the passage of stool to bypass an obstructed or diseased portion of the colon. The stoma should be pink to brick red, indicating vascularity and viability. Minor bleeding and oozing may occur, and mild swelling is normal for 2-3 weeks after surgery. In the immediate post op period, stool will be absent. Option 2: Inadequate blood supply can cause a change in the stoma color. Indications of poor vascularity include pale, dusky, or cyanotic color changes, any of which requires immediate notification of the HCP and surgical intervention to prevent ischemia and necrosis

A client tells the nurse of wanting to lose 20 lbs in time for the client's daughter's wedding, which is 16 weeks away. How many calories will the client have to eliminate from the diet each day to meet this goal? 1. 450 kcal/day 2. 625 kcal/day 3. 860 kcal/day 4. 1,000 kcal/day

2 A reduction or energy expenditure of 3,500 calories will result in a weight loss of 1 lb. To lose 20 lbs, the client needs to reduce intake by a total of 70,000 kcal. (3500 kcal x 20lb= 70,000). Over a period of 16 weeks, this would require a daily reduction of: 625 kcal (70,000 kcal/[16 weeks x 7 days]= 625 kcal/day)

The HCP orders a small bowel follow-through (SBFT) for a client. Which instructions should the nurse include when teaching the client about this test? 1. "After the test, you may notice your stools are tarry black for a few days" 2. "During the test, a series of x-rays will be taken to assess the function of the small bowel" 3. "The HCP will use an endoscope to visualize your small bowel." 4. "Your examination is scheduled for 8am. Please drink all of the polyethylene glycol by midnight."

2 An SBFT examines the anatomy and function of the small intestine using x-ray images taken in succession. Barium is ingested, and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestine. Using this technique, decreased motility (ileus), increased motility (malabsorption syndromes), fistulas, or obstructions are identified Clients should be instructed as follows: -Fast 8 hours prior to the exam -The test usually takes 60-120 min, but if obstruction or decreased motility is present, it can take longer -Drink plenty of fluids after the examination to facilitate barium removal. CHALKY STOOLS may be present 24-72 hours after the exam. If brown stools do not return after 72 hours or abdominal pain or fullness is present, contact the HCP

The RN is supervising a graduate nurse providing postoperative teaching for a male client after an inguinal hernia repair. Which statement by the GN would cause the RN to intervene? 1. "Elevate your scrotum and apply an ice bag to reduce swelling." 2. "Practice coughing to clear secretions and prevent pneumonia." 3. "Stand up to use the urinal if you have difficulty voiding." 4. "Turn in bed and perform deep breathing every 2 hours."

2 An inguinal hernia is the protrusion of abdominal contents through the inguinal canal, which appear as a bulge in the lateral groin. Herniation occurs spontaneously or results from increased intraabdominal pressure (heavy lifting). Inguinal hernias occur most commonly in male clients and are usually repaired with minimally invasive surgery. If intestinal strangulation develops, the client requires emergency treatment to prevent bowel ischemia or perforation. Strangulation symptoms include abdominal distension, severe pain, N/V To prevent hernia reoccurrence after surgical repair, the client is taught to AVOID ACTIVITIES THAT INCREASE INTRAABDOMINAL PRESSURE (coughing, heaving lifting) FOR 6-8 WEEKS. If sneezing or coughing are unavoidable, the client should splint incisions and keep the mouth open while sneezing

The nurse is providing postoperative care to a client returning from a hemorrhoidectomy. Which action is the priority for the nurse to perform? 1. Administer docusate and teach the client to avoid straining during defecation 2. Give pain medications and instructions related to pain control 3. Remove the rectal dressing and check the client for bleeding 4. Teach the client how to self-administer a sitz bath 2-3 times daily

2 Hemorrhoids are caused by INCREASED ANORECTAL PRESSURE (straining to defecate, constipation). Clients may experience symptoms such as rectal bleeding, pain, pruritus, and prolapse. Although removal of hemorrhoids is a minor procedure, the pain associated with it is due to SPASMS OF THE ANAL SPHINCTER and is SEVERE Nursing management for the post-hemorrhoidectomy client includes the following: -PAIN RELIEF: Initially, pain is managed with medications including NSAIDS and/or acetaminophen; opioids can be prescribed initially but may worsen constipation. Beginning 1-2 days post op, warm sitz baths are used as a means to relieve pain. Clients often dread their first bowel movement due to severe pain. Therefore, pain must be appropriately controlled to prevent further constipation -PREVENTING CONSTIPATION: Encourage a high-fiber diet and adequate fluid intake (at least 1500 mL/day). Administer a stool softener such as docusate (Colace) as prescribed. An oil-retention enema may be used if constipation persists for 2-3 days Option 3: Postoperatively, the HCP may pack the rectum and apply a T-binder to hold the packing in place. The dressing is usually removed 1-2 days post op unless excess soaking is noted before Option 4: Warm sitz baths are used beginning 1-2 days post op, 2-3 times daily (15-20 minutes each) for 7-10 days to provide pain relief, decrease swelling, and cleanse the rectal area

