Med Surge Ch 27-30

The nurse's instruction to the patient for peristomal skin care should include: (Select all that apply.) 1. gently remove faceplate of appliance to avoid skin irritation. 2. wash peristomal area vigorously to rid skin of fecal waste. 3. rinse area thoroughly. 4. dry skin with hair dryer set on low heat. 5. apply skin barrier to peristomal area. 6. cut faceplate to allow a -inch opening around stoma.

1. gently remove faceplate of appliance to avoid skin irritation. 3. rinse area thoroughly. 4. dry skin with hair dryer set on low heat. 5. apply skin barrier to peristomal area.

The nurse lists the contributing factors to developing a hernia, which include: (Select all that apply.) 1. heavy lifting. 2. chronic cough. 3. straining at stool. 4. ascites. 5. strenuous sexual activity.

1. heavy lifting. 2. chronic cough. 3. straining at stool. 4. ascites.

The nurse explains that conservative treatment of diverticulosis includes: (Select all that apply.) 1. high-fiber diet. 2. increased fluids. 3. stool softeners. 4. NSAIDs for discomfort. 5. bulk laxatives.

1. high-fiber diet. 2. increased fluids. 3. stool softeners. 4. NSAIDs for discomfort. 5. bulk laxatives.

The nurse preparing a teaching plan for the 20-year-old female who is taking sulfasalazine (Azulfidine) for Crohn's disease will include that this drug will: (Select all that apply.) 1. make the patient photosensitive. 2. interfere with effectiveness of oral contraceptives. 3. increase the effect of hypoglycemic agents. 4. turn the urine orange. 5. cause GI upset.

1. make the patient photosensitive. 2. interfere with effectiveness of oral contraceptives. 3. increase the effect of hypoglycemic agents. 4. turn the urine orange. 5. cause GI upset.

The nursing care of a patient with inflammatory bowel disease (IBS) will include: (Select all that apply.) 1. measurement of intake and output. 2. assessing bowel sounds. 3. documenting daily weight. 4. encouraging periods of rest. 5. assessing for internal bleeding.

1. measurement of intake and output. 2. assessing bowel sounds. 3. documenting daily weight. 4. encouraging periods of rest. 5. assessing for internal bleeding.

The nurse is aware that risk factors for the development of pancreatic cancer include: (Select all that apply.) 1. obesity. 2. Jewish ethnicity. 3. diabetes mellitus. 4. hepatitis A. 5. smoking.

1. obesity. 3. diabetes mellitus. 5. smoking.

For the patient who is anorexic, the interventions the nurse might use to stimulate appetite would include: (Select all that apply.) 1. offer oral care prior to meals. 2. arrange for preferred foods to be served. 3. encourage family members to bring food from home. 4. suggest that family members or friends come and socialize during the meal. 5. give ample time to eat and enjoy the meal.

1. offer oral care prior to meals. 2. arrange for preferred foods to be served. 3. encourage family members to bring food from home. 4. suggest that family members or friends come and socialize during the meal. 5. give ample time to eat and enjoy the meal.

The nurse is aware that the diagnostic criteria for the confirmation of irritable bowel syndrome include: (Select all that apply.) 1. pain relieved by defecation. 2. pain associated with stool frequency. 3. mucorrhea. 4. abdominal tenderness. 5. bloating.

1. pain relieved by defecation. 2. pain associated with stool frequency. 3. mucorrhea. 4. abdominal tenderness. 5. bloating.

The nurse caring for a 70-year-old patient with gastroenteritis following a camping trip to Mexico would anticipate the signs and symptoms of: (Select all that apply.) 1. positive stool culture for Giardia or Shigella. 2. abdominal cramping. 3. intense frontal headache. 4. mucus in stool. 5. blood in stool.

1. positive stool culture for Giardia or Shigella. 2. abdominal cramping. 4. mucus in stool. 5. blood in stool.

The nurse explains that the medically supervised approach to weight reduction will include: (Select all that apply.) 1. reduced-calorie diet. 2. exercise program. 3. participation in a support group. 4. stress reduction. 5. change in concepts about food.

1. reduced-calorie diet. 2. exercise program. 3. participation in a support group. 4. stress reduction. 5. change in concepts about food.

Immediately following a liver biopsy, the nurse should: (Select all that apply.) 1. turn the patient to the right side for 2 hours. 2. provide sand bag support for pressure on puncture site. 3. monitor vital signs every 15 minutes. 4. instruct patient to cough and deep breathe. 5. assess for hematoma at puncture site.

