Total test 1

Which initial treatment is typically recommended for a patient diagnosed with a sliding hiatal hernia?

-Nonpharmacologic treatment such as positioning for sleep and eating

A patient with gastroesophageal reflux disease (GERD) has severe chest pain lasting for several hours after eating. Which common symptom of GERD is the patient experiencing?

-Odynophagia

The nurse is caring for a patient with gastroesophageal reflux disease (GERD) who presents with retrosternal burning. What term does the nurse use to document this symptom?

-Pyrosis

What are common complications associated with gastroesophageal reflux disease (GERD) in the older adult? Select all that apply.

-Sleep apnea -Barrett's esophagus -Esophageal strictures -Aspiration pneumonia

A portion of a patient's fundus and the esophagogastric junction has moved upward and through the esophageal hiatus. Which condition does this describe?

-Sliding hernia

A patient who has undergone a conventional fundoplication is preparing to be discharged home. To minimize the risk that the fundoplication will dehisce, what does the nurse include when teaching this patient about home management?

-The need to contact the provider at the first sign of a respiratory infection

A patient diagnosed with gastroesophageal reflux disease (GERD) reports a sensation of fluid in the throat that does not have the bitter taste previously experienced with reflux. What symptom is this patient experiencing?

-Water brash

A client with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to the treatment regimen. What does the nurse tell the client about the diarrhea and mouth ulcers? A. "A combination of chemotherapeutic agents has caused them." B. "GI problems are symptoms of the advanced stage of your disease." C. "5-FU cannot discriminate between your cancer and your healthy cells." D. "You have these as a result of the radiation treatment."

"5-FU cannot discriminate between your cancer and your healthy cells." 5-FU cannot discriminate between cancer and healthy cells; therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the client's GI problems.

The nurse has placed a nasogastric (NG) tube in a client with upper gastrointestinal (GI) bleeding to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? A. "Saline goes down the tube to help clean out your stomach." B. "Medication goes down the tube to help clean out your stomach." C. "The provider requested the tube to be placed just in case it was needed." D. "We'll start feeding you through it once your stomach is cleaned out."

"Saline goes down the tube to help clean out your stomach." Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots. It does not involve the instillation of medication. An NG tube is not typically placed in a client without a particular purpose in mind. Gastric lavage does not involve enteral feeding.

A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond? A. "Have you asked your health care provider what he or she thinks your chances are?" B. "It is hard to know what can predispose a person to develop a certain disease." C. "No. Just because they both had CRC doesn't mean that you will have it, too." D. "The only way to know whether you are predisposed to CRC is by genetic testing."

"The only way to know whether you are predisposed to CRC is by genetic testing." Genetic testing is the only definitive way to determine whether the client has a predisposition to develop CRC. A higher incidence of the disease has been noted in families who have a history; however, it is not the responsibility of the nurse to engage in genetic counseling, and this client might not be predisposed to developing CRC. Asking the client what the health care provider thinks is an evasive response by the nurse and does not address the client's concerns.

A client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? A. "Maybe you should find a support group to join." B. "Would you like me to contact the hospital chaplain for you?" C. "Do you want me to try to find a therapist for you?" D. "Do you have any friends whom you want me to call?"

"Would you like me to contact the hospital chaplain for you?" It is appropriate for the nurse to suggest contacting the hospital chaplain as a counseling option for the client and family. Suggesting that the client find a support group does not assist the client and the family with the problem. It is inappropriate for the nurse to suggest that the client and the family need a therapist. The spouse has already told the nurse that they have recently moved to the area, so it is unlikely that they have already made close friends.

A client newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the client about why this therapy has been prescribed? A. "It is to stop the diarrhea and bloody stools." B. "This will minimize your GI discomfort." C. "With this medication, your cramping will be relieved." D. "Your intestinal inflammation will be reduced."

"Your intestinal inflammation will be reduced." Sulfasalazine (Azulfidine) is one of the primary treatments for UC. It is thought to inhibit prostaglandin synthesis and thereby reduce inflammation. Although it is hoped that reduction of inflammation will cause the diarrhea and bloody stools to stop, this is not the way that the drug works. Antidiarrheal drugs "stop" diarrhea. The drug's action as an anti-inflammatory will diminish the client's pain as the inflammation subsides, but this is not the purpose of the drug—it is not an analgesic.

The nurse is teaching a patient about taking an antacid containing magnesium salts to treat heartburn associated with gastroesophageal reflux disease (GERD). What does the nurse include in the teaching?

-"If you develop diarrhea, you may need to try an aluminum salt antacid."

A patient newly diagnosed with gastroesophageal reflux disease (GERD) asks the nurse what the prescribed medications are intended to do. What does the nurse tell the patient?

-"One goal of drug therapy is to prevent severe complications."

A patient who will begin taking ranitidine to treat gastroesophageal reflux disease (GERD) asks the nurse if the medication will cure the disease. Which answer by the nurse is correct?

-"Ranitidine does not prevent actual reflux."

A patient with gastroesophageal reflux disease (GERD) has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions?

-"Remain on a soft diet for about a week and avoid raw fruits and vegetables."

The nurse is counseling a patient who has been diagnosed with mild gastroesophageal reflux disease (GERD). What does the nurse teach the patient initially about managing this condition?

-Altering dietary and eating habits

Which complications of gastroesophageal reflux disease (GERD) are more commonly seen in older adults? Select all that apply.

-Barrett's esophagus -Esophageal erosions -Aspiration pneumonia

A patient diagnosed with gastroesophageal reflux disease (GERD) reports heartburn. Which drug classifications may cause heartburn? Select all that apply.

-Calcium channel blockers -Anticholinergic drugs -Oral contraceptives -Nitrates

The nurse is assessing a patient who reports nausea, indigestion, and heartburn. Upon reviewing the patient's lab results, the nurse observes the patient's electrolyte levels are normal. Which condition does the nurse most expect the patient to have?

-Obstructive sleep apnea (OSA)

A patient who had open Nissen fundoplication 2 days ago has been instructed to begin oral fluids but reports dysphagia associated with fluid intake. Which action by the nurse is correct?

-Reassure the patient that this is a temporary problem after this type of surgery

Which findings does the nurse expect with a diagnosis of acute peritonitis? Select all that apply. 1 Fever 2 Diarrhea 3 Vomiting 4 Tachycardia 5 Rigid abdomen

1 Fever 3 Vomiting 4 Tachycardia 5 Rigid abdomen Fever, vomiting, tachycardia, and a rigid, boardlike abdomen accompany the diagnosis of peritonitis from the inflammation of the peritoneal cavity. Diarrhea would not be present, as bowel motility slows, bowel sounds become more distant, and the passage of flatus and feces cease.

What disorders does the nurse identify as acute inflammatory bowel disorders? Select all that apply. 1 Peritonitis 2 Appendicitis 3 Gastroenteritis 4 Crohn's disease 5 Ulcerative colitis

1 Peritonitis 2 Appendicitis 3 Gastroenteritis Appendicitis, gastroenteritis, and peritonitis are classified as acute inflammatory bowel disorders. Appendicitis is an acute inflammation of the vermiform appendix. Gastroenteritis is an acute inflammation of the mucous membranes of the stomach and intestinal tract. Peritonitis is an acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Ulcerative colitis and Crohn's disease are classified as chronic inflammatory bowel diseases.

A client wants to lose 1.5 pounds a week. After reviewing a diet history, the nurse determines the client typically eats 2450 calories a day. What should the client's calorie goal be to achieve this weight loss? (Record your answer using a whole number.) __ calories/day

1700 calories/day

A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? 1 Avoiding the use of bulk-forming agents 2 Using hydrocortisone cream to relieve pain 3 Administering a Fleet enema when needed 4 Applying heat to acute inflammation for pain relief

2 Using hydrocortisone cream to relieve pain Topical anti-inflammatory agents may be effective in relieving the pain associated with anal fissures. Enemas should be avoided when an anal fissure is present. Cold packs should be applied to acute inflammation to diminish discomfort. Bulk-forming agents should be used to decrease pain associated with defecation.

What is a clinical manifestation of Crohn's disease? 1 Nausea 2 Vomiting 3 Abdominal pain 4 Dryness of mucous membranes

3 Abdominal pain Abdominal pain located in the right lower quadrant due to inflammation is a clinical manifestation of Crohn's disease. Nausea and vomiting are common symptoms in many bowel disorders. Dryness of the mucous membranes is due to dehydration.

What physiological change is seen in a patient with ulcerative colitis? 1 Increase in hemoglobin levels 2 Increase in serum albumin levels 3 Increase in white blood cell levels 4 Increase in blood levels of sodium, potassium, and chlorine

3 Increase in white blood cell levels An increased white blood cell count is consistent with inflammatory conditions such as ulcerative colitis. Due to chronic blood loss, hemoglobin levels decrease in patients with ulcerative colitis. Serum albumin levels decrease due to loss of protein (albumin) in the stool. Blood levels of sodium, potassium, and chlorine decrease due to frequent diarrhea stools and malabsorption.

A patient has a low-grade fever and tenesmus. Which other clinical manifestations may indicate ulcerative colitis? 1 Increase in appetite 2 Difficulty passing stools 3 Inflammation of the joints 4 Formation of lesions outside the mouth

3 Inflammation of the joints Ulcerative colitis may have extraintestinal complications such as inflammation of the joints. Appetite would be decreased because mealtimes may be unpleasant since eating is associated with pain. Patients with ulcerative colitis have an increased frequency of stools rather than difficulty passing stools. Patients with ulcerative colitis may have lesions or ulcers inside the mouth involving the tongue, palate, and pharynx rather than outside the mouth.

What are the less-common causes for peritonitis? Select all that apply. 1 Bacteria 2 Chemicals 3 Perforating tumors 4 Leakage during surgery 5 Contamination during surgery

3 Perforating tumors 4 Leakage during surgery 5 Contamination during surgery Peritonitis is an acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Perforating tumors, leakage during surgery, and contamination during surgery are less-common causes for peritonitis. Bacteria and chemicals are the most-common causes for peritonitis.

Which patient is at risk for celiac disease (CE)? 1 The patient with multiple sclerosis 2 The patient who is receiving prednisone 3 The patient with diabetes mellitus type I 4 The patient who is receiving paromomycin

3 The patient with diabetes mellitus type I Diabetes mellitus type I is a metabolic disorder. It affects normal metabolism, which affects the metabolic function and can cause problems in gluten digestion. Diabetes mellitus type I can also result in CE. Multiple sclerosis is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. It does not cause CE. Multiple sclerosis affects sensory function and does not cause gluten digestion problems. Prednisone is a glucocorticoid. Prolonged consumption of prednisone causes osteoporosis as a side effect, not celiac disease. Paromomycin causes dizziness as a side effect and does not place a patient at risk for celiac disease.

The nurse is discussing with a nursing student the care of a client with cirrhosis. Which statement by the student indicates a correct understanding of how to observe for esophageal bleeding in the client? 1 "I should observe for epistaxis." 2 "Hematuria may indicate bleeding varices." 3 "Any melena should be reported immediately." 4 "Prothrombin time should be monitored daily."

3 Melena (tarry stools) may result from bleeding varices; this should be reported. Epistaxis (nosebleed) and hematuria (blood in the urine) may occur with cirrhosis and its resulting prothrombin time (PT) and International Normalized Ratio (INR), but they are not manifestations of esophageal bleeding. PT is prolonged in cirrhosis; however, it is not a specific manifestation of variceal bleeding.

Which question should the nurse ask while assessing a patient with ulcerative colitis (UC)? 1 "Did you eat street food in the last couple of days?" 2 "Have you undergone any surgeries in the past year?" 3 "Does anyone from your family have similar complaints?" 4 "Were you on antibiotic treatments in the past three months?"

4 "Were you on antibiotic treatments in the past three months?" It is essential to collect the patient's medical and medication history before proceeding with the care plan and treatment. Therefore, the nurse should inquire about any antibiotic treatment the patient may have had in the past 2 to 3 months to prevent resistance and overuse. UC may occur due to genetic, immunological, and environmental factors. It is not triggered by street food nor influenced by the history of surgery. UC is a non-communicable disease and may not be transmitted to family members.

The nurse is evaluating a patient who is scheduled to start a protein-sparing modified fast. Which interventions should be initiated before the diet is started? Select all that apply. 1 Renal function tests 2 A respiratory evaluation 3 A low-impact exercise program 4 Nutrition counseling by a dietitian 5 Vitamin and mineral supplementation

4 Nutrition counseling by a dietitian 5 Vitamin and mineral supplementation Nutritional counseling and vitamin and mineral supplementation are important before starting a protein-sparing modified fast. Respiratory evaluation, renal function tests, and a low-impact exercise program are not indicated for this diet prior to starting.

After teaching a client who has a femoral hernia, the nurse assesses the clients understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss? a. I will put on the truss before I go to bed each night. b. IlIl put some powder under the truss to avoid skin irritation. c. The truss will help my hemia because I cant have surgery. d. IfI have abdominal pain, IlI let my health care provider know right away

A

The RN on the medical-surgical unit receives a shift report about four clients. Which client does the nurse assess first? A. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink B. A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern C. A 40-year-old with pneumonia who has abdominal distention and decreased bowel sounds in all quadrants D. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern Ecchymoses in the abdominal area may indicate intraperitoneal or intra-abdominal bleeding; this client requires rapid assessment and interventions. The client who is post colon resection, the client with pneumonia, and the client with FAP do not have an urgent need for further assessment or intervention.

The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include? A. A slice of 5-grain bread B. Chuck steak patty (6 ounces) C. Strawberries (1 cup) D. Tomato (1 medium)

A slice of 5-grain bread Whole-grain breads are recommended to be included in the diet of clients with diverticular disease because cellulose and hemicellulose types of fiber are found in them. Dietary fat should be reduced in clients with diverticular disease. If the client wants to eat beef, it should be of a leaner cut. Foods containing seeds, such as strawberries, should be avoided. Tomatoes should be avoided unless the seeds are removed. The seeds may block diverticula in the client and present problems leading to diverticulitis.

A nurse plans care for a client who is recovering from an inguinal hernia repair. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Encouraging ambulation three times a day b. Encouraging normal urination c. Encouraging deep breathing and coughing d. Providing ice bags and scrotal support e. Forcibly reducing the hernia

A, B, D

A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly? (Select all that apply.) a. Performs hand hygiene and positions the client in high-Fowlers position, with pillows behind the head and shoulders b. Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx c. Checks for correct placement by checking the pH of the fluid aspirated from the tube d. Secures the NG tube by taping it to the clients nose and pinning the end to the pillowcase e. Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

A, C, E

5. A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.) a. Registered dietitian b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Health care provider

A, C, E Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse should collaborate with the registered dietitian, clinical pharmacist, and health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision. DIF: Applying/Application REF: 1201 KEY: Pancreatitis| collaboration| interdisciplinary health care team MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse cares for a client who has a nasogastric (NG) tube. Which actions should the nurse take? (Select all that apply.) a. Assess for proper placement of the tube every 4 hours. b. Flush the tube with water every hour to ensure patency. c. Secure the NG tube to the clients upper lip. d. Disconnect suction when auscultating bowel peristalsis. e. Monitor the clients skin around the tube site for irrigation.

A, D, E

A patient who has been prescribed famotidine (Pepcid) is being discharged home. Which statement by the patient indicates a need for further discharge teaching by the nurse? A. "This drug will increase acid secretion to break down food faster." B. Famotidine will facilitate healing of my esophagus." C. "I will call the healthcare provider if I continue to have heartburn." D. "This drug is available over the counter."

A.

A patient who has been prescribed famotidine (Pepcid) is being discharged home. Which statement by the patient indicates a need for further discharge teaching by the nurse? A. "This drug will increase acid secretion to break down food faster." B." Famotidine will facilitate healing of my esophagus." C. " I will call the healthcare provider if I continue to have heartburn." D. "This drug is available over-the-counter."

A.

A patient with chronic gastritis is being admitted. Which sign/symptom does the nurse identify as being associated with this patient's condition? A. Pernicious anemia B. Gastric hemorrhage C. Hematemesis D. Dyspepsia

A.

Which are the two most common manifestations of GERD? (Select all that apply) A.Dyspepsia B. Eructation C. Water brash D. Regurgitation E. Odynophagia F. Flatulence

A. D.

Which statements about GERD are correct? (Select all that apply) A. Overweight and obese patients are at an increased risk. B. Thin and underweight patients are at an increased risk. C. It is a common disorder in the Asian and his Hispanic populations. D. There is a high incidence in patients who eat mostly hot and spicy foods. E. It is a common upper gastrointestinal disorder in the United States.

A. E.

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) A. Prolonged partial thromboplastin time B. Icterus of skin C. Swollen abdomen D. Elevated magnesium E. Currant jelly stool F. Elevated amylase level

A. Prolonged partial thromboplastin time B. Icterus of skin C. Swollen abdomen The liver produces clotting factors; when it is damaged, prolonged coagulation times and bleeding may result. Icterus, or jaundice, results from cirrhosis. The client with cirrhosis may develop ascites, or fluid in the abdominal cavity. Elevated magnesium is not related to cirrhosis. The client with cirrhosis may develop hypocalcemia and/or hypokalemia. Currant jelly stool is consistent with intussusception, a type of bowel obstruction. Cirrhosis is consistent with elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; amylase is typically elevated in pancreatitis.

A client has undergone a radical neck dissection for cancer and is being discharged home while undergoing radiation therapy. Which is likely to be the most important aspect of this client's outpatient care? A. Dental care B. Infection prevention C. Nutrition services D. Support group for cancer survivors

A. dental care

When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the home health aide? A. Provide oral care using disposable foam swabs. B. Inspect the oral mucosa for evidence of oral candidiasis. C. Instruct the client on how to use nystatin (Mycostatin) oral rinses. D. Assist the client in making appropriate dietary choices.

A. provide oral care using disposable foam swabs

A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number.) ____ mL

ANS: 25 mL 100 lb = 50 kg. 50 kg ´ 5 mg/kg = 250 mg.

2. A nurse cares for a client who is prescribed 4 mg of calcium gluconate to infuse over 5 hours. The pharmacy provides 2 premixed infusion bags with 2 mg of calcium gluconate in 100 mL of D5W. At what rate should the nurse administer this medication? (Record your answer using a whole number.) ____ mL/hr

ANS: 40 mL/hr DIF: Applying/Application REF: 1196 KEY: Medication safety MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

To promote comfort after a colonoscopy, in what position does the nurse place the client? a. Left lateral b. Prone c. Right lateral d. Supine

ANS: A After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.

A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Sulfasalazine (Azulfidine) d. Ceftriaxone (Rocephin)

ANS: A Metronidazole is the drug of choice for a Giardia infection. Ciprofloxacin and ceftriaxone are antibiotics used for bacterial infections. Sulfasalazine is used for ulcerative colitis and Crohn's disease.

A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion

ANS: A Right lower quadrant pain, specifically at McBurney's point, is characteristic of appendicitis. Usually if nausea and vomiting begin first, the client has gastroenteritis. Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis. Abdominal pain due to appendicitis decreases with knee flexion.

When working with older adults to promote good nutrition, what actions by the nurse are most appropriate? (Select all that apply.) a. Allow uninterrupted time for eating. b. Assess dentures for appropriate fit. c. Ensure the client has glasses on when eating. d. Provide salty foods that the client can taste. e. Serve high-calorie, high-protein snacks.

ANS: A, B, C, E NO SALTY FOOD!

The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. Helicobacter pylori infection d. Iron deficiency anemia e. Pernicious anemia

ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse instructs the client and family about the signs of potential complications, which include what problems? (Select all that apply.) a. Cholangitis b. Pancreatitis c. Perforation d. Renal lithiasis e. Sepsis

ANS: A, B, C, E Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.

The nurse understands that malnutrition can occur in hospitalized clients for several reasons. Which are possible reasons for this to occur? (Select all that apply.) a. Cultural food preferences b. Family bringing snacks c. Increased need for nutrition d. Need for NPO status e. Staff shortages

ANS: A, C, D, E FAM NO SNACKS!

1. A nurse obtains a client's health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. "I drink two glasses of red wine each week." b. "I take a lot of Tylenol for my arthritis pain." c. "I have a cousin who died of liver cancer." d. "I got a hepatitis vaccine before traveling."

ANS: B Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.

A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? a. Document the findings in the chart. b. Request an electrocardiogram (ECG). c. Facilitate a serum potassium test. d. Place the client on bedrest.

ANS: B Pyloric stenosis can lead to hypokalemia, which is manifested by muscle weakness. The nurse first obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias. A potassium level is also warranted, as is placing the client on bedrest for safety. Documentation should be thorough, but none of these actions takes priority over the ECG.

A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best? a. "Slippery elm has no benefit for this problem." b. "Slippery elm is often used for this disorder." c. "There is no evidence that this will work." d. "You should not take any herbal remedies."

ANS: B There are several complementary and alternative medicine regimens that are used for gastritis and peptic ulcer disease. Most have been tested on animals but not humans. Slippery elm is a common supplement used for this disorder.

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to what organ dysfunctions? (Select all that apply.) a. Alanine aminotransferase: biliary system b. Ammonia: liver c. Amylase: liver d. Lipase: pancreas e. Urine urobilinogen: stomach

ANS: B, D Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.

An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.) a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations

ANS: B, D Symptoms of hemorrhage and hypovolemic shock include hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool and clammy skin, and confusion.

A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, "All of my family hates me." How should the nurse respond? a. "You should make peace with your family." b. "This is not unusual. My family hates me too." c. "I will help you identify a support system." d. "You must attend Alcoholics Anonymous."

ANS: C Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. The nurse should not minimize the client's concerns by brushing off the client's comment. Attending AA may be appropriate, but this response doesn't address the client's concern. Making peace with the client's family may not be possible. This statement is not client-centered.

A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.

ANS: C This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.

A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting

ANS: C, D Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Measure intake and output every shift. B. Do not administer food or fluids by mouth. C. Administer opioid analgesic medication. D. Assist the client to assume a position of comfort.

Administer opioid analgesic medication. For the client with acute pancreatitis, pain relief is the highest priority. Although measuring intake and output, NPO status, and positioning for comfort are all important, they are not the highest priority.

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? A. Hemoglobin and hematocrit B. Leukocytes C. Alpha-fetoprotein D. Serum albumin

Alpha-fetoprotein Fetal hemoglobin (alpha-fetoprotein) is abnormal in adults; it is a tumor marker indicative of cancers. Although anemia may be present, elevated hemoglobin and hematocrit are not diagnostic of hepatic cancer. White blood cells (leukocytes) are not used to specifically diagnose cancers. Serum albumin levels may be low in liver cancer and in malnutrition.

A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem? (Select all that apply.) A. Antihistamines B. Caffeinated drinks C. Stress D. Sleeping pills E. Anxiety

B. Caffeinated drinks C. Stress E. Anxiety Factors such as ingestion of coffee or other gastric stimulants, stress, anxiety, and milk allergy are being investigated as possible causes of IBS. Antihistamines and sleeping pills are not suspected as causing IBS.

Which factors place a client at risk for gastrointestinal (GI) problems? (Select all that apply.) A. Eating a high-fiber diet B. Smoking a half-pack of cigarettes per day C. Socioeconomic status D. Some herbal preparations E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

B. Smoking a half-pack of cigarettes per day C. Socioeconomic status D. Some herbal preparations E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) Smoking or any tobacco use places a client in a higher-risk category for GI problems. Socioeconomic status can also influence the risk for GI problems; clients may not be able to afford to seek care or treatment and may put off seeking help. Some herbal preparations contribute to GI problems, such as Ayurvedic herbs, which can affect appetite, absorption, and elimination. NSAIDs can predispose clients to peptic ulcer disease or GI bleeding. High-fiber diets are generally believed to be healthy for most clients.

A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home? A. Oral Cancer Foundation B. American Cancer Society (ACS) C. Client Advocate Foundation D. American Medical Supply Foundation

B. american cancer society

The nurse is assessing diagnostic test results for a client with hepatitis. Which elevated test result does the nurse correlate to the presence of jaundice? 1 Bilirubin 2 Blood urea nitrogen (BUN) 3 Aspartate aminotransferase (AST) 4 Alanine aminotransferase (ALT)

Bilirubin Elevation of the bilirubin level correlates to yellow stain of the skin and sclera secondary to biliary obstruction and inflammation. BUN is a measure of renal function. AST and ALT are enzymes released in response to liver inflammation, but do not correlate to jaundice.

What is the cause of late dumping syndrome? A. Rapid emptying of food into the small intestine B. Shift of fluids into the gut leading to abdominal distention C. Release of an excessive amount of insulin D. Rapid entry of high-protein foods into the jejunum

C.

Which drug would the health care provider prescribe to treat H. pylori infection? A. Ranitidine (Zantac) B. Omeprazole (Prilosec) C. Clarithromycin (Biaxin) D. Pantoprazole (Protonix)

C.

The nurse case manager is discussing community resources with a client who has colorectal cancer and is scheduled for a colostomy. Which referral is of greatest value to this client initially? A. Certified Wound, Ostomy, and Continence Nurse (CWOCN) B. Home health nursing agency C. Hospice D. Hospital chaplain

Certified Wound, Ostomy, and Continence Nurse (CWOCN) A CWOCN (or an enterostomal therapist) will be of greatest value to the client because the client is scheduled to receive a colostomy. The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

A client with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client? A. Attaching the tube to high continuous suction B. Auscultating for bowel sounds and peristalsis while the suction runs C. Connecting the tube to low intermittent suction D. Flushing the tube with 30 mL of normal saline every 24 hours

Connecting the tube to low intermittent suction The NG tube should be attached to intermittent low suction unless otherwise requested by the health care provider. Continuous suction is rarely used because it can injure the gastric mucosa of the client's stomach. Bowel sounds should not be auscultated with suction on and running. The tube should be flushed every 4 hours, minimally.

A nurse assesses a client with a mechanical bowel obstnuction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain, Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the clients bowel sounds.

D

A patient is prescribed pantoprazole (Protonix). What does the nurse tell the patient is the major action of this medication? A. It produces a coating on the stomach lining. B. It neutralizes gastric acid. C. It heals esophageal irritation. D. It inhibits gastric acid secretion.

D.

Which statement is true about the drug rabeprazole (Aciphex) for treatment of GERD? A. It is rapidly released into the body after it is administered. B. The tablets are large and maybe crushed if the patient has difficulty swallowing them. C. It is a histamine receptor antagonist. D. If once-a-day dosing does not control symptoms, it may be taken twice a day.

D.

Which type of nonsteroidal anti-inflammatory (NSAID) drug is less likely to cause mucosal damage to the stomach? A. Ibuprofen B. Aspirin C. Acetaminophen D. Celecoxib

D.

In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? 1 Increased blood pressure, increased respiratory rate 2 Decreased blood pressure, increased heart rate 3 Increased respiratory rate, increased apical pulse, pallor 4 Tachypnea, diaphoresis, increased blood pressure

Decreased blood pressure, increased heart rate Decreased blood pressure and increased heart rate are indicative of shock. Increased blood pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis are all indicative of anxiety on the client's part.

In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? A. Increased blood pressure, increased respiratory rate B. Decreased blood pressure, increased heart rate C. Increased respiratory rate, increased apical pulse, pallor D. Tachypnea, diaphoresis, increased blood pressure

Decreased blood pressure, increased heart rate Decreased blood pressure and increased heart rate are indicative of shock. Increased blood pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis are all indicative of anxiety on the client's part.

A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client? A. Encourages the client to look at and touch the colostomy stoma B. Instructs the client about complete care of the colostomy C. Schedules a visit from a client who has a colostomy and is successfully caring for it D. Suggests that the client involve family members in the care of the colostomy

Encourages the client to look at and touch the colostomy stoma The initial intervention is to get the client comfortable looking at and touching the stoma before providing instructions on its care. Instructing the client about colostomy care will be much more effective after the client's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the client only after his or her anxiety level has stabilized. The client has begun to express feelings regarding the colostomy and its care; it is too soon to involve others. The client must get comfortable with this body image change first.

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

Misoprostol (Cytotec) Misoprostol is a prostaglandin analogue that protects against nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers. Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have PUD. Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions, but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection.

The nurse is administering spironolactone (Aldactone) to a client with portal hypertension and portal systemic encephalopathy. Which additional medication order does the nurse question? 1 Potassium chloride 2 Lactulose (Cephulac) 3 Neomycin (Mycifradin) 4 Propranolol (Inderal)

Potassium chloride Spironolactone is a potassium-sparing diuretic; additional potassium may result in potassium intoxication. Cephulac and neomycin are used to control hepatic encephalopathy, which is part of the expected treatment plan. Propranolol is used to prevent gastrointestinal hemorrhage secondary to portal hypertension and gastroesophageal varices, which is an expected treatment for portal hypertension.

Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? A. Absence of jaundice, pain of gradual onset B. Absence of jaundice, pain in right abdominal quadrant C. Presence of jaundice, pain worsening when sitting up D. Presence of jaundice, pain worsening when lying supine

Presence of jaundice, pain worsening when lying supine Pain that worsens when lying supine and the presence of jaundice are the only assessment findings indicative of acute pancreatitis. Pain associated with acute pancreatitis usually has an abrupt onset, is located in the mid-epigastric or upper left quadrant, and lessens with sitting up; also, jaundice is present.

A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? A. Femoral B. Reducible C. Strangulated D. Ventral

Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity. Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. It cannot be a ventral hernia because it would have to occur at the site of a previous surgical incision.

The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication? A. Administer pancrelipase before taking an antacid. B. Chew tablets before swallowing. C. Take pancrelipase before meals. D. Wipe your lips after taking pancrelipase.