After performing a physical assessment and obtaining vital signs for a client immediately after a laparoscopic cholecystectomy, which nursing intervention is the priority? 1. Apply anti-embolism stockings 2. Assist with early ambulation 3. Offer stool softeners 4. Provide low fat foods

2 Postoperative nursing care after a laparoscopic cholecystectomy focuses on prevention of complications. Carbon dioxide is used to inflate and expand the abdominal cavity during laparoscopic procedures to allow insertion of surgical instruments and better visualization of the abdominal organs. CO2 can irritate the phrenic nerve and diaphragm, causing SHALLOW BREATHING and REFERRED PAIN TO THE RIGHT SHOULDER The nurse should assist the client with early ambulation and deep breathing to facilitate dissipation of the CO2 used during surgery. Early ambulation not only improves breathing but also decreases the risk of thromboembolism and stimulates peristalsis

The hospitalized client with anorexia nervosa is started on nutrition via enteral and parenteral routes. Which client assessment is the most important for the nurse to check during the first 24-48 hours of administration? 1. Serum albumin level and body weight 2. Serum potassium and phosphate 3. Symptoms of dumping syndrome 4. White blood cell count and neutrophils

2 Refeeding syndrome is a potentially fatal complication of nutritional rehabilitation in chronically malnourished clients (anorexia, chronic alcoholism). The client's lack of oral intake results in the pancreas making less insulin. After the client receives food or IV fluids with glucose, insulin secretion is increased, leading to phosphorus, potassium, and magnesium shifting intracellularly. PHOSPHORUS is the primary deficient electrolyte as it is required for energy (adenosine triphosphate). HYPOPHOSPHATEMIA causes muscle weakness and RESPIRATORY FAILURE. Deficiencies in potassium and magnesium potentiate cardiac arrhythmias. Therefore, aggressive initiation of nutrition without adequate electrolyte repletion can quickly precipitate cardiopulmonary failure Option 1: Daily weights and periodic serum albumin levels are indicated to evaluate the efficacy of nutritional replenishment but are not the most important assessment as failure to monitor these does not result in death Option 3: Dumping syndrome is seen after surgery for stomach cancer or bariatric surgery, which results in decreased storage area in the stomach. Eating concentrated carbohydrates or excess fluids causes the food to be "dumped"/emptied rapidly into the small intestine. Symptoms include diaphoresis, cramping, weakness, and diarrhea within 30 minutes of eating. Dumping syndrome is not seen with anorexia Option 4: The central lines carry a risk of infection. The signs of infection include leukocytosis and left shift. However, risk of infection is not greatest in the first few days of parenteral nutrition

A student nurse asks why enteral (tube) feedings, rather than total parenteral nutrition (TPN), are being administered to a client with sepsis and respiratory failure. Which is the best response by the RN? 1. "Enteral feedings have no complications" 2. "Enteral feedings maintain gut integrity and help prevent stress ulcers" 3. "Enteral feedings provide higher calorie content" 4. "Risk of hyperglycemia is lower with enteral feedings than with TPN"

2 Stress ulcers are a common complication in critically ill clients because the GI tract is not a preferential organ. In the presence of hypoxemia, blood is shunted to the more vital organs, increasing the risk of stress ulcers. The early initiation of enteral feedings helps preserve the function of the gut mucosa, limits movement of bacteria (translocation) from the intestines into the bloodstream, and prevents stress ulcers Enteral feedings are also associated with lower risk of infectious complications compared with TPN. However, the mortality is the same Option 1: Complications associated with enteral feedings include aspiration, tube displacement, hyperglycemia, diarrhea, abdominal distension, enteral tube misconnections, and clogged tubes Option 4: Illness-related stress hyperglycemia occurs in clients receiving both enteral feedings and TPN

A client is receiving an infusion of TPN with 20% dextrose through a central line at 75 mL/hr. The nurse responds to the client's IV pump alarm, which indicates that the bag is empty. The new bag is not expected to arrive from the pharmacy for an hour. What is the most appropriate nursing action? 1. Hang 0.9% NS until new bag arrives, then increase TPN to 150 mL/hr for 1 hour 2. Hang 10% dextrose in water until the new bag arrives, then resume TPN at 75mL/hr 3. Hang dextran in saline until the new bag arrives, then resume TPN at 75 mL/hr 4. Hang LR until the new bag arrives, then resume TPN at 75 mL/hr

2 TPN is administered via a central venous catheter to meet the nutritional needs (glucose, amino acids, vitamins, minerals) of clients who cannot digest nutrients via the GI tract. The nurse should hang 10% dextrose in water at the same infusion rate until the new bag arrives. If the 20% dextrose solution is temporarily replaced with an infusion lacking dextrose (NS, LR), the pancreas will continue to produce insulin in response to the residual glucose, which may cause hypoglycemia Option 1: The infusion of 0.9% NS without dextrose can lead to hypoglycemia. Rapid infusion (150mL/hr) of TPN can increase the risk for fluid overload and hyperglycemia. The nurse should never increase the rate of central TPN to make up for volume lost in previous hours Option 3: Dextran in saline solution is a colloid used to expand intravascular volume in clients with hypovolemia. It can cause fluid overload and so is not an appropriate action