1. turn the patient to the right side for 2 hours. 2. provide sand bag support for pressure on puncture site. 3. monitor vital signs every 15 minutes. 5. assess for hematoma at puncture site.

The nurse explains that the diagnosis of morbidly obese is reserved for people who are ____% above their recommended weight.

100

The nurse demonstrates that the person whose recommended weight is 150 pounds based on height, age, and body type would be considered obese if the person weighed a minimum of ____________________ pounds.

180

Before a nurse can document the presence of diarrhea, the criteria for diarrhea should be met, which includes: (Select all that apply.) 1. one loose stool in a 24-hour period. 2. multiple liquid or semiliquid stools in a 24-hour period. 3. hyperactive bowel sounds. 4. cramping. 5. fever.

2. multiple liquid or semiliquid stools in a 24-hour period. 3. hyperactive bowel sounds. 4. cramping.

The preprocedure teaching for a patient who is to have a magnetic resonance imaging (MRI) study tomorrow would include: (Select all that apply.) 1. there is only a minimal radiation exposure. 2. the patient must remove all metal objects, including dental bridges, jewelry, and body piercings. 3. the patient will be NPO for 4 hours prior to the procedure. 4. a radiopaque medium may be injected during the procedure. 5. there may be a tingling sensation in metal alloy filling of the teeth.

2. the patient must remove all metal objects, including dental bridges, jewelry, and body piercings. 4. a radiopaque medium may be injected during the procedure. 5. there may be a tingling sensation in metal alloy filling of the teeth.

The nurse calculates the body mass index (BMI) of a man who is 6 feet tall (1.8 meters) and weights 150 pounds (68.1 kilograms) to be:

21.0

For the patient who is taking daily doses of ibuprofen for arthritis, the amount of nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen should be limited, in order to prevent a peptic ulcer, to a daily intake of _____ tablets of 500 mg.

4

The nurse is aware that, prior to documenting absence of bowel sounds, each quadrant must be auscultated for a period of _____ minutes.

5

In reviewing the physical assessments of several patients, the nurse recognizes the patient most likely to have gallstones would be the:

50-year-old obese Mexican American woman who has type 1 diabetes.

The nurse explains that a hernioplasty involves:

Sewing synthetic mesh over the abdominal wall defect to reduce the hernia.

When coffee-ground material comes up through the Salem sump catheter in a patient with extensive burns, the nurse is aware that the probable cause is:

a physiologic stress ulcer.

The patient who had an esophagoenterostomy 3 days ago becomes dyspneic and complains of substernal pain. The nurse suspects the patient has:

a suture line leak into the mediastinum.

The nurse uses a visual aid to demonstrate the process of a mechanical bowel obstruction that occurs when:

a tumor obstructs the lumen of the bowel.

Transfer of nutrients from intestine to bloodstream

absorption

The patient who had a laparoscopic cholecystectomy 4 hours ago complains of fullness in the abdomen and mild discomfort. Because his vital signs are stable, the nurse should:

ambulate the patient to reduce gas.

The 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports he has had an exposure to hepatitis B. The nurse recommends that he get immediate protection by acquiring:

an injection of hepatitis B immune globulin (HBIG).

Repair of body tissue

anabolism

Liquid and unformed stool

ascending colostomy

The assessment of bulging flanks on a patient who is supine with knees flexed leads the nurse to assess further for:

ascites

When the patient complains of gas pains and is unable to expel the gas, the nurse should:

assist the patient to ambulate

The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur:

at bedtime

The nurse will encourage the patient who has gastroesophageal reflux disease (GERD) to modify her diet by:

avoiding garlic

The patient is quite jaundiced and has a serum bilirubin of 2.8 mg/dL. The nurse would anticipate that the patient's urine will:

be dark

The nurse is aware that an unresolved bowel obstruction can lead to:

bowel rupture and shock

The nurse is aware that the person with ulcerative colitis is at risk for:

cancer of the colon

The patient who has had his fifth attack of gallstones is encouraged to have a cholecystectomy to prevent the threat of:

cancer of the gallbladder

Breaking down larger molecules into smaller molecules

catabolism

The nurse explains that diverticula occur in the older adult because:

changes in bowel wall allow herniation.

While the patient with esophageal varices is receiving potent vasoconstrictors to help prevent hemorrhage, the nurse will be alert for complaints of pain in the:

chest

The patient presents in the emergency department with the complaint of severe vomiting and nausea and a temperature elevation to 101° F. The patient complains of stomach pain that radiates to his right scapula. These assessments suggest:

cholecystitis.

