NUR 3 Theory 4

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?

"Avoid foods that cause pain after you eat them."

Which description of the Whipple procedure made by a patient demonstrates a need for further education?

"Complete removal of the stomach."

Four months after bariatric surgery, a patient tells the nurse, "My skin is hanging off me. I think I might want to surgery to remove the skinfolds." Which response by the nurse is most appropriate?

"Cosmetic surgery may be possible once your weight has stabilized."

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate?

"Do you use any over-the-counter drugs?"

The nurse is admitting a 67-yr-old patient with new-onset steatorrhea (fatty stool). Which question is most important for the nurse to ask?

"Have you noticed a recent weight loss?"

Steatorrhea

fat in the feces (fatty stools)

test is used to detect chronic hepatitis C and cirrhosis.

fibro test

The nurse recalls that one gram of protein yields how many calories?

four

gastritis

inflammation of gastric mucosa (stomach lining)

minimum daily requirement for protein formula

kgs X 0.8g

Underweight BMI range

less than 18.5

Paresthesias

numbness or tingling

Obese BMI

over 30

Cobalamin (B12) deficiency causes

paresthesias ( numbness and tingling) peripheral neuropathy Pernicious anemia.

The patient's low transferin and albumin levels indicate low ________________

protein stores.

Macronutrients include

proteins, carbohydrates, fats

Endoscopic retrograde cholangiopancreatography (ERCP)is used to

retrieve a gallstone from distal common bile duct, dilate strictures, and diagnose pseudocysts.

refeeding syndrome signs and symptoms

seizures, heart failure, and comas.

Tenesmus

straining to defecate

A pt with a PEG tube should be positioned

with the head of the bed elevated to at least 30 degrees or use an upright sitting position when administering tube feeding,

The nurse is assessing an alert and independent older adult patient for malnutrition risk.Which is the most appropriate initial question?

"Can you tell me the food that you ate yesterday?"

Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly?

The spleen is usually not palpable, but when palpated, it is located in left upper quadrant of abdomen

The nurse performs a dietary assessment on a patient. The nurse recalls that the Dietary Reference Intake (DRI) recommends that which percentage of total calories should come from carbohydrates?

45% to 65%

A healthy adult woman who weighs 145 lb (66 kg) asks the clinic nurse about the minimumdaily requirement for protein. How many grams of protein will the nurse recommend?

53

The nurse is caring for a patient with hepatic encephalopathy. Which laboratory finding is consistent with the diagnosis?

95 mcg/dL ammonia

A severely malnourished patient reports that he is Jewish. What initial action should the nurse take to meet his nutritional needs?

Ask the patient about food preferences.

Normal BMI range

18.5-25

After change-of-shift report, which patient will the nurse assess first?

A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles

Which disorder is characterized by an unwillingness to maintain a healthy weight?

Anorexia nervosa (AN)

The nurse is preparing to teach a frail 79-yr-old Hispanic man who lives with an adult daughter about ways to improve nutrition. Which action should the nurse take first?

Determine who shops for groceries and prepares the meals.

_____________occurs when serum albumin levels and plasma oncotic pressure decrease.

Edema

is used to detect tumors, polyps, infectious diseases, fissures, and hemorrhoids.

Sigmoidoscopy

cheilosis

a disorder of the lips characterized by crack-like sores at the corners of the mouth

Health risks associated with obesity increase in men with a waist circumference larger than

40 in

Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?

Elevate the head of the bed to at least 30 degrees.

Sucralfate is most effective when the

pH is low and stomach is empty (30 mins before meals)

Kwashiorkor Disease

protein deficiency with appropriate caloric intake

urolithiasis/renal calculi/ nephrolithiasis

stones

Cimetidine (Tagamet) used for

treatment of peptic ulcer and GERD

A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to:

turn, cough, and deep breathe every 2 hours.

Which describes the cognitive abilities of school-age children?

Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

A patient has received a dose of aluminum hydroxide with magnesium and simethicone ( MYLANTA) 30 mL PO. If the medication is effective, which symptom would the patient report as being resolved?

Indigestion

A patient's peripheral parenteral nutrition (PN) bag is nearly empty, and a new PN bag has notarrived yet from the pharmacy. Which intervention by the nurse is appropriate?

Infuse 5% dextrose in water until a new PN bag is delivered

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first?