The nurse asses a client with suspected acute pancreatitis and anticipates the client reporting pain in which anatomical area? 1. Left flank radiating to the left groin area 2. Left upper quadrant radiating to the back 3. Periumbilical area shifting to the right lower quadrant 4. Right upper quadrant radiating to the right shoulder

2 The client with acute pancreatitis will report a sudden onset of unrelenting, severe pain in the LEFT UPPER QUADRANT or MIDEPIGASTRIC area of the abdomen that often RADIATES TO THE BACK. The pain is referred to the back as the pancreas is a retroperitoneal organ. Pain improves with leaning forward and worsens when lying flat. The pain is often preceded or made worse by a high-fat meal. Nausea and vomiting are common due to severe pain. Clients are at risk of developing hypovolemia (third spacing of fluids), acute respiratory distress syndrome (due to intense systemic inflammatory response), and hypocalcemia (necrosed fat binding calcium) Option 1: Kidney stones cause sudden, excruciating pain in the flank, back, or lower abdomen due to stretching of the ureter. The pain radiates to the groin area Option 3: Appendicitis presents as periumbilical pain progressing to the right lower quadrant. Tenderness at McBurney's point is present as pressure is applied, and rebound tenderness occurs when pressure is released Option 4: Cholecystitis causes pain in the right upper quadrant that often radiates to the right shoulder area

A nurse is preparing a presentation about behavioral modifications to support weight loss for clients at an obesity clinic. Which of the following points should the nurse include in the teaching plan? Select all that apply 1. Avoid social gatherings that occur in restaurants or around meals 2. Create multiple small goals with rewards for achievement 3. Identify a list of desired outcomes not directly related to weight loss 4. Perform anxiety-reducing activities rather than using food to cope with stress 5. Utilize visual cues such as motivational quotes to encourage positive behavior

2, 3 ,4 , 5 Option 3: Developing health goals unrelated to weight (ex: climbing stairs without shortness of breath) to measure progress regardless of current weight Option 1: Avoiding social activities in a food setting promotes isolation and negative perceptions. Clients who struggle to make healthy choices in these settings should plan ahead for what will be eaten or bring a separate meal

The nurse is caring for a client with cirrhosis of the liver. Which blood test values would the nurse typically anticipate to be elevated when reviewing the client's morning laboratory results? Select all that apply 1. Albumin 2. Ammonia 3. Bilirubin 4. Prothrombin time 5. Sodium

2, 3, 4 Elevated bilirubin (jaundice) results from functional derangement of liver cells and compression of bile ducts by nodules. The liver has a decreased ability to conjugate and excrete bilirubin Most coagulation factors are produced in the liver. A cirrhotic liver cannot produce the factors essential for blood clotting. As a result, coagulation studies (PT/INR and aPTT) are usually elevated Ammonia from intestinal deamination of amino acids normally goes to the liver and is converted to urea and excreted by the kidney. This does not happen in cirrhosis. Instead, the ammonia level rises as the cirrhosis progresses; ammonia crosses the blood-brain barrier and results in hepatic encephalopathy Albumin holds water inside the blood vessels. In cirrhosis, the liver is unable to synthesize albumin, so hypoalbuminemia would be expected. This is the primary reason that fluid leaks out of vascular spaces into interstitial space (edema, ascites). The kidneys perceive this as low perfusion and try to conserve both sodium and water. The large amount of water in the body results in dilutional effect (low sodium)

The nurse is reinforcing strategies to manage symptoms for a client with irritable bowel syndrome. Which of the following instructions should the nurse include? Select all that apply 1. Consume only clear liquids with severe symptoms 2. Keep a record of symptoms, diet, and stress levels 3. Limit dietary intake of gas-producing foods like legumes 4. Perform aerobic exercise at least three times weekly 5. Reduce the amount of caffeine consumed each day

2, 3, 4, 5 IBS is a chronic GI disorder characterized by abdominal pain and altered bowel motility (constipation, diarrhea, or a combination of both). Clients with IBS also commonly experience bloating, nausea, urgency, and flatulence. Symptoms are often managed through lifestyle and diet modifications. Appropriate management strategies include: -Keep a daily record of symptoms, dietary intake, and stress level to help identify IBS triggers -Limit intake of gas-producing foods such as legumes (beans), cruciferous veggies (cabbage, broccoli) and foods containing fructose (honey, apples)

The nurse is caring for a client with right upper quadrant pain and jaundice. The client's ALT/AST levels are 7 times the normal values. What questions would be most helpful regarding the etiology for these findings? Select all that apply. 1. Do you have black tarry stool? 2. Do you use IV illicit drugs? 3. How much alcohol do you typically drink? 4. Were you recently immunized for pneumonia? 5. What OTC drugs do you take?