Wipe your lips after taking pancrelipase. Pancrelipase is a pancreatic enzyme used for enzyme replacement for clients with chronic pancreatitis. To avoid skin irritation and breakdown from residual enzymes, the lips should be wiped. Pancrelipase should be administered after antacids or histamine2 blockers are taken. It should not be chewed to minimize oral irritation and allow the drug to be released more slowly. It should be taken with meals and snacks and followed with a glass of water.

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond? a. "Ambulating in the hallway twice a day will help." b. "I will apply a cold compress to the painful area on your back." c. "Drinking a warm beverage can relieve this referred pain." d. "You should cough and deep breathe every hour."

a. "Ambulating in the hallway twice a day will help."

A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge? a. "Do you have a one- or two-story home?" b. "Can you check your own pulse rate?" c. "Do you have any alcohol in your home?" d. "Can you prepare your own meals?"

a. "Do you have a one- or two-story home?"

A nurse and a registered dietitian are assessing clients for partial parenteral nutrition (PPN). For which client would the nurse suggest another route of providing nutrition? a. Client with congestive heart failure b. Older client with dementia c. Client who has multiorgan failure d. Client who is post gastric resection

a. Client with congestive heart failure

noninfectious

apathous

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "Drinking at least 2 liters of water each day is suggested." b. "I will decrease the amount of fatty foods in my diet." c. "Drinking fluids with my meals will increase bloating." d. "I will avoid concentrated sweets and simple carbohydrates."

b. "I will decrease the amount of fatty foods in my diet."

A client is awaiting bariatric surgery in the morning. What action by the nurse is most important? a. Answering questions the client has about surgery b. Beginning venous thromboembolism prophylaxis c. Informing the client that he or she will be out of bed tomorrow d. Teaching the client about needed dietary changes

b. Beginning venous thromboembolism prophylaxis

A client is receiving bolus feedings through a Dobhoff tube. What action by the nurse is most important? a. Auscultate lung sounds after each feeding. b. Check tube placement before each feeding. c. Check tube placement every 8 hours. d. Weigh the client daily on the same scale.

b. Check tube placement before each feeding.

Several nurses have just helped a morbidly obese client get out of bed. One nurse accesses the client's record because "I just have to know how much she weighs!" What action by the client's nurse is most appropriate? a. Make an anonymous report to the charge nurse. b. State "That is a violation of client confidentiality." c. Tell the nurse "Don't look; I'll tell you her weight." d. Walk away and ignore the other nurse's behavior.

b. State "That is a violation of client confidentiality."

A nurse cares for a client with acute pancreatitis. The client states, "I am hungry." How should the nurse reply? a. "Is your stomach rumbling or do you have bowel sounds?" b. "I need to check your gag reflex before you can eat." c. "Have you passed any flatus or moved your bowels?" d. "You will not be able to eat until the pain subsides."

c. "Have you passed any flatus or moved your bowels?"

A nurse is caring for four clients receiving enteral tube feedings. Which client should the nurse see first? a. Client with a blood glucose level of 138 mg/dL b. Client with foul-smelling diarrhea c. Client with a potassium level of 2.6 mEq/L d. Client with a sodium level of 138 mEq/L

c. Client with a potassium level of 2.6 mEq/L

A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority? a. Assess the client's pain. b. Check the surgical incision. c. Ensure an adequate airway. d. Program the morphine pump.

c. Ensure an adequate airway.

A nurse attempted to assist a morbidly obese client back to bed and had immediate pain in the lower back. What action by the nurse is most appropriate? a. Ask another nurse to help next time. b. Demand better equipment to use. c. Fill out and file a variance report. d. Refuse to assist the client again.

c. Fill out and file a variance report.

A client having a tube feeding begins vomiting. What action by the nurse is most appropriate? a. Administer an antiemetic. b. Check the client's gastric residual. c. Hold the feeding until the nausea subsides. d. Reduce the rate of the tube feeding by half.

c. Hold the feeding until the nausea subsides.

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy's sign c. Light-colored stools d. Upper abdominal pain after eating

c. Light-colored stools

A client tells the nurse about losing weight and regaining it multiple times. Besides eating and exercising habits, for what additional data should the nurse assess as the priority? a. Economic ability to join a gym b. Food allergies and intolerances c. Psychosocial influences on weight d. Reasons for wanting to lose weight

c. Psychosocial influences on weight

A nursing student is studying nutritional problems and learns that kwashiorkor is distinguished from marasmus with which finding? a. Deficit of calories b. Lack of all nutrients c. Specific lack of protein d. Unknown cause of malnutrition

c. Specific lack of protein

A client asks the nurse about drugs for weight loss. What response by the nurse is best? a. "All weight-loss drugs can cause suicidal ideation." b. "No drugs are currently available for weight loss." c. "Only over-the-counter medications are available." d. "There are three drugs currently approved for this."

d. "There are three drugs currently approved for this."

A client is receiving total parenteral nutrition (TPN). What action by the nurse is most important? a. Assessing blood glucose as directed b. Changing the IV dressing each day c. Checking the TPN with another nurse d. Performing appropriate hand hygiene

d. Performing appropriate hand hygiene

A nurse is weighing and measuring a client with severe kyphosis. What is the best method to obtain this client's height? a. Add the trunk and leg measurements. b. Ask the client how tall he or she is. c. Estimate by measuring clothing. d. Use knee-height calipers.

d. Use knee-height calipers.

generally rustles from infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised

secondary stomatitis

coughing, choking, sensation of food sticking to pharynx, difficulty intitaing the swallowing process

signs of dysphasia

a broad term that refers to inflammation within the oral cavity

stomatitis

A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed? A. "Begin a clear liquid diet 12 to 24 hours before the test." B. "Do not eat or drink anything for 12 hours before the test." C. "Give yourself tap water enemas until the fluid returns are clear." D. "You will have to drink a contrast liquid 2 hours before the test."

"Begin a clear liquid diet 12 to 24 hours before the test." The client is instructed to be on a liquid diet for 12 to 24 hours to cleanse the bowel before a colonoscopy. The client must be NPO (except for water) 4 to 6 hours before a colonoscopy. The client is instructed to drink a liquid preparation for cleaning the bowel (such as sodium phosphate) the evening before the colonoscopy, and may repeat that procedure on the morning of the test. In some cases, the client may require laxatives, suppositories, or one or more small-volume (i.e., Fleet) cleansing enemas. The client is not given an oral contrast liquid to swallow for a colonoscopy.

A patient has been diagnosed with mild gastroesophageal reflux disease (GERD) and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient?

-"Avoid caffeine-containing foods and beverages."

An older client has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best? a. "Changes in your liver cause drugs to be metabolized differently." b. "Perhaps you don't need as high a dose of the drug as before." c. "Stomach muscles atrophy with age and you digest more slowly." d. "Your body probably can't tolerate as much medication anymore."

ANS: A Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels. The other options do not accurately explain this age-related change.

A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best? a. Ask the client about shellfish allergies. b. Document this information on the chart. c. Ensure that the client has a ride home. d. Instruct the client on bowel preparation.

ANS: A PTC uses iodinated dye, so the client should be asked about seafood allergies, specifically to shellfish. Documentation should occur, but this is not the priority. The client will need a ride home afterward if the procedure is done on an outpatient basis. There is no bowel preparation for PTC.

The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.) a. Decreased hydrochloric acid production b. Diminished sensation that can lead to constipation c. Fat not digested as well in older adults d. Increased peristalsis in the large intestine e. Pancreatic vessels become calcified

ANS: A, B, C, E Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.

The nurse is aware of the 2014 American Cancer Society Screening Guidelines for colon cancer, which include which testing modalities for people over the age of 50? (Select all that apply.) a. Colonoscopy every 10 years b. Colonoscopy every 5 years c. Computed tomography (CT) colonography every 5 years d. Double-contrast barium enema every 10 years e. Flexible sigmoidoscopy every 10 years

ANS: A, C The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.

A client who has been taking antibiotics reports severe, watery diarrhea. About which test does the nurse teach the client? a. Colonoscopy b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B c. Ova and parasites d. Stool culture

ANS: B Clients taking antibiotics are at risk for Clostridium difficile infection. The most common test for this disorder is a stool sample for ELISA toxin A+B. Colonoscopy, ova and parasites, and stool culture are not warranted at this time.

The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ? a. Kidneys b. Liver c. Spleen d. Stomach

ANS: B Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.

A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is best? a. Allow the client cool liquids only. b. Assess the client's gag reflex. c. Remind the client to remain NPO. d. Tell the client to wait 4 hours.

ANS: B The local anesthetic used during this procedure will depress the client's gag reflex. After the procedure, the nurse should ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the client's readiness for them.

A client presents to the emergency department reporting severe abdominal pain. On assessment, the nurse finds a bulging, pulsating mass in the abdomen. What action by the nurse is the priority? a. Auscultate for bowel sounds. b. Notify the provider immediately. c. Order an abdominal flat-plate x-ray. d. Palpate the mass and measure its size.

ANS: B This observation could indicate an abdominal aortic aneurysm, which could be life threatening and should never be palpated. The nurse notifies the provider at once. An x-ray may be indicated. Auscultation is part of assessment, but the nurse's priority action is to notify the provider.

The nurse is assessing a client who had abdominal surgery yesterday. What method provides the most accurate data about resumption of peristalsis in the client? A. Asking the client whether he or she has passed flatus (gas) B. Auscultating bowel sounds in all abdominal quadrants C. Counting the number of bowel sounds in each abdominal quadrant D. Observing the abdomen for symmetry and distention

Asking the client whether he or she has passed flatus (gas) The best and most reliable method for assessing the return of peristalsis following abdominal surgery is the client's report of passing flatus within the past 8 hours or stool within the past 12 hours. Although auscultation and counting the number of sounds was once a method of assessing for bowel activity, it is no longer considered the most effective method. Observing the abdomen is one method of examining a client's abdomen, but it is not a reliable way to assess for resumption of activity after surgery.

The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the client's teaching plan? A. Encourage the client to eat acidic foods to decrease bacteria. B. Mouth care should be performed twice daily. C. Rinse the mouth with warm saline or sodium bicarbonate. D. Use a medium-bristled toothbrush for oral care.

C. rinse the mouth with warm saline or sodium bicarbonate

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? A. Broiled fish B. Ice cream C. Salted pretzels D. Scrambled eggs

C. salted pretzels

The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? a. Acyclovir (Zovirax) b. Diphenhydramine (Benadryl) c. Nystatin (Mycostatin) d. Tetracycline syrup (Sumycin syrup)

a. Acyclovir (Zovirax)

As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What collaborative resource does the nurse suggest for this client's care? a. Dentist b. Occupational therapist c. Psychiatrist d. Speech therapist

a. Dentist

Which facial assessment finding in a client with a salivary gland tumor prompts the nurse to notify the health care provider? a. Loss of sensation in tongue b. Alternates smiling and grimacing c. Wrinkles brows on command d. Holds eyes shut as the nurse pulls gently upon the eyebrows

a. Loss of sensation in tongue

Which practice does the nurse include when teaching a client about proper oral care? A. Perform self-examination of the mouth every week, and report any unusual findings. B. Brush the teeth daily and floss as needed. C. Use drugs that reduce the flow of saliva unless lesions are present. D. Getting daily sun exposure is essential to maintain good health.

a. perform self examination of the mouth every week, and report any unusual findings.

When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the unlicensed assistive personnel (UAP)? a. Provide oral care using disposable foam swabs. b. Inspect the oral mucosa for evidence of oral candidiasis. c. Instruct the client on how to use nystatin (Mycostatin) oral rinses. d. Teach the client how to make appropriate dietary choices.

a. Provide oral care using disposable foam swabs.

A client who has undergone surgery and radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? A. Use saliva substitutes, especially when eating dry foods. B. This condition is common but is temporary. C. Use lozenges and hard candies to prevent dry mouth. D. This indicates a complication of therapy.

a. use saliva substitutes, especially when eating dry foods.

After change-of-shift report, which client does the nurse plan to assess first? A. Young adult who had a tracheostomy tube removed at the end of the last shift B. Adult who has severe xerostomia associated with radiation therapy C. Middle-aged adult who is describing oral pain after a partial glossectomy D. Older adult who has lost 10 pounds (4.5 kg) secondary to stomatitis

a. young adult who have a trach tube removed at the end of the last shift

The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? Select all that apply. a. Apples b. Bananas c. Cheese d. Nuts e. Potatoes

c, d, and e

The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? (Select all that apply.) A. Apples B. Bananas C. Cheese D. Nuts E. Potatoes

c, d, e

Which client statement requires immediate nursing intervention? a. "I used to chew tobacco but quit 5 years ago." b. "I use sunscreen to cover my face and body when I'm at the beach." c. "I do not have dental insurance, so I cannot get dental check-ups." d. "I only drink alcohol on special occasions like my birthday and anniversary."

c. "I do not have dental insurance, so I cannot get dental check-ups."

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? a. Applying cold compresses b. Avoiding the use of fruit or citrus-flavored candy c. Massaging the salivary gland d. Restrict fluids

c. Massaging the salivary gland

The nurse is caring for a postoperative client who had an extensive oral and neck surgery. The client is now describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client? a. Diphenhydramine (Benadryl) b. Midazolam (Versed) intravenously c. Morphine sulfate intravenously d. Oxycodone plus acetaminophen (Percocet, Tylox)

c. Morphine sulfate intravenously

The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the client's teaching plan? a. Encourage the client to eat acidic foods to decrease bacteria. b. Mouth care should be performed twice daily. c. Rinse the mouth with warm saline or sodium bicarbonate. d. Use a medium-bristled toothbrush for oral care.

c. Rinse the mouth with warm saline or sodium bicarbonate.

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? a. Broiled fish b. Ice cream c. Salted pretzels d. Scrambled eggs

c. Salted pretzels

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? A. Applying cold compresses B. Avoiding the use of fruit or citrus-flavored candy C. Massaging the salivary gland D. Keeping the head of the bed at 10 degrees when the client is lying down

c. massaging the salivary gland

The nurse is caring for a postoperative client who had a radical neck dissection, and the client is describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client? A. Diphenhydramine (Benadryl) B. Midazolam (Versed) intravenously C. Morphine sulfate intravenously D. Oxycodone plus acetaminophen (Percocet, Tylox)

c. morphine sulfate intravenously

A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? a. Suction the client's oral secretions to clear the airway. b. Place the client on humidified oxygen per nasal cannula. c. Assist the client to an upright position to facilitate breathing. d. Assess the respiratory effort and quantities and types of oral secretions.

d. Assess the respiratory effort and quantities and types of oral secretions.

A client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? a. Listen to the client and then explain that it is normal to feel depressed about the diagnosis. b. Explain the grieving process and listen to what the client has to say. c. Suggest that the client talk with friends and family and seek their support. d. Listen to the client's concerns and feelings and then suggest that the client join a community group of cancer survivors.

d. Listen to the client's concerns and feelings and then suggest that the client join a community group of cancer survivors.

A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? A. Suction the client's oral secretions to clear the airway. B. Place the client on humidified oxygen per nasal cannula. C. Assist the client to an upright position to facilitate breathing. D. Assess the respiratory effort and quantities and types of oral secretions.

d. assess the respiratory effort and quantities and types of oral secretions

Treatment of stomatitis

oral hygiene with soft tooth brush and sodium bicarbonate rinse avoid mouthwash, toothpaste with SIS, citrus fruits, tabacco, alcohol, pototoes, nuts, cheese take antifungal to treat candidas

certain foods that can cause stomatitis

potatoes, coffee, cheese, nuts, citrus fruits, and gluten may trigger allergic responses that cause apathous

stomatitis, apathous, herpes simplex stomatitis, and traumatic ulcers

primary stomatitis

The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? A. Acyclovir (Zovirax) B. Diphenhydramine (Benadryl) C. Nystatin (Mycostatin) D. Tetracycline syrup (Sumycin syrup)

a. acyclovir, zovirax

Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient gastrointestinal (GI) unit? A. A 38-year-old who needs discharge instructions after having an endoscopic retrograde cholangiopancreatography (ERCP) B. A 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy C. A 43-year-old recently admitted with nausea, abdominal pain, and abdominal distention D. A 50-year-old with epigastric pain who needs conscious sedation during a scheduled endoscopy procedure

A 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy A nurse who has experience with chronic GI problems will have experience and training in instructing clients on colonoscopy preparation. Discharge instructions following an ERCP, assessment of an admitted acutely ill client, and monitoring a client who is receiving conscious sedation would be accomplished best by nurses with experience in caring for adults with acute GI problems.

The student nurse studying the gastrointestinal system understands that chyme refers to what? a. Hormones that reduce gastric acidity b. Liquefied food ready for digestion c. Nutrients after being absorbed d. Secretions that help digest food

ANS: B Before being digested, food must be broken down into a liquid form. This liquid is called chyme. Secretin is the hormone that inhibits acid production and decreases gastric motility. Absorption is carried out as the nutrients produced by digestion move from the lumen of the GI tract into the body's circulatory system for uptake by individual cells. The secretions that help digest food include hydrochloric acid, bile, and digestive enzymes.

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride (Versed). The client's respiratory rate is 8 breaths/min. What action by the nurse is best? a. Administer naloxone (Narcan). b. Call the Rapid Response Team. c. Provide physical stimulation. d. Ventilate with a bag-valve-mask.

ANS: C For an EGD, clients are given mild sedation but should still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse's first action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for Versed. The Rapid Response Team is not needed at this point. The client does not need manual ventilation.

A client is admitted to the hospital with elevated serum amylase and lipase levels and a decreased calcium level. Which gastrointestinal health problem is indicated by these laboratory findings? A. Acute pancreatitis B. Cirrhosis C. Crohn's disease D. Diarrhea

Acute pancreatitis These laboratory values are commonly found in clients with acute pancreatitis. They are not indicative of cirrhosis of the liver or Crohn's disease. These laboratory values are not found in a client with diarrhea.

Which practice does the nurse include when teaching a client about proper oral care? a Perform self-examination of the mouth every week, and report any unusual findings. b. Brush the teeth daily and floss as needed. c. Use drugs that reduce the flow of saliva unless lesions are present. d. Regularly rinse mouth with alcohol-based agent.

a Perform self-examination of the mouth every week, and report any unusual findings.

A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? A. "A change in position may be what is needed for you to have intercourse with your wife." B. "Have you considered going to see a marriage counselor with your wife?" C. "What has your wife said about your pouch system?" D. "You must get clearance from your health care provider before you attempt to have intercourse."

"A change in position may be what is needed for you to have intercourse with your wife." A simple change in positioning during intercourse may alleviate the client's apprehension and facilitate sexual relations with his wife. Suggesting marriage counseling may address the client's concerns, but it focuses on the wrong issue; the client has not stated that he has relationship problems. Asking the client what his wife has said about the pouch may address the client's concerns, but it similarly focuses on the wrong issue. Telling the client that he needs to get clearance from his health care provider is an evasive response that does not address the client's primary concern.

A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client? A. "Avoid large crowds and anyone who is sick." B. "Do not take the medication if you are allergic to foods with fatty acids." C. "Expect difficulty with wound healing while you are taking this drug." D. "Monitor your blood pressure and report any significant decrease in it."

"Avoid large crowds and anyone who is sick." The client should avoid being around large crowds to prevent developing an infection. The client should not take the medication if he or she is allergic to certain proteins. Although immune suppression may occur to some degree, the client should not experience difficulty with wound healing while taking adalimumab. The client should not experience a decrease in blood pressure from taking this drug.

A client diagnosed with ulcerative colitis is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? A. "Be aware of the symptoms of toxic megacolon that we discussed." B. "If diarrhea increases, you should let your health care provider know." C. "Pregnancy should be avoided." D. "You will need to decrease your dose of sulfasalazine (Azulfidine)."

"Be aware of the symptoms of toxic megacolon that we discussed." Antidiarrheal drugs may precipitate colonic dilation and toxic megacolon. Toxic megacolon is characterized by an enlarged colon with fever, leukocytosis, and tachycardia. Loperamide will decrease diarrhea rather than increase it. Constipation is sometimes a problem. No contraindication for pregnancy is noted. Sulfasalazine therapy typically continues on a long-term basis.

A certified Wound, Ostomy, and Continence Nurse is teaching a client about caring for a new ileostomy. What information is most important to include? A. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." B. "Call the health care provider if your stoma has a bluish or pale look." C. "Notify the health care provider if output from your stoma has a sweetish odor." D. "Remember that you must wear a pouch system at all times."

"Call the health care provider if your stoma has a bluish or pale look." If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the health care provider must be notified immediately. It is true that output from the stoma after surgery may be a loose, greenish-colored liquid that may contain some blood, but this information is not the highest priority for instruction. It is normal for output from the stoma to have very little odor or a sweetish smell. Although it is true that the client will be required to wear a pouch system at all times, this is not the highest priority for instruction.

Which symptoms should be assessed for in a patient suspected of having gastroesophageal reflux disease (GERD)? Select all that apply.

-Eructation -Flatulence

Esomeprazole is prescribed to a patient with gastroesophageal reflux disease (GERD). What adverse effect might this medication cause?

-Gastrointestinal (GI) infection

The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? Select all that apply.

-Dyspepsia -Regurgitation -Flatulence -Excessive salivation

Which measure is useful in preventing esophageal reflux?

-Eating four to six small meals every day

A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client? A. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." B. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." C. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." D. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." The most effective way to manage diverticulitis is with a low-fiber diet while inflammation is present, followed by a high-fiber diet once the inflammation has subsided. Neither an exclusively low-fiber diet or an exclusively high-fiber diet will effectively manage diverticulitis. A high-fiber diet while diverticulitis is active will only worsen the disease and its symptoms.

A client who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the client to do in the meantime? A. "Avoid all solid foods to allow complete bowel rest." B. "Consume extra fluids to replace fluid losses." C. "Take an over-the-counter antidiarrheal medication." D. "Contact your provider for an antibiotic medication."

"Consume extra fluids to replace fluid losses." Clients should be taught to drink extra fluids to replace fluid lost through vomiting and diarrhea. It is not necessary to stop all solid food intake. Antidiarrheal medications are used if diarrhea is severe. Antibiotics are used if the infection is bacterial.

The nurse is caring for a client who is to be discharged after a bowel resection and the creation of a colostomy. Which client statement demonstrates that additional instruction from the nurse is needed? A. "I can drive my car in about 2 weeks." B. "I should avoid drinking carbonated sodas." C. "It may take 6 weeks to see the effects of some foods on my bowel patterns." D. "Stool softeners will help me avoid straining."

"I can drive my car in about 2 weeks." The client who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The client should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The client should avoid straining at stool.

The nurse is teaching a client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? A. "I will need to avoid sweetened fruit juice beverages." B. "I can eat ice cream in moderation." C. "I cannot drink alcohol at all." D. "It is okay to have a serving of sugar-free pudding."

"I can eat ice cream in moderation." Milk products such as ice cream must be eliminated from the diet of the client with dumping syndrome. The client with dumping syndrome can no longer consume sweetened drinks. Alcohol must be eliminated from the diet. The client can eat sugar-free pudding, custard, and gelatin with caution.

The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions? A. "A dark or purplish-looking stoma is normal and should not concern me." B. "If the skin around the stoma is red or scratched, it will heal soon." C. "I need to check for leakage underneath my colostomy." D. "I should strive for a very tight fit when applying the barrier around the stoma."

"I need to check for leakage underneath my colostomy." The pouch system should be checked frequently for evidence of leakage to prevent excoriation. A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma should be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? A. "A drink of diet soda with dinner is OK for me." B. "I need to go for a walk every evening." C. "Maintaining a low-fiber diet will manage my constipation." D. "Watching the amount of fluid that I drink with meals is very important."

"I need to go for a walk every evening." Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages. Caffeinated beverages can cause bloating or diarrhea and should be avoided in clients with IBS. Fiber is encouraged in clients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups of fluid should be consumed daily to promote normal bowel function.

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "I should avoid alcohol and tobacco." D. "I should eat small meals about six times a day."

"I should avoid alcohol and tobacco." The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia. The client should not eat six small meals daily. This practice may actually stimulate gastric acid secretion.

Which recommendation would the nurse make first to a patient with gastroesophageal reflux disease (GERD) who is overweight and consuming several cups of caffeinated coffee and two soft drinks daily?

-Changing to decaffeinated coffee

A patient with a hiatal hernia is prescribed famotidine. What is the action of this drug in the treatment of hiatal hernia?

-Decreases gastric acid secretions

The Certified Wound, Ostomy, and Continence Nurse is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects a correct understanding of the necessary self-management skills? A. "I will have my spouse change the bag for me." B. "If I have any leakage, I'll put a towel over it." C. "I need to call my home health nurse to come out if I have any problems." D. "I will make certain that I always have an extra bag available."

"I will make certain that I always have an extra bag available." The statement that the client will be certain to bring an extra bag is the only statement illustrating that the client is taking responsibility to care for the colostomy. Using a towel is not an acceptable or effective way to cope with leakage. It is not realistic that the home health nurse can make frequent visits for the purpose of colostomy care.

The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates a correct understanding of the nurse's instructions? A. "I should take Ex-Lax after the surgery to 'keep things moving'." B. "I will need to eat a diet high in fiber." C. "Limiting my fluids will help me with constipation." D. "To help with the pain, I'll apply ice to the surgical area."

"I will need to eat a diet high in fiber." A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements. Stimulant laxatives are discouraged because they are habit-forming. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications; cold therapy is sometimes recommended and useful before surgery for inflamed hemorrhoids.

The nurse is educating a group of older adults about screening for colorectal cancer. Which statement by a group member indicates the need for further clarification about these guidelines? A. "A barium enema every 5 years is a screening option." B. "I will need to have a routine colonoscopy every 5 years." C. "My routine flexible sigmoidoscopy every 5 years is OK." D. "The 'virtual' colonoscopy every 5 years is acceptable."

"I will need to have a routine colonoscopy every 5 years." The 2010 guidelines indicate that routine screening with colonoscopy is performed every 10 years, not every 5 years. Other options are performed at 5-year intervals. A barium enema every 5 years is a screening option. A flexible sigmoidoscopy and a "virtual" colonoscopy every 5 years are also acceptable for screening.

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which client statement indicates a need for further teaching about this procedure? A. "I may have trouble urinating immediately after the surgery." B. "I will need to stay in the hospital overnight." C. "I should not eat after midnight the day of the surgery." D. "My chances of having complications after this procedure are slim."

"I will need to stay in the hospital overnight." Usually, the client is discharged 3 to 5 hours after MIIHR surgery. Male clients who have difficulty urinating after the procedure should be encouraged to force fluids and to assume a natural position when voiding. Clients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most clients who have MIIHR surgery have an uneventful recovery.

A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? A. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." B. "Keep mentioning the AA meetings to your spouse on a regular basis." C. "I'll get you some information on the support group Al-Anon." D. "Tell me more about your frustration with your spouse's refusal to participate in AA."

"I'll get you some information on the support group Al-Anon." Putting the client's spouse in contact with an Al-Anon support group assists with the spouse's frustration. Telling the spouse that the client will sign up for AA meetings when the client is ready and telling the spouse to keep mentioning AA do not address the spouse's frustration with the client's refusal to participate in AA. Encouraging the spouse to say more about his or her frustration may allow the spouse to vent frustration, but it does not offer any options or solutions.

A client with peptic ulcer disease asks the nurse whether a maternal history of gastric cancer will cause the client to develop gastric cancer. What is the nurse's best response? A. "Yes, it is known that a family history of gastric cancer will cause someone to develop gastric cancer." B. "If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." C. "Have you spoken to your health care provider about your concerns?" D. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."

"If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." Genetic counseling will help the client determine whether he or she is at exceptionally high risk to develop gastric cancer. The client cannot know for certain whether family history places him or her at exceptionally high risk to develop gastric cancer unless specific testing is done. Asking the client what the provider has said is an evasive answer by the nurse and does not help answer the client's question. Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.

A client suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the client about this test? A. "During the test, you will drink small amounts of an antacid as directed by the technician." B. "If you have IBS, hydrogen levels may be increased in your breath samples." C. "The test will take between 30 and 45 minutes to complete." D. "You must have nothing to drink (except water) for 24 hours before the test."

"If you have IBS, hydrogen levels may be increased in your breath samples." Excess hydrogen levels are produced in clients with IBS. This is due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted. The client will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes. The client has breath samples taken every 15 minutes for 1 to 2 hours. The client needs to be NPO (except for water) for 12 hours before the test.

Which nursing intervention is beneficial for a patient with a hiatal hernia?

-Elevating the head of the bed to 6 inches at night

A client with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The client asks the nurse how this is helpful for improving symptoms. How does the nurse reply? A. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." B. "It provides key nutrients and extra calories to promote healing." C. "It is bland and reduces the secretion of gastric acids." D. "It does not contain caffeine or other GI tract stimulants."

"It is absorbed quickly and allows the affected part of the GI tract to rest and heal." For less severe exacerbations, an elemental or semi-elemental product such as Vivonex PLUS may be prescribed to induce remission. These products are absorbed in the jejunum and therefore permit the distal small intestine and colon to rest. Nutritional supplements such as Ensure or Sustacal are added to provide nutrients and more calories. GI stimulants such as caffeinated beverages and alcohol should be avoided, but this is not the reason for using Vivonex PLUS.

A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? A. "It is usually ready to be closed in about 1 to 2 months." B. "This is something that you will have to discuss with your health care provider." C. "The period of time is indefinite—I am sorry that I cannot say." D. "You will probably have it for 6 months or longer, until things heal.