Infuse metronidazole (Flagyl) 500 mg IV

The nurse is caring for a patient with an obstructed common bile duct. What condition should the nurse expect?

Steatorrhea

When a patient reports foul-smelling stool, which condition does the nurse suspect?

Steatorrhea

After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition?

Surgical incision is healing normally.

What action should the nurse take after assisting with a needle biopsy of the liver at a patient's bedside?

Place the patient on the right side with the bed flat

Which statement to the nurse from a patient with jaundice indicates a need for teaching?

"I use acetaminophen (Tylenol) every 4 hours for pain."

While assessing a patient with a gastrointestinal (GI) disorder, which questions does the nurse ask? Select all that apply.

Are you having sleep disturbances?" "Have you traveled to foreign lands in the recent past? "Have you undergone an abdominal or rectal surgery in the past?"

Which factors may lead to the development of a hiatal hernia by increasing intraabdominal pressure? Select all that apply.

Ascites Obesity Pregnancy

A patient who takes a nonsteroidal antiinflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What should the nurse anticipate teaching the patient?

Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

Monitor stools for blood because anemia or hemorrhage may occur with IBD

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

Monitor the patient for shortness of breath

Which fluid and electrolyte change occurs with malnutrition?

Movement of sodium within the cell

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis?

Muscle twitching and finger numbness

An older patient reports chronic constipation. To promote bowel evacuation, when should the nurse suggest that the patient attempt defecation?

After eating breakfast

Which psychosocial issue may contribute to poor nutrition in an older adult?

Living alone

Which is an expected assessment finding for a patient who has a vitamin C deficiency?

Poor wound healing

What should the nurse admitting a patient with acute diverticulitis plan for initial care?

Administer IV fluids and NPO

Which are manifestations of anorexia nervosa? Select all that apply.

Muscle wasting Loss of menses

The pancreas is located where?

behind the stomach

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?

Navy bean soup and vegetable salad

tenesmus happens after_________

colonoscopy

Video capsule endoscopy provides

endoscopic visualization of the gastrointestinal tract.It is used to diagnose celiac disease

Which cells of the islets of Langerhans secrete amylin?

β-cells

Which interventions would the nurse implement for a patient with acute pancreatitis who is restless and reports abdominal pain? Select all that apply.

Administer IV morphine Encourage the patient to change positions frequently.

An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question?

Administer loperamide (Imodium) after each stool.

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. What should the nurse teach the patient to take?

Antacids after meals and sucralfate 30 minutes before meals

Which component of nutritional assessment includes determining a patient's body mass index, height, weight, and amount of weight loss?

Anthropometric measurements

A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?

The oral temperature is 101.4° F (perforation)

A young adult contracts hepatitis from contaminated food. What should the nurse expects erologic testing to reveal during the acute (icteric) phase of the patient's illness?

Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM) M= acute G= life long

A patient is hospitalized with abdominal pain, rebound tenderness, and muscle rigidity. The patient's assessment findings include a heart rate of 150 beats/minute. The nurse anticipates that the plan of care will include which treatment strategies? Select all that apply.

Antibiotic therapy Nasogastric (NG) suction

A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. Which condition does the nurse suspect?

Appendicitis

A 60-yr-old man who is hospitalized with an abdominal wound infection has been eating very little and states, "Nothing on the menu sounds good." Which action by the nurse will be most effective in improving the patient's oral intake?

Ask family members to bring favorite foods.

A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first?

Ask the patient to describe the stools and any associated symptoms.

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

Ask the patient to extend both arms forward

The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement?

"I can take a shower and walk around the house tomorrow."

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?

"I eat small meals and have a bedtime snack."

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine)for ulcerative colitis has been effective?

"I should apply sunscreen before going outdoors."

The nurse provides education for a patient who has diverticular disease but is not experiencing an acute episode at this time. Which statement by the patient indicates understanding of the teaching?

"I will decrease my intake of fat and red meat."

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching?

"I will grow an average of 2 inches per year from this point on."

A young adult patient is hospitalized with massive abdominal trauma from a motor vehiclecrash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). What should the nurse explain about the action of the medication?

"It inhibits development of stress ulcers."

How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn?

"It treats gastroesophageal reflux disease by decreasing stomach acid production."

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?

"Keep the head of your bed elevated on blocks."

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?