2, 3, 5 ALT/AST are the enzymes released when hepatic cells are injured (hepatitis). There are smaller amounts in the cardiac, renal, and skeletal tissues, but ALT/AST are used to diagnose hepatic disorders. Besides viral hepatitis, liver injury can occur with excessive chronic alcohol intake, some OTC meds (tylenol), and certain herbal and dietary supplements. IV illicit drug use increases the risk for hepatitis B and C infection Option 1: Black tarry stool (melena) is an expected finding from a gastrointestinal bleed. Melena can be seen in clients with gastric or esophageal varices, which are often complications of hepatic disease. However, melena is not an etiology of liver injury.

The nurse is caring for a debilitated client with a PEG tube that was inserted 3 days ago for the long-term administration of enteral feedings and medications. While the nurse is preparing to administer the feeding, the tube becomes dislodged. What is the most appropriate intervention? 1. Insert a Foley catheter into the existing tract and inflate the balloon 2. Insert a small-bore nasointestinal tube to administer feedings and medications 3. Notify the HCP who inserted the PEG tube 4. Reinsert the PEG tube into the existing tract immediately 3

3 A PEG is a minimally invasive procedure performed under conscious sedation. Using endoscopy, a gastrostomy tube is inserted through the esophagus into the stomach and then pulled through an incision made in the abdominal wall. To keep it secured, the PEG tube has an outer bumper and an inner balloon or bumper The tube's tract begins to mature in 1-2 weeks and is NOT FULLY ESTABLISHED UNTIL 4-6 WEEKS. It begins to close within hours of tube dislodgement. The nurse should NOTIFY THE HCP who placed the PEG tube as early dislodgement (<7 days from placement) requires either surgical or endoscopic replacement Option 1 and 4: The insertion of a Foley catheter or immediate reinsertion of the PEG tube should not be attempted because the tube's tract is only 3 days old (immature). A reinserted tube could be placed inadvertently into the peritoneal cavity, leading to serious consequences such as peritonitis and sepsis Option 2: Small-bore nasointestinal tubes are used for short term rather than long term administration of enteral feedings. They are prone to clogging from enteral feedings, undissolved medications, and inadequate tube flushes. They can also kink, coil, and become dislodged by coughing and may require frequent reinsertion

The nurse is caring for a client who has undergone a colonoscopy. Which client assessment finding should most concern the nurse? 1. Abdominal cramping 2. Frequent, watery stools 3. Positive rebound tenderness 4. Recurring flatus

3 A risk of a colonoscopy is perforation. Signs of perforation include abdominal pain (with shoulder tip pain), positive rebound tenderness, guarding, abdominal distension, tenesmus, and/or boardlike (rigid) abdomen. Another potential complication is rectal bleeding Option 1: Abdominal cramping post procedure is an expected finding. It is caused by the stimulation of peristalsis as the bowel is constantly inflated with air during the procedure Option 2: The preparation for the procedure, emptying the colon of stool, includes clear liquids, cathartics, and/or enemas. The stool is watery and copious and may continue for a short time after the procedure Option 4: During the procedure, air is inflated into the colon. The client needs to expel this gas afterward

The nurse receives new prescriptions for a client with right lower quadrant pain and suspected acute appendicitis. Which prescription should the nurse implement first? 1. Administer 0.25 mg hydromorphone IV push for pain 2. Draw blood for complete blood count and electrolyte levels 3. Initiate IV access and infuse normal saline 100 mL/hr 4. Obtain urine specimen for urinalysis

3 Appendicitis is inflammation of the appendix and often results from obstruction by fecal matter. Appendiceal obstruction traps fluid and mucus typically secreted into the colon, causing increased intraluminal pressure and inflammation. As appendiceal intraluminal pressure and inflammation increase, blood circulation to the appendix is impaired, resulting in swelling and ischemia. These factors increase the risk for appendiceal PERFORATION, a medical emergency, which may lead to PERITONITIS AND SEPSIS Fluid resuscitation with IV crystalloids (normal saline, LR) is an important intervention at PREVENTING CIRCULATORY COLLAPSE resulting from fluid losses (vomiting, diarrhea) and NPO status

Which group of food selections would be the best choice for a client advancing to a full liquid diet 3 days after bariatric surgery? 1. Apple juice, mashed potatoes, chocolate pudding 2. Chicken broth, low-fat cheese omelet, strawberry ice cream 3. Creamy wheat cereal, blended cream of chicken soup, protein shake 4. Low-fat vanilla yogurt, smooth peanut butter, vegetable juice

3 Bariatric surgery reduces stomach capacity. A client's bariatric postoperative diet is restricted to foods that are LOW IN SIMPLE CARBOHYDRATES and high in nutrients (protein, fiber). After gastric surgery, consumption of simple carbs can lead to DUMPING SYNDROME The client will tolerate only small meals of clear liquids at first, advance to full liquids 24-48 hours after surgery, and then progress gradually to solid foods as the GI tract heals. Small, frequent meals are recommended to avoid overstretching of the pouch and to prevent nausea, vomiting, and regurgitation. The best food choices for a bariatric full liquid diet are cream soups, refined cooked cereals, sugar-free drinks, and low-sugar protein shakes and dairy foods Option 1: Fruit juices and puddings are high in sugar and not acceptable for a bariatric full liquid diet. Mashed potatoes are considered appropriate for a soft diet Option 4: Yogurt is high in sugar and not appropriate for a bariatric full liquid diet. Peanut butter and vegetable juice are appropriate for a soft diet