The nurse assesses that the patient with cirrhosis is deteriorating when there is evidence of:

confusion related to rising ammonia levels.

The nurse explains that the jaundice observed in a person with hepatitis is related to the:

congestion in the liver obstructing bile flow.

No effluent

continent ileostomy

In a patient who had a cholecystectomy 3 days ago, the nurse assesses that the bile is no longer obstructed from entering the bowel by the appearance of:

dark brown stool.

Formed stool on relatively regular basis

decending colostomy

The patient with cirrhosis complains of the blandness of the low-protein diet. The nurse reminds the patient that the low-protein diet helps to:

decrease production of ammonia.

The nurse explains to the patient with cholelithiasis that the purpose of the cholescintigraphy (HIDA scan) is to:

diagnose abnormal contraction of the gallbladder.

The nurse assesses loud bowel sounds in each quadrant every 3 seconds. The nurse associates these findings as indicative of:

diarrhea.

A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours. Prior to giving the bolus, the nurse aspirates a residual of 100 mL. After returning the residual to the patient, the nurse should:

document the residual and hold the feeding.

The nurse explains that the advantage of the Kock pouch ileostomy is that the patient:

does not have to wear a collection device.

The nurse is aware that the major cause of Barrett's esophagus is:

esophageal reflux.

The nurse cautions that a common side effect of bariatric surgery is that the patient will develop:

gallstones

The patient asks the nurse why he could not have a lithotripsy. The nurse points out that the criteria for the procedure are rigid and that he failed to meet them because:

he is obese.

The nurse caring for a patient on total parenteral nutrition (TPN) will monitor for the presence of:

hyperglycemia

The nurse cautions that constant stress can cause an alteration to the GI system, which can result in:

increased digestive juices resulting in a gastric ulcer.

The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. The nurse reports this finding as an:

indication of retroperitoneal hemorrhage.

The patient who has had an incarcerated hernia for many years begins to experience abdominal pain and vomit dark material with a fecal odor. The nurse recognizes these signs as indications of:

intestinal obstruction

When the patient with a Salem sump tube for decompression complains of feeling full and has dyspnea and nausea, the initial intervention by the nurse should be:

irrigate tube with normal saline.

The nurse explains that neomycin enemas are given to the person with cirrhosis in order to:

kill intestinal flora.

The nurse caring for the patient with an ileostomy will make special interventions to prevent skin breakdown and irritation at the stomal site because the:

liquid stool from the ileum contains digestive enzymes that are especially harmful to skin.

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of a(n):

liver biopsy

The home health nurse caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH) will be alert for indication of a common side effect of these drugs, which is:

liver disorders.

The nurse explains the most beneficial diet for a person with inflammatory bowel disease (IBD) is:

low fat low fiber

Instruction to a patient who self-medicates with bismuth subsalicylate (Pepto Bismol) tablets should include that the tablets:

may cause aspirin toxicity.

The nurse caring for the 80-year-old 100-pound woman who is undergoing the extensive bowel preparation for a colonoscopy will assess the patient closely for:

metabolic acidosis.

Chemical process to make substances needed by the body

metabolism

The patient with a 4-day-old ileostomy complains of cramping. The nurse notes a drop in the effluent for the ileostomy. The bowel sounds are rapid with a "tinkling" sound. The nurse should:

notify charge nurse immediately of possible obstruction.

The nurse cautions that increased morbidity from hypertension and cardiac disease, even in children, is related to the modifiable risk factor of ____________________.

obesity

When the patient returns to the floor at 12:30 PM from having had an upper GI (UGI) series done, the nurse should:

offer liquids and a snack immediately.

The nurse percussing a patient's abdomen hears a dull thud in the right upper quadrant. This finding indicates that the area being percussed is:

over the liver

The nurse urges the patient with diverticulitis to seek treatment because the inflamed bowel wall may:

perforate and cause peritonitis.

Rhythmic squeezing action of intestinal tract

peristalsis

The multiple doses of liquid laxative that are given prior to a colonoscopy can be made more palatable by:

pouring them over ice.

The nurse reading the laboratory reports on a patient with possible hepatitis B is aware the most definitive indicator for a diagnosis is:

proliferation of hepatitis B surface antigen (HBsAg).

When the patient complains, "I don't see why I can have a CT scan instead of the expensive MRI," the nurse clarifies that the magnetic resonance imaging (MRI) study:

provides better contrast between normal and pathologic tissue.

