Test 3 Quizlet

A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount? 150 mL 250 mL 350 mL 450 mL

450 mL Explanation: A residual of greater than 400 mL strongly suggests obstruction.

A client is receiving a parenteral nutrition admixture that contains carbohydrates, electrolytes, vitamins, trace minerals, and sterile water and is now scheduled to receive an intravenous fat emulsion (Intralipid). What is the best action by the nurse? Stops the admixture while the fat emulstion infuses Starts a peripheral IV site to administer the fat emulsion Attaches the fat emulsion tubing to a Y connector close to the infusion site Connects the tubing for the fat emulsion above the 1.5 micron filter

Attaches the fat emulsion tubing to a Y connector close to the infusion site Explanation: An intravenous fat emulsion is attached to a Y connector close to the infusion site. The fat emulsion is administered simultaneously with the parenteral nutrition admixture. A separate peripheral IV site is not necessary. The fat emulsion is not administered through a filter.

The nurse cares for a client with obesity and discusses the increased risk of certain cancers related to obesity. Which cancers will the nurse include in the teaching? Select all that apply. Breast Colorectal Cervical Skin Brain

Breast Colorectal Cervical Explanation: Obesity increases the risk of developing certain cancers, including: breast, cervical, colorectal, endometrial, esophageal, gallbladder, liver, ovarian, non-Hodgkin lymphoma, pancreatic, prostate, kidney, and thyroid. Obesity is not associated with the increased risk of developing skin or brain cancer.

A client has been receiving radiation therapy to the lungs and now has erythema, edema, and pain of the mouth. What instruction will the nurse give to the client? Use a hard-bristled toothbrush. Rinse with an alcohol-based solution. Brush and floss daily. Continue with the usual diet.

Brush and floss daily. Explanation: The description of erythema, edema, and pain of the mouth following radiation treatment describes stomatitis. Nursing considerations include prophylactic mouth care such as brushing and flossing daily. A soft-bristled toothbrush is recommended. The client is to avoid alcohol-based mouth rinses and hot or spicy foods that may be part of the client's usual diet.

A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply. Dizziness Sweating Fever Hypertension Tachycardia

Dizziness Sweating Tachycardia Explanation: Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that is common among clients who have had bariatric surgery. Symptoms of dumping syndrome include (but are not limited to): sweating, tachycardia, nausea, vomiting, dizziness, and diarrhea. Fever and hypertension are not symptoms of dumping syndrome.

A nurse is assessing a client for GI dysfunction. What is the most common symptom in a client with GI dysfunction? Diffuse pain Dyspepsia Constipation Abdominal bleeding

Dyspepsia Explanation: Dyspepsia is a condition that usually involves a combination of symptoms: abdominal pain, bloating, distention, nausea, and belching. Dyspepsia refers to altered digestion that is not associated with a pathologic condition.

Which of the following is considered an early symptom of gastric cancer? Pain relieved by antacids Weight loss Bloating after meals Dyspepsia

Pain relieved by antacids Explanation: Symptoms of early disease, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms of progressive disease include weight loss, bloating after meals, and dyspepsia.

During assessment of a client for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, what diagnosis will the nurse suspect? Lactose intolerance Celiac disease Pancreatic insufficiency Ileal dysfunction

Pancreatic insufficiency Explanation: These symptoms are consistent with a diagnosis of pancreatic insufficiency. Loss of ileal absorbing surface results in ileal dysfunction. A toxic response to gluten is characteristic of celiac disease, and a deficiency of intestinal lactase results in lactose intolerance.

A client is being treated for prolonged diarrhea. Which foods should the nurse encourage the client to consume? Protein-rich foods Potassium-rich foods High-fiber foods High-fat foods

Potassium-rich foods Explanation: The nurse should encourage the client with diarrhea to consume potassium-rich foods. Excessive diarrhea causes severe loss of potassium. The nurse should also instruct the client to avoid high-fiber or fatty foods because these foods stimulate gastrointestinal motility. The intake of protein foods may or may not be appropriate depending on the client's status.

A client with obesity is interested in trying olistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication? Chronic obstructive pulmonary disease Renal insufficiency Diabetes mellitus Anemia

Renal insufficiency Explanation: Clients with a history of renal sufficiency or liver disease should use caution while taking this medication as it has been linked to increase rates of cholelithiasis and liver failure. The other conditions do not pose an increase risk with this medication.

The nurse cares for a client after an endoscopic examination and prepares the client for discharge. The nurse includes which instruction? Avoid driving for 24 hours. Continue a clear liquid diet. Resume regular diet. Increase fluid intake.

Resume regular diet. Explanation: The nurse includes resumption of regular diet in the client's discharge instructions as the client is able to resume activities and diet after an endoscopic exam. There is no need to adhere to a clear liquid diet or to increase fluid intake. As sedation is not usually involved for endoscopic examinations, the client does not need to avoid driving.

Which type of diarrhea is caused by increased production of water and electrolytes by the intestinal mucosa and their secretion into the intestinal lumen? Osmotic diarrhea Secretory diarrhea Mixed diarrhea Diarrheal disease

Secretory diarrhea Explanation: Secretory diarrhea is usually high-volume diarrhea caused by increased production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen. Osmotic diarrhea occurs when water is pulled into the intestines by the osmotic pressure of nonabsorbed particles, slowing the reabsorption of water. Mixed diarrhea is caused by increased peristalsis (usually from inflammatory bowel disease) and a combination of increased secretion and decreased absorption in the bowel. The most common cause of diarrheal disease is contaminated food.

A client with obesity has been taking lorcaserin for several months and presents to the health care provider's office reporting fever and diarrhea. Which life-threatening condition does the nurse suspect? Serotonin syndrome C-difficile infection Acute gastritis Cushing's syndrome

Serotonin syndrome Explanation: Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, may rarely cause serotonin syndrome, a life-threatening condition. Symptoms of serotonin syndrome include: high fevers, brisk reflexes, agitation, and diarrhea. C-difficile infection and acute gastritis may cause similar symptoms; however, the client most likely has serotonin syndrome due to the medication the client is taking. Cushing's syndrome results from an excess of cortisol and does not present as a febrile condition with diarrhea.

The nurse inspects a client's tongue. Which finding would the nurse evaluate as an indication of potential oral cancer? V formation on dorsum of tongue thin, white coating on dorsum of tongue red plaque on undersurface of tongue large, vallate papillae on dorsum of tongue

red plaque on undersurface of tongue Explanation: Red or white plaque located on the undersurface of the tongue can be indicative of oral cancer. A thin, white coating on the dorsum of the tongue and large vallate papillae that form a V on the distal portion of the tongue are normal findings.

The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of: total gastrectomy. bariatric surgery. diverticulitis. gastroesophageal reflux disease (GERD).

total gastrectomy. Explanation: If a total gastrectomy is performed, injection of vitamin B12 will be required for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin B12 so that it may be absorbed in the ileum. Bariatric surgery, diverticulitis and GERD do not necessitate total gastrectomy and subsequent vitamin B12 supplementation.

A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true? There is a 6-20 year decrease in overall life expectancy for those with obesity. There is a 2-4 year decrease in overall life expectancy for those with obesity. There is a 25-30 year decrease in overall life expectancy for those with obesity. There is a 21-28 year decrease in overall life expectancy for those with obesity.

There is a 6-20 year decrease in overall life expectancy for those with obesity. Explanation: Overall, there is a 6-20 year decrease in overall life expectancy for those with obesity.

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: acute cholecystitis hepatitis A hepatitis B pancreatitis

acute cholecystitis Explanation: Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.

A patient has been NPO for two days anticipating surgery which has been repeatedly delayed. In addition to risks of nutritional and fluid deficits, the nurse determines that this patient is at the greatest risk for: altered oral mucous membranes. physical injury. ineffective social interaction. confusion.

altered oral mucous membranes. Explanation: Not drinking anything by mouth can result in drying of the oral mucous membranes, compromising their integrity. Being NPO is unrelated to physical injury or ineffective social interaction. Confusion is unlikely to result from the client's NPO status.

A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? The nerve fibers of the intestinal lining are experiencing neuropathy. The pancreas secretes digestive enzymes. Elevated glucose levels cause bacteria overgrowth in the large intestine. Insulin has an adverse effect of constipation.

The pancreas secretes digestive enzymes. Explanation: While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as foundi with diabetes, the digestive functioning may be impaired.

The nurse is reviewing the results of a hemoccult test with the client. Which question asked by the nurse is important in screening for the potential of a false-positive result. Select all that apply. "Do you take an iron supplement on a daily basis?" "Does your diet include a moderate amount of vitamin C?" "Are you prescribed regular strength aspirin daily?" "Can you tell me the amount of alcohol that you drink on an average week?" "When was the last time that you included red meat in your diet?"

"Are you prescribed regular strength aspirin daily?" "Can you tell me the amount of alcohol that you drink on an average week?" "When was the last time that you included red meat in your diet?" Explanation: When obtaining a positive Hemoccult test, the client needs to be screened for a false-positive test result. Substances that may cause a false-positive include red meat, aspirin, and excessive alcohol. Screening for the frequency and amount of these are important. False-negative results are screened in individuals who ingest ascorbic acid and iron supplements.

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, what will the nurse discuss? "You must remove all jewelry but can wear your wedding ring." "You must be NPO for the day before the examination." "Do you experience any claustrophobia?" "The examination will take only 15 minutes."

"Do you experience any claustrophobia?" Explanation: MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

A nurse evaluates the effectiveness of discharge teaching for a client who is postoperative from bariatric surgery. Which statement made by the client indicates to the nurse that additional teaching is necessary?" "For minor pain, I should take prescribed ibuprofen." "I will avoid drinking fluids during meals." "I will chew slowly and thoroughly." "For diarrhea, I should take prescribed antimotility medication."

"For minor pain, I should take prescribed ibuprofen." Explanation: The client who is postoperative from bariatric surgery should avoid non-steroidal anti-inflammatory medications due to the risk of gastric ulcers. The other answer choices are all true statements and indicate the client has understood the nurse's teaching.

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." "It is a hereditary disease." "It is probably your nerves."

"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." Explanation: Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.

A client comes to the clinic reporting pain in the epigastric region. What statement by the client suggests the presence of a duodenal ulcer? "My pain resolves when I have something to eat." "The pain really interferes with my quality of life." "I know that my father and my grandfather both had ulcers." "I seem to have bowel movements more often than I usually do."

"My pain resolves when I have something to eat." Explanation: Pain relief after eating is associated with duodenal ulcers. This type of ulcer is not associated with family history or increased frequency of bowel movements. All types of ulcers can affect the client's quality of life.

A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response? "This is an expected finding with this medication." "How much water are drinking?" "Taking this medication with meals decreases this symptom." "Your dose may need to be adjusted."

"This is an expected finding with this medication." Explanation: Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, causes dry mouth. This is an expected and normal finding. Increasing fluid intake does not make this symptom go away. The other answer choices are incorrect. Reference:

Upon hearing that the small intestine lining has thinned, an elderly client asks, "What can this lead to?" What is the best response by the nurse? "You may frequently have diarrhea." "You may frequently experience constipation." "It is the aging process." "At times you may see mucus in your stool."

"You may frequently experience constipation." Explanation: As a person ages, the epithelial cells and villi thin in the small intestine. Implications of this consequence include decreased intestinal motility and transit time, which can lead to constipation. This would lead the nurse to discuss and advise the client on ways to prevent constipation. Reference:

The nurse cares for a client who is post op bariatric surgery whose bowel sounds have returned and is tolerating oral intake. What teaching will the nurse provide the client about the nutrition required at this time? Select all that apply. "You will have three small meals consisting of 500 calories each." "You need to drink plenty of water in between meals." "Stop eating prior to feeling full." "Eat slowly." "You will have six small meals consisting of 600 calories each."

"You need to drink plenty of water in between meals." "Eat slowly." "You will have six small meals consisting of 600 calories each." Explanation: Once the client's bowel sounds have returned and the client is tolerating oral intake, the nurse will advise the client to drink plenty of water between meals, eat slowly, and eat six meals of 600-800 calories each (at the advisement of the health care provider).

The nurse is providing medication administration teaching for a client with obesity who is prescribed liraglutide for weight loss. What will the nurse include in the teaching? "You will be injecting the medication on a daily basis." "You will be taking the medication for a short-term only." "You will be taking the medication with meals." "You will be taking the medication with another medication."