The nurse administers lactulose to a client diagnosed with cirrhosis and hepatic encephalopathy. Which nursing action is inappropriate when administering this medication? 1. Assess mental status and orientation 2. Give on an empty stomach for rapid effect 3. Hold if 3 soft stools occur in a day 4. Mix with fruit juice to improve flavor

3 Hepatic encephalopathy is a reversible neurological complication of cirrhosis caused primarily by INCREASED AMMONIA LEVELS in the blood. Normally, ammonia created in the intestines is converted to urea in the liver and excreted in the kidneys. However, in the presence of liver damage, blood is shunted around the liver portal system and ammonia is able to cross the blood-brain barrier, leading to neurological dysfunction Lactulose can be given orally with water, juice, or milk (to improve flavor) or it can be administered via enema. For faster results, it can be administered on an empty stomach The desired therapeutic effect of lactulose is the production of 2-3 SOFT BOWEL MOVEMENTS EACH DAY; therefore, the dose is titrated until the therapeutic effect is achieved. This therapeutic dose should not be held but instead should be maintained until the desired outcomes are reached (improved mental status, decreased ammonia levels). The client's electrolyte levels should be closely monitored during therapy as lactulose is a laxative that can cause dehydration, hypernatremia, and hypokalemia

The nurse provides discharge instructions to a client with cirrhosis who has portal hypertension, ascites, and esophageal varices. Which statement by the client indicates that the teaching was effective? 1. "I may have one alcoholic drink a day, but no more" 2. "I may take aspirin instead of acetaminophen for fever or pain" 3. "I should avoid straining while having a bowel movement" 4. "I should eat a protein- and sodium- restricted diet"

3 Instructions for client with cirrhosis: Dietary changes --> -Abstain from alcohol -Eat a high calorie (3000 calories/day), high- carbohydrate, low fat, low-sodium diet -Do not totally restrict protein Medications --> -Avoid hepatotoxic medications (tylenol, statins) -Avoid aspirin and NSAIDs when portal HTN or varices are present because bleeding may occur Activity --> -Avoid activities that increase intra-abdominal pressure (straining, coughing, sneezing, vomiting, heavy lifting, wearing tight clothing) this may cause rupture of varices -Get adequate rest When to seek medical attention--> -Presence of blood when vomiting -Bloody or black, tarry stool -Altered mental status (encephalopathy)

A graduate nurse is caring for a client with acute appendicitis who is awaiting surgery. Which action by the GN would require the precepting nurse to intervene? 1. Administers morphine IV prn for pain 2. Initiates continuous normal saline IV 3. Provides a heating pad for abdominal discomfort 4. Teaches client about prescribed strict NPO status

3 Nurses caring for clients with appendicitis should avoid interventions that INCREASE INTESTINAL BLOOD CIRCULATION, gut motility, or appendiceal intraluminal pressure. The application of HEAT TO THE ABDOMEN (heating pad, warm blanket) increases intestinal circulation and the risk for appendiceal perforation Option 2: NPO status and vomiting contribute to dehydration, which frequently requires continuous IV fluids to maintain fluid and electrolyte balance Option 4: Food and drink increase gastric motility, thereby increasing circulation to the appendix and risk of perforation

The nurse assessing a client's pain would expect the client to make which statement when describing the abdominal pain associated with appendicitis? 1. "My pain is a burning sensation in my upper abdomen" 2. "My pain is an 8 out of 10 and on my left side below my belly button" 3. "My pain is excruciating in my lower abdomen above my right hip" 4. "My pain is intermittent in my abdomen and right shoulder"

3 The appendix is a blind pouch located at the junction of the ileum of the small intestine and the beginning of the large intestine (cecum). When infected or obstructed, the appendix becomes inflamed, causing acute appendicitis Signs and symptoms of acute appendicitis include the following: -Pain: Continuous; begins in the periumbilical region and then moves to the right lower quadrant centering at McBurney's point -GI symptoms: Anorexia, nausea, vomiting -Rebound tenderness and guarding Clients with acute appendicitis attempt to decrease pain by preventing increased intra-abdominal pressure (avoiding coughing, sneezing, deep inhalation) and lying still with the right leg flexed Option 1: Burning pain in the upper abdomen can be due to GASTRIC OR DUODENAL ULCERS. If the ulcers are located posteriorly, the client may experience back pain Option 2: Pain in the left lower quadrant is associated with DIVERTICULITIS. Other signs and symptoms include a palpable, tender abdominal mass and systemic symptoms of infection (fever, increased C-reactive protein, and leukocytosis with a left shift) Option 4: Pain and tenderness in the epigastric or right upper quadrant of the abdomen that is referred to the right scapula is associated with ACUTE CHOLECYSTITIS. Clients may also experience indigestion, nausea, vomiting, restlessness, and diaphoresis