The nurse assessing the soma of a patient 1 day after a transverse colostomy will immediately report the finding of a(n):

purplish red stoma.

The nurse explains to the patient receiving bevacizumab (Avastin) for a tumor in the colon that the drug slows cancer cell growth by the process of:

reducing blood flow to the tumor.

For the patient with a hiatal hernia, the nurse recommends avoidance of fats because fats:

relax the sphincter, allowing reflux.

A patient with persistent diarrhea asks why he must take those "horse pills" of Lactobacillus acidophilus. The nurse's most informative response would be that the medication will:

restore intestinal flora.

The nurse explains that the circumgastric banding surgery is considered to be:

restrictive

The nurse caring for a patient who has peritonitis and has developed a paralytic ileus assesses that the patient is passing gas. The assessment is an indication of:

returned peristalsis

In evaluating the efficiency of the swallowing in a patient with dysphagia, the nurse will note with each swallow:

rising of the larynx

The nurse preparing a teaching plan for lifestyle changes for the patient with GERD would include:

smoking cessation

The nurse caring for the patient who has diarrhea from taking a protocol of oral amoxicillin will use ____________________ Precautions in the care.

standard

In caring for the patient with hepatitis B, the nurse would follow guidelines of:

standard precautions

The patient with an incarcerated hernia is at risk for the hernia to become:

strangulated

The nurse is aware that patients who have chronic gastritis from renal failure may present with the first sign of this disorder as:

sudden massive hemorrhage.

The nurse would question an order for esomeprazole (Nexium) for the patient who is:

taking digoxin

Semiliquid stool at unpredictable times

transverse colostomy

The mechanical bowel obstruction caused when the bowel twists on itself is ____________________.

volvulus

To assist the patient with dysphagia to eat a meal, the nurse can: (Select all that apply.) 1. encourage "practice swallowing" prior to meal. 2. coach patient to chew thoroughly. 3. assist patient to sit upright with head forward and chin tucked. 4. offer fluid during meal. 5. thicken liquids.

1. encourage "practice swallowing" prior to meal. 2. coach patient to chew thoroughly. 3. assist patient to sit upright with head forward and chin tucked. 4. offer fluid during meal. 5. thicken liquids.

The nurse outlines behavior seen in a person with anorexia nervosa, which includes: (Select all that apply.) 1. excessive exercise. 2. body image disturbance. 3. amenorrhea. 4. refusal to maintain recommended weight. 5. development of complicated food rituals.

1. excessive exercise. 2. body image disturbance. 3. amenorrhea. 4. refusal to maintain recommended weight. 5. development of complicated food rituals.

To promote bowel health the nurse recommends that the patient: (Select all that apply.) 1. exercise regularly. 2. eat adequate bulk. 3. drink adequate water. 4. defecate at approximately same time every day. 5. take a laxative to remain regular.

1. exercise regularly. 2. eat adequate bulk. 3. drink adequate water. 4. defecate at approximately same time every day.

In taking the history of a person with hepatitis A, an appropriate question for the nurse to ask is:

"Do you eat shellfish or oysters often?"

The nurse evaluates a need for further instruction to the patient with Barrett's esophagus when the patient says:

"I am using snuff instead of smoking."

The 36-year-old woman who had an ascending colostomy angrily declares, "I don't want this hateful thing on my body! This nasty thing is not me." The nurse's most therapeutic response would be:

"What about this colostomy concerns you the most?"

The nurse lists foods and beverages that may trigger an attack of irritable bowel syndromes (IBS), which include: (Select all that apply.) 1. caffeine. 2. dairy products. 3. specific food allergies. 4. wheat products. 5. alcohol.

1. caffeine. 2. dairy products. 3. specific food allergies. 4. wheat products.

The nurse explains that the older adult is prone to digestive disorders because of age-related changes that include: (Select all that apply.) 1. decrease in hydrochloric acid. 2. increase in enzyme levels. 3. inadequate chewing of food. 4. diminished intestinal motility. 5. incompetent gastroesophageal sphincter.

1. decrease in hydrochloric acid. 3. inadequate chewing of food. 4. diminished intestinal motility. 5. incompetent gastroesophageal sphincter.

The nurse instructs the patient on the weight reduction drug sibutramine (Meridia) that side effects will include: (Select all that apply.) 1. dry mouth. 2. hypoglycemia. 3. constipation. 4. facial rash. 5. insomnia.

1. dry mouth. 3. constipation. 5. insomnia.

Extremely watery stool with concentrations of digestive enzymes

Ileostomy