"You will be injecting the medication on a daily basis." Explanation: Liraglutide (Belviq) is administered via subcutaneous injection. The other answer choices are incorrect.

A nurse researches the cost and financial impact of obesity in America. What is the annual health care cost tied to obesity? $147 billion $118 billion $1 trillion $3 trillion

$147 billion

Blood flow to the GI tract is approximately what percentage of the total cardiac output? 10% 20% 30% 40%

20% Explanation: Blood flow to the GI tract is about 20% of the total cardiac output and increases significantly after eating.

A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity? 35 kg/m2 29 kg/m2 34 kg/m2 40 kg/m2

35 kg/m2 Explanation: Class I obesity is defined as 30-34.9 kg/m2. Class II obesity is defined as a BMI of 35-39.9 kg/m2. A BMI of 40 kg/m2 or greater defines Class III obesity.

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use? 5-mL 10-mL 20-mL 30-mL

30-mL Explanation: When small-bore feeding tubes for continuous tube feedings are used and irrigated after administration of medications, a 30-mL or larger syringe is necessary, because the pressure generated by smaller syringes could rupture the tube.

A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. High intake of fruits and vegetables Age 55 years Female gender Caucasian ancestry Previous infection with H. pylori

Age 55 years Previous infection with H. pylori Explanation: The typical client with gastric cancer is between 40 and 70 years, but gastric cancer can occur in younger people. Men have a higher incidence of gastric cancer than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer. A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. Other factors related to the incidence of gastric cancer include chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, subtotal gastrectomy more than 20 years ago, and genetics.

The nurse cares for clients with obesity and understands that causes are multifactorial. What factors contribute to the development of obesity? Select all that apply. Behavior Environment Physiology Genetics Immunology

Behavior Environment Physiology Genetics Explanation: The causes of obesity are complex and multifactorial, and include behavioral, environmental, physiologic, and genetic factors.

A client presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate which area? Between the umbilicus and the left iliac crest Between the umbilicus and the anterior superior iliac spine In the left periumbilical area In the upper right quadrant slightly below the diaphragm

Between the umbilicus and the anterior superior iliac spine Explanation: Local tenderness in the right lower quadrant is elicited at McBurney's point when pressure is applied between the umbilicus and the anterior superior iliac spine.

A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for? Vagotomy Pyloroplasty Billroth I Billroth II

Billroth I Explanation: A Billroth I is the removal of the lower portion (antrum) of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. A vagotomy is a surgical dissection of the vagus nerve to decrease gastric acid. A pyloroplasty is a procedure to widen the pylorus. A Billroth II is the removal of the lower portion (antrum) of stomach with anastomosis to the jejunum.

A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? Bowel disease of unknown origin Cancer Inflammatory bowel disease Occult bleeding

Cancer Explanation: This procedure is used commonly as a diagnostic aid and screening device. It is most frequently used for cancer screening and for surveillance in patients with previous colon cancer or polyps. In addition, tissue biopsies can be obtained as needed, and polyps can be removed and evaluated. Other uses of colonoscopy include the evaluation of patients with diarrhea of unknown cause, occult bleeding, or anemia; further study of abnormalities detected on barium enema; and diagnosis, clarification, and determination of the extent of inflammatory or other bowel disease.

A nurse is planning care for a client who will undergo bariatric surgery in a week. What goals are acceptable during this point in the client's care? Select all that apply. Client will become knowledgeable about the procedure. Client will understand preoperative and postoperative dietary restrictions. Client will have decreased anxiety about the procedure. Client will understand how to maintain normal bowel function. Client will become knowledgable about vitamin requirements.

Client will become knowledgeable about the procedure. Client will understand preoperative and postoperative dietary restrictions. Client will have decreased anxiety about the procedure. Explanation: Prior to surgery, the client should be knowledgable about the procedure and understand the pre and postoperative dietary requirements. Additionally, the client should also have decreased anxiety about the procedure. Understanding maintenance of normal bowel function and vitamin requirements occur postoperatively.

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply. Daily weights Intake and output monitoring Calorie counts for oral nutrients Daily transparent dressing changes Strict bedrest

Daily weights Intake and output monitoring Calorie counts for oral nutrients Explanation: For the client receiving parenteral nutrition at home, the nurse would obtain daily weights initially, decreasing them to two to three times per week once the client is stable. Intake and output monitoring also is necessary to evaluate fluid status. Calorie counts of oral nutrients are used to provide additional information about the client's nutritional status. Transparent dressings are changed weekly. Activity is encouraged based on the client's ability to maintain muscle tone. Strict bedrest is not appropriate.

A nurse is aware that both the sympathetic and parasympathetic portions of the autonomic nervous system affect GI motility. What are the actions of the sympathetic nervous system? Select all that apply. Decreases gastric motility Relaxes the sphincters Increases secretary activities Causes blood vessel constriction Creates an inhibitory effect on the GI tract

Decreases gastric motility Causes blood vessel constriction Creates an inhibitory effect on the GI tract Explanation: Generally, the sympathetic nervous system inhibits the gastrointestinal tract and the parasympathetic nerve stimulates the tract, increasing peristalsis and secretary activities.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Diarrhea Pain Bloating Abdominal distention

Diarrhea Explanation: The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? At least once a day At least once every 2 days Three or four times daily Every 4 to 6 hours

Every 4 to 6 hours Explanation: The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? Remove the tape from the nose of the client. Withdraw the tube gently for 6 to 8 inches. Provide oral hygiene. Flush with 10 mL of water.

Flush with 10 mL of water. Explanation: Before a nasogastric tube is removed, the nurse flushes the tube with 10 mL of water or normal saline to ensure that the tube is free of debris and away from the gastric tissue. The tape keeps the tube in the correct position while flushing is occurring and is then removed from the nose. The nurse then withdraws the tube gently for 6 to 8 inches until the tip reaches the esophagus, and then the remainder of the tube is withdrawn rapidly from the nostril. After the tube is removed, the nurse provides oral hygiene.

The nurse is caring for a client during the postoperative period following radical neck dissection. Which finding should be reported to the physician? High epigastric pain and/or discomfort Crackles that clear after coughing Serous drainage on the dressing Temperature of 99.0°F (37.2°C)

High epigastric pain and/or discomfort Explanation: The nurse should report high epigastric pain and/or discomfort because this can be a sign of impending rupture. Crackles that clear after coughing, serous drainage on the dressing, and a temperature of 99.0°F are normal findings in the immediate postoperative period and do not need to be reported to the physician.

A client who is postoperative open RYGB bariatric surgery is scheduled for discharge and will have a Jackson-Pratt drain to care for while at home. Which teaching will the nurse include specific to this? Select all that apply. How to change the drain How to empty the drain Recording drainage amount When to contact the health care provider How to measure the drainage amount

How to empty the drain Recording drainage amount When to contact the health care provider How to measure the drainage amount Explanation: A client who is discharged with a Jackson-Pratt drain must be taught on methods to measure, record, and empty the drain. Additionally, the nurse should instruct the client on when to contact the health care provider. The client will not change the drain, this is reserved for the health care provider only.

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply. Hypertension Coronary artery disease Heart failure Myocardial infarction Heart murmur

Hypertension Coronary artery disease Heart failure Myocardial infarction Explanation: Various cardiac diseases and conditions may be associated with obesity. These include: hypertension, heart failure, myocardial infarction, and coronary artery disease. Heart murmur is not directly associated with obesity.

x An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? Hyperkalemia Hypokalemia Hyponatremia Hypernatremia

Hypokalemia Explanation: The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon return to the nursing unit, what does the nurse identify as the client goal? Recover from the general anesthesia Decrease nausea and vomiting Increase the amount of fluids Ambulate independently

Increase the amount of fluids Explanation: The client, returning from an upper gastrointestinal series, needs to increase fluids in an effort to eliminate the barium from the body through a bowel movement. General anesthesia is not used. The client typically does not have nausea and vomiting following the procedure. If the client is able to ambulate independently prior to the procedure, the client will be able to ambulate independently following.

A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is Coiling in the client's mouth Irritating the epiglottis Inserted into the lungs Passing into the esophagus

Inserted into the lungs Explanation: The alert client may cough constantly and have difficulty with respirations when the nasogastric tube enters the lungs. The client may cough but will not have difficulty with respirations with the nasogastric tube coiling in the mouth or irritating the epiglottis. Usually if the nastogastric tube is entering the esophagus, the client will not exhibit coughing or dyspnea.

A nurse geneticist is researching the gut microbiome and its relationship to disease. What is true regarding the microbiome? It has over 100 times more genes than the human genome. It is less diverse than human genome. Its function has yet to be discovered. It has over 10 times more genes than the human genome.

It has over 100 times more genes than the human genome. Explanation: The collective genome of the microbiota, or the gut microbiome, has more than 100 times more genes than in the human genome. Its function and relationship to disease has long been studied.

The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly? Maintain intermittent or continuous suction at a rate greater than 120 mm Hg. Keep the vent lumen above the patient's waist to prevent gastric content reflux. Irrigate only through the vent lumen. Tape the tube to the head of the bed to avoid dislodgement.

Keep the vent lumen above the patient's waist to prevent gastric content reflux. Explanation: The blue vent lumen should be kept above the patient's waist to prevent reflux of gastric contents through it; otherwise, it acts as a siphon.

Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium) Famotidine (Pepcid) Nizatidine (Axid)

Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium)

A positive Rovsing's sign is indicative of appendicitis. A nurse knows to assess for this indicator by palpating the: Right lower quadrant. Left lower quadrant. Right upper quadrant. Left upper quadrant.

Left lower quadrant. Explanation: Rovsing's sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant.

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent? Loperamide Bismuth subsalicylate Kaolin and pectin Bisacodyl

Loperamide Explanation: Loperamide and diphenoxylate with atropine sulfate are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate and kaolin and pectin are examples of absorbent antidiarrheal agents. Bisacodyl is a chemical stimulant laxative.

Swallowing is regulated by which area of the central nervous system (CNS)? Medulla oblongata Pons Cerebellum Hypothalamus

Medulla oblongata Explanation: Swallowing begins as a voluntary act that is regulated by the swallowing center in the medulla oblongata of the CNS. The act of swallowing requires the innervations of five cranial nerves (CNs), especially CN V, VII, IX, X, and XII. Swallowing is not regulated by the pons, cerebellum, or hypothalamus.

The nurse cares for a client who receivies continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct? Monitoring the feeding closely. Increasing the feeding rate. Lowering the head of the bed. Flushing the feeding tube.

Monitoring the feeding closely. Explanation: High residual volumes (>200 mL) should alert the nurse to monitor the client more closely. Increasing the feeding rate will increase the residual volume. Lowering the head of the bed increases the client's risk for aspiration.

Urine output that decreased from 60 to 40 mL/hr Heart rate that increased from 82 to 98 beats/min within 2 hours Fluid output of 2150 mL and total fluid intake of 2000 mL for the past 24 hours Explanation: Data supporting a nursing diagnosis of deficient fluid volume include dry skin and mucus membranes, decreased urinary output, lethargy, and increased heart rate.

Notify the health care provider. Explanation: The nurse should notify the health care provider because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

A client has been taking a 10-day course of antibiotics for pneumonia. The client has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the client about? Nystatin Cephalexin Fluocinolone acetonide oral base gel Acyclovir

Nystatin Explanation: Candidiasis is a fungal infection that results in a cheesy white plaque in the mouth that looks like milk curds. It commonly occurs in antibiotic therapy. Antifungal medications such as nystatin (Mycostatin), amphotericin B, clotrimazole, or ketoconazole may be prescribed.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? Constipation Paralytic ileus Peritonitis Accumulation of gas

Peritonitis Explanation: Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

A nurse teaches a client with obesity about the various medication options for the treatment of obesity. Which medication will the nurse include when teaching the client about the class of medications that stimulate noradrenergic receptors? Phentermine Olistat Lorcaserin Liraglutide

Phentermine Explanation: Phentermine, a sympathomimetic amine, stimulates the noradrenergic receptors, causing appetite suppression. The other answer choices represent medications used to treat obesity; however, these do not stimulate noradrenergic receptors.