A client with a 10 year history of unipolar major depression has relapsed and is now hospitalized. The client is currently on phenelzine and weighs 115 lb but weighed 150 lb 3 months prior to admission. Which foods would be the best for this client? 1. Crackers and cheddar cheese 2. Hard-boiled egg with tomatoes 3. Steamed fish and potatoes 4. Tortilla chips with avocado dip

3 The client needs a diet high in calories and protein to promote adequate nutrition and weight gain. In addition, the client has a diagnosis of depression and may have a low energy level; providing foods that are easier to chew and swallow may be better choices for promoting intake Foods that are protein and/or calorie dense include: -Whole milk and dairy products (milkshakes), fruit smoothies -Granola, muffins, biscuits -Potatoes with sour cream and butter -Meat, fish, eggs, dried beans, almond butter -Pasta/rice dishes with cream sauce Option 1: The client is taking phenelzine (Nardil), which is an MAOI. Foods high in tyramine (aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, avocados) need to be restricted to reduce the risk of hypertensive crisis

The nurse is assessing 4 clients in the emergency department. Which client should the nurse prioritize for care? 1. Client with liver cirrhosis and ascites who has increasing abdominal distension and needs therapeutic paracentesis 2. Client with new onset ascites from a suspected ovarian mass who needs paracentesis for diagnostic studies 3. Client with ulcerative colitis who has fever, bloody diarrhea, and abdominal distension and needs an abdominal ex-ray 4. Nursing home client with dementia who has stool impaction and abdominal distension and needs stool disimpaction

3 The client with ulcerative colitis who has abdominal distension, bloody diarrhea, and fever likely has toxic MEGACOLON. This is a common life-threatening complication of IBD and is seen more frequently in ulcerative colitis than in Crohn disease. Toxic megacolon can also be associated with C. diff infection Severe colonic inflammation causes release of inflammatory mediators and bacterial products which contribute to colonic smooth muscle paralysis. Rapid colonic distension ensues, thinning the intestinal wall and making prone to perforation.

An adult diagnosed with celiac disease 3 weeks ago was placed on a gluten-free diet. The client returns for ambulatory care follow-up, reports continuation of symptoms, and does not seem to be responding to therapy. Which is the best response by the nurse? 1. "I will refer you to the dietician." 2. "It should take about 6-8 weeks before you see improvement in your symptoms." 3. "Tell me what you had to eat yesterday." 4. "You must not be following your diet."

3 This client with celiac disease continues to have symptoms. An assessment of the client's food intake must be obtained to determine if it includes foods that contain gluten, a protein in Barley, Rye, Oats, and Wheat. The most common reason for non-responsiveness to a gluten-free diet in clients with celiac disease is that gluten has not been entirely eliminated from their food intake Option 2: Most people experience dramatic relief of GI symptoms within a few days of eliminating gluten from their diet

An 80 year old client has been hospitalized with pneumonia and malnutrition. Physical assessment findings include weakness and decreased muscle mass. Which finding best indicates that the client is responding to treatment? 1. Client consuming 90% of each meal 2. Serum albumin of 3.6 g/dL 3. Weight gain of 2lb in two weeks 4. White blood cell count of 15,000/mm

3 Weight gain is the best indicator that the client is responding to medical nutritional therapy Option 1: Consuming 90% of meals indicates that the client's appetite is good or improving but does not provide conclusive evidence of an improved nutritional status Option 2: Although a serum albumin level of 3.6g/dL is within the normal range of 3.5-5.0 g/dL, visceral protein stores are poor indicators of nutritional status in acute and chronic disease. During an inflammatory response (pneumonia), protein synthesis by the liver is decreased. Serum albumin has a long half-life, so laboratory levels may not reflect the change in nutritional status for over two weeks. Prealbumin has a half life of only 2 days and is quicker and more reliable than serum albumin as an indicator of acute change in nutritional status Option 4: A white blood cell count of 15,000 is elevated (normal: 4,000- 11,000) which indicates that the infection has not resolved

A client with ascites due to cirrhosis has increasing shortness of breath and abdominal pain. The HCP requests that the nurse prepare the client for a paracentesis. Which nursing actions would the nurse implement prior to the procedure? Select all that apply 1. Educate client about the procedure and obtain informed consent 2. Initiate NPO status 6 hours prior to the procedure 3. Obtain baseline vital signs, abdominal circumference, and weight 4. Place client in high fowler's position or as upright as possible 5. Request that the client empty the bladder