"Ranitidine decreases gastric acid secretion."

Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective?

"The cobalamin injections will prevent me from becoming anemic."

Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective?

"Vitamin supplements may prevent anemia."

A 40-yr-old obese woman reports that she wants to lose weight. Which question should the nurse ask first?

"What factors led to your obesity?"

Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet?

"You are likely to notice changes in how you feel after a few weeks of diet and exercise."

treatment for calcium phosphate calculi

* Increase hydration * Increase dietary calcium * Avoid vitamin C

treatment for calcium oxalate calculi

* increase hydration * decrease oxalate, animal products and sodium

Which of the nurse's assigned patients should be referred to the dietitian for a complete nutritional assessment? (Select all that apply.)

*A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily * A 23-yr-old patient who has a history of fluctuating weight gains and losses * A 64-yr-old patient who is admitted for debridement of an infected surgical wound

A patient with liver fibrosis is scheduled for a closed biopsy procedure. Which does the nurse include in the procedural plan of care? Select all that apply.

*Assessing the vital signs *Instructing the patient to hold the breath during needle insertion *Informing the patient that the test is done with CT or ultrasound guidance *Informing the patient that a needle will be inserted on the right side *Providing the patient with information about the local anesthetic that will be administered

Kwashiorkor symptoms

- ↓ Calories - ↓ Muscle - ↓ Fat - EDEMA! - Hyperpigmentation - Hyperkeratosis - Fatty Liver

waist to hip ratio for obesity

0.80

A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect?

2 cups or about 500 mls daily (one cup is 240 ml)

A patient voices a desire to lose weight. The nurse reviews the patient's caloric needs and determines that, to lose weight, the patient should consume how many calories per kilogram?

20 to 25 cal/kg body weight

The nurse recalls that which is the recommended energy intake in a nonobese patient?

25 to 30 cal/kg/day

Overweight BMI range

25-29.9

After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood?

3 oz of roasted pork, a cup of broccoli, and a cup of carrot sticks (1/3 meat, 2/3 plant source)

Health risks associated with obesity increase in women with a waist circumference larger than

35 in

What is the earliest age at which puberty begins?

9

Which patient should the nurse assess first after receiving change-of-shift report for these patients with abdominal issues

A 30-yr-old patient who has a distended abdomen and tachycardia ( hypovolemic shock caused by obstruction)

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?

A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102°F (38.8° C)

After change-of-shift report, which patient should the nurse assess first?

A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa

whipple procedure

A Whipple procedure involves removing the distal part of the stomach, which is a partial removal of the stomach. Complete removal of the duodenum (a duodenectomy), removal of the distal portion of the common bile duct, and removal of the proximal pancreas (head of the pancreas)

Marasmus

A disease of severe protein-calorie malnutrition during early infancy, in which growth stops, body tissues waste away, and the infant eventually dies.

Which patient should the nurse assess first after receiving change-of-shift report?

A patient with esophageal varices who has a rapid heart rate= GI bleed

After successfully losing a pound per week for several months, a patient at the clinic has not lost any weight for the past month. What action should the nurse take first?

Ask the patient whether there have been any changes in exercise or diet patterns.

Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program?

Asking the adults about situations that tend to increase appetite

What should the nurse include when teaching an adult patient to prevent the recurrence of kidney stones?

Drinking 3000 mL of fluid each day

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first?

Place the patient on NPO status 8 hrs prior to procedure

Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?

Absent bowel sounds

Which clinical manifestation does the nurse expect to observe in a patient with ascites?

Accumulation of fluid within the abdominal cavity

Which enzyme is responsible for autodigestion of the pancreas and leads to bleeding in a patient with acute pancreatitis?

Activated trypsin

A patient's blood test report reveals a lipase level of 200 U/L and an amylase level of 150 U/L. Which complication does the nurse suspect based on the findings?

Acute pancreatitis

Which prescribed action will the nurse implement first for a patient who has vomited 1100mL of blood?

Administer 1 L of lactated Ringer's solution

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

Place the patient on a pressure-relief mattress

A patient who is diagnosed with malnutrition experiences edema of the face and legs. The nurse identifies that which event most likely caused the edema to occur?

Due to protein depletion, the synthesis of protein decreases and leads to lowering the oncotic pressure.

What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?

Abdominal distention

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?

Abdominal pain is decreased.