The nurse advises the patient who has just been diagnosed with acute gastritis to: Take an emetic to rid the stomach of the irritating products. Refrain from food until the GI symptoms subside. Restrict food and fluids for 12 hours. Restrict all food for 72 hours to rest the stomach.

Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.

The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator? Serum calcium Serum lipase Serum bilirubin Serum amylase

Serum lipase Explanation: Serum amylase and lipase levels are used in making the diagnosis of acute pancreatitis, although their elevation can be attributed to many other causes (Feldman et al., 2010). In most cases, serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days longer than amylase.

A nurse examines the socioeconomic impact of obesity among Americans. Which statements does the nurse understand is true? Select all that apply. Those with less education are impacted at a greater prevalence of disease. Education is not related to the prevalence of disease. Those with less income are impacted at a greater prevalence of disease. Income is not related to the prevalence of disease. Those who own their own homes have a decreased prevalence of disease.

Those with less education are impacted at a greater prevalence of disease. Those with less income are impacted at a greater prevalence of disease. Explanation: The socioeconomic disparities of obesity among Americans is great. In general, those who are less educated and earn less income are more likely to have obesity. Home ownership does not decrease the prevalence of obesity.

A nurse is creating a care plan for a client with a nasogastric tube. How should the nurse direct other members of the care team to check correct placement of the tube? Auscultate the client's abdomen after injecting air through the tube. Assess the color and pH of aspirate. Locate the marking made after the initial x-ray confirming placement. Use a combination of at least two accepted methods for confirming placement.

Use a combination of at least two accepted methods for confirming placement. Explanation: There are a variety of methods to check tube placement. The safest way to confirm placement is to utilize a variety of assessment methods.

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? Alcohol consumption Activity levels Usual pattern of elimination Current medications

Usual pattern of elimination Explanation: Constipation has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? "I need to chew my food slowly and thoroughly." "I need to drink 8 ounces of water before eating." "A total serving should amount to be less than one cup." "I should pick cereals with less than 2 g of fiber per serving."

"I need to drink 8 ounces of water before eating." Explanation: After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withholding fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly, keeping total serving sizes to less than 1 cup, and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? "I need to chew my food slowly and thoroughly." "I need to drink 8 oz of water before eating." "A total serving should amount to be less than 1 cup." "I should pick cereals with less than 2 g of fiber per serving."

"I need to drink 8 oz of water before eating." Explanation: After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withhold fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly; keeping total serving sizes to less than 1 cup; and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.

After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching? "I'll have to wear an external collection pouch for the rest of my life." "I should eat foods from all the food groups." "I'll need to drink at least eight glasses of water a day." "I'll have to catheterize my pouch every 2 hours."

"I'll have to wear an external collection pouch for the rest of my life." Explanation: The client requires additional teaching if he states that he'll have to wear an external collection pouch for the rest of his life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily.

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? 0.9% NS D5W D10W 0.45% of NS

0.9% NS Explanation: The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

Semi-Fowler position is maintained for at least which timeframe following completion of an intermittent tube feeding? 30 minutes 1 hour 90 minutes 2 hours

1 hour Explanation: The semi-Fowler position is necessary for a a nasogastric (NG) feeding, with the client's head elevated at least 30 to 45 degrees to reduce the risk for reflux and pulmonary aspiration. This position is maintained for at least 1 hour after completion of an intermittent tube feeding and is maintained at all times for clients receiving continuous tube feedings.

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required? 1.0 L 1.5 L 2.0 L 2.5 L

1.5 L Explanation: Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is Less than 5% 15% 25% Greater than 50%

15% Explanation: Fifteen percent of clients with peptic ulcer experience bleeding.

When discussing lifestyle modifications with a client who has obesity, what caloric deficit should the nurse recommend in order for the client to safely lose weight? 500-1,000 calories 250-400 calories 300-600 calories 1,000-1,500 calories

500-1,000 calories Explanation: A client with obesity should be counseled to plan a caloric deficit of between 500 and 1000 calories daily from baseline, in order to achieve a 5% to 10% reduction in weight within about 6 months

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? Abdominal distention Frank blood in the stool A change in bowel habits Abdominal pain

A change in bowel habits Explanation: Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

A client is postoperative following a graft reconstruction of the neck. What intervention is the mostimportant for the nurse to complete with the client? Reinforce the neck dressing when blood is present on the dressing. Assess the graft for color and temperature. Administer prescribed intravenous vancomycin at the correct time. Cleanse around the drain using aseptic technique.

Assess the graft for color and temperature. Explanation: Assessing the graft for color and temperature addresses circulation and is most important for the nurse to complete. Reinforcing the neck dressing is important, but not the priority. Administering medication and cleansing the drain site are not most important interventions with the client after graft reconstruction of the neck.

A client has been taking famotidine at home. What teaching should the nurse include with the client? Famotidine will inhibit gastric acid secretions. Famotidine will neutralize acid in the stomach. Famotidine will shorten the time required for digestion in the stomach. Famotidine will improve the mixing of foods and gastric secretions.

Bloating after meals Explanation: Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, loss or decrease in appetite, and nausea or vomiting.

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding? Abdominal pain below the umbilicus Weight gain Bloating after meals Increased appetite

Bloating after meals Explanation: Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, loss or decrease in appetite, and nausea or vomiting.

the nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding? Abdominal pain below the umbilicus Weight gain Bloating after meals Increased appetite

Bloating after meals Explanation: Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, loss or decrease in appetite, and nausea or vomiting.

In women, which of the following types of cancer exceeds colorectal cancer? Breast Lung Skin Liver

Breast Explanation: In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

A client presents with an infection in the area between the internal and external sphincters. In which chronic disease is this condition commonly seen? Crohn's disease diverticulosis ulcerative colitis irritable bowel syndrome

Crohn's disease Explanation: An anorectal abscess is common in clients with Crohn's disease.

What is the primary nursing diagnosis for a client with a bowel obstruction? Deficient fluid volume Deficient knowledge Acute pain Ineffective tissue perfusion

Deficient fluid volume Explanation: Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation. Therefore, Deficient fluid volume is the primary diagnosis. Deficient knowledge, Acute pain, and Ineffective tissue perfusion are applicable but not the primary nursing diagnosis. Reference:

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom? Hiatal hernia Gastroesophageal reflux disease Gastritis Esophageal tumor

Esophageal tumor Explanation: Esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but less likely to be as significant as esophageal tumor/cancer.

A nurse cares for a client who is postoperative bariatric surgery and has experienced frequent episodes of dumping syndrome. The client now reports anorexia. What is the primary reason for the client's report of anorexia? Fear of eating Taste of food Size of the stomach Absorption of food

Fear of eating Explanation: Dumping syndrome is an unpleasant set of GI and vasomotor symptoms that commonly occur in clients who have had bariatric surgery. The symptoms are so unpleasant that the client may develop a fear of eating, leading to anorexia.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? Cutting the faceplate opening no more than 2? larger than the stoma Gently washing the area surrounding the stoma using a facecloth and mild soap Scrubbing fecal material from the skin surrounding the stoma Maintaining wrinkles in the faceplate so it doesn't irritate the skin

Gently washing the area surrounding the stoma using a facecloth and mild soap Explanation: For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? Slow the current infusion rate so that it will last until the new solution arrives. Hang a solution of dextrose 10% and water until the new solution is available. Have someone go to the pharmacy to obtain the new solution. Begin an infusion of normal saline in another site to maintain hydration.

Hang a solution of dextrose 10% and water until the new solution is available. Explanation: The infusion rate of the solution should not be increased or decreased; if the solution is to run out, a solution of 10% dextrose and water is used until the next solution is available. Having someone go to the pharmacy would be appropriate, but there is no way to determine if the person will arrive back before the solution runs out. Starting another infusion would be inappropriate. Additionally, the infusion needs to be maintained through the central venous access device to maintain patency.

The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: Hemorrhage Intractable ulcer Perforation Pyloric obstruction

Hemorrhage Explanation: Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Intractable ulcer refers to one that is hard to treat, relieve, or cure. Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

A client has just received a diagnosis of hypertension after the completion of diagnostics. What can the client do to decrease the consequences of hypertension? Select all that apply. Lose weight. Manage stress effectively. Use smokeless tobacco. Get plenty of rest.

Lose weight. Manage stress effectively. Explanation: Obesity, inactivity, smoking, excessive alcohol intake, and ineffective stress management are risk factors for hypertension.

A focused GI assessment begins with a complete history and physical examination. Identify the quadrant of the abdomen to be palpated or percussed for a patient with pancreatitis. Right upper Right lower Left upper Left lower

Left upper Explanation: The pancreas, which is about 6 inches long, is located behind the stomach in the upper left side of the body.

The health care provider orders the insertion of a single lumen nasogastric tube. When gathering the equipment for the insertion, what will the nurse select? Salem sump tube Miller-Abbott tube Sengsten-Blakemore tube Levin tube

Levin tube Explanation: A Levin tube is a single lumen nasogastric tube. A Salem sump tube is a double lumen nasogastric tube; a Sengsten-Blakemore tube is a triple lumen nasogastric tube. A Miller-Abbott tube is a double lumen nasoenteric tube.

A nurse cares for a client with obesity who has type 2 diabetes. Which medication does the nurse recognize may assist in weight loss and is also approved to treat type 2 diabetes? Lorcaserin Orlistat Liraglutide Benzphetamine

Liraglutide Explanation: Liraglutide (Saxenda), a GLP-1 receptor agonist, is used for both the treatment of obesity and type 2 diabetes. The other medications are used for the treatment of obesity only.

The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? Maintaining skin integrity Beginning a bowel program to establish continence Instituting a diet high in fiber and increase fluid intake Determining the need for surgical intervention to correct the problem

Maintaining skin integrity Explanation: Fecal incontinence can disrupt perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or older adult patient.

A male client in a wheelchair comes in for his yearly physical examination. He is unable to stand. The nurse retrives the wheelchair scale to obtain an accurate weight. The nurse understands the importance of this assessment with this client. What is the nurse's reasoning for obtaining an accurate weight? People with disabilities have an increased incidence of obesity. A wheelchair-bound client is usually depressed about his or her weight. Wheelchairs make clients very self-conscious about their weight. Weight is more difficult to control if a client is wheelchair-bound.

People with disabilities have an increased incidence of obesity. Explanation: Many clients with disabilities report that they have not been weighed for years because they cannot stand during weighing. Alternative methods such as use of a wheelchair scale is important, because there is an increased incidence of obesity in clients with disabilities.

A client undergoing a diagnostic examination for gastrointestinal disorder was given polyethylene glycol/electrolyte solution as a part of the test preparation. Which of the following measures should the nurse take once the solution is administered? Instruct the client to have low-residue meals. Allow the client to ingest fat-free meal. Permit the client to drink only clear liquids. Provide saline gargles to the client.

Permit the client to drink only clear liquids. Explanation: After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy.

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on? H2-receptor antagonist and two antibiotics H2-receptor antagonist, proton-pump inhibitor, and an antibiotic Proton-pump inhibitor, an antibiotic, and bismuth salts Proton-pump inhibitor and two antibiotics

Proton-pump inhibitor and two antibiotics Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori bacteria. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? Ensure adequate hydration with additional water. Provide frequent mouth care. Keep the feeding formula refrigerated. Flush the tube with water before adding the feedings.

Provide frequent mouth care. Explanation: Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first? Radiography of the gallbladder Barium enema Small bowel series Barium swallow

Radiography of the gallbladder Explanation: Radiography of the gallbladder should be performed before other GI exams in which barium is used because residual barium tends to obscure the images of the gallbladder and its duct.

A nurse works in a bariatric clinic and cares for client with obesity who will or have undergone bariatric surgery. What is the nurse's understanding of how the procedure works? Restricts the client's ability to eat. Impairs caloric absorption. Restricts the client's ability to digest fat. Impairs gastric motility.

Restricts the client's ability to eat. Explanation: Bariatric surgical procedures work by restricting a patient's ability to eat (restrictive procedure), interfering with ingested nutrient absorption (malabsorptive procedures), or both. Bariatric procedures do not impair caloric absorption; rather, nutrients are impaired by malabsorption.

When evaluating the function of the GI tract, the nurse needs to understand the role of hormones. Secretin, stimulated by the pH of chyme in the duodenum, is a major GI hormone that does which of the following? Causes the gallbladder to contract Influences contraction of the esophageal and pyloric sphincters Regulates the secretion of gastric acid Stimulates the production of bicarbonate in pancreatic juice

Stimulates the production of bicarbonate in pancreatic juice Explanation: Secretion inhibits gastric secretion and increases the production of bicarbonate-rich pancreatic juices, thus inhibiting gastric motility.