3, 4, 5 Paracentesis is performed to remove excess fluid from the abdominal cavity or to collect a specimen of ascitic fluid for diagnostic testing. Paracentesis is not a a permanent solution for ascites and is performed on if the client is experiencing impaired breathing or pain due to ascites Prior to a paracentesis, nursing actions include: -Verify that the client received necessary information to give consent and witness informed consent -Instruct the client to void to prevent puncturing the bladder -Assess the client's abdominal girth, weight and vital signs -Place the client in HIGH FOWLERS POSITION or as upright as possible Option 2: NPO status is not required for paracentesis, which is often performed at the bedside or in a HCP's office using only a local anesthetic

The nurse is developing teaching materials for a client diagnosed with ulcerative colitis. The client will receive sulfasalazine. Which of the following instructions are included in the discharge teaching plan? Select all that apply 1. Avoid small, frequent meals 2. Can have a cup of coffee with each meal 3. Eat a low-residue, high protein, high calorie diet 4. Increase fluid intake to at least 2000 mL/day 5. Medication should be continued even after the resolution of symptoms 6. Take daily vitamin and mineral supplements

3, 4, 5, 6 A low-residue, high protein, high calorie diet, along with daily vitamin and mineral supplements is encouraged to meet the nutritional and metabolic needs of the client with ulcerative colitis. The low-residue diet limits trauma to the inflamed colon and may lessen symptoms. Easily digested foods such as enriched breads, rice, pastas, cooked veggies, canned fruits, and tender meats are included in the diet. Raw fruits and veggies, whole grains, highly seasoned foods, fried foods, and alcohol are avoided Option 1: Small, frequent meals are encouraged to lessen the amount of fecal material present in the GI tract and to decrease stimulation Option 5: The prescribed sulfasalazine should be continued even when symptoms subside to prevent relapse. Because sulfasalazine hinders the absorption of folate, folic acid supplements are encouraged

When assessing a client with cholelithiasis and acute cholecystitis, which findings might the nurse note during the health history and physical examination? Select all that apply 1. Flank pain radiating to the groin 2. High-protein food ingestion before the onset of pain 3. Low-grade fever with chills 4. Pain at the umbilicus 5. Right upper quadrant pain radiating to the right shoulder

3, 5 Cardinal symptoms of acute cholecystitis from cholelithiasis include pain in the RUQ with referred pain to the right shoulder and scapula. Clients often report FATTY FOOD ingestion 1-3 hours before the initial onset of pain. Associated symptoms include low-grade fever, chills, nausea, vomiting, and anorexia During an acute attack, inflammation of the mucous lining and wall of the gallbladder occurs as a result of gallstone obstruction of the cystic bile duct. The inflammation and increased pressure in the gallbladder from the blocked bile duct results in Murphy's sign; palpation over the RUQ causes pain and inability to take a deep breath. Lab results show leukocytosis Option 1: Flank pain radiating to the groin is seen with kidney stones Option 4: Initial onset of pain at the umbilicus is seen with acute appendicitis

The clinic nurse provides teaching for a client scheduled for a barium enema the next day. Which statement by the client shows a need for further instruction? 1. "I can expect chalky white stool after the procedure." 2. "I cannot eat or drink 8 hours before the procedure." 3. "I may have abdominal cramping during the procedure." 4. "I will avoid laxatives after the procedure"

4 A barium enema, or lower GI series, uses fluoroscopy to visualize the colon outlined by contrast to detect POLYPS, ULCERS, TUMORS, and DIVERTICULA. This procedure is contraindicated for clients with acute diverticulitis as it may rupture inflamed diverticula and cause subsequent peritonitis Preprocedure instructions include: -Take a cathartic (magnesium citrate, polyethylene glycol) to empty stool from the colon -Follow a clear liquid diet the day before the procedure to aid in bowel preparation and to prevent dehydration; avoid red and purple liquids -Do not eat or drink anything 8 hours before the test -Expect to be placed in various positions during the procedure. You may experience abdominal cramping and an urge to defecate Postprocedure instructions include: -Expect the passage of chalky, white stool until all barium contrast has been expelled -Take a laxative to assist in expelling the barium. Retained barium can lead to fecal impaction -Drink plenty of fluids to promote hydration and eat a high-fiber diet to prevent constipation

A client comes to the clinic for a follow-up visit after a Billroth II surgery (gastrojejunostomy). The client reports occasional episodes of sweating, palpitations, and dizziness 30 minutes after eating. Which nursing action is most appropriate? 1. Check serum blood glucose for hypoglycemia 2. Ensure that the client consumes fluids with meals 3. Take the client's blood pressure while lying and standing 4. Teach the client to lie down after eating

4 Billroth II surgery removes part of the stomach and shortens the upper GI tract. After a partial gastrectomy, many clients experience dumping syndrome. This results in HYPOTENSION, abdominal pain, N/V, dizziness, generalized sweating, and tachycardia To reduce the occurrence of symptoms, clients should AVOID FLUIDS WITH MEALS and LIE DOWN AFTER EATING to slow gastric emptying

The nurse is evaluating a client with liver cirrhosis who received IV albumin after a paracentesis to drain ascites. Which assessment finding indicates that the albumin has been effective? 1. Abdominal circumference reduced from admission recording 2. Flapping tremor no longer visible with arm extension 3. Shortness of breath no longer experienced in supine position 4. Vital signs remain within the client's normal parameters