"It is usually ready to be closed in about 1 to 2 months." The RPC-IPAA has become the most effective alternate method for UC clients who have surgery to remove diseased portions of intestines. Stage 1 creates a temporary ileostomy to be used while an internally created pouch is healing. Stage 2 closes the ileostomy, and the client begins to use the pouch for storage of stool. The time between the surgeries is generally 1 to 2 months. Telling the client that he or she will have to discuss it with the health care provider evades the question; the nurse can give generalities to the client based on past practice and available data. The time that the client has the ileostomy is not "indefinite." The intent of this procedure is to eliminate the need to have a permanent ileostomy. The pouch should heal in 1 to 2 months, not 6 months; this estimate is not based on the expected outcome.

A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices? A. "Drinking carbonated beverages will help with your abdominal distress." B. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." C. "Lactose-containing foods should be reduced or eliminated from your diet." D. "Raw vegetables and high-fiber foods may help to diminish your symptoms."

"Lactose-containing foods should be reduced or eliminated from your diet." Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of clients with UC. Carbonated beverages are GI stimulants that can cause discomfort and should be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms; nurses should never advise clients that any amount of cigarette smoking is "OK." Raw vegetables and high-fiber foods can cause GI symptoms in clients with UC.

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A. "Cirrhosis is a chronic disease that has scarred my liver." B. "The scars on my liver create problems with blood circulation." C. "Because of the scars on my liver, blood clotting and blood pressure are affected." D. "My liver is scarred, but the cells can regenerate themselves and repair the damage."

"My liver is scarred, but the cells can regenerate themselves and repair the damage." Although cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage. Cirrhosis is a chronic condition that leaves scars on the liver. Permanent scars form in response to attempts by the cells to regenerate and create problems in blood circulation moving through the liver. Liver scarring will create problems with blood clotting, cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.

The nurse is teaching a client with peptic ulcer disease about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

"Nizatidine (Axid) needs to be taken three times a day to be effective." Nizatidine is most effective if administered once daily. A dose of ranitidine at bedtime should decrease acid production throughout the night. Sucralfate should be taken 1 hour before a

A client with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? A. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." B. "It is inherited, so it could run in your family." C. "It might be caused by a virus, so you could have gotten it almost anywhere." D. "Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine."

"Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine." Stating that the disorder is the result of flattening of the mucosa of the large intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

Which dietary modifications will be important for a patient newly diagnosed with gastroesophageal reflux disease (GERD)? Select all that apply.

-Avoidance of chocolate -Avoidance of tomatoes and tomato-based foods -Avoidance of coffee and other caffeinated beverages

What symptoms are suggestive of a sliding hiatal hernia? Select all that apply.

-Belching -Heartburn -Difficulty in swallowing -Backward flow of food into throat

A client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your provider told you about participating in hospice?" C. "I can speak to your provider about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

"Pain control is a major component of the care provided by hospice and its staff members." Telling the client that pain control is a major component of hospice care correctly describes the services provided by hospice and its staff members, and reassures the client about their expertise in pain management. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's concerns. The nurse does not need to speak to the provider because pain control is an integral part of hospice services. It is inappropriate to tell a terminally ill client in need of pain control that he or she may become too dependent on pain medication.

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

"See your health care provider immediately when experiencing symptoms of a gallbladder attack." In this case, the client's pancreatitis was likely triggered by the development of gallstones. A diagnostic statement must come from the provider. Also, the client may not require removal of the gallbladder. The client must see the provider promptly when experiencing gallbladder disease and should not wait. Because this client's acute pancreatitis is likely related to gallstones, alcohol consumption need not be restricted.

The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information? A. "Do you usually binge drink?" B. "Do you tend to drink more on holidays or weekends?" C. "Tell me more about your alcohol intake." D. "Estimate how many episodes of binge drinking you do in a week."

"Tell me more about your alcohol intake." Asking the client about his or her alcohol intake is the only way that will allow the client to provide information in the client's own words and to the extent that the client wishes to provide it. Asking the client if he or she binge drinks or tends to drink more on holidays or weekends may put the client on the defensive rather than provide the desired information. It has not yet been determined whether the client engages in binge drinking.

A client with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client? A. "Are you afraid of what your spouse will think of the colostomy?" B. "Don't worry. You will get used to the colostomy eventually." C. "Tell me what worries you the most about this procedure." D. "Why are you so afraid of having this procedure done?"

"Tell me what worries you the most about this procedure." Asking the client about what worries him or her is the only question that allows the client to express fears and anxieties about the diagnosis and treatment. Asking the client if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response); it closes the dialogue and is not therapeutic. Telling the client not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place clients on the defense and are not therapeutic because they close the conversation.

A client with long-standing alcoholic liver disease has a decrease in serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) from previously assessed levels. What does the nurse tell the client about these results? 1 "These results indicate improvement." 2 "These decreases may indicate liver deterioration." 3 "These results indicate depletion of AST and ALT enzymes." 4 "These decreases usually occur when osteoporosis is present.

"These decreases may indicate liver deterioration." AST and ALT are elevated because these enzymes are released into the blood during liver inflammation. As the liver deteriorates, however, the hepatocytes become unable to initiate an inflammatory response and cannot release these enzymes, so the levels decline. In a client with acute liver disease, a decline in these levels may indicate improvement, but not in a client whose disease is long-standing and chronic. The levels drop because they are not produced, not because they are depleted. Osteoporosis causes an increase in alkaline phosphatase.

A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

"These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." Although licorice and slippery elm may be helpful in managing PUD, the client should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The client should not use over-the-counter medications without first discussing it with his or her provider.

What symptom should be assessed for in a patient suspected of having gastroesophageal reflux disease (GERD)?

-Eructation

An older female client is diagnosed with gastric cancer. Which statement made by the client's family demonstrates a correct understanding of the disorder? A. "This may be related to her recurring ulcer disease." B. "This is probably curable with surgery." C. "Gastric cancer has a strong genetic component." D. "Thank goodness she won't have to undergo surgery."

"This may be related to her recurring ulcer disease." Infection with Helicobacter pylori is the largest risk factor for gastric cancer because it carries the cytotoxin-associated antigen A (CagA) gene. Clients with chronic ulcers are probably infected with this organism. Surgery is not curative; most gastric cancers do not present with symptoms until late in the disease and have a high fatality rate. There is no strong genetic predisposition to gastric cancer. Surgery is part of the treatment.

A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? A. "This may be an indication that you are developing sepsis." B. "The gallstones are present, but have become fibrotic and contracted." C. "This type of gallbladder inflammation is associated with hypovolemia." D. "This may be an indication of pancreatic disease."

"This type of gallbladder inflammation is associated with hypovolemia." This type of gallbladder inflammation is associated with hypovolemia. Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed.

The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? A. "The diabetes could be related to your obesity." B. "What has your doctor told you about your disease?" C. "Do you consume alcohol on a frequent basis?" D. "Type 1 diabetes can occur when the pancreas is destroyed by disease."

"Type 1 diabetes can occur when the pancreas is destroyed by disease." Telling the client that type 1 diabetes can occur when the pancreas is destroyed by disease is the only response that accurately describes the relationship of the client's diabetes to pancreatic destruction. Type 2, not type 1, diabetes is usually related to obesity. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's question. Many factors could produce acute pancreatitis other than alcohol consumption.

A client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

"We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. It is not known to be a direct cause of the disease. Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease process in and of itself. Asking the client what the doctor has said is an evasive response on the part of the nurse and does not help answer the client's question.

The outpatient clinic nurse is caring for a recovering client who had a colonoscopy. The client asks for a drink. How does the nurse respond to this request? A. "After I hear bowel sounds, you can have a drink." B. "Twenty minutes after the procedure was completed, you may have some liquids." C. "When you are able to pass flatus (gas), you can have a drink." D. "You can have fluids when you get home and are settled."

"When you are able to pass flatus (gas), you can have a drink." Fluids are permitted after the client's peristalsis has returned, which is validated by the client's passing flatus, not by auscultation of bowel sounds. There is no set time period after the procedure that is considered safe for the client to have something to drink. The client will not be discharged home without the nurse determining that peristalsis has returned. The client must report that he or she is passing flatus to go home; therefore, the client should be given a drink before being sent home.

A client is admitted with severe viral gastroenteritis caused by norovirus. The client asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? A. "You may have contracted it from an infected infant." B. "You may have consumed contaminated food or water." C. "You may have come into contact with an infected animal." D. "You may have had contact with the blood of an infected person."

"You may have consumed contaminated food or water." Norovirus is the leading foodborne disease that causes gastroenteritis. It is transmitted via the fecal-oral route from person to person and from contaminated food and water. Vomiting causes the virus to become airborne. Campylobacter can be transmitted by contact with infected infants or animals. Escherichia coli may be spread via animals and contaminated food, water, or fomites. HIV may be spread via the blood, but not norovirus. Campylobacter and E. coli both cause bacterial gastroenteritis, while norovirus causes viral gastroenteritis.

The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole once daily. The patient reports that the drug doesn't completely control the symptoms. The nurse contacts the provider to discuss which intervention?

-Changing to a twice-daily dosing regimen

The nurse is counseling an asymptomatic client who is worried about possible hepatitis C exposure several years ago. What does the nurse tell this client about the risk of this disease? 1 "Unless you have signs of liver disease, you are no longer infected." 2 "You have probably cleared the virus since you have not had symptoms." 3 "You may be a carrier, but will never have serious symptoms of the disease." 4 "You may have serious long-term damage even without symptoms."

"You may have serious long-term damage even without symptoms." Clients exposed to hepatitis C may develop chronic infection even without symptoms until the damage occurs over decades of infection. A client is likely to be asymptomatic for months or years before the virus is detected. A carrier may or may not have serious symptoms of the disease. Individuals with HCV do not clear the virus like those with HBV.

The nurse is preparing a health promotion and lifestyle changes chart for a patient with gastroesophageal reflux disease (GERD). Which teaching will the nurse include?

-"Avoid sleeping flat in the bed."

The nurse is teaching a patient with a hiatal hernia about how to prevent heartburn. What statement by the patient indicates a need for further teaching?

-"I should lie down in the flat position following meals."

The nurse is teaching a group of nursing students about the postoperative interventions needed following laparoscopic Nissen fundoplication (LNF). Which statement by a nursing student indicates a need for further instruction?

-"Small dressings can be removed after 10 days."

What risk factors are associated with the development of gastroesophageal reflux disease (GERD)? Select all that apply.

-Ascites -Obesity -Pregnancy -Wearing tight girdles

The nurse is assessing an older patient with diverticulitis. Which instructions given by the nurse will be beneficial to this patient? Select all that apply. 1 "Refrain from drinking alcohol." 2 "Use mild laxatives three times a day." 3 "Refrain from physical activities like bending." 4 "Add tomatoes and strawberries in your diet." 5 "Eat a high-fiber diet during severe abdominal pain."

1 "Refrain from drinking alcohol." 3 "Refrain from physical activities like bending." Inflammation of diverticula indicates diverticulitis. A patient with diverticulitis should avoid alcohol because it irritates the bowel. An older patient with diverticulitis should refrain from physical activities such as bending and coughing to prevent an increase in intra-abdominal pressure, which can result in perforation of the diverticulum. An older patient should refrain from taking laxatives because laxatives increase intestinal motility. Tomatoes and strawberries should not be consumed as they contain seeds that may block the diverticula. In the acute phase of diverticulitis, the patient should refrain from eating a high-fiber diet.

What is the typical incubation period of the Norwalk virus in a person with a normal immune system? 1 48 hours 2 72-96 hours 3 7 days 4 2-7 weeks

1 48 hours The Norwalk virus has an incubation period of 48 hours. The incubation period for shigellosis is 1-7 days. The period that campylobacter enteritis is communicable is 2-7 weeks. None of the disorders discussed in the chapter has a specific incubation period of 72-96 hours.

A patient is admitted to the hospital with appendicitis. What signs/symptoms are consistent with this diagnosis? Select all that apply. 1 Anorexia 2 Nausea and vomiting 3 Rebound tenderness 4 Decreased white blood cell count 5 Abdominal pain relieved by coughing

1 Anorexia 2 Nausea and vomiting 3 Rebound tenderness Symptoms consistent with appendicitis include abdominal pain that is aggravated by coughing, nausea and vomiting, anorexia, rebound tenderness, and an increased white blood cell count.

What is a risk factor for liver cancer? 1 Cirrhosis 2 Fatty liver 3 Hepatomegaly 4 Portal vein thrombosis

1 Cirrhosis Cirrhosis is a severe scarring of the liver, and this chronic condition may lead to liver cancer. Fatty liver is caused by the accumulation of fats and etiological factors, which include diabetes mellitus and obesity; this condition may not lead to liver cancer. Hepatomegaly is a sign of underlying problems, which may or may not include liver cancer. Portal vein thrombosis is blockage or narrowing of the portal vein by a blood clot; this condition may not be a risk factor for liver cancer.

Which condition is the most common cause of peritonitis? 1 Diverticulitis 2 Peritoneal dialysis 3 Perforating tumors 4 Leakage during surgery

1 Diverticulitis Peritonitis mostly occurs due to contamination of the peritoneal cavity by bacteria or chemicals. Diverticulitis may lead to peritonitis due to the bacterial invasion into the peritoneum. Conditions such as peritoneal dialysis, perforating tumors, and leakage during surgery are less likely to cause peritonitis.

When performing an abdominal assessment on a patient diagnosed with pancreatitis, the nurse notes gray-blue discoloration around the periumbilical area, a dull sound on percussion, and normal bowel sounds. What action by the nurse is priority? 1 Document the findings 2 Prepare the patient for the operating room 3 Contact the health care provider immediately 4 Obtain a stat hemoglobin and hematocrit level

1 Document the findings A blue discoloration around the periumbilical area is a normal finding in a patient with acute pancreatitis. A dull sound on percussion may be caused from pancreatic ascites. The findings should be documented. The patient does not need to go to the operating room. The health care provider does not need to be contacted immediately. Checking the hemoglobin and hematocrit level is not indicated.

The nurse is caring for a patient admitted for gastroenteritis. What symptoms does the nurse expect to see in the patient? Select all that apply. 1 Fever 2 Hypertension 3 Acute confusion 4 Poor skin turgor 5 Excessive urination

1 Fever 3 Acute confusion 4 Poor skin turgor The patient with gastroenteritis loses a considerable amount of fluid through diarrhea and vomiting. This may lead to dehydration manifested by fever, acute confusion, and poor skin turgor. Therefore, the patient has oliguria or a decreased urine output. Hypotension, rather than hypertension, is present in patients with gastroenteritis.

While assessing a patient with gastroenteritis, the nurse suspects that the patient has severe dehydration. Which findings support the nurse's suspicion? Select all that apply. 1 Fever 2 Polyuria 3 Hypertension 4 Poor skin turgor 5 Dry mucous membranes

1 Fever 4 Poor skin turgor 5 Dry mucous membranes Gastroenteritis is a condition in which the stomach and the intestines become inflamed. A patient with gastroenteritis usually develops dehydration as fluids and electrolytes are lost as a result of diarrhea and vomiting. The clinical manifestations of severe dehydration include fever, poor skin turgor, and dry mucous membranes. Oliguria, not polyuria, and hypotension, not hypertension, are manifestations observed in patients with severe dehydration caused by gastroenteritis.

What is a common complication of Crohn's disease? 1 Fistulas 2 Tenesmus 3 Liquid stools 4 Bloody stools

1 Fistulas Crohn's disease is an inflammatory disease that usually affects the small intestine and the colon. The patient with Crohn's disease is at risk for fistulas due to the presence of strictures and deep ulcerations in the bowel wall. Patients with ulcerative colitis have bloody and liquid stools and report tenesmus, an unpleasant and urgent sensation to defecate. The lower abdominal colicky pain reduces with defecation.

What are potential complications of Crohn's disease? Select all that apply. 1 Fistulas 2 Osteoporosis 3 Malabsorption 4 Stomach cancer 5 Abscess formation

1 Fistulas 2 Osteoporosis 3 Malabsorption 5 Abscess formation The complications of Crohn's disease include abscess formation, colon cancer, malabsorption, fistulas, and osteoporosis. Stomach cancer is not a complication of Crohn's disease; colorectal cancer, however, is a possible complication of ulcerative colitis.

A patient with ulcerative colitis complains of severe diarrhea with exacerbations. What is the drug of choice in this condition? 1 Glucocorticoids 2 Aminosalicylates 3 Immunomodulators 4 Antidiarrheal drugs

1 Glucocorticoids Glucocorticoids such as prednisone and prednisolone are prescribed during exacerbation of ulcerative colitis. Aminosalicylates are used to treat mild to moderate ulcerative colitis. Immunomodulators alone are not effective in treating ulcerative colitis. Antidiarrheal drugs provide symptomatic management of diarrhea.

Which laboratory parameters should the nurse assess in the patient who presents with symptoms of diverticulitis? Select all that apply. 1 Hematocrit 2 Hemoglobin 3 Serum albumin 4 Serum potassium 5 White blood cell (WBC) count

1 Hematocrit 2 Hemoglobin 5 White blood cell (WBC) count The hematocrit and hemoglobin values should be monitored in the patient with diverticulitis because the hematocrit value may decrease due to severe bleeding. The WBC count may be elevated in the patient due to infection. Serum albumin levels should be monitored in the patient with malabsorption syndrome. Serum potassium levels should be assessed in the patient with diarrhea.

The nurse is preparing to administer the prescribed dose of pancrelipase to a patient with chronic pancreatitis. What pancreatic enzymes make up this medication? Select all that apply. 1 Lipase 2 Trypsin 3 Elastase 4 Amylase 5 Protease

1 Lipase 4 Amylase 5 Protease Pancrelipase provides the enzymes that the body is unable to produce because of chronic pancreatitis. It is a combination of the enzymes lipase, amylase, and protease in different concentrations. It does not contain trypsin and elastase.

What would be the drug of choice for a patient with gastroenteritis who is prescribed antiperistaltic agents? 1 Loperamide 2 Ciprofloxacin 3 Acetaminophen 4 Docusate sodium

1 Loperamide Loperamide has antiperistaltic action and is used in patients with gastroenteritis. Ciprofloxacin is an antibiotic. Acetaminophen is not indicated in the treatment of gastroenteritis. Docusate sodium is a drug used for softening stool.

What measures should be taken by a patient who has gastroenteritis to prevent transmission of the infection? 1 Maintain clean bathroom facilities. 2 Share glasses, dishes, and eating utensils with others. 3 Prepare or handle food that will be consumed by others. 4 Inform the primary health care provider if symptoms persist beyond 5 days.

1 Maintain clean bathroom facilities. Gastroenteritis can be transmitted via the fecal-oral route. Maintaining a clean bathroom facility helps to avoid exposure to infected stool. The sharing of glasses, dishes, and eating utensils with others should be avoided to prevent transmission of an infection. The preparation and handling of food that will be consumed by others may promote the spread of infection and should be avoided. Informing the primary health care provider if symptoms persist beyond 3 days prevents further progression of the disease.

A patient reports pain in the abdomen below the diaphragm. On assessment, the nurse finds the body temperature as 101 oF, hiccups, and pulse rate of 103 beats per minute. Which condition does the nurse suspect in the patient? 1 Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative colitis (UC)

1 Peritonitis Peritonitis is an inflammation and infection of the visceral and parietal peritoneum and endothelial lining of the abdominal cavity; this is life-threatening. Peritonitis presents with pain in the abdominal area, elevated body temperature, hiccups, and increased pulse rate. Gastroenteritis may cause diarrhea, nausea, and vomiting due to inflammation and infection of the mucosa in the intestine and stomach. Crohn's disease and UC are types of inflammatory bowel disease. Crohn's disease is characterized by pain near the terminal ileum. UC begins in the rectum and proceeds in a continuous manner toward the cecum.

Which bacteria may cause gastroenteritis? 1 Shigella species 2 Gonococcal species 3 Pneumococcal species 4 Staphylococcal species

1 Shigella species Gastroenteritis is a very common health problem that affects the small bowel and is caused either by bacterial or viral infection. Shigella species bacteria are transmitted by direct and indirect fecal-oral routes leading to gastroenteritis . Peritonitis may occur due to Gonococcus, Staphylococcus, and Pneumococcus infections .

What is the common symptom associated with anorexia? 1 Vomiting 2 Diarrhea 3 Abdominal cramping 4 Temperature greater than 101°F

1 Vomiting Common symptoms of anorexia are nausea and vomiting. Gastroenteritis may manifest as diarrhea and abdominal cramping. Perforation of the appendix may result in peritonitis with a temperature greater than 101°F.

Which instruction is essential for the nurse to include when teaching a client who is undergoing treatment for hepatitis with ribavirin? 1 Never miss a dose. 2 Avoid going out in the sun. 3 Take the medication on an empty stomach. 4 Take the medication at the same time each day

1 Clients being treated with Ribavirin for hepatitis C are instructed to never miss a dose of the drug. The nurse should assist the client in methods to use for reminders such as setting an alarm or alert. Exposure to sun is not contraindicated with ribavirin; this restriction pertains to sulfonamides or antipsychotic medications. This medication is often taken with food.

What type of cirrhosis is caused by hepatitis C? 1 Postnecrotic 2 Laennec's 3 Biliary 4 Cholestatic

1 The hepatitis C virus causes postnecrotic cirrhosis. Laennec's cirrhosis is caused by chronic alcoholism. Biliary cirrhosis is also called cholestatic cirrhosis; it is caused by chronic biliary obstruction or autoimmune disease.

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? Select all that apply. 1 Prolonged partial thromboplastin time (PTT) 2 Icterus of skin 3 Swollen abdomen 4 Elevated magnesium 5 Currant jelly stool 6 Elevated amylase level

1, 2, 3 The liver produces clotting factors; when it is damaged, prolonged coagulation times and bleeding may result. Icterus, or jaundice, results from cirrhosis. The client with cirrhosis may develop ascites, or fluid in the abdominal cavity. Currant jelly stool is consistent with intussusception, a type of bowel obstruction. Cirrhosis is consistent with elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; amylase is typically elevated in pancreatitis.

A certified Wound, Ostomy, and Continence Nurse is teaching a patient about caring for a new ileostomy. What information is most important to include? 1 "Remember that you must wear a pouch system at all times." 2 "Call the health care provider if your stoma has a bluish or pale look." 3 "Notify the health care provider if output from your stoma has a sweetish odor." 4 "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present."

2 "Call the health care provider if your stoma has a bluish or pale look." If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the health care provider must be notified immediately. It is true that output from the stoma after surgery may be a loose, greenish-colored liquid that may contain some blood, but this information is not the highest priority for instruction. It is normal for output from the stoma to have very little odor or a sweetish smell. Although it is true that the patient will be required to wear a pouch system at all times, this is not the highest priority for instruction.

Which examination is used first to identify an enlarged appendix in a patient? 1 X-ray study 2 Abdominal ultrasound 3 Computed tomography 4 Palpation of the abdomen

2 Abdominal ultrasound An abdominal ultrasound study may show the presence of an enlarged appendix. An x-ray is used in identification of free air or abdominal fluid. A computed tomography scan may be used after an ultrasound to confirm the diagnosis. Palpation of the abdomen may reveal muscle rigidity and guarding.

A patient has a low-grade body temperature of 99 oF, tachycardia, and lesions in the mouth. The laboratory results reveal a hemoglobin level of 8.7 g/dL and the erythrocyte sedimentation rate (ESR) as 38 mm per hour. Which treatment strategy may benefit the patient? 1 Opioids 2 Aminosalicylates 3 Antiperistaltic agents 4 Bulk-producing agents

2 Aminosalicylates Low-grade body temperature of 99 oF, tachycardia, and lesions in the mouth may indicate inflammatory bowel disease (IBD). The patient may have a low hemoglobin level of 8.7 g/dL (normal range: 13 to 16 g/dL) and ESR of 38 per hour (normal range: 20 to 30 mm per hour). Aminosalicylates such as sulfasalazine are used in the treatment of IBD. They provide anti-inflammatory effects by inhibiting prostaglandins and are usually effective in 2 to 4 weeks. Opioids are used to provide comfort in a patient with appendicitis pain. Antiperistaltic agents are useful in controlling the bowel movements in a patient with diarrhea. Bulk-producing agents such as psyllium hydrophilic mucilloid help in minimizing the pain from defecation in a patient with anal fissure.

The nurse is caring for a patient with peritonitis. What assessment findings will the nurse observe? Select all that apply. 1 Diarrhea 2 Anorexia 3 Low-grade fever 4 Distended abdomen 5 Increased urine output

2 Anorexia 4 Distended abdomen Peritonitis is an acute inflammation of the visceral and the parietal peritoneum and the endothelial lining of the abdominal cavity. A patient with peritonitis presents with a distended abdomen and anorexia. The patient has a high fever rather than a low-grade fever. Urine output is decreased because fluid shifts from the vascular compartment to the peritoneal cavity. There is no diarrhea; rather, the patient is unable to pass flatus because peristalsis slows or stops due to severe peritoneal inflammation.

Which condition is suspected in a patient who presents with right quadrant abdominal pain followed by anorexia, nausea, and vomiting? 1 Peritonitis 2 Appendicitis 3 Gastroenteritis 4 Crohn's disease

2 Appendicitis Appendicitis is an acute inflammation of the appendix associated with pain in the right lower quadrant followed by anorexia, nausea, and vomiting. Inflammation occurs due to the blockage of the appendix, which results in infection because the bacteria invade the wall of the appendix. Perforation of appendix leads to peritonitis, which results in inflammation and infection of peritoneum. Gastroenteritis is manifested by nausea and vomiting before abdominal pain. Crohn's disease is an inflammatory bowel disease that is manifested by pain at the terminal ileum.

A pathology report indicates a patient who has impaired digestion and bowel function is infected with Trypanosoma cruzi. The nurse notes the patient has cardiac dysrhythmia. Which condition does the nurse suspect? 1 Giardiasis 2 Chagas disease 3 Celiac disease (CD) 4 Intestinal amebiasis

2 Chagas disease Impaired digestion, impaired bowel function, and cardiac dysrhythmias with the infection of Trypanosoma cruzi indicate that the patient has Chagas disease. Giardiasis is caused by Giardia lamblia, which mainly affects intestinal system and leads to diarrhea and malabsorption syndrome. CD is characterized by anorexia, diarrhea and/or constipation, steatorrhea, and abdominal pain. Entamoeba histolytica causes intestinal amebiasis.

The nurse is caring for a patient with a low grade fever of 101°F, chills, and a heart rate of 98 beats per minute. The abdominal ultrasonography reveals bowel thickening. The blood test reports reveal a white blood cell (WBC) count of 19,000cells/ mm 3 and hemoglobin levels of 9.8 g/dL. Which condition does the nurse suspect in the patient? 1 Peritonitis 2 Diverticulitis 3 Gastroenteritis 4 Crohn's disease

2 Diverticulitis Diverticulitis is the inflammation of diverticula. A patient with diverticulitis may have an elevated WBC count of 19,000 cells/mm 3 and decreased hemoglobin and hematocrit values. Peritonitis is manifested by abdominal distention, hiccups, abdominal pain, a WBC above 20,000 cells/mm 3, and elevated neutrophils. Gastroenteritis causes diarrhea and vomiting due to inflammation of the mucous membranes of the stomach and intestinal tract. Crohn's disease is manifested by malaise, anorexia, anemia, dehydration, fever, and weight loss.

What term is used to describe a fistula that is present between the bowel and the bladder? 1 Enteroenteric fistula 2 Enterovesical fistula 3 Enterovaginal fistula 4 Enterocutaneous fistula

2 Enterovesical fistula A fistula that is present between the bowel and bladder is referred to as an enterovesical fistula. A fistula that is present between two segments of bowel is called an enteroenteric fistula. A fistula that is present between the skin and bowel is an enterocutaneous fistula. A fistula that is present between the bowel and vagina is called an enterovaginal fistula.

Which statements about shigellosis are accurate? Select all that apply. 1 Antibiotics are not typically ordered. 2 Humans are possible carriers for months. 3 Cipro may be used for treatment of gastroenteritis 4 Shigellosis is transmitted by direct fecal-oral routes. 5 Shigellosis carries an incubation period of 10 days or more.

2 Humans are possible carriers for months. 3 Cipro may be used for treatment of gastroenteritis 4 Shigellosis is transmitted by direct fecal-oral routes. Shigellosis is transmitted by direct and indirect fecal-oral routes and carries an incubation period of 1 to 7 days. It is communicable during the acute illness to 4 weeks after the illness. Humans are possible carriers for months. If gastroenteritis is due to shigellosis, anti-infective agents such as trimethoprim/sulfamethoxazole or ciprofloxacin are prescribed.

A patient is scheduled for magnetic resonance enterography (MRE). Which nursing action is effective in this situation? 1 Injecting the patient with general anesthesia before the test 2 Instructing the patient to fast for 4 to 6 hours before the test 3 Positioning the patient in supine, knee-chest position during the test 4 Instructing the patient to clean the anal region with absorbent material after the test

2 Instructing the patient to fast for 4 to 6 hours before the test MRE is performed to study the bowel in patients with inflammatory bowel disease. The nurse should instruct the patient to fast for 4 to 6 hours prior to the test because the patient is allowed to drink a contrast medium that leads to diarrhea. Consumption of food prior to the MRE may increase the time required to perform the test. General anesthesia is not used in the patient undergoing this test because it does not involve a procedure that induces pain. A patient with an ileostomy has to lie down in a supine, knee-chest position to obtain relief from pain. A patient with gastroenteritis has to clean the anal region with an absorbent material to prevent skin irritation.