A client comes to the clinic complaining of a sore throat. When assessing the client, the nurse observes a reddened ulcerated lesion on the lip. The client tells the nurse that it has been there for a couple of weeks but it does not hurt. What should the nurse consult with the health care provider about testing for? HIV Syphilis Gonorrhea Herpes simplex

Syphilis

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention? Serosanguineous drainage on the dressing Foley catheter bag containing 500 ml of amber urine A piggyback infusion of levofloxacin The client lying in a lateral position, with the head of bed flat

The client lying in a lateral position, with the head of bed flat A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery? Vagus Hypoglossal Vestibulocochlear Trigeminal

Vagus Explanation: Cardiac complications include atrial fibrillation, which occurs due to irritation of the vagus nerve at the time of surgery. The hypoglossal nerve controls muscles of the tongue. The vestibulocochlear nerve functions in hearing and balance. The trigeminal nerve functions in chewing of food.

To ensure patency of central venous line ports, diluted heparin flushes are used with continuous infusions. before drawing blood. when the line is discontinued. daily when not in use.

daily when not in use. Explanation: Daily instillation of dilute heparin flush when a port is not in use will maintain the port. Continuous infusion maintains the patency of each port. Heparin flushes are used after each intermittent infusion. Heparin flushes are used after blood drawing to prevent clotting of blood within the port. Heparin flush of ports is not necessary if a line is to be discontinued.

The nurse establishes a learning contract with an overweight client. The contract is best if it is an oral contract between the nurse and the client has an overall goal of 30-pound weight loss in six months contains an agreement to ingest a well-balanced diet includes an incremental goal of 1-2 pound weight loss this week

includes an incremental goal of 1-2 pound weight loss this week Explanation: The learning contract is recorded in writing. It is to be clear and describe what is to be achieved. A well-balanced diet is too vague. The nurse provides frequent and positive reinforcement as the client moves from one goal to the next. It is easier for the client to achieve a smaller, obtainable goal, such as 1-2 pound weight loss in one week, versus 30 pounds in 6 months.

Which is a true statement regarding the nursing considerations in administration of metronidazole? It may cause weight gain. The drug should be given before meals. Metronidazole decreases the effect of warfarin. It leaves a metallic taste in the mouth.

it leaves a metallic taste in the mouth. Explanation: Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.

Lisa Bentley, a 32-year-old teacher, presents to the gastroenterology office where you work. She is known to have a history of Crohn's disease, and you have met with her several times to discuss the various health concerns that she has related to her diagnosis. When talking with the client, the nurse explains that having a GI disorder doesn't mean her problems are limited to the one area that is diseased but might also involve all of the following except ________. metabolism ingestion digestion absorption elimination

metabolism Explanation: The client with a GI disorder may experience a wide variety of health problems that involve disturbances of ingestion, digestion, absorption, and elimination. The client with a GI disorder may experience health problems that involve disturbances of ingestion, digestion, absorption, and elimination.

The healthcare provider of a client with oral cancer has ordered the placement of a GI tube to provide nutrition and to deliver medications. What would be the preferred route? nasogastric intubation orogastric intubation nasoenteric intubation gastrostomy

nasogastric intubation Explanation: The nasal route is the preferred route for passing a tube when the client's nose is intact and free from injury.

A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers? "Sit in a semi-recumbent position while eating." "Keep the head of your bed propped on blocks at night." "Avoid taking non-steroidal anti-inflammatory drugs." "Avoid taking antacid drugs."

"Avoid taking non-steroidal anti-inflammatory drugs." Explanation: The only statement that aids in avoiding gastric ulcers is the statement instructing the client to avoid taking non-steroidal anti-inflammatory (NSAID) drugs. Sitting in a semi-recumbent of low Fowler's position aids in digestion but does not aid in the prevention of gastric ulcers. Propping the head of the bed would be beneficial for a client report GERD or acid reflux. antacid drugs do not increase the risk of gastric ulcers.

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." "I need to use laxatives regularly to prevent constipation." "I need to drink 2 to 3 liters of fluids every day." "I should exercise four times per week."

"I need to use laxatives regularly to prevent constipation." Explanation: The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

The nurse provides client education to a client about to undergo hydrogen breath testing. The nurse evaluates that the client understands the test when the client makes which statement? "First, I will drink a cherry flavored liquid." "The test will detect the presence of staph." "I should avoid antibiotics for 1 month before the test." "The test will detect the presence of oral cancer."

"I should avoid antibiotics for 1 month before the test." Explanation: The nurse evaluates that the client understands the education when the client states antibiotics should be avoided one month before the test. In addition, the client should avoid loperamide, sucralfate, and omeprazole for 1 week prior to the test, and cimetidine, famotidine, and ranitidine for 24 hours before the test. During the test, the client swallows a capsule of carbon-labeled urea and a breath sample is obtained 10 to 20 minutes later. The hydrogen breath test detects the presence of <italic>Helicobacter pylori, the bacteria that causes peptic ulcer disease.

After teaching a client about the procedure for inserting a nontunneled central catheter, the nurse determines that the client has understood the instructions based on which statement? "I need to keep my head turned directly toward you and the health care provider." "I will be lying on my back but my legs will be higher than my head." "I will need to take long, slow, deep breaths when the catheter is inserted." "I'll have to wear a thick, bulky dressing over the site."

"I will be lying on my back but my legs will be higher than my head." Explanation: For catheter insertion, the client is in the Trendelenburg position to produce dilation of the neck and shoulder vessels, which makes entry easier and decreases the risk of air embolus. The client is instructed to turn the head away from the site of the venipuncture and to remain motionless while the catheter is inserted and the site is dressed. During insertion, until the syringe is detached from the needle and the catheter is inserted, the client may be asked to perform the Valsalva maneuver, not take long, slow, deep breaths. Typically a transparent dressing is applied o

A nurse is caring for a client who will undergo bariatric surgery. Which nutritional recommendation will the nurse include in the client teaching? "Increase your intake of complex carbohydrates." "Increase your intake of monounsaturated fats." "Increase your intake of plant-based proteins." "Increase your intake of fluids at meals."

"Increase your intake of plant-based proteins." Explanation: The client should be advised to increase protein intake, particularly plant-based protein because animal-based protein may not be tolerated well. The client should be advised to decrease fat intake, regardless of the source. Additionally, the client should be advised to decrease fluid intake at meals, not increase intake.

A nurse is teaching a group of adults on the risks of obesity on neurological health. What statement will the nurse include in the teaching regarding obesity and the risk for developing Alzheimer disease? "Individuals with obesity are four times more likely to develop Alzheimer disease than those who do not have obesity." "Individuals with obesity are twice as likely to develop Alzheimer disease than those who do not have obesity." "Individuals with obesity have the same risk for developing Alzheimer disease than those who do not have obesity." "Individuals with obesity have a decreased risk of developing Alzheimer disease than those who do not have obesity."

"Individuals with obesity are twice as likely to develop Alzheimer disease than those who do not have obesity." Explanation: Individuals with obesity are four times more likely to develop Alzheimer disease than those who do not have obesity.

A nurse cares for a client with obesity who is scheduled to undergo vegal blocking therapy. When teaching the client about the procedure or device, which statements will the nurse include? Select all that apply. "It is a pacemaker-type device that is implanted under your skin." "It is a stent-like device that is inserted into your vein." "A pre-programed pulsating signal is delivered." "A liquid medication is slowly delivered." "Recharge the device two times per week."

"It is a pacemaker-type device that is implanted under your skin." "A pre-programed pulsating signal is delivered." "Recharge the device two times per week." Explanation: Vagal blocking therapy involves placement of a pacemaker-like device into the subcutaneous tissue in the lateral thoracic cavity with two leads that are laparoscopically implanted at the point where the vagus nerve truncates, at the gastroesophageal junction. A pre-programed pulsating signal is delivered, "blocking" the vagus nerve. This leads to decreased gastric contraction and emptying, limited ghrelin secretion, and diminished pancreatic enzyme secretion; these cause increased satiety, decreased cravings, and diminished absorption of calories, all of which lead to weight loss.

A client has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The client is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond? "Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery." "The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate." "Your body will absorb slightly fewer nutrients from the food you eat, but you won't be aware of this." "Your small intestine will adapt over time to the absence of your appendix."

"Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery." Explanation: The appendix is an appendage of the cecum (not the small intestine) that has little or no physiologic function. Its absence does not affect digestion or absorption.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established.

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Explanation: A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.

After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? Volvulus Intussusception Tumor Abdominal surgery

Abdominal surgery Explanation: In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.

A patient tells the nurse that it feels like food is "sticking" in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate? Achalasia Diffuse spasm Gastroesophageal reflex disease Hiatal hernia

Achalasia Explanation: Achalasia is absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing. Narrowing of the esophagus just above the stomach results in a gradually increasing dilation of the esophagus in the upper chest. The main symptom is difficulty in swallowing both liquids and solids. The patient has a sensation of food sticking in the lower portion of the esophagus.

The nurse is conducting a community education session on the prevention of oral cancers. The nurse includes which cancer as being a type of premalignant squamous cell skin cancer? Herpes simplex 1 Actinic cheilitis Chancre Krythoplakia

Actinic cheilitis Explanation: Actinic cheilitis is a type of premalignant squamous cell skin cancer that presents as scaling, crusty fissures or a white overgrowth of the horny layer of the epidermis. Herpes simplex 1 is an opportunistic infection frequently seen in immunosuppressed clients. Chancres are reddened circumscribed lesions that ulcerate and become crusted and are the primary lesions of syphilis. Krythoplakia is a red patch on the oral mucous membrane that is frequently seen in the elderly.

A nurse is performing an assessment for a client who presents to the clinic with an erythemic, fissuring lip lesion with white hyperkeratosis. What does the nurse suspect that these findings are characteristic of? Actinic cheilitis Human papillomavirus lesion Frey syndrome Sialadenitis

Actinic cheilitis Explanation: Actinic cheilitis is an irritation of the lips associated with scaling, crusting, fissure, and overgrowth of a white, horny layer of epidermis (hyperkeratosis). Human papillomavirus lesions appear as flat lesions, small cauliflower-like bumps, or tiny stemlike protrusions. Frey syndrome is damage to the parotid glands after surgery resuting in saliva disturbances. Sialadenitis is an infection associated with pain, tenderness, redness, and gradual, localized swelling affecting the salivary gland.

What is the most common cause of small-bowel obstruction? Hernias Neoplasms Adhesions Volvulus

Adhesions Explanation: Adhesions are scar tissue that forms as a result of inflammation and infection. Adhesions are the most common cause of small-bowel obstruction, followed by tumors, Crohn's disease, and hernias. Other causes include intussusception, volvulus, and paralytic ileus.

When preparing a client for a hemorrhoidectomy, the nurse should take which action? Administer an enema as ordered. Administer oral antibiotics as ordered. Administer topical antibiotics as ordered. Administer analgesics as ordered.

Administer an enema as ordered. Explanation: When preparing a client for a hemorrhoidectomy, the nurse should administer an enema, as ordered, and record the results. After surgery, the client may require antibiotics and analgesics.

A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms? A pattern of distinct exacerbations and remissions Severe diarrhea An absence of blood in stool Involvement of the rectal mucosa

An absence of blood in stool Explanation: Bloody stool is far more common in cases of UC than in Crohn's. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohn's) and clients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohn's often has a more prolonged and variable course.

A client has undergone a radical neck dissection. His skin graft site is pale. This indicates which condition? Possible necrosis Arterial thrombosis Venous congestion Infection

Arterial thrombosis Explanation: A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion. Reference:

A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver? Select all that apply. Ascites Hepatomegaly Distented bladder Sister Mary Joseph's nodules Petechiae at the palpation site

Ascites Hepatomegaly Explanation: The physical examination is usually not helpful in detecting the cancer because most early gastric tumors are not palpable. Advanced gastric cancer may be palpable as a mass. Ascites and hepatomegaly (enlarged liver) may be apparent if the cancer cells have metastasized to the liver. Palpable nodules around the umbilicus, called Sister Mary Joseph's nodules, are a sign of a GI malignancy, usually a gastric cancer. A distended bladder is not significant. Petechiae at the palpation site is a distractor for the question.