Where does Zenker's diverticulum occur?

Above the upper esophageal sphincter

Which nursing action is of highest priority for a patient with kidney stones who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

Administer prescribed analgesics.

The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority?

Administer prescribed opioids to relieve pain as needed

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?

Administer the spironolactone

Which prescribed treatment would the nurse expect to administer to a patient with pancreatitis who has a BP of 80/70 mm Hg?

Albumin

Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis?

Albumin level

What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis?

Alcohol use

Which antacid used in the treatment of gastrointestinal reflux disease (GERD) causes phosphorus depletion with chronic use?

Aluminum hydroxide

What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?

Ammonia levels

A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?

Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

Which condition would the nurse suspect in a patient who reports pain and discomfort in the upper abdomen?

Dyspepsia

A patient is being admitted for bariatric surgery. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)?

Assist with IV insertion by holding adipose tissue out of the way.

Which findings indicate that a patient with gastroesophageal reflux disease has aspirated gastric contents into the lower airways? Select all that apply.

Asthma Pneumonia Chronic bronchitis

When assessing a patient's abdomen, which technique does the nurse use?

Auscultate the abdomen before palpation

Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?

Avoiding all alcohol use

Which condition causes the formation of biliary sludge?

Bile stasis

Which term is used for the substance made of cholesterol crystals and calcium salts found in a patient with pancreatitis?

Biliary sludge

When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include?

Blood glucose test

A patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter would the nurse monitor?

Bowel sounds

A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), what should the nurse plan to assess more frequently than is routine?

Breath sounds=GERD= aspiration

Which information will the nurse include when teaching a patient how to avoid chronic constipation?

Bulk-forming laxatives are an excellent source of fiber. Walking or cycling frequently will help bowel motility A good time for a bowel movement may be after breakfast Some over-the-counter (OTC) medications cause constipation

Which is a positive acute phase protein?

C-reactive protein

Which acute phase protein is elevated during inflammation?

C-reactive protein (CRP)

Which medication has a side effect of milk-alkali syndrome?

Calcium carbonate

When examining a patient's mouth, the nurse notes white curd like lesions surrounded by erythematous mucosa. Which condition does the nurse suspect?

Candidiasis

Which action should the nurse in the emergency department take first for a new patient whois vomiting blood?

Check blood pressure and heart rate.

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action?

Check for tube placement and reposition it.

The nurse is caring for patient who is scheduled for a liver biopsy. Which interventions are appropriate to be included in the patient's plan of care? Select all that apply.

Check the bleeding time Check the prothrombin time Maintain NPO status for eight hours before the test. Instruct the patient to expire fully and not breathe when the needle is inserted

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next?

Check the calcium level in the chart

Which assessment action will help the nurse determine if an obese patient has metabolic syndrome?

Check the patient's blood pressure.

A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?

Check the vital signs.

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective?

Cherry gelatin with fruit

Which symptoms that occur in gastroesophageal reflux disease (GERD) are considered otolaryngologic symptoms? Select all that apply.

Choking Hoarseness Sore throat

Which is a cause of primary peritonitis?

Cirrhosis with ascites

What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia?

Cobalamin (B12) supplements

What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy?

Cobalamin (vitamin B12) deficiency

A patient has been admitted to a medical unit with clinical manifestations of a blockage of the large intestine. The nurse expects a prescription for which diagnostic procedure?

Colonoscopy

What should the nurse preparing for the annual physical exam of a 45-yr-old man plan toteach the patient about?

Colonoscopy

A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasingab dominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG)drainage in the past hour. What is the highest priority action by the nurse?

Contact the surgeon. (hemorrhage)

Kwashiorkor treatment

Convince them to feed children more protein, but not too much

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease?

Corn tortilla with scrambled eggs= no gluten

The nurse is providing preoperative care for a patient who was instructed to have NPO. The patient is observed holding an empty but moist drinking glass. The nurse suspects that the patient consumed a liquid based on which assessment finding?

Easily heard, loud gurgling in the right upper quadrant

Which action is likely to exacerbate the condition of a patient who has pancreatitis?

Eating three large meals a day

When teaching a patient with diverticular disease about dietary choices, which foods does the nurse recommend?

Correct4 Dried beans, All Bran (100%) cereal, and raspberries***HIGH FIBER***

A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?