What surgical techniques are involved in the treatment of Crohn's disease? 1 Minimal invasive surgery (MIS) and ileostomy 2 Minimal invasive surgery (MIS) and stricturoplasty 3 Ileostomy and natural orifice transluminal endoscopic surgery (NOTES) 4 Stricturoplasty and natural orifice transluminal endoscopic surgery (NOTES)

2 Minimal invasive surgery (MIS) and stricturoplasty MIS is performed for treating Crohn's disease which involves one or more small incisions, less pain, and quicker surgical recovery. Stricturoplasty is performed for bowel strictures related to Crohn's disease. Ileostomy and NOTES are the surgical techniques performed for treating ulcerative colitis.

Which organism causes gastroenteritis and is possibly transmitted through the respiratory route? 1 Shigella 2 Norovirus 3 Escherichia coli 4 Campylobacter enteritis

2 Norovirus Norovirus, also known as Norwalk-like viruses, causes gastroenteritis and is transmitted through the fecal-oral route and possibly the respiratory route. Shigella transmits through direct and indirect fecal-oral routes . Escherichia coli transmit through fecal contamination of food, water, or fomites. Campylobacter enteritis causes gastroenteritis through the fecal-oral route or by contact with infected animals or infants.

Which nursing action focuses on the promotion of nutrition intake for older adult? 1 Provide antiemetics after meals 2 Observe the patient during meals 3 Provide an environment of privacy 4 Bedpans should be placed within sight

2 Observe the patient during meals The patient should be observed during meal time to monitor food intake. The patient should be provided antiemetics prior to meals, if nausea and vomiting interfere with intake. A private environment can lead to loneliness so the patient should be in an environment that offers socialization and relaxation. Bedpans, urinals, and emesis basins should be removed from the patient's sight.

What medications are administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply. 1 Imipenem 2 Ranitidine 3 Meperidine 5 Ciprofloxacin

2 Ranitidine 4 Omeprazole Ranitidine is a histamine receptor antagonist, and omeprazole is a proton pump inhibitor. Both medications help decrease gastric acid secretion. Imipenem and ciprofloxacin are antibiotics. Meperidine is an opiate analgesic.

A patient reports having seven to nine bloody stools per day. The nurse finds that the patient has fever, tachycardia, anemia, and abdominal pain. The patient's laboratory reports indicate elevated C-reactive protein. Which classification of ulcerative colitis should the nurse suspect? 1 Mild 2 Severe 3 Moderate 4 Fulminant

2 Severe A patient who presents with greater than 6 and less than 10 bloody stools per day, fever, tachycardia, anemia, abdominal pain, and elevated C-reactive protein levels is suspected to have severe ulcerative colitis (UC). Absence of abnormal laboratory findings and less than 4 stools per day without blood indicate mild UC. Mild abdominal pain, nausea, and more than 4 stools per day without blood indicate moderate UC. Colonic distention, anemia, and more than 10 stools per day indicate fulminant UC.

Which of the following are classic symptoms of celiac disease? Select all that apply. 1 Weight gain 2 Steatorrhea 3 Osteoporosis 4 Abdominal pain 5 Diarrhea and/or constipation

2 Steatorrhea 4 Abdominal pain 5 Diarrhea and/or constipation Classic symptoms of celiac disease include weight loss, anorexia, diarrhea and/or constipation, steatorrhea, abdominal pain and distention, and vomiting. Atypical symptoms include osteoporosis, joint pain, lactose intolerance, iron deficiency anemia, depression, and migraines.

A nurse is caring for a patient with a new diagnosis of moderate ulcerative colitis (UC). The nurse anticipates an order for which medication? 1 Azathioprine 2 Sulfasalazine 3 Mercaptopurine 4 Sulfamethoxazole

2 Sulfasalazine Several drugs can be prescribed to treat UC, including two aminosalicylates, one of which is sulfasalazine. Sulfamethoxazole is an antibiotic that can be used to treat gastroenteritis caused by shigellosis. Both azathioprine and mercaptopurine are prescribed to manage the symptoms of Crohn disease.

The community health nurse educates people in a senior citizen center about consuming spinach and lettuce. What is the reason behind this instruction? 1 To prevent possible viral infection 2 To prevent possible gastroenteritis 3 To reduce the risk for acute kidney failure 4 To reduce the frequency of bowel movements

2 To prevent possible gastroenteritis The community health nurse should instruct people about spinach and lettuce because they may be highly contaminated with bacteria; this can help to prevent gastroenteritis. Viral infections do not occur from plants. However, patients must maintain proper hygiene to prevent transmission of the virus through the fecal-oral route. Acute kidney failure may occur in a patient with chronic peritonitis due to the shift in fluid and electrolytes. Frequency of bowel movements may be reduced only after elimination of the causative organism.

Which medication prevents the migration of white blood cells (WBCs) to inflamed bowel tissue? 1 Prednisone 2 Vedolizumab 3 Azathioprine 4 Metronidazole

2 Vedolizumab Vedolizumab is an intestinal-specific leukocyte traffic inhibitor. It prevents the migration of WBCs to inflamed bowel tissue. Prednisone is used to treat ulcerative colitis. Azathioprine is used to treat Crohn's disease. Metronidazole is the drug of choice to treat giardiasis.

A client is receiving continuous tube feeding at 70 mL/hr. When the bag is empty, how much formula does the nurse add? (Record your answer using a whole number.) _____ mL

280 mL

The emergency room nurse is caring for a patient with an acute anal fissure. What time frame is expected for the fissure to heal? 1 6 days 2 6 years 3 6 weeks 4 6 months

3 6 weeks An acute anal fissure is expected to heal within 6 weeks. Chronic fissures may reoccur and require intervention, prolonging the healing process. Acute fissures won't heal in 6 days, but they will heal quicker than 6 years or 6 months.

The primary health care provider inserts a nasogastric tube while performing open traditional abdominal surgery in a patient with right lower quadrant pain and a white blood cell (WBC) count of 20,500 cell/mm 3. The rationale behind this intervention is to prevent which condition? 1 Septicemia 2 Toxic megacolon 3 Abdominal distention 4 Respiratory atelectasis

3 Abdominal distention A patient with pain in the right lower quadrant and an elevated WBC count of 20,500 cell/mm 3 may have appendicitis. Open traditional surgery may be performed in the patient to remove the inflamed appendix. Nasogastic tube insertion is useful to decompress the stomach and prevent abdominal distension due to peritonitis or formation of abscesses while performing an open traditional surgery. The head of the patient's bed may be raised to reduce atelectasis after surgery. Intravenous antibiotic administration helps reduce septicemia. Infliximab may help reduce complications such as toxic megacolon in patients with ulcerative colitis.

While assessing a patient with peritonitis, which finding would make the nurse suspect that the inflammation has progressed? 1 Slow heart rate 2 Sunken abdomen 3 Absence of bowel sounds 4 Increased intestinal motility

3 Absence of bowel sounds Peritonitis is an inflammation of the peritoneum, which is the tissue that lines the inner wall of the abdomen that covers and supports most of the abdominal organs. Bowel sounds usually disappear when the inflammation progresses. Heart rate will increase due to the progression of inflammation in patients with peritonitis. Progressive abdominal distention is observed when the inflammation is progressed due to reduced intestinal motility.

The nurse is assessing a 70-year-old patient with abdominal distention, hyperactive bowel sounds, and poor skin turgor. The nurse suspects that the patient has gastroenteritis. What are the other findings that support the nurse's suspicion? Select all that apply. 1 Hemoglobin of 9.8 g/dL 2 Hematocrit of 25 percent 3 Body temperature of 101°F 4 Blood pressure of 100/70 mm Hg 5 Serum potassium level of 3.0 mEq/L

3 Body temperature of 101°F 4 Blood pressure of 100/70 mm Hg 5 Serum potassium level of 3.0 mEq/L An older patient with gastroenteritis may have an elevated body temperature of 101 oF due to a viral or bacterial infection. Heavy fluid imbalance may lead to hypotension (100/70 mm Hg) in the patient. The patient with gastroenteritis has severe emesis resulting in reduced serum potassium levels. Therefore, a low serum potassium level of 3.0 mEq/L (normal range: 3.5 to 5.5 mEq/L), sodium and chloride levels are observed in the patient. Low levels of hemoglobin (9.8 g/dL) and hematocrit (25 percent) may be observed in the patient with inflammatory bowel disease due to gastrointestinal bleeding.

A patient has vague symptoms that indicate an inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? 1 Epigastric cramping 2 Hypotension with vomiting 3 Chronic diarrhea, abdominal pain, and fever 4 Abdominal pain relieved by bending the knees

3 Chronic diarrhea, abdominal pain, and fever Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

Which sign of peritonitis appears first in an older adult? 1 Chills 2 Fever 3 Confusion 4 Abdominal pain

3 Confusion The first sign of peritonitis in older adults may be a sudden change in mental status (e.g., acute confusion). For those who have dementia, the confusion worsens. Fever and chills may not be present because of normal physiologic changes associated with aging. Abdominal pain will be present but will not be the first sign.

Which disorder is associated with inflammation of the small intestine? 1 Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative colitis

3 Crohn's disease Crohn's disease is an inflammatory disorder of the small intestine, sometimes the colon, or both. Peritonitis is inflammation of the peritoneum. Gastroenteritis is inflammation of the gastrointestinal tract. Ulcerative colitis is inflammation of the rectum and rectosigmoid colon and can extend to the entire colon.

Which diagnostic test is the gold standard for diagnosing gastritis? A. Esophagogastroduodenoscopy (EGD) B. Computed tomography (CT) scan C. Upper gastrointestinal (GI) series D. Cholangiogram

A.

While assessing a patient with pain in the right lower quadrant, the nurse finds that the patient has a body temperature of 39 oC and a pulse rate of 100 beats per minute. Which surgical intervention does the nurse anticipate will control the patient's condition? 1 Ileostomy 2 Total proctocolectomy 3 Exploratory laparotomy 4 Uncomplicated appendectomy

3 Exploratory laparotomy A patient with pain in the right lower quadrant, a body temperature of 39 oC, and a pulse rate of 100 beats per minute may have a perforated appendix with peritonitis. An exploratory laparotomy is used to treat the patient's condition, which involves the surgical removal of the inflamed and perforated organ followed by irrigation of peritoneum with antibiotic solutions. An ileostomy involves the drainage of fecal material into a pouching system worn on the abdomen of a patient with ulcerative colitis. A total proctocolectomy is performed in a patient who does not want the ileo-anal pouch. The procedure involves the removal of the colon, rectum, and anus with surgical closure of the anus. Uncomplicated appendectomy involves the removal of the inflamed appendix.

The patient requires a large amount of calories daily to promote the healing of a fistula. Which kind of diet should the nurse provide to the patient? 1 High-fiber food 2 Low-vitamin food 3 High-protein food 4 Low-calorie meals

3 High-protein food A high-protein diet is beneficial for wound healing. High-fiber foods cause discomfort and indigestion problems. High-vitamin foods are suggested to speed up the wound cure. Low-calorie meals do not increase caloric intake.

Which type of intervention gives a patient who is diagnosed with liver cancer a chance for long-term survival? 1 Chemotherapy 2 Radiation therapy 3 Liver transplantation 4 Hepatic artery embolization

3 Liver transplantation Liver transplantation may ensure long-term survival in a patient with liver cancer. Chemotherapy, radiation therapy, and hepatic artery embolization individually do not assure long-term survival.

A patient reports pain midway between the anterior iliac crest and the umbilicus in the right lower quadrant. The nurse documents that the patient is experiencing pain in which location? 1 Rebound point 2 Appendix point 3 McBurney's point 4 Right lower quadrant point

3 McBurney's point McBurney's point is located midway between the anterior iliac crest and the umbilicus in the right lower quadrant. Pain in this area is common in the later stages of appendicitis.

What are the common signs and symptoms of gastroenteritis? 1 Fecaliths 2 Polyphagia 3 Nausea and vomiting 4 Abdominal pain that increases with cough

3 Nausea and vomiting Nausea and vomiting are the first symptoms in a patient who has gastroenteritis. Fecaliths usually occur when the lumen of the appendix is obstructed. Anorexia is associated with gastroenteritis but not polyphagia. Abdominal pain that increases with cough or movement and bending the right hip or the knees suggests peritonitis and perforation.

The nurse is caring for a patient who has had abdominal distention and loose stools for 3 days due to gastroenteritis. The serum potassium is 3.0 mEq/L and blood pressure is 94/60 mm Hg. Which treatment may be best suitable for the patient in this situation? 1 Loperamide 2 Sulfasalazine 3 Oral rehydration solution 4 Diphenoxylate hydrochloride

3 Oral rehydration solution Abdominal distention, loose stools, a low serum potassium level of 3.0 mEq/L, and blood pressure of 94/60 mm Hg indicate that the patient has gastroenteritis. Oral rehydration therapy in the patient helps replenish fluid and electrolyte levels. Loperamide can prevent the organism from being eliminated from the body; therefore, it should not be given to a patient with bacterial or viral gastroenteritis. Sulfasalazine is effective in the treatment of ulcerative colitis. Diphenoxylate hydrochloride reduces gastrointestinal motility, but it is used sparingly due to its habit-forming ability.

In which position will the nurse place a patient who has had bariatric surgery in order to reduce the risk of sleep apnea? 1 Fowler's 2 Side-lying 3 Semi-Fowler's 4 Trendelenburg

3 Semi-Fowler's A postoperative patient should be placed in semi-Fowler's position to reduce the risk of sleep apnea; this will promote lung expansion in the patient. The patient should not be placed in Fowler's or side-lying positions as these may increase the risk of obstructive sleep apnea (OSA). Trendelenburg position does not improve airway patency.

What is the incubation period of norovirus? 1 1 to 7 days 2 1 to 10 days 3 10 to 51 hours 4 24 to 48 hours

4 24 to 48 hours Norovirus causes gastroenteritis through the fecal-oral route from person to person and from contaminated food and water. The incubation period is 24 to 48 hours. Shigella causes gastroenteritis within 1 to 7 days after invading the patient. The incubation period of Campylobacter is 1 to 10 days. An epidemic virus may show its pathological effects within 10 to 51 hours after invading the patient.

The nurse is preparing the patient for magnetic resonance enterography (MRE). What intervention slows down the bowel activity and motility in the patient in preparation for the MRE? 1 Positioning the patient in prone position 2 Having the patient drink a contrast medium 3 Teaching the patient to fast 4 to 6 hours prior to the test 4 Administering two subcutaneous injections of glucagon

4 Administering two subcutaneous injections of glucagon MRE is a major examination used to study the bowel in a patient who has inflammatory bowel disease. Two doses of glucagon are administered subcutaneously to slow bowel activity and motility in the patient. Positioning the patient, having the patient drink a contrast medium, and teaching the patient to fast are not interventions used to slow down the bowel motility.

Which is the most common manifestation of anal fissures? 1 Dysuria 2 Pruritus 3 Urinary retention 4 Bright red blood in the stool

4 Bright red blood in the stool Bright red blood in the stool and pain during and after defecation are the most common manifestations of anal fissures. Dysuria, pruritus, and urinary retention are the other less common manifestations of anal fissure.

A 68-year-old patient with severe abdominal pain, vomiting, and loose watery-mucous stools for 3 days is receiving medication to treat the symptoms. The patient reports frequent dizziness and falls. Which medication may contribute to frequent falls in the patient? 1 Oxycodone 2 Loperamide 3 Azithromycin 4 Diphenoxylate with atropine sulfate

4 Diphenoxylate with atropine sulfate A 68-year-old patient with severe abdominal pain, vomiting, and loose watery-mucous stools for 3 days may have gastroenteritis. Diphenoxylate hydrochloride with atropine sulfate reduces gastrointestinal motility in the patient, thereby reducing the symptoms. This medication, however, may contribute to drowsiness and falls. Therefore it should not be used for older adult patients. Oxycodone may be used cautiously in older adult patients to reduce pain. Loperamide is used to treat diarrhea and may not cause falls in the patient. Azithromycin is an antibiotic used to treat gastroenteritis caused by bacterial infections.

A patient with an anal fissure reports having painful intercourse. Which term should the nurse use in recording and reporting this condition? 1 Pyuria 2 Tenesmus 3 Atelectasis 4 Dyspareunia

4 Dyspareunia Dyspareunia is painful sexual intercourse, which is experienced in patients with anal fissures. Pyuria is the presence of white blood cells or pus in the urine. Tenesmus is feeling the urge to defecate and is observed in patients with parasitic infections. Atelectasis reduces gas exchange due to closure of the lungs.

The student nurse is caring for a patient who underwent open abdominal surgery for peritonitis. Which intervention made by the student nurse indicates a need for further teaching? 1 Positioning the patient at a 45° angle in bed 2 Monitoring the level of patient's consciousness 3 Supplying oxygen to the patient through facial mask 4 Encouraging the patient to lift 20 pound weights daily

4 Encouraging the patient to lift 20 pound weights daily The student nurse should advise the patient who underwent open abdominal surgery for peritonitis to refrain from lifting objects for at least 6 weeks after surgery. This helps in preventing abdominal pressure and complications. Positioning the patient at a 45 oangle in bed, which is in semi-Fowler's position, promotes drainage of the peritoneal contents into the lower region of the abdominal cavity; this also provides lung expansion. Monitoring the level of consciousness, vital signs, intake and output of fluids, and respiratory status is essential in the patient who underwent abdominal surgery. The nurse should continuously monitor the oxygen saturation in the patient and provide oxygen when the pulse oximetry reads less than 93 percent.

A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? 1 Overcooked food 2 Insufficient vaccinations 3 Bacteria on the patient's hands 4 Ingestion of parasites in the water

4 Ingestion of parasites in the water A main cause of gastroenteritis when traveling outside the country is ingestion of water that is infested with parasites. Bacteria on the patient's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.

Which medication is helpful in patients who have fistulas associated with Crohn's disease? 1 Mesalamine 2 Sulfasalazine 3 Azithromycin 4 Metronidazole

4 Metronidazole Fistulas occur due to acute exacerbations of Crohn's disease. Metronidazole is used to treat patients with fistulas due to Crohn's disease. Mesalamine and sulfasalazine are effective in the treatment of inflammatory bowel disease. Azithromycin is used in the treatment of gastroenteritis.

A patient with suspected appendicitis reports having abdominal pain around the umbilicus for the past 2 days, associated with decreased hunger and episodes of vomiting. Which nursing statement and patient response helps in confirming the diagnosis? 1 Nurse: "Have you eaten in restaurants within the past two days?" Patient response: "Yes, once at a fast-food restaurant." 2 Nurse: "Do you have an allergy toward milk and milk products?" Patient response: "Yes." 3 Nurse: "Were you traveling recently?" Patient response: "Yes, two week ago." 4 Nurse: "When did the pain and vomiting begin?" Patient response: "The pain started 2 days ago, and yesterday I started vomiting."

4 Nurse: "When did the pain and vomiting begin?" Patient response: "The pain started 2 days ago, and yesterday I started vomiting." A patient with pain in the periumbilical region, anorexia, and vomiting may have appendicitis. Pain followed by nausea and vomiting indicate appendicitis and could help differentiate the diagnosis from gastroenteritis. A patient with gastroenteritis may have nausea and vomiting prior to abdominal pain. The nurse should ask the patient with gastroenteritis about travel history and about consumption of food from restaurants to detect the source of outbreak of infection. The nurse has to inquire about travel history and food allergies such as allergy to milk and milk products to evaluate the presence of inflammatory bowel disease from other gastrointestinal disorders.

The laboratory report of a patient with appendicitis indicates a white blood count (WBC) of 23,000/mm 3. Which condition does the nurse suspect from this finding? 1 Fecalith 2 Anal fissure 3 Gastroenteritis 4 Perforated appendix

4 Perforated appendix A WBC count that is greater than 20,000/mm 3 indicates a perforated appendix in the patient with appendicitis. Fecaliths, gastroenteritis, and anal fissures do not typically manifest with a WBC greater than 20,000/mm 3.

Which clinical findings in a patient indicate ulcerative colitis? 1 Bowel fistulas 2 Thickened bowel wall 3 Inflammation of the ileum and colon 4 Presence of blood and mucus in the stool

4 Presence of blood and mucus in the stool Presence of blood and mucus in the stool is caused by bleeding in the intestinal mucosa. This symptom is indicative of ulcerative colitis. Strictures and deep ulcerations occur in Crohn's disease, which put the patient at risk for developing bowel fistulas. Thickened bowel walls and inflammation of ileum and colon are seen in Crohn's disease.

What changes take place in a patient after a total proctocolectomy with a permanent ileostomy? 1 The effluent has a foul odor. 2 The stool becomes reddish in color. 3 Stool volume increases and becomes thin. 4 Stool volume decreases and becomes thick.

4 Stool volume decreases and becomes thick. After undergoing a total proctocolectomy with a permanent ileostomy, the stool volume decreases and becomes thick or pastelike due to increased absorption of sodium and water. Effluent has little sweet odor; a foul odor only occurs when there is a blockage or infection. After the procedure, the stool becomes yellow-green or yellow-brown in color. If the stool is red in color, the surgery was not successful.

What drug has a complication of hemolytic anemia in a patient with ulcerative colitis if taken in higher doses? 1 Oslalazine 2 Balsalazide 3 Mesalamine 4 Sulfasalazine

4 Sulfasalazine Sulfasalazine is an aminosalicylate drug that causes hemolytic anemia if taken in high doses. Oslalazine, balsalazide, mesalamine are drugs used for ulcerative colitis that do not necessarily cause hemolytic anemia.

A patient has had abdominal surgery for peritonitis and is being discharged home with antibiotics and opioid analgesics. The primary health care provider prescribes docusate sodium. What is the rationale for the use of docusate sodium? 1 To relieve pain 2 To relieve fever 3 To fight infections 4 To soften the stools

4 To soften the stools Docusate sodium is a stool softener that may be prescribed to a patient taking opioid analgesics to help soften the stools. Opioid analgesics are prescribed to relieve pain. Acetaminophen is prescribed to relieve fever. Antibiotics are prescribed to fight infections.

Which surgical procedure for removal of an inflamed appendix involves minimal intervention? 1 Laparotomy 2 Laparoscopy 3 Exploratory laparotomy 4 Transluminal endoscopic surgery

4 Transluminal endoscopic surgery Transluminal endoscopic surgery is a new procedure that does not require an external skin incision. Instead, an endoscope is inserted through a natural orifice such as the mouth or anus and then an internal incision is made into the colon, thus avoiding any external incision. Laparotomy is an open surgical method used for complicated or atypical appendicitis. Uncomplicated appendectomy procedures are performed through laparoscopy. An exploratory laparotomy is a surgical opening into the abdomen to remove or repair the inflamed or perforated organ.

What diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease? 1 Computed tomography (CT) scan 2 Colonoscopy 3 Magnetic resonance enterography 4 X-ray examination with barium enema

4 X-ray examination with barium enema An x-ray examination with a barium enema is preferred over other tests to differentiate between ulcerative colitis and Crohn's disease due to its accuracy. A CT scan is done to confirm the disease or its complications. A colonoscopy may be done to aid in diagnosis. A magnetic resonance enterography helps to assess the status of a patient's inflammatory bowel disease.

Which diet instruction does the nurse give to a client with active hepatitis? 1 Consume soft, easy-to-chew foods. 2 Follow a low-protein, low-fat diet. 3 Eat a normal diet with fluid restrictions. 4 Eat small meals at frequent intervals

4 Small, frequent meals are often preferable to three standard meals for the client with hepatitis because these clients often experience nausea and vomiting and dietary intolerance. Soft, easy-to-chew foods are used with clients who have problems with dentition/chewing. The diet of the client with hepatitis should be high in carbohydrates and calories with moderate amounts of fat and protein after nausea and anorexia subside; clients with liver disease should limit fat in the diet due to intolerance. Fluid restriction is only recommended in clients with severe ascites and anasarca.

A client weighs 228 pounds (103.6 kg) and is 5'3" (160 cm) tall. What is this client's body mass index (BMI)? (Record your answer using a decimal rounded up to the nearest tenth.) _____

40.4

A nurse prepares to administer 12 mg/kg of 5-fluorouracil chemotherapy intravenously to a client who has colon cancer. The client weighs 132 lb. How many milligrams should the nurse administer? (Record your answer using a whole number.) ___________mg

720 mg

A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. Have you been experiencing any constipation? b. Are you eating a diet high in fiber and fluids? c. Do you have a history of high blood pressure? d. What vitamins and supplements are you taking?

A

A nurse assesses a client who is prescribed finding should alert the nurse to contact the health care provider? 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment a. White blood cell (WBC) count of 1500/mm3 b. Fatigue c. Nausea and diarrhea d. Mucositis and oral ulcers

A

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, The stool in my pouch is still liquid. How should the nurse respond? a. The stool will always be liquid with this type of colostomy. b. Eating additional fiber will bulk up your stool and decrease diarrhea. c. Your stool will become firmer over the next couple of weeks. d. This is abnormal. I will contact your health care provider.

A

A nurse cares for a client who has a new colostomy. Which action should the nurse take? a. Empty the pouch frequently to remove excess gas collection. b. Change the ostomy pouch and wafer every morning. c. Allow the pouch to completely fill with stool prior to emptying it. d. Use surgical tape to secure the pouch and prevent leakage.

A

A nurse cares for a client who states, My husband is repulsed by my colostomy and refuses to be intimate with me. How should the nurse respond? a. Lets talk to the ostomy nurse to help you and your husband work through this. b. You could try to wear longer lingerie that will better hide to ostomy appliance. c. You should empty the pouch first so it will be less noticeable for your husband. d. If you are not careful, you can hurt the stoma if you engage in sexual activity.

A

14. A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge? a. Do you have a one- or two-story home? b. Can you check your own pulse rate? c. Do you have any alcohol in your home? d. Can you prepare your own meals?

A A client recovering from chronic pancreatitis should be limited to one floor until strength and activity increase. The client will need a bathroom on the same floor for frequent defecation. Assessing pulse rate and preparation of meals is not specific to chronic pancreatitis. Although the client should be encouraged to stop drinking alcoholic beverages, asking about alcohol availability is not adequate to assess this clients safety. DIF: Applying/Application REF: 1201 KEY: Pancreatitis| patient education MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

16. A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider? a. Drainage from a fistula b. Absent bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

A Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis. Absent bowel sounds, pain at the incision site, and NG tube drainage are normal postoperative findings. DIF: Applying/Application REF: 1207 KEY: Whipple procedure| postoperative nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

The student nurse is performing a gastric lavage on a patient with an active upper GI bleed. Which action by the student requires intervention by the supervising nurse? A. Using an ice-cold solution to perform lavage on the stomach. B. Instilling the lavage solution in volumes of 200 to 300 mL. C. Continuing the lavage until the solution returned is clear or light pink without clots. D. Positioning the patient on his left side during the procedure.

A.

1. A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond? a. Bile salts accumulate in the skin and cause the itching. b. Toxins released from an inflamed gallbladder lead to itching. c. Itching is caused by the release of calcium into the skin. d. Itching is caused by a hypersensitivity reaction.

A In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate. DIF: Understanding/Comprehension REF: 1192 KEY: Cholecystitis MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

8. A nurse cares for a client with end-stage pancreatic cancer. The client asks, Why is this happening to me? How should the nurse respond? a. I dont know. I wish I had an answer for you, but I dont. b. Its important to keep a positive attitude for your family right now. c. Scientists have not determined why cancer develops in certain people. d. I think that this is a trial so you can become a better person because of it.

A The client is not asking the nurse to actually explain why the cancer has occurred. The client may be expressing his or her feelings of confusion, frustration, distress, and grief related to this diagnosis. Reminding the client to keep a positive attitude for his or her family does not address the clients emotions or current concerns. The nurse should validate that there is no easy or straightforward answer as to why the client has cancer. Telling a client that cancer is a trial is untrue and may diminish the client-nurse relationship. DIF: Applying/Application REF: 1208 KEY: Pancreatic cancer| coping| support MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity

3. A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond? a. Ambulating in the hallway twice a day will help. b. I will apply a cold compress to the painful area on your back. c. Drinking a warm beverage can relieve this referred pain. d. You should cough and deep breathe every hour.

A The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Cold compresses and drinking a warm beverage would not be helpful. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide. DIF: Applying/Application REF: 1195 KEY: Cholecystitis| postoperative nursing MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

7. A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first? a. Assess the clients endotracheal tube with 40% FiO2. b. Insert an indwelling Foley catheter to gravity drainage. c. Place the clients nasogastric tube to low intermittent suction. d. Start lactated Ringers solution through an intravenous catheter.

A Using the ABCs, airway and oxygenation status should always be assessed first, so checking the endotracheal tube is the first action. Next, the nurse should start the IV line (circulation). After that, the Foley catheter can be inserted and the nasogastric tube can be set. DIF: Applying/Application REF: 1208 KEY: Whipple procedure| postoperative nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

The RN receives a change-of-shift report about four clients. Which client does the nurse assess first? A. A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift B. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F C. A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it D. A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F This client with possible appendicitis may have developed a perforation and may be at risk for peritonitis. Rapid assessment and possible surgical intervention are needed. The client with UC who had six liquid stools, the client whose colostomy bag does not have any stool in it, and the client who was admitted with acute gastroenteritis all need assessment and intervention by an RN, but they are not at immediate risk for life-threatening complications. The client with possible appendicitis has a life-threatening emergency.

Which client does the charge nurse assign to an experienced LPN/LVN? A. A 28-year-old who requires teaching about how to catheterize a Kock ileostomy B. A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy C. A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 D. A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy The LPN/LVN should be familiar with the purpose, adverse effects, and client teaching required for neomycin. Teaching about how to catheterize a Kock ileostomy, assessing the client with UC with a high white blood cell count, and monitoring the client with gastroenteritis receiving IV fluids present complex problems that require assessment or intervention by an RN.

Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit? A. A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis B. A 36-year-old who needs teaching about an endoscopic retrograde cholangiopancreatography C. A 40-year-old who will need administration of IV midazolam hydrochloride (Versed) during an upper endoscopy D. A 46-year-old who was recently admitted with abdominal cramping and diarrhea of unknown causes

A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis Nasogastric tube insertion is included in LPN/LVN education and is an appropriate task for an experienced LPN/LVN. Assessment and client teaching should be done by an RN. IV hypnotic medications should be administered by an RN.

An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which client does the charge nurse assign to the float nurse? A. A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula B. A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas C. A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir D. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

A 36-year-old with peritonitis who just returned from surgery with multiple drains in place The ICU nurse is familiar with the care of a client with peritonitis, including monitoring for complications such as sepsis and kidney failure. The client with CD who has a draining enterocutaneous fistula, the client with UC who needs discharge teaching, and the client with questions about an ileo-anal reservoir are best assigned to a medical-surgical nurse who is more familiar with the care and teaching needed for clients with their respective disorders.

Which client does the medical-surgical unit charge nurse assign to an LPN/LVN? A. A 41-year-old who needs assistance with choosing a site for a colostomy stoma B. A 47-year-old who needs to receive "whole gut" lavage before a colon resection C. A 51-year-old who has recently arrived on the unit after having an open herniorrhaphy D. A 56-year-old who has obstipation and a recent emesis of foul-smelling liquid

A 47-year-old who needs to receive "whole gut" lavage before a colon resection Because administration of medications is within the LPN/LVN scope of practice, this preoperative client can be assigned to the LPN/LVN. Assistance with choosing a site for a colostomy stoma is an intervention that should be provided by an RN. The recent postoperative client and the critically ill client will need assessments and interventions that can only be done by an RN.

While working in the outpatient procedure unit, the RN is assigned to these clients. Which client does the nurse assess first? A. A 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP) B. A 54-year-old who is ready for discharge following a colonoscopy C. A 58-year-old who has just arrived for basal gastric secretion and gastric acid stimulation testing D. A 60-year-old with questions about an endoscopic ultrasound examination

A 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP) ERCP requires conscious sedation, so the client needs immediate assessment of respiratory and cardiovascular status. The other clients are not at risk for depressed respiratory status.

The nursing student caring for a patient with a duodenal ulcer is about to administer a proton pump inhibitor (PPI). Which statement about this medication is true? A. These drugs should not be used for a prolonged period of time because they may contribute to osteoporotic-related fractures. B. PPIs may not be given by a feeding tube. C. These drugs help prevent stress-induced ulcer's. D. PPIs work by coating the stomach with a protective barrier.

A.

4. A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? (Select all that apply.) a. Contact the provider immediately. b. Lower the head of the bed. c. Decrease intravenous fluids. d. Ask the client to bear down. e. Administer prescribed opioids.

A, B Clients who are experiencing biliary colic may present with tachycardia, pallor, diaphoresis, prostration, or other signs of shock. The nurse should stay with the client, lower the clients head, and contact the provider or Rapid Response Team for immediate assistance. Treatment for shock usually includes intravenous fluids; therefore, decreasing fluids would be an incorrect intervention. The clients tachycardia is a result of shock, not pain. Performing the vagal maneuver or administering opioids could knock out the clients compensation mechanism. DIF: Applying/Application REF: 1193 KEY: Cholecystitis| shock MSC: Integrated Process: Nursing Process: Intervention NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this clients plan of care? (Select all that apply.) a. Using premoistened disposable wipes for perineal care b. Turning the client from right to left every 2 hours c. Using an antibacterial soap to clean after each stool d. Applying a barrier cream to the skin after cleaning e. Keeping broken skin areas open to air to promote healing

A, B, D

A nurse assesses a client with irritable bowel syndrome (IBS), Which questions should the nurse include in this clients assessment? (Select all that apply.) a. Which food types cause an exacerbation of symptoms? b. Where is your pain and what does it feel like? c. Have you lost a significant amount of weight lately? d. Are your stools soft, watery, and black in color? e. Do you experience nausea associated with defecation?

A, B, E

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L b. Loss of 15 pounds without dieting c. Abdominal pain in upper quadrants d. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L

A, C, E

2. A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this clients condition? (Select all that apply.) a. Body mass index of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

A, D, F Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasis. A diet low in saturated fats and moderate alcohol intake may decrease the risk. Although metabolic syndrome is a precursor to diabetes, it is not a risk factor for cholelithiasis. The client should be informed of the connection. DIF: Remembering/Knowledge REF: 1192 KEY: Cholecystitis| health screening MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

The gastric ulcer patient's abdomen is rigid, tender, and painful. He prefers lying in a knee-chest (fetal) position. What is the nurse's priority action at this time? A. Notify the healthcare provider. B. Administer opioid pain medication. C. Re-position the patient supine. D. Measure the abdominal circumference.

A.

The nurse is assessing a patient's nasogastric drainage following a conventional fundoplication procedure. How does the nurse expect the drainage to appear the first 8 hours after surgery? A. Dark brown B. Bright red mixed with brown C. Yellowish to Green D. Green to clear

A.

The nurse is caring for a patient who underwent gastric resection. On assessment, the nurse notes that the patient's tongue is smooth, shiny, and appears "beefy." What does the nurse suspect has occurred? A. Vitamin B 12 deficiency B. Anemia C. Hypovolemia D. Inadequate nutrition

A.

The nurse is caring for a patient with esophageal cancer who is scheduled to undergo an esophagogastrostomy with a section of the jejunum to replace the esophagus. Which procedure does the nurse expect to perform preoperatively? A. Complete bowel preparation B. Chest tube placement C. Urinary catheter placement D. Nasogastric tube placement for feeding

A.

The nurse is teaching a patient with dumping syndrome about diet. Which statement by the patient indicates that teaching has been effective? A. "I will use sugar-free gelatin with caution." B. "I will avoid rice in my diet." C. "Meat in my diet will consist of a total of 8 ounces a day." D. "I will limit fluids with my meals to 8 ounces."

A.

What is the primary focus of care after conventional surgery for hiatal hernia? A. Prevention of respiratory complications B. Pain management C. Management of fluid balance D. Teaching the patient self-care activities

A.

Which statement about general principles of diet therapy for patients with dumping syndrome is true? A. Patients with dumping syndrome should have liquids between meals only. B. Patients with dumping syndrome should be encouraged to eat a diet high in roughage. C. Patients with dumping syndrome should eat a high-carbohydrate diet. D. The diet for a patient with dumping syndrome must be low in fat and protein.

A.

Which statement is true about Barrett's epithelium in the patient with GERD? A. While the body heals, a different type of cell forms on the lower part of the esophagus. B. This new tissue is less resistant to acid so it must be taken care of. C. Barrett's epithelium is resistant to the development of cancer. D. Esophageal stricture's are less likely to occur with this type of epithelium.

A.

Which type of gastric ulcer does the nurse expect may occur when caring for a patient with extensive burns? A. Curling's ulcer B. Cushing's ulcer C. Stress ulcer D. Ischemic ulcer

A.

A patient with peptic ulcer disease is receiving Maalox. Which actions does the nurse take when administering this medication? (Select all that apply) A. Give the medication 2 hours after the patient's meal. B. Do not give other drugs within 1 to 2 hours of antacids. C. Assess the patient for a history of renal disease before giving Maalox. D. Assess the patient for a history of heart failure before giving Maalox. E. Observe the patient for the side effect of constipation.

A. B. C. D.

The nurse is giving discharge instructions to a patient after a fundoplication procedure. The patient is instructed to avoid which activities? (Select all that apply) A. Drinking more than 8 ounces of carbonated beverage at one time B. Chewing gum C. Drinking with a straw D. Eating gas-producing foods E. Drinking non-carbonated beverages

A. B. C. D.

A patient develops an active upper GI bleed. Which are the priority actions the nurse takes in caring for this patient? (Select all that apply) A. Provide oxygen. B. Start 1 or 2 large-bore IV lines. C. Prepare to infuse 0.9% normal saline solution or lactated Ringer's solution. D. Monitor serum electrolytes. E. Prepare for nasogastric (NG) tube insertion.

A. B. C. E.

Uncontrolled GERD can be a cause of which adult-onset disorders? (Select all that apply) A. Dental caries B. Aspiration pneumonia C. Laryngitis D. Diverticulitis E. Asthma

A. B. C. E.

Nonsurgical treatment options for cancer of the esophagus can include which therapies? (Select all that apply) A. Swallowing therapy B. Chemoradiation C. Targeted therapies D. Smoking cessation programs E. Photodynamic therapy F. Endoscopic therapies

A. B. C. E. F.

Which statements will the nurse include one providing health teaching for a patient with hiatal hernia? (Select all that apply) A. "Elevate the head of your bed at least 6 inches for sleeping at night." B. "Remain in the upright position for several hours after eating." C. "Avoid straining or excessive vigorous exercise." D. "After surgery, you will have no dietary restriction." E. "Avoid wearing clothing that is tight around the abdomen." F. "Avoid eating in the late evening."

A. B. C. E. F.

What manifestations are expected when a patient has esophageal diverticula? (Select all that apply) A. Halitosis B. Dysphasia C. Swelling with difficulty breathing D. Nocturnal cough E. Regurgitation

A. B. D. E.

When performing an assessment on a patient with an active upper GI bleed, which conditions does the nurse identify as common causes of upper GI bleeding? (Select all that apply) A. Esophageal cancer B. Esophageal varices C. Gastroesophageal reflux disease D. Duodenal ulcer E. Gastritis F. Gastric cancer

A. B. D. E. F.

The nurse is caring for several patients with gastric and duodenal ulcers. Which differential features of gastric ulcers compared to duodenal ulcers does the nurse identify? (Select all that apply) A. Normal secretion or hyposecretion B. Relieved by ingestion of food C. Hematemesis more common than melena D. No gastritis present E. Most often, the patient has type O blood

A. C.

The nurse is teaching a patient about health promotion and maintenance to prevent gastritis. Which information does the nurse include? (Select all that apply) A. "A balanced diet can help prevent gastritis." B. "To prevent gastritis, you should limit your intake of salt." C. "If you stop smoking, there is less of a chance that you will develop gastritis." D. "Yoga has been found to be effective in preventing gastritis." E. "Although regular exercise is good for you, it has not been found to have an effect on the prevention of gastritis."

A. C. D.

Drug therapy for peptic ulcer disease is implemented for which purposes? (Select all that apply) A. Pain relief B. Rebuild the mucosal lining of the stomach C. Eliminate H. pylori infection D. Heal ulcerations E. Prevent recurrence

A. C. D. E.

Which are possible complications of chronic gastritis? (Select all that apply) A. Pernicious anemia B. Thickening of the stomach lining C. Gastric cancer D. Decreased gastric acid secretion E. Peptic ulcer disease

A. C. D. E.

Which are symptoms of early dumping syndrome? (Select all that apply) A. Tachycardia B. Confusion C. Desire to lie down D. Syncope E. Occurs 30 minutes after eating

A. C. D. E.

Which statements about Barrett's esophagus are accurate? (Select all that apply) A. It is considered to be a premalignant condition. B. It is associated with excessive intake of fresh fruits and vegetables. C. It results from exposure to acid and pepsin. D. It is associated with pickled and fermented foods. E. Normal cells undergo dysplasia to become cancerous.

A. C. D. E.

Which strategies does the nurse expect to implement in the management of dumping syndrome? (Select all that apply) A. Provide more frequent smaller meals. B. Provide a high-carbohydrate diet. C. Eliminate liquids ingested with meals. D. Increase protein and fat in the diet. E. Administer acarbose to decrease carbohydrate absorption.

A. C. D. E.

Which are pathologic changes associated with acute gastritis? (Select all that apply) A. Vascular congestion B. Severe mucosal damage and ruptured vessels C. Edema D. Acute inflammatory call infiltration E. Decreased cell production in the superficial epithelium of the stomach lining

A. B. C. D.

The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) A. Acupuncture B. Decreasing physical activities C. Herbs (moxibustion) D. Meditation E. Peppermint oil capsules F. Yoga

A. Acupuncture C. Herbs (moxibustion) D. Meditation E. Peppermint oil capsules F. Yoga Acupuncture is recommended as a complementary therapy for IBS. Moxibustion is helpful for some clients with IBS. Meditation, yoga, and other relaxation techniques help many clients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.

The nurse is teaching a client who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the client to report to the health care provider? (Select all that apply.) A. Anorexia B. Depression C. Drowsiness D. Frequent urination E. Headache F. Vomiting

A. Anorexia E. Headache F. Vomiting Anorexia, headache, and nausea/vomiting are side effects of sulfasalazine that should be reported to the health care provider. Depression, drowsiness, and urinary problems are not side effects of sulfasalazine.

The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) A. Broccoli B. Buttermilk C. Mushrooms D. Onions E. Peas F. Yogurt

A. Broccoli C. Mushrooms D. Onions E. Peas Broccoli, mushrooms, onions, and peas often cause flatus. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications? (Select all that apply.) A. Check blood glucose often. B. Check bowel sounds and stools. C. Ensure that drainage color is clear. D. Monitor mental status. E. Place the client in the supine position.

A. Check blood glucose often. B. Check bowel sounds and stools. D. Monitor mental status. Glucose should be checked often to monitor for diabetes mellitus. Bowels sounds and stools should be checked to monitor for bowel obstruction. A change in mental status or level of consciousness could be indicative of hemorrhage. Clear, colorless, bile-tinged drainage or frank blood with increased output may indicate disruption or leakage of a site of anastomosis. The client should be placed in semi-Fowler's position to reduce tension on the suture line and the anastomosis site and to optimize lung expansion.

When caring for a client with portal hypertension, the nurse assesses for which potential complications? (Select all that apply.) A. Esophageal varices B. Hematuria C. Fever D. Ascites E. Hemorrhoids

A. Esophageal varices D. Ascites E. Hemorrhoids Portal hypertension results from increased resistance to or obstruction (blockage) of the flow of blood through the portal vein and its branches. The blood meets resistance to flow and seeks collateral (alternative) venous channels around the high-pressure area. Veins become dilated in the esophagus (esophageal varices), rectum (hemorrhoids), and abdomen (ascites due to excessive abdominal [peritoneal] fluid). Hematuria may indicate insufficient production of clotting factors in the liver and decreased absorption of vitamin K. Fever indicates an inflammatory process.

SHORT ANSWER 1. A nurse cares for a client with acute pancreatitis who is prescribed gentamicin (Garamycin) 3 mg/kg/day in 3 divided doses. The client weighs 264 lb. How many milligrams should the nurse administer for each dose? (Record your answer using a whole number.) ____ mg/dose

ANS: 120 mg/dose 264 lb (2.2 lb/kg) = 120 kg. 3 mg/kg/day 120 kg = 360 mg/day. 360 mg/day 3 divided doses = 120 mg/dose. DIF: Applying/Application REF: 1196 KEY: Medication safety MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse cares for a client with ulcerative colitis. The client states, "I feel like I am tied to the toilet. This disease is controlling my life." How should the nurse respond? a. "Let's discuss potential factors that increase your symptoms." b. "If you take the prescribed medications, you will no longer have diarrhea." c. "To decrease distress, do not eat anything before you go out." d. "You must retake control of your life. I will consult a therapist to help."

ANS: A Clients with ulcerative colitis often express that the disorder is disruptive to their lives. Stress factors can increase symptoms. These factors should be identified so that the client will have more control over his or her condition. Prescription medications and anorexia will not eliminate exacerbations. Although a therapist may assist the client, this is not an appropriate response.

A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)? a. Lavaging the tube with ice water b. Performing frequent oral care c. Re-positioning the tube every 4 hours d. Taking and recording vital signs

ANS: B Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Re-positioning the tube, if needed, is also done by the nurse. The UAP can take vital signs, but this is not a comfort measure.

A nurse reviews the chart of a client who has Crohn's disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions? a. Serum potassium of 2.6 mEq/L b. Client ate 20% of breakfast meal c. White blood cell count of 8200/mm3 d. Client's weight decreased by 3 pounds

ANS: A Fistulas place the client with Crohn's disease at risk for hypokalemia which can lead to serious dysrhythmias. This potassium level is low and should cause the nurse to intervene. The white blood cell count is normal. The other two findings are abnormal and also warrant intervention, but the potassium level takes priority.

A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.

A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the client's weight by 6 kg

ANS: A Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client's weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? a. "It's a good thing I love orange and cherry gelatin." b. "My spouse will be here to drive me home." c. "I should refrigerate the GoLYTELY before use." d. "I will buy a case of Gatorade before the prep."

ANS: A The client should be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show a good understanding of the preparation for the procedure.

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? a. "Drink plenty of fluids to prevent dehydration." b. "You should only drink 1 liter of fluids daily." c. "Increase your protein intake by drinking more milk." d. "Sips of cola or tea may help to relieve your nausea."

ANS: A The client should drink plenty of fluids to prevent dehydration. Milk products may not be tolerated. Caffeinated beverages increase intestinal motility and should be avoided.

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the client's foods. d. Make the client NPO.

ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.

A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, "I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone!" Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the client's refusal, and call the health care provider. d. Contact the provider to request an extra dose of the client's diuretic.

ANS: A The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status.

A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Pale and bluish stoma b. Liquid stool c. Ostomy pouch intact d. Blood-smeared output

ANS: A The nurse should assess the stoma for color and contact the health care provider if the stoma is pale, bluish, or dark. The nurse should expect the client to have an intact ostomy pouch with dark green liquid stool that may contain some blood.

A nurse assesses a client with Crohn's disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Distended abdomen b. Temperature of 100.0° F (37.8° C) c. Loose and bloody stool d. Lower abdominal cramps

ANS: A The presence of strictures predisposes the client to intestinal obstruction. Abdominal distention may indicate that the client has developed an obstruction of the large bowel, and the client's provider should be notified right away. Low-grade fever, bloody diarrhea, and abdominal cramps are common symptoms of Crohn's disease.

A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, "I do not want to take this medication because it causes diarrhea." How should the nurse respond? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take Kaopectate liquid daily for loose stools." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory."

ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this client's discharge education? a. "Use a pill organizer to ensure you take this medication as prescribed." b. "Transient muscle aching is a common side effect of this medication." c. "Follow up with your provider in 1 week to test your blood for toxicity." d. "Take your radial pulse for 1 minute prior to taking this medication."

ANS: A Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.

The nurse working in the gastrointestinal clinic sees clients who are anemic. What are common causes for which the nurse assesses in these clients? (Select all that apply.) a. Colon cancer b. Diverticulitis c. Inflammatory bowel disease d. Peptic ulcer disease e. Pernicious anemia

ANS: A, B, C, D In adults, the most common cause of anemia is GI bleeding. This is commonly associated with colon cancer, diverticulitis, inflammatory bowel disease, and peptic ulcer disease. Pernicious anemia is not associated with GI bleeding.

The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A, B, C, E Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.

The nurse is supervising a senior nursing student in the care of a patient after esophageal surgery. For which action by the student must the nurse intervene? A. Student secures the NG tube to prevent dislodgment. B. Student prepares to irrigate NG tube. C. Student provides mouth care every 2 to 4 hours. D. Student elevates the head of the patient's bed.

B.

A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) a. Lower gastrointestinal bleeding - Erosion of the bowel wall b. Abscess formation - Localized pockets of infection develop in the ulcerated bowel lining c. Toxic megacolon - Transmural inflammation resulting in pyuria and fecaluria d. Nonmechanical bowel obstruction - Paralysis of colon resulting from colorectal cancer e. Fistula - Dilation and colonic ileus caused by paralysis of the colon

ANS: A, B, D Lower GI bleeding can lead to erosion of the bowel wall. Abscesses are localized pockets of infection that develop in the ulcerated bowel lining. Nonmechanical bowel obstruction is paralysis of the colon that results from colorectal cancer. When the inflammation is transmural, fistulas can occur between the bowel and bladder resulting in pyuria and fecaluria. Paralysis of the colon causing dilation and subsequent colonic ileus is known as a toxic megacolon.

A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood? (Select all that apply.) a. Ask a second nurse to double-check the blood. b. Prime the IV tubing with normal saline. c. Prime the IV tubing with dextrose in water. d. Take and record a set of vital signs. e. Teach the client about reaction manifestations.

ANS: A, B, D, E Prior to starting a blood transfusion, the nurse asks another nurse to double-check the blood (and client identity), primes the IV tubing with normal saline, takes and records a baseline set of vital signs, and teaches the client about manifestations to report. The IV tubing is not primed with dextrose in water.

A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Distended abdomen b. Inability to pass flatus c. Bradycardia d. Hyperactive bowel sounds e. Decreased urine output

ANS: A, B, E A client with peritonitis may present with a distended abdomen, diminished bowel sounds, inability to pass flatus or feces, tachycardia, and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associated with peritonitis.

A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition? (Select all that apply.) a. Administer vitamin B12 injections. b. Ask the provider about folic acid replacement. c. Educate the client on enteral feedings. d. Obtain consent for total parenteral nutrition. e. Provide iron supplements for the client.

ANS: A, B, E After gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse should provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.

A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. "How frequently do you drink alcohol?" b. "Have you ever had sex with a man?" c. "Do you have a family history of cancer?" d. "Have you ever worked as a plumber?" e. "Were you previously incarcerated?"

ANS: A, B, E When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis.

A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown bag. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.

ANS: A, B, E When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.

A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy

ANS: A, C, D Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the client's stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome.

A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. "Apply lotion to the client's dry skin areas." b. "Use a basin with warm water to bathe the client." c. "For the client's oral care, use a soft toothbrush." d. "Provide clippers so the client can trim the fingernails." e. "Bathe with antibacterial and water-based soaps."

ANS: A, C, D Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the client's nails should be trimmed short to prevent the client from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

After teaching a client with an anal fissure, a nurse assesses the client's understanding. Which client actions indicate that the client correctly understands the teaching? (Select all that apply.) a. Taking a warm sitz bath several times each day b. Utilizing a daily enema to prevent constipation c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories e. Taking a laxative each morning

ANS: A, C, D Taking warm sitz baths each day, using bulk-producing agents, and administering anti-inflammatory suppositories are all appropriate actions for the client with an anal fissure. The client should not use enemas or laxatives to promote elimination, but rather should rely on bulk-producing agents such as psyllium hydrophilic mucilloid (Metamucil).

An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

ANS: A, C, D, E Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.

A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Wash leafy vegetables carefully before eating or cooking them." b. "Do not ingest water from the garden hose or the pool." c. "Wash your hands before and after using the bathroom." d. "Be sure meat is cooked to the proper temperature." e. "Avoid eating eggs that are sunny side up or undercooked."

ANS: A, C, D, E Salmonella is usually contracted via contaminated eggs, beef, poultry, and green leafy vegetables. It is not transmitted through water in garden hoses or pools. Clients should wash leafy vegetables well, wash hands before and after using the restroom, make sure meat and eggs are cooked properly, and, because it can be transmitted by flies, keep flies off of food.

A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this group's teaching? (Select all that apply.) a. "Rotavirus is more common among infants and younger children." b. "Escherichia coli diarrhea is transmitted by contact with infected animals." c. "To prevent E. coli infection, don't drink water when swimming." d. "Clients who have botulism should be quarantined within their home." e. "Parasitic diseases may not show up for 1 to 2 weeks after infection."

ANS: A, C, E Rotavirus is more common among the youngest of clients. Not drinking water while swimming can help prevent E. coli infection. Parasitic diseases may take up to 2 weeks to become symptomatic. People with botulism need to be hospitalized to monitor for respiratory failure and paralysis. Escherichia coli is not transmitted by contact with infected animals.

Which statement about the use of antacids in the treatment of gastric ulcers is true? A. Antacids should be administered with meals. B. Patients should take calcium carbonate (Tums) if they still have pain after taking their usual antacid. C. The patient should take antacid on an empty stomach. D. Avoid using antacids with phenytoin (Dilantin).

D.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this group's teaching? (Select all that apply.) a. "Wash your hands after any contact with animals." b. "It is not necessary to buy a meat thermometer." c. "Stay away from people who are ill with diarrhea." d. "Use separate cutting boards for meat and vegetables." e. "Avoid swimming in backyard pools and using hot tubs."

ANS: A, D Washing hands after contact with animals and using separate cutting boards for meat and other foods will help prevent E. coli infection. The other statements are not related to preventing E. coli infection.

The nurse is teaching a patient being discharged home about taking prescribed medications to include sucralfate (Carafate). Which statement by the patient indicates teaching has been effective? A. "The main side effect of sucralfate is diarrhea." B. "I will take sucralfate with meals." C. "I will take sucralfate along with the antacid medication I take." D. "Sucralfate works to heal my ulcer."

D.

A nurse assesses a client who is hospitalized for botulism. The client's vital signs are temperature: 99.8° F (37.6° C), heart rate: 100 beats/min, respiratory rate: 10 breaths/min, and blood pressure: 100/62 mm Hg. Which action should the nurse take? a. Decrease stimulation and allow the client to rest. b. Stay with the client while another nurse calls the provider. c. Increase the client's intravenous fluid replacement rate. d. Check the client's blood glucose and administer orange juice.

ANS: B A client with botulism is at risk for respiratory failure. This client's respiratory rate is slow, which could indicate impending respiratory distress or failure. The nurse should remain with the client while another nurse notifies the provider. The nurse should monitor and document the IV infusion per protocol, but this client does not require additional intravenous fluids. Allowing the client to rest or checking the client's blood glucose and administering orange juice are not appropriate actions.

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.

ANS: B All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.

A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. "A low-protein diet will help the liver rest and will restore liver function." b. "Less protein in the diet will help prevent confusion associated with liver failure." c. "Increasing dietary protein will help the client gain weight and muscle mass." d. "Low dietary protein is needed to prevent fluid from leaking into the abdomen."

ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the client's dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I will avoid large crowds and people who are sick." b. "I will take this medication with my breakfast each morning." c. "Nausea and vomiting are common side effects of this drug." d. "I must wash my hands after I play with my dog."

ANS: B Adalimumab (Humira) is an immune modulator that must be given via subcutaneous injection. It does not need to be given with food or milk. Nausea and vomiting are two common side effects. Adalimumab can cause immune suppression, so clients receiving the medication should avoid large crowds and people who are sick, and should practice good handwashing.

The nurse is teaching a patient about ranitidine (Zantac) prescribed for gastritis. Which statement by the patient indicates effective teaching by the nurse? A. "The drug will heal the areas of my stomach that are sore." B. "This drug will block the secretions of my stomach." C. "Zantac will coat the inside of my stomach to protect it from acid." D. "This pill kills the bacterial infection I have in my stomach."

B.

A nurse cares for a client with hepatitis C. The client's brother states, "I do not want to contract this infection, so I will not go into his hospital room." How should the nurse respond? a. "If you wear a gown and gloves, you will not get this virus." b. "Viral hepatitis is not spread through casual contact." c. "This virus is only transmitted through a fecal specimen." d. "I can give you an update on your brother's status from here."

ANS: B Although family members may be afraid that they will contract hepatitis C, the nurse should educate the client's family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the client's status with the brother.

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I cannot drink any alcohol at all anymore." b. "I need to avoid protein in my diet." c. "I should not take over-the-counter medications." d. "I should eat small, frequent, balanced meals."

ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I will let my husband do all of the cooking for my family." b. "I'll take the ciprofloxacin until the diarrhea has resolved." c. "I should wash my hands with antibacterial soap before each meal." d. "I must place my dishes into the dishwasher after each meal."

ANS: B Ciprofloxacin should be taken for 10 to 14 days to treat Salmonella infection, and should not be stopped once the diarrhea has cleared. Clients should be advised to take the entire course of medication. People with Salmonella should not prepare foods for others because the infection may be spread in this way. Hands should be washed with antibacterial soap before and after eating to prevent spread of the bacteria. Dishes and eating utensils should not be shared and should be cleaned thoroughly. Clients can be carriers for up to 1 year.

What diagnostic test best identifies a hiatal hernia? A. EGD B. 24-hour ambulatory pH monitoring C. Esophageal manometry D. Barium swallow study with fluoroscopy

D.

A nurse cares for an older adult client who has Salmonella food poisoning. The client's vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first? a. Apply oxygen via nasal cannula. b. Administer intravenous fluids. c. Provide perineal care with a premedicated wipe. d. Teach proper food preparation to prevent contamination.

ANS: B Dehydration caused by diarrhea can occur quickly in older clients with Salmonella food poisoning, so maintenance of fluid balance is a high priority. Monitoring vital signs and providing perineal care are important nursing actions but are of lower priority than fluid replacement. The nurse should teach the client about proper hand hygiene to prevent the spread of infection, and preparation of food and beverages to prevent contamination.

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, "I am experiencing right flank pain and have a temperature of 101° F." How should the nurse respond? a. "The anti-rejection drugs you are taking make you susceptible to infection." b. "You should go to the hospital immediately to have your new liver checked out." c. "You should take an additional dose of cyclosporine today." d. "Take acetaminophen (Tylenol) every 4 hours until you feel better."

ANS: B Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

Which peptic ulcer disease drug is useful to protect patients against NSAID-induced ulcers? A. Magnesium hydroxide (Maalox) B. Omeprazole (Prilosec) C. Esomeprazole (Nexium) D. Misoprostol (Cytotec)

D.

A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure.

ANS: B For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure.