A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. What would be the first activity performed by the nurse? Assess lung sounds bilaterally. Administer prescribed morphine intravenously. Obtain consent for the esophagogastroscopy. Suction the oral cavity of the client.

Assess lung sounds bilaterally. Explanation: All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment.

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? Vomiting Hemorrhage Awakening in pain Constipation

Awakening in pain Explanation: The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.

A client who underwent abdominal surgery and has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first? Measure abdominal girth. Auscultate bowel sounds. Assess patency of the NG tube. Assess vital signs.

Assess patency of the NG tube. Explanation: When an NG tube is no longer patent, stomach contents collect in the stomach, giving the client a sensation of fullness. The nurse should begin by assessing patency of the NG tube. The nurse can measure abdominal girth, auscultate bowels, and assess vital signs, but she should check NG tube patency first to help relieve the client's discomfort.

A client had a central line inserted for parenteral nutrition and is awaiting transport to the radiology department for catheter placement verification. The client reports feeling anxious and has a respiratory rate of 28 breaths/minute. What is the next action of the nurse? Auscultate lung sounds Position client flat in bed Apply nasal cannula oxygen Consult with the healthcare provider

Auscultate lung sounds Explanation: Following placement of a central line, the client is at risk for a pneumothorax. The client's report of anxiety and increased respiratory rate may be the first signs and symptoms of a pneumothorax. The nurst should first assess the client by auscultating lung sounds before applying oxygen, placing the client in Fowler's position, and consulting with the healthcare provider about findings.

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease? Minimize intake of caffeine, beer, milk, and foods containing peppermint or spearmint. Avoid eating or drinking 2 hours before bedtime. Elevate the foot of the bed on 6- to 8-inch blocks. Eat a low-carbohydrate diet.

Avoid eating or drinking 2 hours before bedtime. Explanation: The client should not recline with a full stomach. The client should be instructed to avoid caffeine, beer, milk, and foods containing peppermint or spearmint, and to eat a low-fat diet. The client should be instructed to elevate the head of the bed on 6- to 8-inch blocks.

A nurse prepares nutrition education for a client who will undergo bariatric surgery. What nutrition suggestion best indicates a beneficial effect on the number and quality of bowel movements the client may have after surgery? Increase fluid intake Avoid high-fat foods Eat a wide variety of foods Increase protein intake

Avoid high-fat foods Explanation: Reducing the amount of fat will have a direct beneficial effect on the number and quality of bowel movements a client may have. Increasing fluid intake will help, but it is not the most beneficial. The client should not be encouraged to eat a wide variety of foods; rather, instruction on foods that will be best tolerated will be encouraged. Protein intake does not have a direct correlation to the client's quality of bowel movements post-bariatric surgery.

The nurse is creating a plan of care for a client who is not able to tolerate brushing his teeth. The nurse includes which mouth irrigation in the plan of care? Dextrose and water Baking soda and water Full-strength peroxide Mouthwash and water

Baking soda and water Explanation: When a client is unable to tolerate teeth brushing, the following irrigating solutions are recommended: 1 tsp baking soda in 8 oz warm water, half-strength hydrogen peroxide, or normal saline solution.

A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor? Both tests need to be done before breakfast. The ultrasonography should be scheduled before the GI procedure. The upper GI should be scheduled before the ultrasonography. The client may eat a light meal before either test.

Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.

A nurse inspects the Stensen duct of the parotid gland to determine inflammation and possible obstruction. What area in the oral cavity would the nurse examine? Buccal mucosa next to the upper molars Dorsum of the tongue Roof of the mouth next to the incisors Posterior segment of the tongue near the uvula

Buccal mucosa next to the upper molars Explanation: The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

A nurse cares for a client with obesity who is also diagnosed with depression. Which medication does the nurse expect the health care provider will prescribe, which also aids in weight loss? Bupropion Amitriptyline Nortriptyline Doxepin

Bupropion Explanation: Bupropion (Wellbutrin) is an antidepressant medication which promotes weight loss. The other medications are antidepressants; however, these promote weight gain, not weight loss.

The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism? Compromised peripheral blood flow Increased blood viscosity Impaired clotting Increased fat accumulation in the blood

Compromised peripheral blood flow Explanation: A client with obesity is at increased risk for developing thromboembolism due to compromised blood flow and resulting venous stasis. Although the client with obesity is at risk for high cholesterol levels, increased fat in the blood does not directly impact the risk for developing thromboembolism. Increased blood viscosity and impaired clotting do not typically occur in obesity and are not the reason a clie

A nurse cares for a client with obesity. Which medication that the client takes may be contributing to the client's obesity? Topiramate Metformin Gabapentin Bupropion

Gabapentin Explanation: Gabapentin (Neurontn) is an anticonvulsant medication which promotes weight gain. The other answer choices are medications which promote weight loss, not gain.

A nurse is preparing to administer a client's scheduled parenteral nutrition (PN). Upon inspecting the bag, the nurse notices that small amounts of white precipitate are present in the bag. What is the nurse's best action? Recognize this as an expected finding. Place the bag in a warm environment for 30 minutes. Shake the bag vigorously for 10 to 20 seconds. Contact the pharmacy to obtain a new bag of PN.

Contact the pharmacy to obtain a new bag of PN. Explanation: Before PN infusion is given, the solution must be inspected for separation, oily appearance (also known as a "cracked solution"), or any precipitate (which appears as white crystals). If any of these are present, it is not used. Warming or shaking the bag is inappropriate and unsafe.

A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: Coronary artery disease Diabetes Use of lithium Peptic ulcer disease

Coronary artery disease Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.

A client with gastric cancer is having a resection. What is the nursing management priority for this client? Discharge planning Correcting nutritional deficits Preventing deep vein thrombosis (DVT) Teaching about radiation treatment

Correcting nutritional deficits Explanation: Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.

A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of? Crohn's disease Ulcerative colitis Irritable bowel syndrome Diverticulitis

Crohn's disease Explanation: The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

A client with a 10-year history of Crohn's disease is seeing the physician due to increased diarrhea and fatigue. Additionally, the client has developed arthritis and conjunctivitis. What is the mostlikely cause of the latest symptoms? Crohn's disease staph infections irritable bowel syndrome All options are correct.

Crohn's disease Explanation: The systemic nature of Crohn's disease is evidenced by symptoms outside the GI tract, referred to as extraintestinal manifestations of IBD. They include arthritis, arthralgias, skin lesions, eye inflammation (uveitis, conjunctivitis, and iritis), and disorders of the liver and gallbladder.

Which ulcer is associated with extensive burn injury? Cushing ulcer Curling ulcer Peptic ulcer Duodenal ulcer

Curling ulcer Explanation: Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? Curling's ulcer Peptic ulcer Esophageal ulcer Meckel's ulcer

Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.

A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply. Hypertension Diarrhea Decreased bowel sounds Tachycardia Diaphoresis

Diarrhea Tachycardia Diaphoresis Explanation: Dumping syndrome is manifested by hypotension, diarrhea, tachycardia, and diaphoresis. The client often reports a feeling of fullness, nausea, and vomiting. Because of the rapid movement of water to the stomach and intestines, bowel sounds would most likely be increased.

What would the nurse identify as a characteristic finding when assessing a client for pilonidal sinus? Pain in the perianal area Purulent drainage from the gluteal fold Dilated pits of hair follicles in the cleft Abdominal pain

Dilated pits of hair follicles in the cleft

The nurse is caring for an older adult who reports xerostomia. The nurse evaluates for use of which medication? Steroids Antibiotics Antiemetics Diuretics

Diuretics Explanation: Diuretics, frequently taken by older adults, can cause xerostomia (dry mouth). This is uncomfortable, impairs communication, and increases the client's risk for oral infection. Antibiotics, antiemetics, and steroids are not medications typically taken orally by adults that cause dry mouth.

A nurse is educating a client who will undergo bariatric surgery on methods to prevent dysphagia. What teaching will the nurse include? Select all that apply. "Eat slowly." "Chew your food thoroughly." "Avoid eating tough foods." "Eat bland foods such as doughy bread." "Avoid eating overcooked meats."

Eat slowly." "Chew your food thoroughly." "Avoid eating tough foods." "Avoid eating overcooked meats." Explanation: Dysphagia means "difficulty swallowing." This complication may occur after restrictive bariatric surgery and tends to be most severe 4 to 6 weeks after surgery and persists for up to 6 months. The nurse should instruct the client to chew thoroughly and eat slowly. Advise the client to avoid eating tough foods, doughy breads, and overcooked meats.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test

Endoscopy Explanation: Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

A nurse caring for a client who is post op bariatric surgery notes that the client has no bowel sounds and suspects the client may have a bowel obstruction. What treatment or therapy does the nurse expect the client will require? Nasogastric tube Endoscopy GI-motility agent Stool softener

Endoscopy Explanation: While NG tube insertion is common in a client with bowel obstruction, it is contraindicated in the client who has undergone bariatric surgery. Endoscopy is the treatment of choice for this client. Gi-motility agents or stool softeners are not indicated in this client and would make the client's situation worse.

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be Diarrhea Hemorrhoids Fecal incontinence Dark, tarry stools

Fecal incontinence Explanation: The nurse should anticipate fecal incontinence as one of the assessment findings. Other possible assessment findings include constipation and abdominal distention.

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for? Anorectal manometry Transit study Flexible sigmoidoscopy Barium enema

Flexible sigmoidoscopy Explanation: The treatment of fecal incontinence depends on the cause. A rectal examination and other endoscopic examinations, such as a flexible sigmoidoscopy, are performed to rule out tumors, inflammation, or fissures. X-ray studies such as barium enema, computed tomography (CT), anorectal manometry, and transit studies may be helpful in identifying alterations in intestinal mucosa and muscle tone or in detecting other structural or functional problems.

Which of the following is a function of the stomach? Select all that apply. Food storage Secretion of digestive fluids Propels partially digested food into small intestine Secretion of digestive enzymes Secretion of bile

Food storage Secretion of digestive fluids Propels partially digested food into small intestine Explanation: The stomach stores food during eating, secretes digestive fluids, and propels the partially digested foods into the small intestine. Secretion of digestive enzymes is completed by the pancreas. The liver secretes bile.

A nurse is assessing the abdomen of a client just admitted to the unit with a suspected GI disease. Inspection reveals several diverse lesions on the client's abdomen. How should the nurse best interpret this assessment finding? Abdominal lesions are usually due to age-related skin changes. Integumentary diseases often cause GI disorders. GI diseases often produce skin changes. The client needs to be assessed for self-harm.

GI diseases often produce skin changes. Explanation: Abdominal lesions are of particular importance, because GI diseases often produce skin changes. Skin problems do not normally cause GI disorders. Age-related skin changes do not have a pronounced effect on the skin of the abdomen when compared to other skin surfaces. Self-harm is a less likely explanation for skin lesions on the abdomen.

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? Peptic ulcer disease Esophageal cancer Gastroesophageal reflux disease Diverticulitis

Gastroesophageal reflux disease Explanation: Symptoms may include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia (pain on swallowing), hypersalivation, and esophagitis.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? Sigmoid colon Appendix Spleen Liver

Liver Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 43: Assessment of Digestive and Gastrointestinal Function, Anatomy of the Gastrointestinal System, p. 1225.

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. Liver Pancreas Bladder Duodenum Lungs

Liver Pancreas Duodenum Explanation: Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Pelvic x-ray Stool specimen Nasogastric tube insertion Oral contrast

Nasogastric tube insertion Explanation: The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.

A client with obesity taking lorcaserin reports feeling agitated lately and has had diarrhea for several days. What is the nurse's priority response? Notify the health care provider. Assess the frequency of bowel movements. Prepare for intravenous fluid replacement. Obtain a stool sample.

Notify the health care provider. Explanation: The client may be developing serotonin syndrome, a potentially life-threatening condition which the health care provider needs to know about right away.

Which of the following medications is classified as a proton pump inhibitor (PPI)? Omeprazole Ranitidine Cimetidine Famotidine

Omeprazole Explanation: Omeprazole is classified as a PPI. Ranitidine, Cimetidine, and Famotidine are classified as H2 receptor antagonists.