Crackles are heard halfway up the posterior chest= pulm edema=slow down IV rate

Which condition involves inflammation of all layers of the bowel wall?

Crohn's disease

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus?

Cullen sign

Which lab result is associated with steatorrhea in a patient with malnutrition?

Decreased serum levels of fat-soluble vitamins

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy?

Decreased urine output

The nurse assigns which nursing diagnostic statement as the highest priority in the plan of care for a patient who has ulcerative colitis?

Deficient fluid volume

Which condition results from sympathetic activation?

Diaphoresis

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care?

Discontinue the patient's oral food intake and rest the bowel by making the patient NPO

Which item should the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting?

Dish of lemon gelatin

The BP of a patient with pancreatitis dropped from 125/80 mm Hg to 90/60 mm Hg. The nurse administers isotonic fluid without an increase in the patient's BP. Which medication would the nurse anticipate will be prescribed by the health care provider?

Dopamine

The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include?

Drink fluids between meals but not with meals. Fluids with meals cause dumping syndrome and diarrhea

he nurse is caring for a patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the provider?

Emesis of bile-colored fluid past the nasogastric (NG) tube

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study would the nurse expect to be scheduled for this patient?

Endoscopic biopsy

Which diagnostic study is used to stage esophageal cancer?

Endoscopic ultrasonography (EUS)

What diagnostic test should the nurse anticipate for an older patient who is vomiting"coffee-ground" emesis?

Endoscopy

Which finding is often the first indication of gastroesophageal reflux disease and hiatal hernia in an older adult?

Esophageal bleeding

Which esophageal disorder would the nurse expect in a patient who is admitted to the emergency unit after drinking a strong acid?

Esophageal stricture

Which medication used in gastroesophageal reflux disease decreases the conversion of pepsinogen to pepsin?

Famotidine

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

Fever ***Remicade suppress the immune system

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

Fistulas can form between the bowel and bladder.

A young adult with extensive facial injuries from a motor vehicle crash is receiving continuous enteral nutrition through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?

Flush the tube with 30 mL of water every 4 hours.

Which menu choice best indicates that the patient is implementing the nurse's suggestion to choose high-calorie, high-protein foods?

Fried chicken with potatoes and gravy

Which conditions may cause pancreatitis? Select all that apply.

Gallstones Cystic fibrosis Alcohol abuse

Which surgery is used to attach the stomach subdiaphragmatically and prevent reherniation?

Gastropexy

bruising over the flanks.

Grey Turner's sign (pancreatitis)

A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung with a new tubing and filter 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action should the nurse take?

Hang a new container of PN and change the IV tubing and filter. Document 50 ml remained

Which common adverse effect of ondansetron would the nurse teach the patient to report?

Headache

A patient receives a prescription for an indirect serum bilirubin test. The nurse recognizes that the test is being performed to diagnose which health problem?

Hemolytic condition

A patient experiences difficulty defecating due to constipation. A recommended treatment is the Valsalva maneuver. The nurse recognizes that it is important to obtain which history information prior to assisting the patient with this maneuver? Select all that apply.

Hemorrhoids Cardiac problems Abdominal surgery

A patient is being admitted to the hospital with abdominal pain. Which information does the nurse include when obtaining the patient's gastrointestinal (GI) history? Select all that apply.

Hemorrhoids Lactose intolerance Abdominal distention Nausea and vomiting

Which predisposing factor would the nurse associate with the development of small renal calculi trapped within a patient's ureter?

Hyperoxaluria

Which is the hallmark electrolyte imbalance associated with refeeding syndrome?

Hypophosphatemia

Cobalamin (B12) supplements are given

IM or nasal spray

The nurse provides care for a patient who is hospitalized with malnutrition. Which physiologic change is the result of the inflammation that occurs during the starvation process?

Increased C-reactive protein (CRP)

A 49-yr-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first?

Infuse normal saline at 250 mL/hr

Which sequence does the nurse follow when examining a patient's abdomen?

Inspection first, then auscultation, percussion, and palpation

What action should the nurse take when caring for a patient with a soft, silicone nasogastric tube in place for enteral nutrition?

Keep head of bed elevated to 30- to 45-degree angle.

After a patient has undergone an esophagogastroduodenoscopy (EGD), which is the nursing priority?