A nurse plans care for a client with Crohn's disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client's plan of care? a. Low-fiber diet b. Skin protection c. Antibiotic administration d. Intravenous glucocorticoids

ANS: B Protecting the client's skin is the priority action for a client who has a heavily draining fistula. Intestinal fluid enzymes are caustic and can cause skin breakdown or fungal infections if the skin is not protected. The plan of care for a client who has Crohn's disease includes adequate nutrition focused on high-calorie, high-protein, high-vitamin, and low-fiber meals, antibiotic administration, and glucocorticoids.

A nurse cares for a client with a new ileostomy. The client states, "I don't think my friends will accept me with this ostomy." How should the nurse respond? a. "Your friends will be happy that you are alive." b. "Tell me more about your concerns." c. "A therapist can help you resolve your concerns." d. "With time you will accept your new body."

ANS: B Social anxiety and apprehension are common in clients with a new ileostomy. The nurse should encourage the client to discuss concerns. The nurse should not minimize the client's concerns or provide false reassurance.

An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a "steering wheel mark" across the client's chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

ANS: B The liver is often injured by a steering wheel in a motor vehicle crash. Because the client's chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the client's position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position.

A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a. "Do you have family or friends for support?" b. "I'd like to know what you are feeling now." c. "Well, we knew this would probably happen." d. "Would you like me to refer you to hospice?"

ANS: B The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and "yes-or-no" questions are not therapeutic. Stating that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.

After teaching a client who has a new colostomy, the nurse provides feedback based on the client's ability to complete self-care activities. Which statement should the nurse include in this feedback? a. "I realize that you had a tough time today, but it will get easier with practice." b. "You cleaned the stoma well. Now you need to practice putting on the appliance." c. "You seem to understand what I taught you today. What else can I help you with?" d. "You seem uncomfortable. Do you want your daughter to care for your ostomy?"

ANS: B The nurse should provide both approval and room for improvement in feedback after a teaching session. Feedback should be objective and constructive, and not evaluative. Reassuring the client that things will improve does not offer anything concrete for the client to work on, nor does it let him or her know what was done well. The nurse should not make the client convey learning needs because the client may not know what else he or she needs to understand. The client needs to become the expert in self-management of the ostomy, and the nurse should not offer to teach the daughter instead of the client.

An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the family's wishes. d. Tell the family that such secrets cannot be kept.

ANS: B The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking "why" questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to follow the family's wishes or keep their confidence will not help move this family from their position and will set up an adversarial relationship.

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a. "Some medications have been known to cause hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I was infected with hepatitis A through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.

ANS: B This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.

After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I'll rinse my rectal area with warm water after each stool and apply zinc oxide ointment." b. "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." c. "I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry." d. "I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."

ANS: B Toilet paper can irritate the sensitive perineal skin, so warm water rinses or soft cotton washcloths should be used instead. Although aloe vera may facilitate healing of superficial abrasions, it is not an effective skin barrier for diarrhea. Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools. Patting the skin is recommended instead of rubbing the skin dry.

When teaching a patient about pernicious anemia, which statement does the nurse include? A. "Patients with pernicious anemia are not able to digest fats." B. "Pernicious anemia results in a deficiency of vitamin B 12." C. "All patients with gastrointestinal bleeding will eventually develop pernicious anemia." D. "Oral iron supplements are an effective treatment for pernicious anemia."

B.

Which lifestyle adjustment made a patient have to make two best control GERD? A. Sleep in the Trendelenburg position. B. Attain and maintain ideal body weight. C. Wear snug-fitting belts and waistbands. D. Engage in strenuous exercise such as weightlifting.

B.

After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the client's understanding. Which statements made by the client indicate that the client correctly understands the teaching? (Select all that apply.) a. "I'll have my housekeeper keep my toilet clean." b. "I must take a shower or bathe every day." c. "I should have my well water tested." d. "I will ask my sexual partner to have a stool test." e. "I must only eat raw vegetables from my own garden."

ANS: B, C, D Parasitic infections can be transmitted to other people. The client himself or herself should keep the toilet area clean instead of possibly exposing another person to the disease. Parasites are transmitted via unclean water sources and sexual practices with rectal contact. The client should test his or her well water and ask sexual partners to have their stool examined for parasites. Raw vegetables are not associated with parasitic gastrointestinal infections. The client can eat vegetables from the store or a home garden as long as the water source is clean.

Which physiological factor contributes to gastroesophageal reflux disease (GERD)? A. Accelerated gastric emptying B. Irritation from reflux of stomach contents C. Competent lower esophageal sphincter D. Increased esophageal clearance

B.

A client's small-bore feeding tube has become occluded after the nurse administered medications. What actions by the nurse are best? (Select all that apply.) a. Attempt to dissolve the clog by instilling a cola product. b. Determine if any of the medications come in liquid form. c. Flush the tube before and after administering medications. d. Mix all medications in the formula and use a feeding pump. e. Try to flush the tube with 30 mL of water and gentle pressure.

ANS: B, C, E LIQUID FLUSH FLUSH

Which procedure would the health care provider recommend for immediate relief of dysphasia? A. Photodynamic therapy B. Esophageal dilation C. Targeted therapy D. Chemoradiation therapy

B.

A nurse is designing a community education program to meet the Healthy People 2020 objectives for nutrition and weight status. What information about these goals does the nurse use to plan this event? (Select all that apply.) a. Decrease the amount of fruit to 1.1 cups/1000 calories. b. Increase the amount of vegetables to 1.1 cups/1000 calories. c. Increase the number of adults at a healthy weight by 25%. d. Reduce the number of adults who are obese by 10%. e. Reduce the consumption of saturated fat by nearly 10%.

ANS: B, D, E Take Healthy People to BED

A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the client's confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

Which statements about gastritis are accurate? (Select all that apply) A. The diagnosis of gastritis is made solely on clinical symptoms. B. The onset of infection with Helicobacter pylori can result in acute gastritis. C. Long-term use of acetaminophen (Tylenol) is a high risk factor for acute gastritis. D. Atrophic gastritis is a form of chronic gastritis that is seen most in older adults. E. Type B chronic gastritis affects the glands in the antrum, that may affect all of the stomach.

B. D. E.

Which types of ulcers are included in peptic ulcer disease? (Select all that apply) A. Esophageal ulcers B. Gastric ulcers C. Pressure ulcers D. Duodenal ulcers E. Stress ulcers

B. D. E.

A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a. Assess the client for iodine or shellfish allergies. b. Educate the client on the side effects of sedation. c. Inform the client a second scan may be needed. d. Teach the client about bowel preparation for the scan.

ANS: C A second scan may be performed in 1 to 2 days to see if interventions have worked. The nuclear medicine scan does not use iodine-containing contrast dye or sedation. There is no required bowel preparation.

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is best? a. Ask the client to call back if this happens again today. b. Instruct the client to go to the emergency department. c. Remind the client that a small amount of bleeding is possible. d. Tell the client to come in to the clinic this afternoon.

ANS: C After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse should remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.

A nurse answers a client's call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.

ANS: C All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid contamination with blood or body fluids.

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a. Inspection of oral mucosa b. Recent dietary intake c. Heart rate and rhythm d. Percussion of abdomen

ANS: C Although the client with severe diarrhea may experience skin irritation and hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea. The client should have her or his electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, recent dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this client than heart rate and rhythm.

A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, "I am having trouble swallowing this pill." Which action should the nurse take? a. Contact the clinical pharmacist and request the medication in suspension form. b. Empty the contents of the capsule into applesauce or pudding for administration. c. Ask the health care provider to prescribe the medication as an enema instead. d. Crush the pill carefully and administer it in applesauce or pudding.

ANS: C Asacol is the oral formula for mesalamine and is produced as an enteric-coated pill that should not be crushed, chewed, or broken. Asacol is not available as a suspension or elixir. If the client is unable to swallow the Asacol pill, a mesalamine enema (Rowasa) may be administered instead, with a provider's order.

fter teaching a client who has diverticulitis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I'll ride my bike or take a long walk at least three times a week." b. "I must try to include at least 25 grams of fiber in my diet every day." c. "I will take a laxative nightly at bedtime to avoid becoming constipated." d. "I should use my legs rather than my back muscles when I lift heavy objects."

ANS: C Laxatives are not recommended for clients with diverticulitis because they can increase pressure in the bowel, causing additional outpouching of the lumen. Exercise and a high-fiber diet are recommended for clients with diverticulitis because they promote regular bowel function. Using the leg muscles rather than the back for lifting prevents abdominal straining.

A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate? a. "Aspirin must be avoided." b. "Do not worry about black stools." c. "Report diarrhea to your provider." d. "Take 1 hour before meals."

ANS: C Maalox can cause hypermagnesemia, which causes diarrhea, so the client should be taught to report this to the provider. Aspirin is avoided with bismuth sulfate (Pepto-Bismol). Black stools can be caused by Pepto-Bismol. Maalox should be taken after meals.

For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age

ANS: C Misoprostol can cause abortion, so pregnant women should not take this drug. The other clients have no contraindications to taking misoprostol.

The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor

ANS: C Sucralfate is a mucosal barrier fortifier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.

After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the client's understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. "I should drink bottled water during my travels." b. "I will not eat off another's plate or share utensils." c. "I should eat plenty of fresh fruits and vegetables." d. "I will wash my hands frequently and thoroughly."

ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.

After in esophagectomy, what is the nurse's priority for patient care? A. Wound care B. Nutrition care C. Respiratory care D. Hydration care

C.

A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find? a. Positive Murphy's sign with rebound tenderness to palpitation b. Dull, hypoactive bowel sounds in the lower abdominal quadrants c. High-pitched, rushing bowel sounds in the right lower quadrant d. Reports of abdominal cramping that is worse at night

ANS: C The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohn's disease. A positive Murphy's sign is indicative of gallbladder disease, and rebound tenderness often indicates peritonitis. Dullness in the lower abdominal quadrants and hypoactive bowel sounds are not commonly found with Crohn's disease. Nightly worsening of abdominal cramping is not consistent with Crohn's disease.

nurse cares for a teenage girl with a new ileostomy. The client states, "I cannot go to prom with an ostomy." How should the nurse respond? a. "Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance." b. "The pouch won't be as noticeable if you avoid broccoli and carbonated drinks prior to the prom." c. "Let's talk to the enterostomal therapist about options for ostomy supplies and dress styles." d. "You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable."

ANS: C The ostomy nurse is a valuable resource for clients, providing suggestions for supplies and methods to manage the ostomy. A larger dress size will not necessarily help hide the ostomy appliance. Avoiding broccoli and carbonated drinks does not offer reassurance for the client. Ileostomies have an almost constant liquid effluent, so pouch removal during the prom is not feasible.

An older adult patient is admitted with an upper GI bleed. Which finding does the nurse expect to assess in the patient? A. Decreased pulse B. Increased hemoglobin and hematocrit C. Acute confusion D. Increased blood pressure

C.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition

ANS: C The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a person's risk for developing liver cancer.

A nurse has delegated feeding a client to an unlicensed assistive personnel (UAP). What actions does the nurse include in the directions to the UAP? (Select all that apply.) a. Allow 30 minutes for eating so food doesn't get spoiled. b. Assess the client's mouth while providing premeal oral care. c. Ensure warm and cold items stay at appropriate temperatures. d. Remove bedpans, soiled linens, and other unpleasant items. e. Sit with the client, making the atmosphere more relaxed.

ANS: C, D, E UAP RES!

The definitive diagnosis for esophageal cancer is made with which procedure? A. Barium swallow B. Esophageal manometry C. Esophageal ultrasound with fine needle aspiration D. EGD

C.

A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a. Albumin: 2.1 g/dL b. Hematocrit: 28% c. Hemoglobin: 8.1 mg/dL d. International normalized ratio (INR): 4.2

ANS: D An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albumin is low and is an expected finding. The hematocrit and hemoglobin are also low, but this is expected in gastric cancer.

After teaching a client with diverticular disease, a nurse assesses the client's understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice

ANS: D Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup of bean soup) should be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.

A nurse is examining a client reporting right upper quadrant (RUQ) abdominal pain. What technique should the nurse use to assess this client's abdomen? a. Auscultate after palpating. b. Avoid any palpation. c. Palpate the RUQ first. d. Palpate the RUQ last.

ANS: D If pain is present in a certain area of the abdomen, that area should be palpated last to keep the client from tensing up, which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain

ANS: D Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.

A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection. Which assessment should the nurse complete first? a. Heart rate and rhythm b. Bowel sounds c. Urinary output d. Respiratory rate

ANS: D Severe infection with C. botulinum can lead to respiratory failure, so assessments of oxygen saturation and respiratory rate are of high priority for clients with suspected C. botulinum infection. The other assessments may be completed after the respiratory system has been assessed.

The nurse is assessing a patient who has had a total gastrectomy today and notes bright-red blood in the NG and abdominal distention. What does the nurse do next? A. Irrigate the NG tube. B. Re-position the NG tube. C. Inform the surgeon of these findings. D. Remove the NG tube.

C.

A client presents to the family practice clinic reporting a week of watery, somewhat bloody diarrhea. The nurse assists the client to obtain a stool sample. What action by the nurse is most important? a. Ask the client about recent exposure to illness. b. Assess the client's stool for obvious food particles. c. Include the date and time on the specimen container. d. Put on gloves prior to collecting the sample.

ANS: D To avoid possible exposure to infectious agents, the nurse dons gloves prior to handling any bodily secretions. Recent exposure to illness is not related to collecting a stool sample. The nurse can visually inspect the stool for food particles, but it still needs analysis in the laboratory. The container should be dated and timed, but safety for the staff and other clients comes first.

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

ANS: D Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the client's willingness and ability to follow the regimen. The other assessment findings are not as critical.

The patient with GERD describes painful swallowing. Which symptom does the nurse recognize? A. Dyspepsia B. Regurgitation C. Odynophagia D. Dysphasia

C.

The patient with a gastric ulcer suddenly developed sharp epigastric pain that spreads over the entire abdomen. What complication has the patient most likely developed? A. Hemorrhage B. Gastric erosion C. Perforation D. Gastric cancer

C.

A client is scheduled for discharge after surgery for inflammatory bowel disease. The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and the spouse with regard to the client's home care? A. Ability of the client and spouse to perform incision care and dressing changes B. Effective coping mechanisms for the client and spouse after the surgical experience C. Knowledge about the client's requested pain medications D. Understanding of the importance of keeping scheduled follow-up appointments

Ability of the client and spouse to perform incision care and dressing changes Assessing the client's and the spouse's ability to carry out incision care and dressing changes is essential for avoiding further development of the infectious process, as well as infection of the surgical incision itself. Assessing coping mechanisms and knowledge of the client's pain medication are important, but are not the priority. Understanding the importance of scheduled follow-up appointments is important, but is not the priority.

The nurse finds a client vomiting coffee-ground emesis. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

Administering intravenous (IV) fluids Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the client's change in mental status, which is hypovolemia.

A client who has liver disease with ascites refuses the evening dinner tray and reports moderate abdominal pain. The nurse notifies the provider after assessing a low-grade temperature elevation and rigidity of the abdomen. The provider prepares to perform a paracentesis and orders an antibiotic to be given. When does the nurse expect to administer the antibiotic? 1 After a sample of fluid is sent to the lab for culture 2 After a short-term ascites drain has been placed 3 Before the paracentesis to prevent sepsis from the procedure 4 After the culture and sensitivity results are returned from the lab

After a sample of fluid is sent to the lab for culture This client has symptoms characteristic of spontaneous bacterial peritonitis. The nurse should give the ordered antibiotic after a sample of ascitic fluid has been sent for culture. Since the client is symptomatic, the antibiotic should be given before the culture results are known.

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? 1 Hemoglobin and hematocrit 2 Leukocytes 3 Alpha-fetoprotein 4 Serum albumin

Alpha-fetoprotein Fetal hemoglobin (alpha-fetoprotein) is abnormal in adults; it is a tumor marker indicative of cancers. Although anemia may be present, elevated hemoglobin and hematocrit are not diagnostic of hepatic cancer. White blood cells (leukocytes) are not used to specifically diagnose cancers. Serum albumin levels may be low in liver cancer and in malnutrition.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a client with advanced colorectal cancer for relief of symptoms? A. Analgesics and antiemetics B. Analgesics and benzodiazepines C. Steroids and analgesics D. Steroids and anti-inflammatory medications

Analgesics and antiemetics Clients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these clients.

A client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? A. Explain to the client the importance of drinking the enteral supplements prescribed. B. Ask the client's family to try to persuade the client to drink the supplements. C. Inform the client that a nasogastric tube may be necessary if he or she fails to comply. D. Ask the client if a change in flavor would make the supplement more palatable.

Ask the client if a change in flavor would make the supplement more palatable. Asking the client if a change in flavor would help shows that the nurse is attempting to determine why the client is not drinking the supplements. Many clients don't like certain supplement flavors. The nurse should not assume that the client does not understand the importance of drinking the supplements or that the client requires persuasion to drink the supplements. The problem may be entirely different. Telling the client that a nasogastric tube may be necessary could be construed as threatening the client.

A male client in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing the client's incision for signs of infection B. Assisting the client to stand to void C. Instructing the client in how to deep-breathe D. Monitoring the client's pain level

Assisting the client to stand to void Assisting the client with activities is part of the UAP role. Assessment of the client's incision and pain level requires broader education and scope of practice and should be done by licensed nursing personnel. Client teaching—even about something as fundamental as taking "deep breaths"—likewise requires broader education and scope of practice and should be done by licensed nursing personnel.

The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? 1 Positive Babinski's sign 2 Hyperreflexia 3 Kehr's sign 4 Asterixis

Asterixis Liver flap or asterixis is related to increased serum ammonia levels—the dorsiflexed hands begin to flap upward and downward when outstretched for a few moments. Babinski's sign is positive when the sole of the foot is stroked, the great toe points up, and the toes fan out. Hyperreflexia refers to deep tendon reflexes that are overactive. Kehr's sign is reflected by increased abdominal pain, exaggerated by deep-breathing, and is referred to the right shoulder.

The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? A. Positive Babinski's sign B. Hyperreflexia C. Kehr's sign D. Asterixis

Asterixis Liver flap or asterixis is related to increased serum ammonia levels—the dorsiflexed hands begin to flap upward and downward when outstretched for a few moments. Babinski's sign is positive when, as the sole of the foot is stroked, the great toe points up and the toes fan out. Hyperreflexia refers to deep tendon reflexes that are overactive. Kehr's sign is reflected by increased abdominal pain, exaggerated by deep breathing, and referred to the right shoulder.

A client who has liver disease with ascites asks about any necessary dietary changes. What instruction does the nurse include when teaching this client? 1 Avoid using table salt. 2 Consume a high-protein diet. 3 Eat foods high in calcium. 4 Take potassium supplements

Avoid using table salt Because of the fluid accumulation associated with ascites, this client should be on a sodium-restricted diet and should be taught to avoid table salt. High-protein or high-calcium diets are not recommended. Potassium supplements may be prescribed for clients taking certain diuretics, but are not routinely recommended.

A nurse assesses a client who is recovering from a hemorrhoidectomy nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the that was done the day before. The distended area. Which action should the nurse take? a. Assess the clients heart rate and blood pressure. b. Determine when the client last voided. c. Ask if the client is experiencing flatus. d. Auscultate all quadrants of the clients abdomen.

B

A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? a. Contact the provider and recommend a psychiatric consult for the client. b. Encourage the client to verbalize feelings about the diagnosis. c. Provide education about new treatment options with successful outcomes. d. Ask family and friends to visit the client and provide emotional support.

B

A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, I need to have a bowel movement. Which action should the nurse take? a. Obtain a bedside commode for the client to use. b. Stay with the client while providing privacy. c. Make sure the call light is in reach to signal completion. d. Gather supplies to collect a stool sample for the laboratory.

B

A nurse cares for a middle-aged male client who has irritable bowel syndrome (IBS). The client states, I have changed my diet and take bulk-forming laxatives, but my symptoms have not gotten better. I heard about a drug called Amitiza. Do you think it might help? How should the nurse respond? a. This drug is still in the research phase and is not available public use yet. b. Unfortunatey, lubiprostone is approved only for use in women. c. Lubiprostone works well. I will recommend this prescription to your provider. d. This drug should not be used with bulk-forming laxatives.

B

After teaching a client with iritable bowel syndrome (IBS), a nurse assesses the clients understanding. Which menu selection indicates that the client correctly understands the dietary teaching? a. Ham sandwich on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice c. Grilled cheese sandwich, small banana, cup of hot tea with lemon d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

B

An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the clients lower abdomen. Which action should the nurse take first? a. Measure the clients abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the clients hemoglobin and hematocrit. d. Obtain the clients complete health history.

B

2. After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. Drinking at least 2 liters of water each day is suggested. b. I will decrease the amount of fatty foods in my diet. c. Drinking fluids with my meals will increase bloating. d. I will avoid concentrated sweets and simple carbohydrates.

B After cholecystectomy, clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients. Good fluid intake is healthy for all people but is not related to the surgery. Drinking fluids between meals helps with dumping syndrome, which is not seen with this procedure. Restriction of sweets is not required. DIF: Applying/Application REF: 1196 KEY: Cholecystitis| postoperative nursing MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

17. A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take? a. Clamp the nasogastric tube. b. Place the client in semi-Fowlers position. c. Assess vital signs once every shift. d. Provide oral rehydration.

B Postoperative care for a client recovering from an open Whipple procedure should include placing the client in a semi -Fowlers position to reduce tension on the suture line and anastomosis sites, setting the nasogastric tube to low suction to remove free air buildup and pressure, assessing vital signs frequently to assess fluid and electrolyte complications, and providing intravenous fluids. DIF: Applying/Application REF: 1207 KEY: Whipple procedure| postoperative nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

5. A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowlers position with the head of bed elevated.

B The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort. DIF: Applying/Application REF: 1200 KEY: Pancreatitis| NPO| pain MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

12. A nurse cares for a client who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The client states, When I wake up I am in pain. Which action should the nurse take? a. Administer intravenous morphine while the client sleeps. b. Encourage the client to use the PCA pump upon awakening. c. Contact the provider and request a different analgesic. d. Ask a family member to initiate the PCA pump for the client.

B The nurse should encourage the client to use the PCA pump prior to napping and upon awakening. Administering additional intravenous morphine while the client sleeps places the client at risk for respiratory depression. The nurse should also evaluate dosages received compared with dosages requested and contact the provider if the dose or frequency is not adequate. Only the client should push the pain button on a PCA pump. DIF: Applying/Application REF: 1196 KEY: Cholecystitis| pain| postoperative care MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

After teaching a client who is recovering from a colon resection, the nurse assesses the clients understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) a. I must change the ostomy appliance daily and as needed. b. I will use warm water and a soft washcloth to clean around the stoma. c. I might start bicycling and swimming again once my incision has healed. d. Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown. e. I will check the stoma regularly to make sure that it stays a deep red color. f. must avoid dairy products to reduce gas and odor in the pouch.

B, C, D

6. A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is in the healing phase of acute pancreatitis. Which statements focused on nutritional requirements should the nurse include when delegating care for this client? (Select all that apply.) a. Do not allow the client to eat between meals. b. Make sure the client receives a protein shake. c. Do not allow caffeine-containing beverages. d. Make sure the foods are bland with little spice. e. Do not allow high-carbohydrate food items.

B, C, D During the healing phase of pancreatitis, the client should be provided small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals. Protein shakes can be provided to supplement the diet. Foods and beverages should not contain caffeine and should be bland. DIF: Applying/Application REF: 1201 KEY: Pancreatitis| nutritional requirements| collaboration| unlicensed assistive personnel (UAP) MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

7. A nurse cares for a client with pancreatic cancer who is prescribed implanted radioactive iodine seeds. Which actions should the nurse take when caring for this client? (Select all that apply.) a. Dispose of dirty linen in a red biohazard bag. b. Place the client in a private room. c. Wear a lead apron when providing client care. d. Bundle care to minimize exposure to the client. e. Initiate Transmission-Based Precautions.

B, C, D The client should be placed in a private room and dirty linens kept in the clients room until the radiation source is removed. The nurse should wear a lead apron while providing care, ensuring that the apron always faces the client. The nurse should also bundle care to minimize exposure to the client. Transmission-Based Precautions will not protect the nurse from the implanted radioactive iodine seeds. DIF: Applying/Application REF: 1206 KEY: Pancreatic cancer| radiation therapy MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

MULTIPLE RESPONSE 1. A nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure? (Select all that apply.) a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

B, C, D, E Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and renal failure (urine output of 20 mL/6 hr) are just some of the complications for which the nurse must assess the client after the Whipple procedure. Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure. DIF: Understanding/Comprehension REF: 1207 KEY: Whipple procedure| postoperative nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Take a 20-minute walk at least 5 days each week. b. Attend local Alcoholics Anonymous (AA) meetings weekly. c. Choose whole grains rather than foods with simple sugars. d. Use cooking spray when you cook rather than margarine or butter. e. Stay away from milk and dairy products that contain lactose. f. We can talk to your doctor about a prescription for nicotine patches.

B, D, F The client should be advised to stay sober, and AA is a great resource. The client requires a low-fat diet, and cooking spray is low in fat compared with butter or margarine. If the client smokes, he or she must stop because nicotine can precipitate an exacerbation. A nicotine patch may help the client quit smoking. The client must rest until his or her strength returns. The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones. Dairy products do not cause a problem. DIF: Applying/Application REF: 1201 KEY: Pancreatitis| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

A patient is scheduled to have several diagnostic tests to verify the medical diagnosis of GERD. Which diagnostic test is the most accurate method of diagnosing this disorder? A. Esophagogastroduodenoscopy (EGD) B. 24-hour ambulatory pH monitoring C. Esophageal manometry D. Motility testing

B.

A patient is undergoing a work up for carcinoma of the esophagus. What are the two primary risk factors associated with the development of this carcinoma? A. High-fat, low-fiber diet and tobacco use B. Tobacco use and obesity C. Sedentary lifestyle and family history of squamous cell carcinoma D. Heavy alcohol intake and high-fat, low-fiber diet

B.

A patient with GERD is on a medication that raises the pH of gastric contents. Which drug does the nurse expect to administer? A. Ranitidine B. Mylanta C. Gaviscon D. Omeprazole

B.

A patient with GERD is on a medication that raises the pH of gastric contents. Which drug does the nurse expect to administer? A. Ranitidine B. Mylanta C. Gaviscon D. Omeprazole

B.

The nurse has provided instruction for a patient prescribed sucralfate (Carafate) to treat a gastric ulcer. Which statement by the patient indicates that teaching has been effective? A. "This drug will stop the secretion of acid in my stomach." B. "I will take this drug on an empty stomach." C. "I will not be able to take ranitidine (Zantac) with this drug." D. "The main side effect of this drug that I can expect is diarrhea."

B.

The nurse has provided postoperative teaching for a patient who underwent a laparoscopic Nissen fundoplication (LNF). Which statement by the patient indicates a need for additional teaching? A. "I will walk every day." B. "I will no longer need the anti-reflux drugs after the surgery." C. "I will report a fever above 101°F." D. "I'll remove the gauze dressing 2 days after surgery and shower."

B.

The nurse is caring for a postoperative patient after esophageal surgery. On assessment, the nurse discovers that the patient's temperature is 10 1°F, heart rate is 120/minute, and respiratory rate is 32/minute. Lung sounds include bilateral crackles. What is the nurses priority first action? A. Raise the head of the patient's bed. B. Call the Rapid Response Team. C. Apply oxygen at 2L per nasal cannula. D. Administer IV normal saline at 75 mL/hour.

B.

A 49-year-old woman comes to the emergency department with reports of black tarry stools that started 2 weeks ago. In taking a gastrointestinal (GI) history, which questions does the nurse ask that pertain to Gordon's Functional Health Patterns? (Select all that apply.) A. "Are you having any difficulty having sex? How frequently do you have sex?" B. "Do you have any difficulty chewing or swallowing?" C. "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?" D. "What is your usual bowel elimination pattern? Frequency? Character?" E. "When was your last colonoscopy?"

B. "Do you have any difficulty chewing or swallowing?" C. "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?" D. "What is your usual bowel elimination pattern? Frequency? Character?" E. "When was your last colonoscopy?" Chewing or swallowing difficulties affect the client's ability to get food into her GI system. Pain, diarrhea, gas, and foods that cause these symptoms constitute very important data for collection in the GI history. The client needs to be questioned about usual bowel elimination patterns—frequency and character are two descriptors. Colonoscopy history is also elicited from the client. Sexual difficulties and frequency are not generally affected by GI problems; this would not be a routine question in a GI problem inquiry.

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? A. Right shoulder pain B. Polyuria C. Bone marrow suppression D. Bleeding

Bleeding When monitoring a client post hepatic artery embolization, an arterial approach is taken; therefore, prompt detection of hemorrhage is the priority. Discomfort may be present, but the priority is to assess for hemorrhage. The nurse must assess for signs of shock, not polyuria. Embolization does not suppress the bone marrow; if chemotherapy or immune modulators are used, the nurse then assesses for bone marrow suppression.

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? 1 Right shoulder pain 2 Polyuria 3 Bone marrow suppression 4 Bleeding

Bleeding When monitoring a client post-hepatic artery embolization, an arterial approach is taken; therefore, prompt detection of hemorrhage is the priority. Discomfort may be present, but the priority is to assess for hemorrhage. The nurse must assess for signs of shock, not polyuria. Embolization does not suppress the bone marrow; if chemotherapy or immune modulators are used, the nurse then assesses for bone marrow suppression.

The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

Blood pressure from 140/90 to 110/70 mm Hg A decrease in blood pressure is the most indicative sign of bleeding. A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding.