An elderly client comes into the emergency department reporting an earache. The client and has an oral temperature of 37.9° (100.2ºF) and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next? Palpate the client's parotid glands to detect swelling and tenderness. Assess the temporomandibular joint for evidence of a malocclusion. Test the integrity of cranial nerve XII by asking the client to protrude the tongue. Inspect the client's gums for bleeding and hyperpigmentation.

Palpate the client's parotid glands to detect swelling and tenderness. Explanation: Older adults and debilitated clients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness, as well as swelling of the parotid glands. Pain radiates to the ear. Pain associated with malocclusion of the temporomandibular joint may also radiate to the ears; however, a temperature elevation would not be associated with malocclusion. The 12th cranial nerve is not associated with the auditory system. Bleeding and hyperpigmented gums may be caused by pyorrhea or gingivitis. These conditions do not cause earache; fever would not be present unless the teeth were abscessed.

A patient reports an inflamed salivary gland below the right ear. The nurse documents probable inflammation of which gland? Buccal Parotid Sublingual Submandibular

Parotid Explanation: The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

An examiner is performing the physical assessment of the rectum, perianal region, and anus. While this examination can be uncomfortable for many clients, health care providers must approach it in a prepared, confident manner. Which of the following considerations will help this examination flow smoothly and efficiently for both provider and client? Select all that apply. Position the client on the right side with the knees up to the chest. Ask the client to bear down for visual inspection. Cleanse gloved fingers with water to allow for easy insertion. Dim the lights to decrease the client's embarrassment. Ask the client to produce a bowel movement after the procedure.

Position the client on the right side with the knees up to the chest. Ask the client to bear down for visual inspection. Explanation: While examination of the rectum, perineum, and anus may be uncomfortable for the client, it is necessary for a thorough examination. The examiner will position the client on the right side with the knees up. He or she will use a gloved finger lubricated with a water-soluble lubricant for ease of insertion. The health care provider will encourage deep breathing during the procedure and ask the client to bear down while inspecting the anal area. The examination requires appropriate lighting for thorough inspection.

The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? Works best when taken on an empty stomach Increases the speed of gastric emptying Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Decreases mucus production

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding? Rapid gastric dumping Excessive fat intake Decreased motility Decreased gastric size

Rapid gastric dumping Explanation: Rapid gastric dumping may lead to steatorrhea, excessive fat in the feces. The primary cause of this finding is rapid gastric dumping. Excessive fat intake can make the problem worse; however, this is not the primary cause of the symptoms. Steatorrhea results from increased motility, not decreased and the size of the stomach does not contribute to this finding. Reference:

A client is treated for gastrointestinal problems related to chronic cholecystitis. What pathophysiological process related to cholecystitis does the nurse understand is the reason behind the client's GI problems? Contractile spasms of the gallbladder decreases appetite and leads to malnutrition. Inflammation of the gallbladder causes pain and impacts gastric motility. Reduced or absent bile as a result of obstruction impacts digestion. Increased bile as a result of inflammation leads to indigestion.

Reduced or absent bile as a result of obstruction impacts digestion. Explanation: Digestion is impacted by cholecystitis because an obstruction of the gallbladder results in reduced or absent bile. Contractile spasms and inflammation of the gallbladder leads to pain, not problems with digestion.

A nursing instructor is preparing a class about gastrointestinal intubation. Which of the following would the instructor include as reason for this procedure? Select all that apply. Remove gas and fluids from the stomach Diagnose gastrointestinal motility disorders Flush ingested toxins from the stomach Evaluate for masses in the large colon Administer nutritional substances

Remove gas and fluids from the stomach Diagnose gastrointestinal motility disorders Flush ingested toxins from the stomach Administer nutritional substances Explanation: Gastrointestinal intubation is used to decompress the stomach and remove gas and fluids, lavage the stomach and remove ingested toxins or other harmful materials, diagnose disorders of GI motility, administer medications and feedings, compress a bleeding site, and aspirate gastric contents for analysis. Because gastrointestinal intubation involves the insertion of a tube into the stomach, beyond the pylorus into the duodenum or jejunum, it could not be used to evaluate for masses in the large colon.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? Draw a circle around the moist spot and note the date and time. Notify the physician. Remove the catheter, check for catheter integrity, and send the tip for culture. Remove the dressing, clean the site, and apply a new dressing.

Remove the dressing, clean the site, and apply a new dressing. Explanation: A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. She should notify the physician if she observes any catheter-related complications. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.

The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? Referred pain Rebound pain Rovsing sign Cremasteric reflex

Rovsing sign Explanation: When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the right lower quadrant, this is referred to as a positive Rovsing sign and suggests acute appendicitis. Referred pain indicates pain in another area but is not necessarily manipulated by the examiner. Rebound pain is indicated when the pain of palpation is worse when the pressure is off of the site. The cremasteric reflex is a superficial reflex that is present in male clients. Reference:

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. Constipation Hypocalcemia Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas Explanation: ZES consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. Smoking cessation Substitution of coffee with decaffeinated products Avoidance of alcohol Eating whenever hungry Following a regular schedule for rest, relaxation, and meals

Smoking cessation Avoidance of alcohol Following a regular schedule for rest, relaxation, and meals Explanation: The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.

A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome? Decreased intestinal lactose Folate deficiency Lymphadenopathy Steatorrhea

Steatorrhea Explanation: Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis.

A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose? Stimulate GI peristalsis Assess for intact swallowing Assess for gastric perforation Stimulate digestive hormones

Stimulate GI peristalsis

The client has a chancre on the lips. What instruction should the nurse provide? Apply warm soaks to the lip. Gargle with an antiseptic solution. Avoid foods that could irritate the lesion. Take measures to prevent spreading the lesion to other people.

Take measures to prevent spreading the lesion to other people. Explanation: A chancre is a primary lesion of syphilis and very contagious. It is important to instruct the client about ways to prevent spreading the lesion to others. Other nursing considerations include cold soaks to the lip, good mouth care (brushing and flossing), and administration of antibiotics as prescribed.

A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client? Take the medication 2 hours before or after other medications Blood levels will be evaluated after 1 week Take the medication at bedtime to accommodate sedative effects Ensure adequate potassium intake during therapy

Take the medication 2 hours before or after other medications Explanation: Sucralfate should be taken at least 2 hours before or after other medications. It does not decrease potassium levels and laboratory follow up is unnecessary. Sucralfate does not cause sedation.

While preparing a client for an upper GI endoscopy (esophagogastroduodenscopy), the nurse should implement which interventions? Choose all that apply. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda. Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. Tell the client he must be on a clear liquid diet for 24 hours before the procedure. Inform the client that he will receive a sedative before the procedure. Tell the client that he may eat and drink immediately after the procedure.

Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. Inform the client that he will receive a sedative before the procedure. Explanation: The client should be NPO for 8 hours prior to the examination. Before the introduction of the endoscope, the client is given a local anesthetic gargle or spray. Midazolam (Versed), a sedative that provides moderate sedation and relieves anxiety during the procedure, may be administered. Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle.

The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply. The client must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). The health care provider will be able to determine if there is a presence of bowel disease. The client must have bowel cleansing prior to the procedure.

The client must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). Explanation: The client should be NPO for 8 hours prior to the examination. Before the introduction of the endoscope, the client is given a local anesthetic gargle or spray. Midazolam (Versed), a sedative that provides moderate sedation with loss of the gag reflex and relieves anxiety during the procedure, is administered. Temporary loss of the gag reflex is expected; after the client's gag reflex has returned, lozenges, saline gargle, and oral analgesic agents may be offered to relieve minor throat discomfort.

The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized? The client will fast prior to the procedure. The client will have moderate sedation. The client will receive antibiotics before and after the procedure. The client will change positions frequently throughout the procedure.

The client will change positions frequently throughout the procedure. Explanation: It is essential that the client understands that cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed.

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length? A length of 50 cm (20 in) A point that equals the distance from the nose to the xiphoid process The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process The distance determined by measuring from the tragus of the ear to the xiphoid process

The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process Explanation: Before inserting the tube, the nurse determines the length that will be needed to reach the stomach or the small intestine. A mark is made on the tube to indicate the desired length. This length is traditionally determined by (1) measuring the distance from the tip of the nose to the earlobe and from the earlobe to the xiphoid process, and (2) adding up to 15 cm (6 in) for NG placement or at least 20 to 25 cm (8 to 10 in) or more for intestinal placement.

A nurse is admitting a client diagnosed with late-stage gastric cancer. The client's family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor most likely contributed to the client's late diagnosis? Gastric cancer does not cause signs or symptoms until metastasis has occurred. Adherence to screening recommendations for gastric cancer is exceptionally low. Early symptoms of gastric cancer are usually attributed to constipation. The early symptoms of gastric cancer are usually not alarming or highly unusual.

The early symptoms of gastric cancer are usually not alarming or highly unusual. Explanation: Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing. Symptoms precede metastasis, however, and do not include constipation.

The nurse is caring for a geriatric client experiencing diarrhea. When teaching about the site in the body where water and electrolytes are absorbed, the nurse is most correct to instruct on which location? The small intestine The stomach The large intestine The cecum

The large intestine Explanation: The nurse is correct in instructing the client that water and electrolytes are mainly absorbed in the large intestine. The other options are not the best site for absorption.

Which nursing instruction is correct to provide the client following a barium enema? The client will maintain a low residue diet. The stools may be a white or clay colored. Sips of fluid may be increased if tolerated. An enema will be used to clear the bowel.

The stools may be a white or clay colored. Explanation: It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

Ulcerative colitis Explanation: The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption. Reference:

A client is postoperative day 1 following gastrostomy. The nurse is planning interventions to address the nursing diagnosis of Risk for Infection Related to Presence of Wound and Tube. What intervention is most appropriate? Administer antibiotics via the tube as prescribed. Wash the area around the tube with soap and water daily. Cleanse the skin within 2 cm of the insertion site with hydrogen peroxide once per shift. Irrigate the skin surrounding the insertion site with normal saline before each use.

Wash the area around the tube with soap and water daily. Explanation: Infection can be prevented by keeping the skin near the insertion site clean using soap and water. Hydrogen peroxide is not used, due to associated skin irritation. The skin around the site is not irrigated with normal saline and antibiotics are not given to prevent site infection.

The client is receiving 50% dextrose parenteral nutrition with fat emulsion therapy through a peripherally inserted central catheter (PICC). The nurse has developed a care plan for the nursing diagnosis "Risk for infection related to contamination of the central catheter site or infusion line." The nurse includes the intervention Change the transparent dressing every 3 days. Wear a face mask during dressing changes. Assess the PICC insertion site daily. Use clean gloves when providing site care.

Wear a face mask during dressing changes. Explanation: The Centers for Disease Control and Prevention (CDC) recommends changing central vascular access device dressings every 7 days. During dressing changes, the nurse and client wear face masks to reduce the possibility of airborne contamination. The transparent dressing allows for frequent assessments of the site. This is to be done more frequently than daily. During dressing changes, the nurse wears sterile gloves.

After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. How would the nurse explain this procedure to the family? Limited resection in the distal portion of the stomach and removal of about 25% of the stomach Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach Proximal subtotal gastrectomy Total gastrectomy and esophagogastrectomy

Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach Explanation: The Billroth I involves a limited resection and offers a lower cure rate than the Billroth II. The Billroth II procedure is a wider resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence. A proximal subtotal gastrectomy may be performed for a resectable tumor located in the proximal portion of the stomach or cardia. A total gastrectomy or an esophagogastrectomy is usually performed in place of this procedure to achieve a more extensive resection.

The nurse cares for a client after a gastroscopy for which the client received sedation. The nurse should report which finding to the physician? loss of gag reflex minor throat pain drowsiness difficulty swallowing

difficulty swallowing Explanation: The nurse should report difficulty swallowing to the physician as this may be a sign of perforation. Loss of gag reflex, minor throat pain, and drowsiness are expected findings after a gastroscopy for which the client received sedation and therefore there is no need to report to the physician.

A client is in the initial stages of oral cancer diagnosis and is frightened about the side effects of treatment and subsequent prognosis. The client has many questions regarding this type of cancer and asks where oral cancer typically occurs. What is the nurse's response? floor of the mouth base of the tongue roof of the mouth inside of the cheeks

floor of the mouth Explanation: Malignant growths can be found anywhere in the oral cavity, but cancers usually occur on the lips, sides of the tongue, or floor of the mouth.