Keep the patient NPO until the gag reflex returns

Which complications can occur due to long-term use of proton pump inhibitors in patients with gastroesophageal reflux disease (GERD)? Select all that apply.

Kidney disease Decreased bone density Magnesium deficiency

Which risk factor would the nurse associate with the patient's development of urinary tract calculi?

Large intake of dietary proteins

Which respiratory complication occurs due to irritation of the upper airway by gastric secretions?

Laryngospasm

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. What should the nurse teach the patient to do?

Lie down for about 30 minutes after eating. ***hypoglycemia due to dumping syndrome***

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

Lipase

A patient has been diagnosed with urinary tract stones that are high in uric acid. Which foods will the nurse teach the patient to avoid?

Liver Chicken meats=purines=uric acid

An adult with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding should the nurse report to the health care provider?

Liver edge 3 cm below the costal margin

What information will the nurse include in teaching for a 35-yr-old woman who is over weight and starting a weight-loss plan?

Low carbohydrate diets lead to rapid weight loss but are difficult to maintain

Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless?

Maintain adequate nutrition.

The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome?

Maintaining normal respiratory function

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool.Which action should the nurse take first?

Manually remove the impacted stool.

Deep tenderness halfway between the umbilicus and the right iliac crest, known as

McBurney's sign= appendicitis

What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)?

Mealtime

What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B?

Measures for improving appetite

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient?

Medication use

A patient who is a strict vegan avoids taking any vitamin and mineral supplements. The nurse recognizes that the patient is predisposed to which condition?

Megaloblastic anemia

Which medication used to treat nausea and vomiting may cause dyskinesia?

Metoclopramide

An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the healthcare provider before administration?

Metoclopramide (Reglan)

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?

Place the patient on contact precautions.

The nurse suspects that a patient's assessment findings are indicative of upper gastrointestinal (GI) bleeding. Which medication in the patient's prescriptions may be responsible for this condition?

Nonsteroidal antiinflammatory drug (NSAID)

A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention should the nurse anticipate?

Nystatin tablets

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease(IBD) indicates a need for more teaching?

Oatmeal with cream

Which action should the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea?

Obtain a stool specimen for culture

The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)

Offer the patient the prescribed nutritional supplement between meals.

A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy(EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?

Offering the patient a pitcher of water

The nurse educator provides teaching for the nursing staff related to postoperative care of a patient following a laparotomy and includes which information?

Ondansetron may be prescribed to treat postoperative nausea and vomiting.

Which assessment finding is of most concern for a patient with acute pancreatitis?

Palpable abdominal mass (pancreatitis abcess)

Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates?

Pancreatic pseudocyst

The nurse is providing care to a patient who underwent an endoscopic retrograde cholangiopancreatography (ERCP) examination. Which is the most common post procedure complication?

Pancreatitis

When assessing a patient with a gastrointestinal disorder, the nurse finds an absence of bowel sounds. The assessment findings are indicative of which condition?

Paralytic ileus

Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation?

Paresthesias

After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective?

Patient schedules an appointment for allergy testing.

To assess a patient's liver, which assessment techniques does the nurse use? Select all that apply.

Percussion Deep palpation

A patient presents with clinical manifestations of peritonitis. The nurse assesses the patient and notes the absence of ascites. The nurse anticipates a prescription for which diagnostic test?

Peritoneoscopy

A patient presents to the emergency department with a knife wound to the abdomen. The nurse identifies that the patient is at risk for which gastrointestinal condition?

Peritonitis

A 76-yr-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted. Which assessment finding will the nurse expect?

Pitting edema

Which is the correct technique for the nurse to palpate the liver during a head-to-toe physical assessment?

Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin.

Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile?

Place the patient in a private room on contact isolation.

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care?

Position patient with the knees flexed.

A patient who is hospitalized with pneumonia reports taking pantoprazole 40 mg PO qd for 3 years. After reviewing the patient's laboratory results, the nurse relates which finding to the long-term use of the medication?

Positive C. difficile

Which finding is the most common indication of esophageal cancer?

Progressive dysphagia

A patient who has gastroesophageal reflux disease (GERD) is planning to become pregnant. Which type of medication would the nurse question being prescribed to treat the GERD?

Prostaglandins=uterine rupture and miscarriage

A patient has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low serum transferrin and albumin levels. What should the nurse encourage the patient to increase in the diet?