A client with liver disease has portal hypertension. Which clinical finding prompts the nurse to notify the provider immediately? 1 Blood pressure of 145/95 mm Hg 2 Blood-tinged emesis 3 Liver distention 4 Urine output of 200 mL/hr

Blood-tinged emesis Clients with portal hypertension are at risk for hemorrhage and should be monitored closely; blood-tinged emesis may indicate bleeding esophageal varices and should be reported immediately. A moderate elevation in blood pressure and liver distention are common, nonemergent findings in clients with liver disease. A urine output of 200 mL/hr does not need to be reported because normal urine output is 1500-2000 mL per day.

What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? A. Bulk-forming laxatives B. Saline laxatives C. Stimulant laxatives D. Stool-softening agents

Bulk-forming laxatives For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water. Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

C

A nurse cares for a client with colon cancer who has a new colostomy. The client states, I think it would be helpful to talk with someone who has had a similar experience. How should the nurse respond? a. I have a good friend with a colostomy who would be willing to talk with you. b. The enterostomal therapist will be able to answer all of your questions. c. I will make a referral to the United Ostomy Associations of America. d. Youll find that most people with colostomies dont want to talk about them.

C

A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, My doctor told me that the fecal occult blood test was negative for colon cancer. I dont think I need the colonoscopy and would like to cancel it. How should the nurse respond? a. Your doctor should not have given you that information prior to the colonoscopy. b. The colonoscopy is required due to the high percentage of false negatives with the blood test. c. A negative fecal occult blood test does not rule out the possibility of colon cancer. d. I will contact your doctor so that you can discuss your concerns about the procedure.

C

A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? a. Eat low-fiber and low-residual foods. b. White rice and bread are easier to digest. c. Add vegetables such as broccoli and cauliflower to your new diet. d. Foods high in animal fat help to protect the intestinal mucosa

C

A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this clients plan of care? a. You may experience nausea and vomiting for the first few weeks. b. Carbonated beverages can help decrease acid reflux from anastomosis sites. c. Take a stool softener to promote softer stools for ease of defecation. d. You may return to your normal workout schedule, including weight lifting.

C

9. A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the clients bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care providers notes about the prognosis for the client.

C Before conducting an assessment about the clients feelings, the nurse should determine whether he or she is willing and able to talk about them. If the client is open to the conversation and his or her room is not appropriate, an alternative meeting space may be located. The nurse should be present for the client during this time, and pulling up a chair and sitting with the client indicates that presence. Because the nurse is assessing the clients response to a terminal diagnosis, it is not necessary to have detailed information about the projected prognosis; the nurse knows that the client is facing an end-of-life illness. DIF: Applying/Application REF: 1208 KEY: Pancreatic cancer| coping| support MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity

11. A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1 F (37.8 C) b. Positive Murphys sign c. Light-colored stools d. Upper abdominal pain after eating

C Jaundice, clay -colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen equally with both chronic and acute cholecystitis. DIF: Understanding/Comprehension REF: 1193 KEY: Cholecystitis| assessment/diagnostic examination MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

10. A nurse assesses clients at a community health center. Which client is at highest risk for pancreatic cancer? a. A 32-year-old with hypothyroidism b. A 44-year-old with cholelithiasis c. A 50-year-old who has the BRCA2 gene mutation d. A 68-year-old who is of African-American ethnicity

C Mutations in both the BRCA2 and p16 genes increase the risk for developing pancreatic cancer in a small number of cases. The other factors do not appear to be linked to increased risk. DIF: Remembering/Knowledge REF: 1205 KEY: Pancreatic cancer| health screening MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

13. A nurse cares for a client with acute pancreatitis. The client states, I am hungry. How should the nurse reply? a. Is your stomach rumbling or do you have bowel sounds? b. I need to check your gag reflex before you can eat. c. Have you passed any flatus or moved your bowels? d. You will not be able to eat until the pain subsides.

C Paralytic ileus is a common complication of acute pancreatitis. The client should not eat until this has resolved. Bowel sounds and decreased pain are not reliable indicators of peristalsis. Instead, the nurse should assess for passage of flatus or bowel movement. DIF: Applying/Application REF: 1197 KEY: Pancreatitis| NPO| assessment/diagnostic examination MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

6. After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. The capsules can be opened and the powder sprinkled on applesauce if needed. b. I will wipe my lips carefully after I drink the enzyme preparation. c. The best time to take the enzymes is immediately after I have a meal or a snack. d. I will not mix the enzyme powder with food or liquids that contain protein.

C The enzymes should be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together. DIF: Applying/Application REF: 1202 KEY: Pancreatitis| medication safety MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes? (Select all that apply.) a. Indirect inguinal hernia An enlarged plug of fat eventually pulls the peritoneum and often the bladder into a sac b. Femoral hernia A peritoneum sac pushes downward and may descend into the scrotum c. Direct inguinal hernia A peritoneum sac passes through a weak point in the abdominal wall. d. Ventral hernia Results from inadequate healing of an incision e. Incarcerated hernia Contents of the bermia sac cannot be reduced back into the abdominal cavity

C, D, E

When assessing a client with hepatitis B, the nurse anticipates which assessment findings? (Select all that apply.) A. Recent influenza infection B. Brown stool C. Tea-colored urine D. Right upper quadrant tenderness E. Itching

C. Tea-colored urine D. Right upper quadrant tenderness E. Itching The urine may be brown, tea-, or cola-colored in clients with hepatitis. Inflammation of the liver may cause right upper quadrant pain. Deposits of bilirubin on the skin, secondary to high bilirubin levels, and jaundice irritate the skin and cause itching. Hepatitis B virus, not the influenza virus, causes hepatitis B, which is spread by blood and body fluids. The stool in hepatitis may be tan or clay-colored.

A home health client has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the client with self-care? A. Instructing the client about the use of electrolyte-containing oral rehydration products B. Administering loperamide (Imodium) 4 mg from the client's medicine cabinet C. Checking and reporting the client's heart rate and blood pressure in lying, sitting, and standing positions D. Teaching the client how to clean the perineal area after each loose stool

Checking and reporting the client's heart rate and blood pressure in lying, sitting, and standing positions Obtaining the client's blood pressure and heart rate is included in the education of home health aides and other UAP. Client teaching and medication administration are complex skills that should be performed by licensed nurses who have the education and scope of practice needed to safely implement these actions.

The nurse and the dietitian are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is best for this client? A. Chicken salad on whole wheat bread B. Liver and onions C. Chicken and rice D. Cobb salad with buttermilk ranch dressing

Chicken and rice Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products. The client with dumping syndrome should not be allowed to have mayonnaise, onions, or buttermilk ranch dressing; the dressing is made from milk products. The client can have whole wheat bread only in very limited amounts.

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? A. Abdominal pain relieved by bending the knees B. Chronic diarrhea, abdominal pain, and fever C. Epigastric cramping D. Hypotension with vomiting

Chronic diarrhea, abdominal pain, and fever Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? 1 Client who is taking lactulose and has diarrhea 2 Client with hepatitis C who requires a dressing change 3 Client with end-stage cirrhosis who needs teaching about a low-sodium diet 4 Obtunded client with alcoholic encephalopathy who needs a blood draw

Client with end-stage cirrhosis who needs teaching about a low-sodium diet The RN is responsible for client teaching; therefore, the client with end-stage cirrhosis should be assigned to the RN. Assisting a client with toileting and recording stool number and amount can be accomplished by nonprofessional staff. The LPN/LVN can provide dressing changes. Ancillary staff can perform venipuncture.

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? A. Client who is taking lactulose and has diarrhea B. Client with hepatitis C who requires a dressing change C. Client with end-stage cirrhosis who needs teaching about a low-sodium diet D. Obtunded client with alcoholic encephalopathy who needs a blood draw

Client with end-stage cirrhosis who needs teaching about a low-sodium diet The RN is responsible for client teaching; therefore, the client with end-stage cirrhosis should be assigned to the RN. Assisting a client with toileting and recording stool number and amount can be accomplished by nonprofessional staff. The LPN/LVN can provide dressing changes. Ancillary staff can perform venipuncture.

The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? A. Client with ascites who had a paracentesis 2 hours ago and is reporting a headache B. Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse C. Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL and thrombocytopenia D. Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse A change in the level of consciousness (LOC) of the client with PSE is the greatest concern; actions to improve the client's LOC should be rapidly implemented. Although uncomfortable, a headache in the client with ascites is not likely related to liver disease and does not pose an immediate threat or complication. A hemoglobin of 10.9 g/dL and thrombocytopenia are expected findings in a client with cirrhosis and do not pose an immediate threat. Elevated ALT and AST levels are expected for the client with hepatitis A and do not indicate a risk for severe complications.

The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? A. Client with hepatitis A reporting severe and ongoing itching B. Client with severe ascites who has a temperature of 101.4° F (38° C) C. Client with cirrhosis who has had a 3-pound weight gain over 2 days D. Client with esophageal varices and mild right upper quadrant pain

Client with severe ascites who has a temperature of 101.4° F (38° C) The client with ascites and an elevated temperature may have spontaneous bacterial peritonitis; the nurse should call this client first. Itching is anticipated with jaundice, this client may be called last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrhosis may cause mild right upper quadrant pain; this client should be called after the client with severe ascites.

The community health nurse is exploring the cause of an outbreak of hepatitis A. Which individual does the nurse suspect may be the source? 1 Individual who recently got a tattoo 2 Clients who were infected after eating at the same restaurant 3 Spouse of an intravenous drug abuser who developed hepatitis 4 Client who had a blood transfusion during cardiac surgery in 1985

Clients who were infected after eating at the same restaurant Hepatitis A is spread by the fecal-oral route either by person-to-person contact, or by consuming contaminated food or water; failure to clean the hands after using the toilet and then preparing food is an example of how hepatitis can be spread by this route. Tattoos, injection drug use, and blood transfusions can spread hepatitis B or C through blood or body fluids.

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? A. Clients with CD experience about 20 loose, bloody stools daily. B. Clients with UC may experience hemorrhage. C. The peak incidence of UC is between 15 and 40 years of age. D. Very few complications are associated with CD.

Clients with UC may experience hemorrhage. Hemorrhage is commonly experienced by clients with UC. Five to six stools daily is common with CD. The peak incidences of UC are between 15 to 25 and 55 to 65 years of age. Fistulas commonly occur as a complication of CD.

A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? 1 Colon cancer with metastasis to the liver 2 Hypertension 3 Hepatic encephalopathy 4 Ascites and shortness of breath (SOB)

Colon cancer with metastasis to the liver Transplantation is performed for hepatitis and primary (not secondary) liver cancers. Hypertension is a controllable factor and would not preclude the client from a liver transplant. Encephalopathy is a consequence of advanced liver disease, consistent with the condition of a client awaiting transplantation; it can be treated with lactulose and nonabsorbable antibiotics. Ascites and resulting shortness of breath are also consequences of advanced liver disease, consistent with the client awaiting transplantation; they can be managed with diuretics and paracentesis.

A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? A. Colon cancer with metastasis to the liver B. Hypertension C. Hepatic encephalopathy D. Ascites and shortness of breath

Colon cancer with metastasis to the liver Transplantation is performed for hepatitis and primary (not secondary) liver cancers. Hypertension is a controllable factor and would not preclude the client from a liver transplant. Encephalopathy is a consequence of advanced liver disease, consistent with the condition of a client awaiting transplantation; it can be treated with lactulose and nonabsorbable antibiotics. Ascites and resulting shortness of breath are also consequences of advanced liver disease, consistent with the client awaiting transplantation; they can be managed with diuretics and paracentesis.

When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? A. Having a larger meal early in the morning B. Consuming increased carbohydrates and moderate protein C. Restricting fluids to 1500 mL/day D. Limiting alcoholic beverages to once weekly

Consuming increased carbohydrates and moderate protein To repair the liver, the client should have a high-carbohydrate and moderate-protein diet; fats may cause dyspepsia. The client with hepatitis feels full easily and should have four to six small meals daily. Fluids are restricted with ascites caused by cirrhosis; not all clients with hepatitis progress to cirrhosis. Complete abstention from alcohol is necessary until the liver enzymes return to normal.

An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first? a. Send a blood sample for a type and crossmatch. b. Insert a large intravenous line for fluid resuscitation. c. Obtain the heart rate and blood pressure. d. Assess and maintain a patent airway

D

A client with ulcerative colitis is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the client's medication regimen? A. Corticosteroid therapy will be stopped. B. Sulfasalazine (Azulfidine) will be stopped. C. Corticosteroid therapy will be tapered. D. Sulfasalazine (Azulfidine) will be tapered.

Corticosteroid therapy will be tapered. Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period. Stopping corticosteroid therapy abruptly is unsafe—steroids must be gradually decreased in clients. Usually the amount that they have been taking dictates how quickly or slowly they can be stopped. Sulfasalazine therapy will be taken on a long-term basis. It may be increased or decreased, depending on the client's symptoms, but will likely never be stopped. These decisions are made over a long period of therapy.

A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily b. A 44-year-old with irritable bowel syndrome (IBS) c. A 60-year-old lawyer who works 65 hours per week d. A 72-year-old who eats fast food frequently

D

A nurse cares for a client who has a family history of colon cancer. The client states, My father and my brother had colon cancer. What is the chance that I will get cancer? How should the nurse respond? a. If you eat a low-fat and low-fiber diet, your chances decrease significantly b. You are safe. This is an autosomal dominant disorder that skips generations. c. Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer d. You should have a colonoscopy more frequently to identify abnormal polyps early

D

The nurse is caring for a patient who vomited coffee-ground blood. Where does the nurse suspect the patient is bleeding? A. Colon B. Rectum C. Small intestine D. Upper GI system

D.

4. After teaching a client who has a history of cholelithiasis, the nurse assesses the clients understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

D Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner. DIF: Applying/Application REF: 1195 KEY: Cholecystitis| nutritional requirements MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance

15. A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer? a. A 26-year-old with a body mass index of 21 b. A 33-year-old who frequently eats sushi c. A 48-year-old who often drinks wine d. A 66-year-old who smokes cigarettes

D Risk factors for pancreatic cancer include obesity, older age, high intake of red meat, and cigarette smoking. Sushi and wine intake are not risk factors for pancreatic cancer. DIF: Applying/Application REF: 1205 KEY: Pancreatic cancer| health screening MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A patient comes to the emergency department (ED) reporting rapid onset of epigastric pain with nausea and vomiting. The patient says the pain is worse than any heartburn he has had, and that he has not had an appetite for the past day. What does the nurse suspect this patient has? A. Peritonitis B. H. pylori infection C. Duodenal ulcer D. Acute gastritis

D.

A patient has returned to the unit after a Stretta procedure for GERD. Which action by the student nurse requires the supervising nurse to intervene? A. The patient is offered clear liquids in the early post-procedure period. B. The patients routine 81 mg of aspirin is held. C. A proton pump inhibitor is administered. D. A nasogastric tube is prepared for insertion.

D.

A patient with acute gastritis is receiving treatment to block and buffer gastric acid secretion's to relieve pain. Which drug does the nurse identify as an anti-secretory agent (proton-pump inhibitor/PPI)? A. Sacralfate (Carafate) B. Ranitidine (Zantac) C. Mylanta D. Omeprazole (Prilosec)

D.

The nurse has provided teaching to a patient with GERD. Which statement by the patient indicates the teaching has been effective? A. "I will eat three meals a day." B. "I won't snack for one hour before I go to bed." C. "I won't nap for 30 minutes after eating dinner." D. "I won't lift heavy objects."

D.

The nurse has provided teaching to a patient with GERD. Which statement by the patient indicates the teaching has been effective? A. "I will eat three meals a day." B. "I won't snack for one hour before I go to bed." C. "I won't nap for 30 minutes after eating dinner." D. "I won't life heavy objects."

D.

A client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? A. Listen to the client and then explain that it is normal to feel depressed about the diagnosis. B. Explain the grieving process and listen to what the client has to say. C. Suggest that the client talk with friends and family and seek their support. D. Listen to the client's concerns and feelings, and then suggest that the client join a community group of cancer survivors.

D. listen to the clients concerns and feelings, and then suggest that the client join a community group of cancer survivors.

What is a common gastrointestinal problem that older adults experience more frequently as they age? A. Decreased hydrochloric acid B. Excess lipase production C. Increased liver enzymes D. Increased peristalsis

Decreased hydrochloric acid Atrophy of the gastric mucosa causes a decreased ratio of gastrin-secreting cells to somatostatin-secreting cells. This results in a decrease in hydrochloric acid, causing decreased absorption of iron and vitamin B12. In the pancreas, calcification of pancreatic vessels occurs, with a decrease in lipase production. The decrease in lipase results in decreased fat absorption and digestion. Steatorrhea and diarrhea can subsequently occur. The number and size of hepatic cells are decreased, which results in decreased enzyme activity; decreased liver enzyme activity depresses drug metabolism, and therefore may cause accumulation of drugs to toxic levels. In the large intestine, peristalsis is decreased and nerve impulses are dulled, which can result in postponement of bowel movements in older adults.

Which is an important institutional measure that a hospital may take to prevent the transmission of hepatitis B (HBV) to health care workers? 1 Develop a hospital-wide needleless system for delivery of medications. 2 Provide immunoglobulin injections within 14 days of exposure to the virus. 3 Provide information about HBV transmission to at-risk employees. 4 Reinforce Standard Precautions procedures among all hospital employees.

Develop a hospital-wide needleless system for delivery of medications. Needlesticks are the leading cause of HBV exposure among health care workers, so eliminating needles would make a huge impact on preventing transmission of the disease. Providing immunoglobulin injections, providing HBV information, and reinforcing Standard Precautions may all be done as well, but are not as important as the implementation of needleless systems.

When caring for a client with Laennec's cirrhosis and portal hypertension, which point is essential for the nurse to emphasize to the client and family? 1 Do not consume any alcohol. 2 Reduce the amount of sodium in the diet. 3 Avoid saturated fats in the diet. 4 Adhere to anticoagulant therapy.

Do not consume any alcohol Laennec's cirrhosis is otherwise known as alcoholic cirrhosis; it is caused by chronic alcohol use. Avoiding alcohol is essential to prevent further organ damage. Sodium restriction is recommended for ascites. Fat intolerance may occur with liver disease; however, reduction of alcohol is essential, especially with Laennec's cirrhosis. Anticoagulants are not used to manage cirrhosis as there is a risk of bleeding related to prolonged International Normalized Ratio and prothrombin time.

When teaching a client with viral hepatitis, which instructions does the nurse include in the plan of care? Select all that apply. 1 Do not consume any alcohol. 2 Consume a high-protein diet. 3 Do not drive a car for 1-2 weeks. 4 Monitor blood pressure and pulse daily. 5 Avoid medications containing acetaminophen. 6 Avoid carbonated beverages.

Do not consume any alcohol. Avoid medications containing acetaminophen. The client with hepatitis should avoid all alcohol as well as hepatotoxic medications such as acetaminophen unless instructed otherwise by the provider. The diet should be high in carbohydrates with moderate fat and moderate protein content. The client may drive if he or she feels well. As hepatitis does not directly affect the cardiovascular system, there is no need to monitor vital signs. While carbonated beverages may contribute to a sense of fullness, it is not required that they be absolutely excluded.

The nurse is teaching a spouse and client with hepatitis C about preventing the spread of infection. Which instruction does the nurse include in the teaching plan? 1 "Drink only bottled water." 2 "Do not share toothbrushes." 3 "Donate blood only once yearly." 4 "You should use a separate bathroom."

Do not share toothbrushes Household members should not share any personal items with the client infected with hepatitis C such as a toothbrush, razor, drinking glasses, drug paraphernalia, or any item where blood or body fluids could be encountered by others. Bottled water is not necessary as the client is not at risk for contamination from tap water. The client with hepatitis C may become a carrier, so blood should not be donated. There is no need to use a separate bathroom if the client is continent of urine and stool and if the bathroom can be regularly disinfected.

A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? A. Decrease in liver function test results B. Elevated carcinoembryonic antigen C. Elevated hemoglobin levels D. Negative test for occult blood

Elevated carcinoembryonic antigen Carcinoembryonic antigen may be elevated in many clients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

Elevated lipase, elevated white blood cell count, elevated glucose Elevated lipase is more specific to a diagnosis of acute pancreatitis. Many pancreatic and nonpancreatic disorders can cause increased serum amylase levels. Bilirubin and alkaline phosphatase levels will be increased only if pancreatitis is accompanied by biliary dysfunction. Usually, calcium and magnesium will be increased and BUN increased, not decreased, in acute pancreatitis.

Which activity by the nurse will best relieve symptoms associated with ascites? A. Administering oxygen B. Elevating the head of the bed C. Monitoring serum albumin levels D. Administering intravenous fluids

Elevating the head of the bed The enlarged abdomen of ascites limits respiratory excursion; Fowler's position will increase excursion and reduce shortness of breath. The client may need oxygen, but first the nurse should raise the head of the bed to improve respiratory excursion and oxygenation. Monitoring will detect anticipated decreased serum albumin levels associated with cirrhosis and hepatic failure but does not relieve the symptoms of ascites. Administering IV fluids will contribute to fluid volume excess and fluid shifts into the peritoneal cavity, worsening ascites.

A client with newly diagnosed irritable bowel syndrome (IBS) reports having five to six loose stools daily. What is the common psychological client response to this gastrointestinal health problem? A. Acceptance B. Embarrassment C. Euphoria D. Grief

Embarrassment The client who has a new onset of IBS with frequent stools most likely would be embarrassed. The client normally would not react to a new onset of IBS with acceptance or grief. It would be an abnormal reaction for the client to feel euphoria over a new onset of IBS.

A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? A. Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation B. Examines the RUQ of the abdomen last C. Has the client lie in a supine position with legs straight and arms at the sides D. Views the abdomen by looking directly down while standing over the client's abdominal area

Examines the RUQ of the abdomen last If the client reports pain in the RUQ, the nurse would examine this area last in the examination sequence. This sequence prevents the client from tensing abdominal muscles because of the pain, which would make the examination difficult. The sequence for examining the abdomen is inspection, auscultation, percussion, and then palpation. This sequence prevents the increase in intestinal activity and bowel sounds caused by palpation and percussion. The client would be positioned supine with the knees bent, while keeping the arms at the sides to prevent tensing of the abdominal muscles. It is best to inspect the abdomen by standing at the side of the bed and then looking down on the abdomen, and also from the side at eye level.

A client with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? A. Asks the client whether family members could be trained in stoma care B. Has another client with a stoma who performs self-care talk with the client C. Requests that the health care provider request antidepressants and a psychiatric consult D. Suggests that the health care provider request a home health consultation so stoma care can be performed by a home health nurse

Has another client with a stoma who performs self-care talk with the client Talking with another client who successfully cares for his or her stoma may give the client the confidence to begin his or her self-care. If at all possible, the client should perform stoma care so that he or she can be as independent as possible. Although the client may need medication for depression, the priority is to encourage the client to look at, touch, and begin caring for the stoma. A home health nurse can be a support, but cannot provide all of the care that the client will need.

Which intervention is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today? A. Measure and record drainage. B. Monitor aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. C. Obtain informed consent for the procedure. D. Have the client void before the procedure is performed.

Have the client void before the procedure is performed. Voiding before the procedure prevents bladder injury. The drainage color and amount will be recorded after the procedure. Liver enzymes are expected to be elevated; this is the purpose of the procedure. The health care provider performing the procedure should discuss the intervention and potential complications with the client and obtain informed consent.

A client with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the client's care does the nurse make certain to discuss with the health care provider before the client's discharge? A. Having a home health consultation for wound care B. Requesting an antianxiety medication C. Requesting pain medication for the client's osteoarthritis D. Placing the client in a skilled nursing facility for rehabilitation

Having a home health consultation for wound care Home health services are most appropriate for this client because wound care will be extensive and the client's mobility may be limited. No indication suggests that the client is experiencing anxiety regarding postoperative care. Pain medication may be needed for the client's osteoarthritis, but this is not the highest priority. A skilled nursing facility is not necessary if the client can remain in his or her home with sufficient support services.

A client has a routine sigmoidoscopy with a tissue biopsy. What complication is the nurse looking for in a postprocedure assessment? A. Excessive diarrhea B. Heavy bleeding C. Nausea and vomiting D. Severe rectal pain

Heavy bleeding Excessive or heavy bleeding is a possible complication following a sigmoidoscopy. It must be reported immediately to the health care provider. Excessive diarrhea, nausea, vomiting, and severe rectal pain are not common complications of sigmoidoscopy.

The nurse is caring for a client with cirrhosis and profound ascites. Which assessment finding causes the nurse to notify the provider? 1 Anasarca 2 Marked jaundice 3 Multiple ecchymoses 4 Inaudible breath sounds

Inaudible breath sounds Orthopnea and dyspnea can result from ascites, which limit thoracic expansion and diaphragmatic excursion; this is manifested by decreased or absent breath sounds. Anasarca is an expected finding in cirrhosis as the liver is unable to produce plasma proteins which exert colloid osmotic pressure to pull fluid from interstitial tissues. Jaundice, another expected finding, results when the failing liver cannot excrete bilirubin. Ecchymosis is typical when the client with cirrhosis cannot produce prothrombin, which promotes blood clotting.

Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall B. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase C. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall D. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall An increased WBC count is evidence of inflammation. Only calcified gallstones will be visualized on abdominal x-ray. Ultrasonography of the right upper quadrant is the best diagnostic test for cholecystitis. Acute cholecystitis is seen as edema of the gallbladder wall and pericholecystic fluid. Alkaline phosphatase will be elevated if liver function is abnormal; this is not common in gallbladder disease.

The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and then daily. D. Insert a nasogastric tube and connect to low intermittent suction.

Infuse lactated Ringer's solution at 200 mL/hr. The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia. A type and crossmatch, administration of pantoprazole, and insertion of a nasogastric tube must all be done, but the nurse's immediate concern is correcting the client's hypovolemia.

A client has developed gastroenteritis while traveling outside the country. What is the likely cause of the client's symptoms? A. Bacteria on the client's hands B. Ingestion of parasites in the water C. Insufficient vaccinations D. Overcooked food

Ingestion of parasites in the water A main cause of gastroenteritis when traveling outside the country is ingestion of water that is infested with parasites. Bacteria on the client's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.

The nurse practitioner is performing an abdominal assessment on a newly admitted client. In which order should the nurse proceed with assessment technique? A. Auscultation, percussion, palpation, inspection B. Inspection, auscultation, percussion, palpation C. Palpation, percussion, inspection, auscultation D. Percussion, auscultation, palpation, inspection

Inspection, auscultation, percussion, palpation Abdominal examination usually begins at the client's right side and proceeds in a systematic fashion: RUQ, LUQ, LLQ, RLQ. However, if the client is experiencing pain in a specific quadrant, that area should be assessed last in the examination sequence to prevent the client from tensing abdominal muscles because of the pain, which would make the examination difficult. Therefore, the LLQ would be the last area assessed for this client.

The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect? A. Acute diarrhea B. Aortic aneurysm C. Intestinal obstruction D. Pancreatitis

Intestinal obstruction Peristaltic movements are rarely seen except in thin clients and should be reported since the finding may indicate an intestinal obstruction. Acute diarrhea does not cause visible peristaltic movements. Aortic aneurysm may cause a bulging, pulsatile mass. Pancreatitis is characterized by severe pain.

Which substance, produced in the stomach, facilitates the absorption of vitamin B12? A. Glucagon B. Hydrochloric acid C. Intrinsic factor D. Pepsinogen

Intrinsic factor Parietal cells in the stomach produce intrinsic factor, a substance that facilitates the absorption of vitamin B12. Absence of intrinsic factor causes pernicious anemia. Glucagon, which is produced by the alpha cells in the pancreas, is essential for the regulation of metabolism. Parietal cells secrete hydrochloric acid, but this does not facilitate the absorption of vitamin B12. Pepsinogen is secreted by the chief cells; pepsinogen is a precursor to pepsin, a digestive enzyme.

.What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? A. It destroys the cancer's cell wall, which will kill the cell. B. It decreases blood flow to rapidly dividing cancer cells. C. It stimulates the body's immune system and stunts cancer growth. D. It blocks factors that promote cancer cell growth.

It blocks factors that promote cancer cell growth. Cetuximab, a monoclonal antibody, may be given for advanced disease. This drug works by binding to a protein (epidermal growth factor receptor) to slow cell growth. The medication does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. The treatment does not decrease blood flow to rapidly dividing cancer cells.

Which statement about hepatitis A is accurate? 1 It is transmitted by the fecal-oral route. 2 It is resistant to the action of chlorine (bleach). 3 It is more common in affluent countries. 4 It is more severe in children and young adults

It is transmitted by the fecal oral route Hepatitis A virus is spread via the fecal-oral route either by consumption of contaminated water and food, or by person-to-person contact in those who engage in oral-anal sexual activity. The virus is destroyed by chlorine (bleach). It is more common in nonaffluent countries where sanitation is inadequate or lacking. The course of the infection is more severe in those who are older than 40 years.

A client with refractory ascites has a tunneled ascites drain (PleurX catheter). The community health nurse teaches the client and family which most important aspect of care while this device is in place? 1 Remaining on bedrest 2 Keeping hands and the area clean 3 Observing for diminished urine output 4 Learning to take blood pressure each day

Keeping hands and the area clean Clients with an indwelling device are prone to infection. Clients with ascites may also develop spontaneous bacterial peritonitis. Therefore, hands should always be cleansed before touching the area or using the device. Bedrest is necessary after a procedure such as paracentesis, but is not necessary while the drainage device is in place. Diminished urine output and a lower blood pressure are typically present with hepatic failure and ascites because fluid is third-spaced. Blood pressure may also drop with bleeding varices; however, daily monitoring is not needed with the ascites drainage device.