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: stress and anxiety. gram-negative bacteria. alcohol and tobacco. ibuprofen and aspirin.

gram-negative bacteria. Explanation: The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).

A client describes being constipated, but also experiencing abdominal cramping, pain, and urgent diarrhea. These symptoms occur more often when the client is nearing a deadline or is under emotional stress. What would be recommended to treat these symptoms? Select all that apply. high-fiber diet psyllium low-residue diet cholinergic

high-fiber diet psyllium Explanation: Dietary changes reduce flatulence and abdominal discomfort. A high-fiber diet (30 to 40 g/day) or a bulk-forming agent, such as products containing psyllium, is prescribed to regulate bowel elimination. The fiber draws water into constipated stool and adds bulk to watery stool. An anticholinergic, such as dicyclomine (Bentyl), has an antispasmodic effect if taken before meals.

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). What diagnosis will the nurse suspect for this client? inflammatory bowel disease (IBD) colorectal cancer diverticulitis liver failure

inflammatory bowel disease (IBD) Explanation: IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. Colorectal cancer is usually diagnosed after the client complains of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states he has chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.

A client is scheduled to undergo rhinoplasty in the morning, and reports medications used on a daily basis, which the nurse records on the client's chart. Which daily medications have the potential to result in constipation? laxative multivitamin without iron NSAIDs acetaminophen

laxative Explanation: Constipation may also result from chronic use of laxatives ("cathartic colon")because such use can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex.

A client has symptoms suggestive of peritonitis. Nursing management would not include: limiting analgesics to avoid the formation of paralytic ileus. accurate recording of input and output. inserting a nasogastric tube. inserting a urinary retention catheter.

limiting analgesics to avoid the formation of paralytic ileus. Explanation: Analgesics such as meperidine or IV morphine sulfate are ordered to relieve pain and promote rest. Because hypovolemia can occur from fluids leaking into the peritoneal cavity, input and output are monitored closely to assist in determining fluid replacement. A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and stagnant upper GI fluids. If hypovolemia is present, renal perfusion can become decreased, requiring close monitoring.

The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is loose, watery stools. increased urination. elevated blood pressure. decreased pulse rate.

loose, watery stools. Explanation: When the client indicates that loose, watery stools are a sign/symptom of metabolic complications, the nurse evaluates that the client understands the teaching of metabolic complications. Signs and symptoms of metabolic complications from PN include neuropathies, changes in mental activity, diarrhea, nausea, skin changes, and decreased urine output.

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with: paralytic ileus. Crohn's disease. gastroenteritis. complete bowel obstruction.

paralytic ileus. Explanation: Bowel sounds are hypoactive or absent in a client with a paralytic ileus. Clients with Crohn's disease and gastroenteritis have hyperactive bowel sounds because of increased intestinal motility. A complete bowel obstruction causes absent bowel sounds below the obstruction and hyperactive sounds above the obstruction.`

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for recent foods ingested. occult blood. ingestion of bismuth. pilonidal cyst.

recent foods ingested. Explanation: The nurse should assess for recent foods that the client ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black and, when occult blood is present, the stool can appear to be tarry black.

Which enzyme aids in the digestion of protein? trypsin lipase pepsin ptyalin

trypsin Explanation: Trypsin, amylase, and lipase are digestive enzymes secreted by the pancreas. Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein. Amylase is an enzyme that aids in the digestion of starch.

The nurse administers a tube feeding to a client via the intermittent gravity drip method. The nurse should administer the feeding over at least which period of time? 15 minutes 30 minutes 60 minutes 80 minutes

30 minutes Explanation: Tube feedings administered via intermittent gravity drip should be administered over 30 minutes or longer.

A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client? Colectomy Segmental resection Abdominoperineal resection A low colectomy

Abdominoperineal resection Explanation: A cancerous mass in the lower third of the rectum will result in aabdomin operinealre section with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resectionis performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.

Which of the following is the primary function of the small intestine? Absorption Digestion Peristalsis Secretion

Absorption Explanation: Absorption is the primary function of the small intestine. Digestion occurs in the stomach. Peristalsis occurs in the colon. The duodenum secretes enzymes.

Which of the following are functions of saliva? Select all that apply. Lubrication Protection against harmful bacteria Digestion Elimination Metabolism

Lubrication Protection against harmful bacteria Digestion Explanation: The three main functions of saliva are lubrication, protection against harmful bacteria, and digestion. Elimination and metabolism are not functions of saliva.

A client with cancer has a neck dissection and laryngectomy. An intervention that the nurse will do is: Make a notation on the call light system that the client cannot speak. Teach the client exercises for the neck and shoulder area to perform 1 day after surgery. Provide oxygen without humidity through the tracheostomy tube. Encourage the client to position himself on his side.

Make a notation on the call light system that the client cannot speak. Explanation: The client who has a laryngectomy cannot speak. Other personnel need to know this when answering the call light system. Exercises for the neck and shoulder are usually started after the drains have been removed and the neck incision is sufficiently healed. Humidified oxygen is provided through the tracheostomy to keep secretions thin. To prevent pneumonia, the client should be placed in a sitting position.

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and would make a recommendation when noticing which circumstance? No land line; cell phone available and taken by family member during working hours Water of low pressure that can be obtained through all faucets Little food in the working refrigerator Electricity that loses power, usually for short duration, during storms

No land line; cell phone available and taken by family member during working hours Explanation: A telephone is necessary for the client receiving PN for emergency purposes. Water, refrigeration, and electricity are available, even if the circumstances are not optimal.

The nurse working in the recovery room is caring for a client who had a radical neck dissection. The nurse notices that the client makes a coarse, high-pitched sound upon inspiration. Which intervention by the nurse is appropriate? Document the presence of stridor Administer a breathing treatment Notify the physician Lower the head of the bed

Notify the physician Explanation: The presence of stridor, a coarse, high-pitched sound upon inspiration, in the immediate postoperative period following radical neck dissection, indicates obstruction of the airway, and the nurse must report it immediately to the physician.

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepcid) Omeprazole (Prilosec)

Omeprazole (Prilosec) Explanation: Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.

Which of the following is an enzyme secreted by the gastric mucosa? Pepsin Trypsin Ptyalin Bile

Pepsin Explanation: Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile.

A home care nurse is caring for a client with reports of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? "I'll avoid eating or drinking anything 6 to 8 hours before the test." "I'll drink full liquids the day before the test." "There is no need for special preparation before the test." "I'll take a laxative to clear my bowels before the test."

"I'll avoid eating or drinking anything 6 to 8 hours before the test." Explanation: The client demonstrates understanding of a barium swallow when stating he or she must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? "I'll eat three large meals every day without any food restrictions." "I'll lie down immediately after a meal." "I'll gradually increase the amount of heavy lifting I do." "I'll eat frequent, small, bland meals that are high in fiber."

"I'll eat frequent, small, bland meals that are high in fiber." Explanation: In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: "It tells the physician what type of cancer is present." "It indicates if a cancer is present." "It determines functionality of the liver." "It detects a protein normally found in the blood."

"It indicates if a cancer is present." Explanation: The carcinoembryonic antigen (CEA) blood test detects the presence of cancer by identifying the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.

A client is recovering from percutaneous endoscopic gastrostomy (PEG) tube placement. The nurse Immediately starts the prescribed tube feeding Administers an initial bolus of 50 mL water Maintains a gauze dressing over the site for 3 days Pushes the stabilizing disk firmly against the skin

Administers an initial bolus of 50 mL water Explanation: The first fluid nourishment may consist of water, saline, or 10% dextrose. This may be administered as a bolus of 30 to 60 mL. By the second day, formula feeding may begin. A gauze dressing is applied between the tube insertion site and the gastrostomy tube. The dressing is changed daily or as needed. The nurse gently manipulates the stabilizing disk daily to prevent skin breakdown.

The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? Abdominal mass Agitation Hepatomegalia Ascites

Agitation Explanation: The nurse understands that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older client. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? Spray the oropharynx with an anesthetic spray. Have the patient maintain a backward tilt head position. Allow the patient to sip water as the tube is being inserted. Have the patient eat a cracker as the tube is being inserted.

Allow the patient to sip water as the tube is being inserted. Explanation: During insertion, the patient usually sits upright with a towel or other protective barrier spread in a biblike fashion over the chest. The nostril may be swabbed or the oropharynx sprayed with an anesthetic agent to numb the nasal passage and suppress the gag reflex. The tip of the patient's nose is tilted upward, and the tube is aligned to enter the nostril. When the tube reaches the nasopharynx, the patient is instructed to lower the head slightly and, if able, to begin to swallow as the tube is advanced. The patient may also be encouraged to sip water through a straw to facilitate advancement of the tube if this action is not contraindicated.

The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction. Amount of hydrochloric acid (HCL) secretion in the stomach Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) Presence of H. pylori Patient's age

Amount of hydrochloric acid (HCL) secretion in the stomach Explanation: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer evidences hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.

While caring for a patient who has had radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What does the nurse know is an expected amount of drainage in the wound unit? Between 40 and 80 mL Approximately 80 to 120 mL Between 120 and 160 mL Greater than 160 mL

Approximately 80 to 120 mL Explanation: Wound drainage tubes are usually inserted during surgery to prevent the collection of fluid subcutaneously. The drainage tubes are connected to a portable suction device (e.g., Jackson-Pratt), and the container is emptied periodically. Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours.

A client has undergone a radical neck dissection. His skin graft site is pale. This indicates which condition? Possible necrosis Arterial thrombosis Venous congestion Infection

Arterial thrombosis Explanation: A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion.

A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. What would be the first activity performed by the nurse? Assess lung sounds bilaterally. Administer prescribed morphine intravenously. Obtain consent for the esophagogastroscopy.

Assess lung sounds bilaterally. Explanation: All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment. Reference:

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the intial appropriate action by the nurse? Notify the health care provider. Irrigate the client's NG tube. Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs.

Assess the client's abdomen and vital signs. Explanation: Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? Provide adequate quantity of food. Obtain medical and allergy history. Assist client to increase dietary fiber. Obtain complete food history.

Assist client to increase dietary fiber. Explanation: The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to Apply water-based lubricant to the nares daily. Auscultate lung sounds every 4 hours. Inspect the nose daily for skin irritation. Change the nasal tape every 2 to 3 days.

Auscultate lung sounds every 4 hours. Explanation: Pulmonary complications may occur as a result of nasogastric intubation. It is a high priority according to Maslow's hierarchy of needs and takes a higher priority over assessing the nose, changing nasal tape, or applying a water-based lubricant.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? Appendicitis Rectal fissures Bowel perforation Diverticulitis

Bowel perforation Explanation: Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first? Call the physician. Apply a dry sterile dressing to the site. Clamp the catheter. Tell the client to take and hold a deep breath.

Clamp the catheter. Explanation: If a central venous catheter becomes disconnected, the nurse should immediately apply a catheter clamp. If a clamp isn't available, the nurse may place a sterile syringe or catheter plug in the catheter hub. After cleaning the hub with alcohol or povidone-iodine solution, the nurse must replace the I.V. extension set and restart the infusion. Calling the physician, applying a dry sterile dressing to the site, and telling the client to take a deep breath aren't appropriate interventions at this time.

Which clients will the nurse recognize as being at high risk for complication if taking Lorcaserin for obesity? Select all that apply. Client with type 2 diabetes Client taking medication for migraines Client taking medication for depression Client with asthma Client taking medication for cholesterol

Client with type 2 diabetes Client taking medication for migraines Client taking medication for depression Explanation: Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, can cause hypoglycemia in a client with type 2 diabetes. Additionally, this medication can cause synergistic effects for clients taking medication for migraines or for depression. The client with asthma or the client taking medication for cholesterol are not at increased risk while taking this medication.