Protein

The nurse provides education to a group of nursing students about normal nutrition and includes information about which macronutrient?

Proteins

What should the nurse anticipate teaching a patient with a new report of heartburn?

Proton pump inhibitors

Which action for a patient receiving enteral nutrition through a percutaneous endoscopicgastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/VN)?

Providing skin care to the area around the tube site

A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first?

Question the patient about risk factors for constipation

Which diagnostic test detects reflux of gastric contents?

Radionuclide test

A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. What is the appropriate action by the nurse?

Recheck the capillary blood glucose level in 4 to 6 hours. (mild hyperglycemia is expected the first few days of starting PN infusion)

The nurse provides education for a group of nursing students and differentiates ulcerative colitis and Crohn's disease. The nurse explains that which characteristics are more common with ulcerative colitis? Select all that apply.

Rectal bleeding tenesmus (the sensation of incomplete bowel evacuation)

A patient with ulcerative colitis has been prescribed sulfasalazine. Which instruction does the nurse give to the patient regarding the medication?

Rectal forms of the medication deliver the medication directly to the affected tissue.

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?

Red patches on the buccal mucosa (erythroplasia)

A patient with gastroesophageal reflux disease reports to the nurse, "I feel like there is a hot, bitter liquid in my mouth." Which finding would the nurse document in the patient's medical record?

Regurgitation

For which purpose would a patient with pancreatic cancer receive radiation therapy?

Relieve pain

The nurse inserts a urinary catheter into a patient with an intestinal obstruction. One hour after insertion, the nurse calculates that the urinary output is 0.4 mL/kg of the patient's body weight. Which is a priority nursing intervention?

Report the finding to the primary health care provider. below 0.5ml/kg = kidney injury

A patient is experiencing cheilosis. The nurse suspects that which is the cause of the patient's condition?

Riboflavin deficiency

While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). What area of patient knowledge should the nurse plan to assess?

Risk for developing colorectal cancer

A 19-yr-old woman admitted with anorexia nervosa is 5 ft, 6 in (163 cm) tall and weighs 88 lb(41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority?

Risk for electrolyte imbalance

occurs when palpation of theleft lower quadrant causes pain in the right lower quadrant

Rovsing sign (acute appendicitis)

Which change in the gallbladder is associated with acute cholecystitis?

Scarring of the wall

A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate?

Schedule the patient for HCV genotype testing before treatment

A 19-yr-old patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?

Schedule the patient for yearly colonoscopy

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?

Temperature 102.1° F (38.9° C)= surgery leakage

A patient is suspected of having acute pancreatitis after presenting to the emergency department with severe abdominal pain. The nurse identifies that which important diagnostic laboratory value peaks in 24 hours and then returns to normal in 48 to 72 hours?

Serum amylase

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports"feeling too tired to eat." Which action should the nurse take first?

Serve multiple small feedings of high-calorie, high-protein foods.

A patient with esophageal cancer regurgitates blood-flecked esophageal contents. Which condition would the nurse suspect is present?

Severe esophageal stenosis

A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube.What should the nurse plan for when this patient has a computed tomography (CT) scanordered?

Shut the feeding off 30 to 60 minutes before the scan.

A patient who has just been started on enteral nutrition of full-strength formula at 100 mL/hr has 6 liquid stools the first day. Which action should the nurse plan to take?

Slow the infusion rate of the feeding.

A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What should the nurse teach the patient to avoid?

Smoked foods such as ham and bacon or sausage

Which body substance would the nurse observe to evaluate the effectiveness of pancreatic enzyme replacement for a patient with chronic pancreatitis?

Stool

Which medication for treating gastroesophageal reflux disease (GERD) may cause constipation?

Sucralfate

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?

Suggest the patient lie on the side, flexing the right leg= appendicitis

After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care?

Support the surgical incision during patient coughing and turning in bed

Which side effect may occur in a patient with gastroesophageal reflux disease who is on bethanechol therapy?

Syncope

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching?

Take prescribed pain medications before you expect a bowel movement.

Which assessment should the nurse perform first for a patient who just vomited bright red blood?

Taking the blood pressure (BP) and pulse

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass?

Teaching the patient on coughing and breathing techniques

The nurse and a licensed practical/vocational nurse (LPN/VN) are working together to carefor a patient who had an esophagectomy 2 days ago. Which action by the LPN/VN requires that the nurse intervene?