4 Clients undergoing paracentesis must be monitored closely for HYPOTENSION as changes in abdominal pressure often result in systemic vasodilation Clients may receive IV albumin (a colloid) after paracentesis, which increases intravascular oncotic pressure resulting in increased intravascular fluid volume. Albumin administration prevents hypotension and tachycardia by mitigating hemodynamic changes associated with paracentesis

The nurse is caring for a client with acute pancreatitis admitted 2 days ago. Which assessment finding is most concerning? 1. Blood glucose levels for the past 24 hours are >250 mg/dL 2. Client is lying with knees drawn up to the abdomen to alleviate pain 3. Five large, liquid stools that are yellow and foul-smelling 4. Temperature of 102.2 F with increasing abdominal pain

4 Clients with acute pancreatitis are at risk for pancreatic abscess development. This mainly results from secondary infection of pancreatic pseudocysts or pancreatic necrosis. HIGH FEVER, LEUKOCYTOSIS, and increasing abdominal pain may indicate abscess formation. The HCP should be notified immediately as antibiotic therapy and immediate surgical management may be required Option 1: Elevated blood glucose is an expected finding in clients with pancreatitis. Elevated blood glucose is associated with pancreatic dysfunction and may necessitate insulin administration, but this is not the most concerning finding Option 3: The client with pancreatitis may develop steatorrhea (fatty, yellow, foul-smelling stools) due to a decrease in lipase production

The nurse is reinforcing teaching to a client with a hiatal hernia. Which statement by the client indicates that further teaching is needed? 1. "I need to raise the head of my bed on blocks by at least 6 inches." 2. "I will remain sitting up for several hours after I eat any food." 3. "If my reflux and abdominal pain don't improve, I might need surgery." 4. "Losing weight may reduce my reflux, so I plan to take a weight-lifting class."

4 Hiatal hernia is a group of medical conditions characterized by ABNORMAL MOVEMENT OF THE STOMACH and/or esophagogastric junction into the chest due to a WEAKNESS IN THE DIAPHRAGM. Although hiatal hernias may be asymptomatic, many people experience heartburn, chest pain, dysphagia, and shortness of breath when the abdominal organs move into the chest Symptoms of hiatal hernias are often exacerbated by INCREASED ABDOMINAL PRESSURE, which promotes upward movement of the abdominal organs. Clients with hiatal hernias who are obese are often encouraged to lose excess weight by performing light activities (short walks) because obesity increases abdominal pressure. However, nurses should teach clients to avoid activities that promote straining (weight lifting) Option 3: If symptoms of hiatal hernias are uncontrolled with home management (weight loss, diet modification, positioning after meals), surgical revision of the diaphragm may be required to prevent organ movement

The nurse prepares to assess a newly admitted client diagnosed with chronic alcohol abuse whose laboratory report shows a magnesium level of 1.0mEq/L. Which assessment finding does the nurse anticipate? 1. Constipation and polyuria 2. Increased thirst and dry mucous membranes 3. Leg weakness and soft, flabby muscles 4. Tremors and brisk deep tendon reflexes

4 Hypomagnesemia, a low blood magnesium level (normal 1.5-2.5) is associated with alcohol abuse due to poor absorption, inadequate nutritional intake, and increased losses via the GI and renal systems. It is associated with 2 major issues: 1. Ventricular arrhythmias (torsades de pointes): This is the most serious concern 2. Neuromuscular excitability: manifestations of low magnesium, similar to those found in hypocalcemia and demonstrated by neuromuscular excitability, include tremors, hyperactive reflexes, positive Trousseau and Chvostek signs, and seizures Option 1: Constipation and polyuria indicate hypercalcemia. Calcium has a diuretic effect Option 2: Increased thirst with dry mucous membranes indicate hypernatremia Option 3: Hypokalemia results in muscle weakness/paralysis and soft, flabby muscles. Paralytic ileus (abdominal distension, decreased bowel sounds) is also common with hypokalemia. However, the most serious complication is cardiac arrhythmias

The nurse is admitting a client with cholelithiasis and acute cholecystitis. Suddenly, the client vomits 250mL of greenish-yellow stomach contents and reports severe pain in the right upper quadrant with radiation to the right shoulder. Which intervention would have the highest priority? 1. Administer promethazine 25 mg suppository 2. Infuse normal saline 100mL/hr 3. Insert NG tube to low suction 4. Maintain NPO status

4 The highest priority intervention for an actively vomiting client with cholelithiasis is maintenance of strict NPO status to avoid additional gallbladder stimulation. Option 1: Promethazine 25mg suppository is the second priority. Promethazine promotes the relief of nausea and vomiting Option 2: Obtaining fluid and electrolyte replacement with sodium chloride 100mL/hr is the third priority Option 3: Insertion of an NG tube to low suction is the fourth priority. NG suction provides gastric decompression, alleviates N/V, and promotes bowel rest