A client is scheduled for several diagnostic tests to evaluate gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when the client identifies which test as not requiring the use of a contrast medium? Small bowel series Computer tomography Colonoscopy Upper GI series

Colonoscopy Explanation: A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A nurse administered a full strength feeding with an increased osmolality through a jejunostomy tube to a client. Immediately following the feeding, the client expelled a large amount of liquid brown stool and exhibited a blood pressure of 86/58 and pulse rate of 112 beats/min. The nurse Increases the amount of feeding at the next feeding Consults with the physician about decreasing the feeding to half-strength Administers the feeding at a cooler temperature Discusses with the nutritionist about increasing the osmolality of the feeding

Consults with the physician about decreasing the feeding to half-strength Explanation: The osmolality of normal body fluids is 300 mOsm/kg. A feeding with a higher osmolality may cause dumping syndrome. The client may report a feeling of fullness, nausea, or both and may exhibit diarrhea, hypotension, and tachycardia. The nurse needs to take steps to prevent dumping syndrome. Increasing the amount of the feeding, administering the feeding at an extreme temperature, or increasing the osmolality of the feedings will continue dumping syndrome. The nurse needs to decrease the osmolality of the feeding as in administering a half-strength solution.

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? Dysphagia Malnutrition Pain Regurgitation of food

Dysphagia Explanation: Dysphagia (difficulty swallowing), the most common symptom of esophageal disease, may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute odynophagia (pain on swallowing).

The nurse is investigating a client's report of pain in the duodenal area. Where should the nurse perform the assessment? Epigastric area and consider possible radiation of pain to the right subscapular region Hypogastrium in the right or left lower quadrant Left lower quadrant Periumbilical area, followed by the right lower quadrant

Epigastric area and consider possible radiation of pain to the right subscapular region Explanation: Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation; it occurs in approximately 25% of the adult population (Harmon & Peura, 2010).

An elderly client states, "I don't understand why I have so many caries in my teeth." What assessment made by the nurse places the client at risk for dental caries? Exhibiting hemoglobin A1C 8.2 Drinking fluoridated water Eating fruits and cheese in diet Using a soft-bristled toothbrush

Exhibiting hemoglobin A1C 8.2 Explanation: Measures used to prevent and control dental caries include controlling diabetes. A hemoglobin A1C of 8.2 is not controlled. It is recommended for hemoglobin A1C to be less than 7 for people with diabetes. Other measures to prevent and control dental caries include drinking fluoridated water; eating foods that are less cariogenic, which include fruits, vegetables, nuts, cheese, or plain yogurt; and brushing teeth evenly with a soft-bristled toothbrush.

A client has a new order for metoclorpramide. What potential side effects should the nurse educate the client about? Extrapyramidal Peptic ulcer disease Gastric slowing Nausea

Extrapyramidal Explanation: Metoclorpramide (Reglan) is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

A client is recovering from gastric surgery. What is the correct position for the nurse to place this client? Supine Semi-Fowler's Trendlenberg Fowler's

Fowler's Explanation: Placing the client in the Fowler's position after gastric surgery promotes comfort and allows emptying of the stomach.

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the: Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. Digestive process occurs more rapidly as a result of the feedings not having to pass through the esophagus. Feedings can be administered with the patient in the recumbent position. The patient cannot experience the deprivational stress of not swallowing.

Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. Explanation: Gastrostomy is preferred over NG feedings in the patient who is comatose because the gastroesophageal sphincter remains intact. Regurgitation and aspiration are less likely to occur with a gastrostomy than with NG feedings.

The nurse is caring for a client who has a gastrostomy tube feeding. Upon initiating care, the nurse aspirates the gastrotomy tube for gastric residual volume (GRV) and obtains 200 mL of gastric contents. What is the priority action by the nurse? Discontinue the infusion. Place the client in a semi-Fowler's position with the head of the bed at 45 degrees. Remove the aspirated fluid and do not reinstill. Dilute the gastric tube feeding solution with water and continue the feeding.

Place the client in a semi-Fowler's position with the head of the bed at 45 degrees. Explanation: Feedings and medications should always be administered with the client in the semi-Fowler's position, and the client's head should be elevated at least 30 to 45 degrees to reduce the risk of reflux and pulmonary aspiration. This position is maintained at least 1 hour after completion of an intermittent tube feeding and is maintained at all times for clients receiving continuous tube feedings.

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is: H2-receptor antagonists. Antispasmodics Proton pump inhibitors. Antacids

Proton pump inhibitors. Explanation: Proton pump inhibitors are the strongest inhibitors of acid secretions. The H2-receptor antagonists are the next most powerful.

Which hormones released throughout the gastrointestinal tract promote satiety? Select all that apply. Somatostatin Cholecystokinin Insulin Ghrelin Neuropeptide y

Somatostatin Cholecystokinin Insulin Explanation: Somatostatin, cholecystokinin, and insulin are all hormones released throughout the gastrointestinal tract that promote satiety. Ghrelin and neuropeptide y are orexigenic, and stimulate hunger.

It is important for a nurse to have an understanding of the major digestive enzymes and their actions. Choose the gastric mucosa secretion that plays an important role in the digestion of triglycerides. Ptyalin Trypsin Amylase Steapsin

Steapsin Explanation: Ptyalin and amylase work to digest starch; trypsin works on proteins and polypeptides. Triglycerides are digested by steapsin, and pharyngeal and pancreatic lipase.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge? Hold his breath Take long, slow breaths Bear down as if having a bowel movement Pant like a dog

Take long, slow breaths Explanation: During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control? The client exhibits signs of adequate GI perfusion. The client expresses positive feelings about himself. The client verbalizes a manageable level of discomfort. The client maintains skin integrity.

The client exhibits signs of adequate GI perfusion. Explanation: Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

The nurse is caring for a geriatric client experiencing diarrhea. When teaching about the site in the body where water and electrolytes are absorbed, the nurse is most correct to instruct on which location? The small bowel The stomach The large bowel The cecum

The small bowel Explanation: The nurse is correct in instructing the client that water and electrolytes are mainly absorbed in the small bowel. The other options are not the best site for absorption.

When preparing to insert a nasogastric tube, the nurse determines the length of the tube to be inserted. The nurse nurse places the distal tip of the tube at which location? Tip of patient's nose Tragus of the ear Base of the neck Tip of the xiphoid process

Tip of patient's nose Explanation: To measure the length of the nasogastric tube, the nurse first places the distal tip of the tubing at the tip of the patient's nose, extends the tube to the tragus of the ear, and then extends the tube straight down to the tip of the xiphoid process.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

Ulcerative colitis Explanation: The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.) Until bowel sound is present Until flatus is passed Until peristalsis is resumed Until the patient stops vomiting Until the tube comes out on its own

Until bowel sound is present Until flatus is passed Until peristalsis is resumed Explanation: Before removing an enteral tube, the nurse may intermittently clamp it for a trial period of several hours to ensure that the patient does not experience nausea, vomiting, or distention. Before any tube is removed, it is flushed with 10 mL of water or normal saline to ensure that it is free of debris and away from the gastric lining. Gloves are worn when removing the tube. The tube is withdrawn gently and slowly for 15 to 20 cm (6 to 8 in) until the tip reaches the esophagus; the remainder is withdrawn rapidly from the nostril. If the tube does not come out easily, force should not be used, and the problem should be reported to the primary provider. As the tube is withdrawn, it is concealed in a towel to prevent secretions from soiling the patient or nurse. After the tube is removed, the nurse provides oral hygiene.

A client with a nasogastric tube set to low intermittent suction is receiving D51/2NS at 100 mL/hr. The nurse has identified a nursing diagnosis of deficient fluid volume. Which of the following are data that support this diagnosis? Select all that apply. Urine output that decreased from 60 to 40 mL/hr Heart rate that increased from 82 to 98 beats/min within 2 hours Tolerance for ambulating in the room only with the tube clamped Fluid output of 2150 mL and total fluid intake of 2000 mL for the past 24 hours Normal skin turgor

Urine output that decreased from 60 to 40 mL/hr Heart rate that increased from 82 to 98 beats/min within 2 hours Fluid output of 2150 mL and total fluid intake of 2000 mL for the past 24 hours Explanation: Data supporting a nursing diagnosis of deficient fluid volume include dry skin and mucus membranes, decreased urinary output, lethargy, and increased heart rate.

Which of the following interventions are appropriate for clients with gastritis? Select all that apply. Use a calm approach to reduce anxiety. Give the client food and fluids every 4 hours. Discourage cigarette smoking. Notify the physician of inidicators of hemorrhagic gastritis. Provide general education about how to prevent recurrences.

Use a calm approach to reduce anxiety. Discourage cigarette smoking. Notify the physician of inidicators of hemorrhagic gastritis. Explanation: The nurse should use a calm approach when answering questions and providing teaching. He or she should discuss smoking cessation and monitor for any indicators of hemorrhagic gastritis. The client will take nothing by mouth for up to a few days until symptoms subside. The nurse needs to develop an individualized teaching plan for the client that includes information about stress management, diet, and medications.

Which of the following is the most common type of diverticulum? Zenker's diverticulum Midesophageal Epiphrenic Intramural

Zenker's diverticulum Explanation: The most common type of diverticulum, which is found three times more frequently in men than women, is Zenker's diverticulum (also known as pharyngoesophageal pulsion diverticulum or a pharyngeal pouch).

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test

`Endoscopy Explanation: Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds? Mild High-pitched Hyperactive Absent

bsent Explanation: Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

A client is scheduled to have an endoscopic retrograde cholangiopancreatography. Which structures are visualized during this procedure? common bile duct, pancreatic duct, and biliary tree common bile duct, portal vein, and gallbladder portal vein, pancreatic duct, and biliary tree portal vein, gallbladder, and pancreatic duct

common bile duct, pancreatic duct, and biliary tree Explanation: With the use of endoscopy, dye is injected through a catheter into the common bile duct and the pancreatic duct, permitting visualization and evaluation of the biliary tree. The common bile duct, the pancreatic duct, and the biliary tree are visualized.

The nurse attempts to unclog a client's feeding tube. Attempts with warm water agitation and milking the tube are unsuccessful. The nurse uses evidence-based practice principles when subsequently using which technqiue to unclog the tube? digestive enzymes and sodium bicarbonate cola mixed with cranberry juice sodium bicarbonate mixed with water meat tenderizer diluted with saline

digestive enzymes and sodium bicarbonate Explanation: The nurse should attempt to unclog the tube with digestive enzymes activated with sodium bicarbonate. Although historically both cranberry juice and cola have sometimes been used to unclog feeding tubes, evidence has shown that their acidic nature worsens the clog by causing precipitation of proteins. Meat tenderize diluted with saline is not applicable.

When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported? chronic atrophic gastritis duodenal ulcer gastric cancer pernicious anemia

duodenal ulcer Explanation: Clients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Clients with chronic atrophic gastritis secrete little or no acid. Clients with gastric cancer secrete little or no acid. Clients with pernicious anemia secrete no acid under basal conditions or after stimulation.

The most common symptom of esophageal disease is nausea. vomiting. dysphagia. odynophagia.

dysphagia. Explanation: Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

The most common symptom of esophageal disease is nausea. vomiting. dysphagia. odynophagia.

dysphagia. Explanation: This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

The nurse recognizes that medium-length nasoenteric tubes are used for decompression. feeding. aspiration. emptying.

feeding. Explanation: Placement of the tube must be verified prior to any feeding. A gastric sump and nasoenteric tube are used for gastrointestinal decompression. Nasoenteric tubes are used for feeding. Gastric sump tubes are used to decompress the stomach and keep it empty.

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate? respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis

metabolic acidosis Explanation: Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. Loss of acid, which occurs with severe vomiting, may lead to metabolic alkalosis. Diarrhea doesn't lead to respiratory acid-base imbalances, such as respiratory acidosis and respiratory alkalosis.

The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). The nurse notes in the client's record that the client is taking carbidopa/levodopa. Which order for the client by the health care provider should the nurse question? a low-fat diet elevation of upper body on pillows pantaprazole metoclopramide

metoclopramide Explanation: The instructions are appropriate for the client experiencing gastroesophageal reflux disease. The client is prescribed carbidopa/levodopa (Sinemet), which is used for Parkinson's disease. Metoclopramide can have extrapyramidal effects, and these effects can be increased in clients with Parkinson's disease.

Which procedure is performed to examine and visualize the lumen of the small bowel? small bowel enteroscopy colonoscopy panendoscopy peritoneoscopy

small bowel enteroscopy Explanation: Small bowel enteroscopy is the endoscopic examination and visualization of the lumen of the small bowel. Colonoscopy is the examination of the entire large intestine with a flexible fiberoptic colonoscope. Panendoscopy is the examination of both the upper and lower GI tracts. Peritoneoscopy is the examination of GI structures through an endoscope inserted percutaneously through a small incision in the abdominal wall.