The LPN/VN positions the head of the bed in the flat position ( use Fowler position to prevent reflux and gastric content aspiration)

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices?

The medication will prevent irritation of the enlarged veins.

A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?

The patient ate a low-fat bagel 4 hours ago for breakfast.

The nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?

The patient declined to drink the prescribed laxative solution

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider?

The patient has noticed blood in the stools.

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis?

The patient is alert and oriented.

A patient has just been admitted to the emergency department with nausea and vomiting.Which information requires the most rapid intervention by the nurse?

The patient is lethargic and difficult to arouse.= aspiration

The body mass index (BMI) of a patient is 26 kg/m2. How does the nurse interpret the assessment finding?

The patient is overweight.

Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider?

The patient is pale and has many bruises. ****issues with vitamin K and coagulation

Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?

The patient used IV drugs about 20 years ago.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

The patient uses witch hazel compresses to soothe irritation.

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

The patient's hands flap back and forth when the arms are extended

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider?

The patient's lungs have crackles audible to the midchest= pulmonary edema= slow IV infusion rate

A 20-yr-old woman is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?

The patient's serum potassium level is 2.9 mEq/L

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis?

The patient's stools are tan colored.

Which statement characterizes moral development in the older school-age child?

They are able to judge an act by the intentions that prompted it rather than just by the consequences.

Which describes moral development in younger school-age children?

They know the rules and behaviors expected of them but do not understand the reasons behind them.

Which surgical instrument is used preoperatively in a patient who will be undergoing an open cholecystectomy?

Transhepatic biliary catheter

Which information will the nurse provide for a patient with achalasia?

Treatment may include endoscopic procedures

Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?

Unintended weight loss

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

Use care when eating high-fiber foods to avoid obstruction of the ileum

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What should the nurse ask the patient about to determine possible risk factors for gastritis?

Use of nonsteroidal antiinflammatory drugs (NSAIDs)

During the abdominal examination of a healthy patient, which actions does the nurse take? Select all that apply.

Use warm hands. Raise the head of the bed slightly Ask the patient to breathe slowly through the mouth. Instruct the patient to assume the supine position with knees flexed

The nurse recognizes that which test is used to assess areas of the gastrointestinal tract not accessible by an upper and lower endoscopy?

Video capsule endoscopy (VCE)

The nurse is coaching a community group for persons who are overweight. Which participant behavior is an example of the best exercise plan for weight loss?

Walking for 40 minutes 6 or 7 days/week

spironolactone

a potassium-sparing diuretic and will help increase the patient's potassium level.

Which predisposing factor would the nurse associate with the development of cystine calculi

acidic urine

Two types of gastritis

acute and chronic

Antacids are most effective when taken

after eating.

Which predisposing factor would the nurse associate with the development of calcium phosphate calculi

alkaline urine hyperparathyroidism

fistula

an abnormal connection between two body parts

The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient's blood specimen reveals:

anti-HBs.

Refeeding syndrome

appears when food is introduced too quickly after a period of malnourishment. Shifts in electrolyte levels (Low Phosphate) can cause serious complications

calcium oxalate calculi

are small and often become trapped in the ureter

A diet high in fiber and low in fats and red meat is recommended to prevent

diverticulitis

cullen's sign for acute pancreatitis

ecchymosis around the area of umbilicus

hyperoxaluria

excessive urinary excretion of oxalate.

Achalasia

failure of the lower esophagus sphincter muscle to relax

steatorrhea

fatty stool

People with IBD should avoid foods high in

fiber, fatty, spicy food

Which laboratory value would the nurse expect to be decreased for a patient with acute pancreatitis?

calcium

cystine calculi

genetic autosomal defect

Which predisposing factor would the nurse associate with the development of uric acid

gout acidic urine inherited condition

treatment for cystine calculi

increase hydration captopril Potassium citrate to keep urine alkaline

characteristics of metabolic syndrome

large waistline high triglyceride level, low HDL level, high blood pressure, high fasting blood sugar

The nurse administering -interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for:

leukopenia.

Pancreatic enzyme supplements are to be taken along with

meals or snacks.

Calcium phosphate calculi

mixed stones

Cimetidine (Tagamet) function

decreases gastric motility and causes constipation.