A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? 1 Preventing hypotension 2 Keeping the T-tube in a dependent position 3 Administering antibiotic vaccinations 4 Administering immune-suppressant drugs

Keeping the T-tube in a dependent position Keeping the T-tube in a dependent position and secured to the client is likely to prevent bile leakage, abscess formation, and hepatic thrombosis. Preventing hypotension will help to prevent the complication of acute kidney injury. Administering antibiotic vaccination will help to prevent infection. Administering immune-suppressant drugs will help to prevent graft rejection.

A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? A. Preventing hypotension B. Keeping the T-tube in a dependent position C. Administering antibiotic vaccinations D. Administering immune-suppressant drugs

Keeping the T-tube in a dependent position Keeping the T-tube in a dependent position and secured to the client is likely to prevent bile leakage, abscess formation, and hepatic thrombosis. Preventing hypotension will help to prevent the complication of acute kidney injury. Administering antibiotic vaccinations will help to prevent infection. Administering immune-suppressant drugs will help to prevent graft rejection.

When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? 1 Kidney failure 2 Refractory ascites 3 Fetor hepaticus 4 Paracentesis scheduled for today

Kidney failure The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic, and should not be taken by the client with hepatic encephalopathy. Cirrhosis and hepatic failure cause both ascites and encephalopathy; no contraindication for neomycin is known. Fetor hepaticus causes an ammonia smell to the breath when serum ammonia levels are elevated; neomycin is used to decrease serum ammonia levels. The client may be NPO for a few hours before paracentesis, but may take neomycin when the procedure is complete, or with less than 30 mL of water, depending on hospital policy.

When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? A. Kidney failure B. Refractory ascites C. Fetor hepaticus D. Paracentesis scheduled for today

Kidney failure The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic, and should not be taken by the client with hepatic encephalopathy. Cirrhosis and hepatic failure cause both ascites and encephalopathy; no contraindication for neomycin is known. Fetor hepaticus causes an ammonia smell to the breath when serum ammonia levels are elevated; neomycin is used to decrease serum ammonia levels. The client may be NPO for a few hours before paracentesis, but may take neomycin when the procedure is complete, or with less than 30 mL of water, depending on hospital policy.

A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? A. Limiting the client's activities to one floor of the home B. Instructing the client to take an as-needed (PRN) sleeping medication at night C. Arranging for the client to have a nutritional consult to assess the client's diet D. Asking the health care provider for a request for PRN nasal oxygen

Limiting the client's activities to one floor of the home Limiting the client's activities to one floor of the home will prevent tiring the client with stair climbing. Taking a PRN sleeping medication may not necessarily increase the client's strength level or conserve strength; also, the client may not be experiencing difficulty sleeping. Arranging for a nutritional consult or placing the client on PRN nasal oxygen will not necessarily result in an increase in the client's strength level or conserve strength; no information suggests that the client has any history of breathing difficulties.

A client admitted with severe gastroenteritis has been started on an IV, but the client continues having excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing? A. Balsalazide (Colazal) B. Loperamide (Imodium) C. Mesalamine (Asacol) D. Milk of Magnesia (MOM)

Loperamide (Imodium) If the health care provider determines that antiperistaltic agents are necessary, an initial dose of loperamide (Imodium) 4 mg can be administered orally, followed by 2 mg after each loose stool, up to 16 mg daily. Balsalazide is not the best choice for control of diarrhea in this scenario. Mesalamine is used for clients with ulcerative colitis for long-term therapy. MOM is a laxative.

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? A. The client must not consume alcohol. B. Avoid sharing the bathroom with the client. C. Members of the household must not share toothbrushes. D. Drink only bottled water and avoid ice.

Members of the household must not share toothbrushes. Toothbrushes, razors, towels, and items that may spread blood and body fluids should not be shared. The client should not consume alcohol, but abstention will not prevent spread of the virus. The client may share a bathroom if he or she is continent. To prevent hepatitis A when traveling to foreign countries, bottled water should be consumed and ice made from tap water should be avoided.

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? A. Clients who work with shellfish B. Men who prefer sex with men C. Clients traveling to a third-world country D. Clients with elevations of aspartate aminotransferase and alanine aminotransferase

Men who prefer sex with men Men who prefer sex with men are at increased risk for hepatitis B, which is spread by the exchange of blood and body fluids during sexual activity. Consuming raw or undercooked shellfish may cause hepatitis A, not hepatitis B. Travel to third-world countries exposes the traveler to contaminated water and risk for hepatitis A; hepatitis B is not of concern, unless the client is exposed to blood and body fluids during travel. Clients who have liver disease should receive the vaccine, but men who have sex with men are at higher risk for contracting hepatitis B.

The nurse expects that which client will be discharged to the home environment first? A. Older obese adult who has had a laparoscopic cholecystectomy B. Middle-aged thin adult who has had a laparoscopic cholecystectomy C. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy D. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

Middle-aged thin adult who has had a laparoscopic cholecystectomy The combination of client age, a thin frame, and the type of procedure performed will determine that the middle-aged thin client who had a laparoscopic cholecystectomy will be discharged first. Although the older obese client who had a laparoscopic cholecystectomy will have a faster discharge time than one with a traditional cholecystectomy, the client's obesity and age probably will require a longer stay. A traditional cholecystectomy will always require a longer recovery time. The older obese client with a history of COPD will likely have a more lengthy recovery because of associated breathing problems.

A client diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the client states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this client? A. Antidiarrheal agent B. Muscarinic receptor antagonist C. Serotonin antagonist D. Tricyclic antidepressant

Muscarinic receptor antagonist A muscarinic (M3) receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this client. A tricyclic antidepressant is not going to be effective for this client's diarrhea.

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? 1 Vitamin K-containing products 2 Potassium-sparing diuretics 3 Nonabsorbable antibiotics 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDS Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites. Nonabsorbable antibiotics are used to decrease ammonia levels.

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? A. Vitamin K-containing products B. Potassium-sparing diuretics C. Nonabsorbable antibiotics D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites. Nonabsorbable antibiotics are used to decrease ammonia levels.

The nurse is assessing a client who comes to the emergency department with acute abdominal pain. The nurse notes a bulging, pulsating mass when inspecting the abdomen. Which action by the nurse is correct? A. Auscultate the abdomen to determine the presence of bowel sounds. B. Notify the provider about this finding immediately. C. Palpate the client's abdomen to determine the outlines of the mass. D. Question the client about recent stool habits.

Notify the provider about this finding immediately. A bulging, pulsating mass may indicate an abdominal aortic aneurysm, and the nurse should notify the provider immediately. Palpating the abdomen or even touching the abdomen with a stethoscope may cause this to rupture, which would be a life-threatening emergency. Because this is a potential life-threatening situation, questioning the client about stool habits is not appropriate.

The nurse suspects that which client is at highest risk for developing gallstones? A. Obese male with a history of chronic obstructive pulmonary disease B. Obese female on hormone replacement therapy C. Thin male with a history of coronary artery bypass grafting D. Thin female who has recently given birth

Obese female on hormone replacement therapy Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk.

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? A. Obtain the charts from the previous admission. B. Listen for bowel sounds in all quadrants. C. Obtain pulse and blood pressure. D. Ask about abdominal pain.

Obtain pulse and blood pressure. The nurse should assess vital signs to detect hypovolemic shock caused by hemorrhage. Obtaining charts, assessing bowel sounds, and pain assessment can be delayed until the client has stabilized. Assessment for adequate perfusion is the highest priority at this time.

A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be best for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assessing dietary risk factors for cholecystitis B. Checking for bowel sounds and distention C. Determining precipitating factors for abdominal pain D. Obtaining the admission weight, height, and vital signs

Obtaining the admission weight, height, and vital signs Obtaining height, weight, and vital signs is included in the education for UAP and usually is included in the job description for these staff members. Assessment, checking bowel sounds, and determining precipitating factors for abdominal pain require broader education and are within the scope of practice of licensed nursing staff.

The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1½ to 3 hours after a meal, usually at night. B. Pain is worsened by the ingestion of food. C. The client has a malnourished appearance. D. The client is a man older than 50 years.

Pain occurs 1½ to 3 hours after a meal, usually at night. A key symptom of duodenal ulcers is that pain usually awakens the client between 1:00 a.m. and 2:00 a.m., occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.

Which individual has the greatest risk for developing hepatitis A? 1 Health care worker 2 Intravenous drug user 3 Client receiving hemodialysis 4 Person who consumes raw oysters

Person who consumes ray oysters Undercooked or raw shellfish from contaminated waters and food handled by those who have not washed their hands thoroughly are at risk for hepatitis A. Intravenous drug users, those undergoing hemodialysis, and health care workers are more at risk for hepatitis B or C, which is spread by blood or body fluids.

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? A. Apply antiembolism stockings. B. Place a nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.

Place a nasogastric (NG) tube, and connect to suction. To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolism stockings will need to be applied, monitoring output is important, and famotidine (Pepcid) will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis.

The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? 1 Assessing skin integrity and abdominal distention 2 Drawing blood from a central venous line for electrolyte studies 3 Evaluating laboratory study results for the presence of hypokalemia 4 Placing the client in a semi-Fowler's position

Placing the client in a semi-Fowler's position Positioning the client in a semi-Fowler's position is included within UAP education and scope of practice, although the RN will need to supervise the UAP in providing care and will evaluate the effect of the semi-Fowler's position on client comfort and breathing. Assessment of skin integrity and abdominal distention, obtaining blood from a central line, and evaluation of laboratory results should be done by the RN.

The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing skin integrity and abdominal distention B. Drawing blood from a central venous line for electrolyte studies C. Evaluating laboratory study results for the presence of hypokalemia D. Placing the client in a semi-Fowler's position

Placing the client in a semi-Fowler's position Positioning the client in a semi-Fowler's position is included within UAP education and scope of practice, although the RN will need to supervise the UAP in providing care and will evaluate the effect of the semi-Fowler's position on client comfort and breathing. Assessment of skin integrity and abdominal distention, obtaining blood from a central line, and evaluation of laboratory results should be done by the RN.

Which problem for a client with cirrhosis takes priority? A. Insufficient knowledge related to the prognosis of the disease process B. Discomfort related to the progression of the disease process C. Potential for injury related to hemorrhage D. Inadequate nutrition related to an inability to tolerate usual dietary intake

Potential for injury related to hemorrhage Potential for injury related to hemorrhage is the priority client problem because this complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate nutrition are not priorities because these issues are not immediately life-threatening.

A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? A. Administers medication for pain B. Changes the nasogastric suction level from "intermittent" to "constant" C. Positions the client in high-Fowler's position D. Prepares the client for emergency surgery

Prepares the client for emergency surgery The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention. Pain medication may mask the client's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the client's pain and could be particularly ineffective if a nonvented tube is in use. A high-Fowler's position will have no effect on an intestinal perforation or peritonitis, which this client is likely experiencing.

A client demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention? A. Assessing the client for changes in vital signs B. Medicating the client for pain C. Monitoring for changes in the client's mentation D. Preparing the client for emergency surgery

Preparing the client for emergency surgery The highest priority for this client is to prepare him or her for emergency surgery so that the source of the infection can be removed. It is expected that the client will experience changes in vital signs as a result of the infectious process and accompanying pain. Although monitoring the client's vital signs is important, the client has an immediate need to go to surgery. Medicating the client for pain and determining whether the client is experiencing changes in mentation are important, but are not the highest priority.

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? A. Provides enzymes necessary to digest dairy products B. Reduces portal pressure C. Promotes gastrointestinal (GI) excretion of ammonia D. Decreases GI bleeding

Promotes gastrointestinal (GI) excretion of ammonia Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is the enzyme that digests dairy products. The mechanism of action of lactulose is not to reduce portal pressure. Lactulose does not affect bleeding.

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. Carbohydrates B. High fat C. High fiber D. Protein

Protein Enzyme preparations should not be mixed with foods containing protein because the enzymes will dissolve the food into a watery substance. No evidence suggests that enzyme preparations should not be mixed with carbohydrates, food with high fat content, and food with high fiber content.

After a colonoscopy, a client reports severe abdominal pain. The nurse obtains these data: temperature 100.2° F (37.9° C), pulse 122 beats/min, blood pressure 100/45 mm Hg, respirations 44 breaths/min, and O2 saturation 89%. Which request from the health care provider does the nurse implement first? A. Give cefazolin (Ancef) 500 mg IV. B. Infuse normal saline at 200 mL/hr. C. Give morphine sulfate 2 mg IV. D. Provide oxygen at 6 L/min per nasal cannula.

Provide oxygen at 6 L/min per nasal cannula. Based on the data given, the client may be experiencing complications of colonoscopy such as bleeding or perforation. The most immediate concern involves respiratory status, so the client should be placed on oxygen first. An antibiotic request is important, but is not the first priority. Fluid supplementation is important, but the client's oxygen saturation level places the client's respiratory status as the priority. The client's need for analgesia should be delayed until respiratory status is addressed. Morphine depresses respiratory status and therefore might not be the right choice for this client.

A client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider B. Asking the provider for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider Providing the client and spouse with both oral and written instructions on symptoms to report to the provider, as well as on how to perform the dressing change, will reinforce important points and boost the spouse's confidence. Obtaining a referral and recruiting other family members prevent the client and spouse from taking responsibility for the client's care. The spouse's concerns have already been clearly expressed.

After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? A. LPN/LVN who has worked with many home health clients after colostomy surgeries B. LPN/LVN with 20 years of experience in the home health agency C. RN who is new to the agency with 5 years experience in the emergency department D. Social worker who is experienced with case management of older clients

RN who is new to the agency with 5 years experience in the emergency department Clients with medical or surgical diagnoses have complex physiologic needs that should be assessed by an RN. For this reason, Medicare requires that the initial assessment must be done by an RN, although LPN/LVNs and social workers are likely to be part of the health care team.

A client arrives at the emergency department with acute abdominal pain in the left lower quadrant. In which order does the nurse examine and assess the client's left lower quadrant (LLQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and right upper quadrant (RUQ)? A. LLQ, RLQ, LUQ, RUQ B. LUQ, LLQ, RUQ, RLQ C. RLQ, LLQ, RUQ, LUQ D. RUQ, LUQ, RLQ, LLQ

RUQ, LUQ, RLQ, LLQ Abdominal examination usually begins at the client's right side and proceeds in a systematic fashion: RUQ, LUQ, LLQ, RLQ. However, if the client is experiencing pain in a specific quadrant, that area should be assessed last in the examination sequence to prevent the client from tensing abdominal muscles because of the pain, which would make the examination difficult. Therefore, the LLQ would be the last area assessed for this client.

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? A. Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. B. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. C. Document instructions for a client with chronic gastritis about how to use "triple therapy." D. Assess the gag reflex for a client who has arrived from the postanesthesia care unit after a laparoscopic gastrectomy.

Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.

A client with severe cirrhosis of the liver has a urine output of 400 mL for the past 2 days despite adequate intravenous fluid administration. What is the priority nursing action for this client? 1 Contact the provider to discuss obtaining a urine culture. 2 Encourage the client to increase oral fluid intake. 3 Perform a bladder scan to assess for urinary retention. 4 Request an order for blood urea nitrogen (BUN) and serum creatinine levels

Request an order for blood urea nitrogen (BUN) and serum creatinine levels Clients with cirrhosis may develop hepatorenal syndrome (HRS), which is characterized by oliguria less than 500 mL/day and elevated BUN and creatinine levels. The nurse should request these additional tests to help determine this. Decreased urine output is not a sign of urinary tract infection (UTI), so a culture is not indicated. The client has been receiving adequate fluids, so additional intake is not indicated. If BUN and creatinine levels are normal, assessing for retention may then be warranted.

A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? A. Requesting vaccination for hepatitis A B. Using a needleless system in daily work C. Getting the three-part hepatitis B vaccine D. Requesting an injection of immunoglobulin

Requesting an injection of immunoglobulin The administration of immunoglobulin, antibodies to hepatitis A, may prevent development of the disease. The vaccine for hepatitis A will take several weeks to stimulate the development of antibodies; passive immunity in the form of immunoglobulin is needed. Implementing a needleless system and getting the three-part vaccine may prevent the development of hepatitis B, not hepatitis A.

How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? 1 Provides small frequent meals for the client 2 Suggests taking daily potassium supplements 3 Elevates the head of the bed in high Fowler's position 4 Requests a bedside commode for the client

Requests a bedside commode for the client Lactulose therapy increases the frequency of stools, so a bedside commode should be made available to the client, especially if he or she has difficulty reaching the toilet. Small frequent meals and elevating the head of the bed will not have any effect on the side effects of lactulose. Although lactulose produces excessive stools and could potentially result in loss of potassium, it is inappropriate for the nurse to suggest that the client take potassium supplements.

How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? A. Provides small frequent meals for the client B. Suggests taking daily potassium supplements C. Elevates the head of the bed in high-Fowler's position D. Requests a bedside commode for the client

Requests a bedside commode for the client Lactulose therapy increases the frequency of stools, so a bedside commode should be made available to the client, especially if he or she has difficulty reaching the toilet. Small frequent meals and elevating the head of the bed will not have any effect on the side effects of lactulose. Although lactulose produces excessive stools and could potentially result in loss of potassium, it is inappropriate for the nurse to suggest that the client take potassium supplements.

A client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? A. Schedule of the client's follow-up examinations and x-ray assessments B. Information on family members' progress in learning how to perform dressing changes C. Copy of the diet plan prepared for the client by the hospital dietitian D. Detailed account of what occurred during the client's surgical procedure

Schedule of the client's follow-up examinations and x-ray assessments Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly. It may take family members a long time to become proficient at tasks such as dressing changes. Although the case manager should be aware of the diet, family members will likely be preparing the client's daily diet, and they should be provided with this information. It is not necessary for the case manager to have details of the client's surgical procedure unless a significant event has occurred during the procedure.

A client returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after the client is situated in bed? A. High Fowler's B. Lateral Sims' (side-lying) C. Semi-Fowler's D. Supine

Semi-Fowler's The client is maintained in semi-Fowler's position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion. High-Fowler's position would be too high for the client postoperatively; it would place strain on the abdominal incision(s), and, if the client was still drowsy from anesthesia, this position would not enhance the client's ability to rest. Sims' position does not promote drainage to the lower abdomen. The supine position does not facilitate drainage to the abdomen or increased lung expansion; the client would be more likely to develop complications (wound drainage stasis and atelectasis) in this position.

The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client? A. Supine, with a pillow supporting the abdomen B. Up in a chair between frequent periods of ambulation C. High-Fowler's position, with pillows used as needed D. Side-lying position, with knees drawn up to the chest

Side-lying position, with knees drawn up to the chest The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis. No evidence suggests that supine position, sitting up in a chair, or high-Fowler's position have any effect on abdominal discomfort related to acute pancreatitis.

Which precaution is most appropriate for the nurse to implement with a client with hepatitis A? 1 Enteric precautions 2 Droplet precautions 3 Protective isolation 4 Standard Precautions

Standard Precautions Standard Precautions are used with all clients to prevent the spread of blood and body fluids, including the client with hepatitis A. Standard Precautions prevent the spread of hepatitis A infection, which is spread by the fecal-oral route. Enteric precautions would be needed for clients with gastrointestinal infection if Standard Precautions were not used. Droplet precautions prevent the inhalation of respiratory droplets that spread infection, such as with meningitis. Protective isolation involves strict handwashing and limiting visitors and plants to protect the immunocompromised client.

After an automobile crash, a client is admitted to the emergency department with possible abdominal trauma. Which health care provider request does the nurse implement first? A. Insert a nasogastric tube and connect it to intermittent suction. B. Obtain a complete blood count and coagulation panel. C. Start an IV line and infuse normal saline at 200 mL/hr. D. Arrange for a computed tomography (CT) scan of the abdomen.

Start an IV line and infuse normal saline at 200 mL/hr. After the initial airway, breathing, and circulation assessment is completed, the most immediate concerns are the high risks for hemorrhage and shock. To rapidly treat for these possible complications, IV access and infusion of fluids are necessary as the priority intervention. Inserting a nasogastric tube, laboratory studies, and arranging a CT scan are secondary to establishing IV access and instilling fluids.

An 80-year-old client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider request does the nurse implement first? A. Administer acetaminophen (Tylenol) 650 mg rectally. B. Draw blood for a complete blood count and serum electrolytes. C. Obtain a stool specimen for culture and sensitivity. D. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. Fluid therapy is the focus of treatment for clients with gastroenteritis. Older clients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure. Acetaminophen 650 mg should be rapidly administered rectally, and blood draws and stool specimen collection should be implemented rapidly, but prevention and treatment of dehydration are the priorities for this client.

A client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Starting a large-bore IV B. Administering IV pain medication C. Preparing equipment for intubation D. Monitoring the client's anxiety level

Starting a large-bore IV A large-bore IV should be placed as requested, so that blood products can be administered. IV pain medication is not a recommended treatment for gastrointestinal bleeding. Intubation is not a recommended treatment for bleeding related to PUD. The mental status of the client should be monitored, but it is not necessary to monitor the anxiety level of the client.

An obese client is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the client's home health nurse requires immediate action? A. Pain when coughing B. States, "I am too tired to walk very much" C. States, "I feel like the incision is splitting open" D. Temperature of 100.8° F (38.2° C).

States, "I feel like the incision is splitting open" The client feeling like the incision is splitting open is at risk for poor wound healing and possible wound dehiscence; the nurse should immediately assess the wound and notify the health care provider. Reports of pain when coughing, being too tired to ambulate, and a temperature of 100.8° F (38.2° C) all require further assessment or intervention, but are not as great a concern as the possibility of wound dehiscence for this client.

A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? A. Steak with pasta B. Spaghetti with tomato sauce C. Steamed broccoli with turkey D. Tuna salad with wheat crackers

Steamed broccoli with turkey Steamed broccoli with turkey contains low-fat meat and no refined carbohydrates. Animal fat from red meats is carcinogenic, and pasta is high in refined carbohydrates, which are known to contribute to colon cancer. Spaghetti and wheat crackers also contain large amounts of refined carbohydrates.

A 21-year-old with a stab wound to the abdomen has come to the emergency department. Once stabilized, the client is admitted to the medical-surgical unit. What does the admitting nurse do first for this client? A. Administer pain medication. B. Assess skin temperature and color. C. Check on the amount of urine output. D. Take vital signs.

Take vital signs. Assessment of vital signs should be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the client's condition. The client should not be medicated for pain until his or her alertness level is determined. Skin temperature and color are not specifically indicative of the client's overall condition. If the client is in shock, urine output will be scant and will not be an accurate assessment variable.

Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the heath care provider? A. The dressing has a 2-cm area of serous drainage. B. The client's platelet count is 135,000/mm3. C. The client's albumin level is 2.8 mg/dL. D. The client's heart rate is 122 beats/min.

The client's heart rate is 122 beats/min. Rapid removal of fluid may cause symptoms of shock; tachycardia, especially when associated with hypotension, should be reported to the provider. A small amount of serous fluid may leak; the dressing should be reinforced. Platelets will be checked before the procedure; these are slightly low, but this is not a cause for concern. An albumin level of 2.8 mg/dL is an expected finding for a client with cirrhosis; it is not life threatening. Awarded 1.0 points out of 1.0 possible points.

Which client assessment information is correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C. Hematemesis and anorexia D. Treatment with radiation therapy

Treatment with radiation therapy Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Anorexia, nausea, and vomiting are all symptoms of acute gastritis. Corticosteroid use and hematemesis are also more likely to be signs of acute gastritis.

The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? A. Steak and French fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this client. Steak, French fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a client with gallbladder disease.

A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? A. Cramping intermittently, metabolic acidosis, and minimal vomiting B. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis C. Metabolic acidosis, upper abdominal distention, and intermittent cramping D. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

Upper abdominal distention, metabolic alkalosis, and great amount of vomiting A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, metabolic acidosis, and minimal vomiting are all symptoms of a large bowel obstruction.

A client with cirrhosis is preparing for discharge home. What instruction does the nurse include when teaching this client about dietary supplements? 1 Additional fat-soluble vitamins are usually necessary. 2 An iron supplement should be taken daily. 3 Niacin is an important vitamin when treating cirrhosis. 4 Use only supplements prescribed by the provider

Use only supplements prescribed by the provider The client with cirrhosis should only take vitamin supplements prescribed by the provider. Fat-soluble vitamins, iron, and niacin are toxic to the liver and should be avoided.

A client has an anal fissure. Which intervention most effectively promotes perineal comfort for the client? A. Administering a Fleet's enema when needed B. Applying heat to acute inflammation for pain relief C. Avoiding the use of bulk-forming agents D. Using hydrocortisone cream to relieve pain

Using hydrocortisone cream to relieve pain Witch hazel wipes may be effective in relieving the pain associated with anal fissures. Enemas should be avoided when an anal fissure is present. Cold packs should be applied to acute inflammation to diminish discomfort. Bulk-forming agents should be used to decrease pain associated with defecation.

A client admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this client? A. Applying hydrocortisone cream B. Cleaning the area with soap and hot water C. Using sitz baths three times daily D. Wearing absorbent cotton underwear

Using sitz baths three times daily Clients with skin breakdown may use sitz baths for comfort 2 or 3 times daily. Barrier creams, not hydrocortisone creams, may be used. The skin should be cleaned gently with soap and warm water. Absorbent cotton underwear helps keep the skin dry, but is not a comfort measure.

A client who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The client tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? A. A list of medical supply facilities where wound care supplies may be purchased B. Proper handwashing techniques to avoid cross-contamination of the client's wound C. The amount of pain medication that the client is allowed to take in each dose D. Written and oral instructions regarding symptoms to report to the health care provider

Written and oral instructions regarding symptoms to report to the health care provider It is most important to provide the client and case manager with both written and oral instructions on reportable symptoms to avoid the development of complications. Although instruction on proper handwashing and the client's medication regimen are important, they are not the highest priority. It will be the home health nurse's responsibility to bring supplies to the client's home.

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention. The client with cholecystitis and the client with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult client's glucose level will require intervention but, again, is not a medical emergency.

The nurse working during the day shift on the medical unit has just received report. Which client does the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy The client with epigastric pain is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or re-positioning. The client who had a subtotal gastrectomy is not in a life-threatening situation and does not require immediate assessment. The client with gastric cancer and the older adult with advanced gastric cancer are in stable condition and do not require immediate assessment.

The nurse is instructing a client on measures to maintain effective oral health. Which measures does the nurse include in the client's teaching plan? Select all that apply. a. Regular dental checkups b. Use of mouthwashes containing alcohol c. Ensuring that dentures are slightly loose-fitting d. Managing stress as much as possible e. Eating a balanced diet

a, d, and e

A client completing radiation treatment has developed dysphagia and stomatitis. What teaching will the nurse provide? (Select all that apply.) a. Brush teeth twice daily with chemobrush. b. Thin liquids will make it easier to swallow. c. Limit alcohol consumption to three drinks per day. d. Rinse mouth with mild saline and water mix before and after eating. e. Refrain from using liquid dietary supplements, as these will irritate mucous membranes. f. Plan to eat soft foods like cheese, well-cooked legumes, peanut butter, and pudding.

a, d, and f

The nurse is instructing a client on measures to maintain effective oral health. Which measures does the nurse include in the client's teaching plan? (Select all that apply.) A. Regular dental checkups B. Use of mouthwashes containing alcohol C. Ensuring that dentures are slightly loose-fitting D. Managing stress as much as possible E. Eating a balanced diet

a, d, e

As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What community resource does the nurse suggest for this client's care? A. Dentist B. Occupational therapist C. Psychiatrist D. Speech therapist

a. dentist

A nurse cares for a client who has obstructive jaundice. The client asks, "Why is my skin so itchy?" How should the nurse respond? a. "Bile salts accumulate in the skin and cause the itching." b. "Toxins released from an inflamed gallbladder lead to itching." c. "Itching is caused by the release of calcium into the skin." d. "Itching is caused by a hypersensitivity reaction."

a. "Bile salts accumulate in the skin and cause the itching."

A nurse cares for a client with end-stage pancreatic cancer. The client asks, "Why is this happening to me?" How should the nurse respond? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's important to keep a positive attitude for your family right now." c. "Scientists have not determined why cancer develops in certain people." d. "I think that this is a trial so you can become a better person because of it."

a. "I don't know. I wish I had an answer for you, but I don't."

A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate? a. "Increase the fiber and water in your diet." b. "Reduce fat to less than 30% each day." c. "Report dry mouth and decreased sweating." d. "Lorcaserin may cause loose stools for a few days."

a. "Increase the fiber and water in your diet."

A nurse is caring for a client receiving enteral feedings through a Dobhoff tube. What action by the nurse is best to prevent hyperosmolarity? a. Administer free-water boluses. b. Change the client's formula. c. Dilute the client's formula. d. Slow the rate of infusion.

a. Administer free-water boluses.

A client is in the family practice clinic. Today the client weighs 186.4 pounds (84.7 kg). Six months ago the client weighed 211.8 pounds (96.2 kg). What action by the nurse is best? a. Ask the client if the weight loss was intentional. b. Determine if there are food allergies or intolerances. c. Perform a comprehensive nutritional assessment. d. Perform a rapid bedside blood glucose test.

a. Ask the client if the weight loss was intentional.

A client is receiving total parenteral nutrition (TPN). On assessment, the nurse notes the client's pulse is 128 beats/min, blood pressure is 98/56 mm Hg, and skin turgor is dry. What action should the nurse perform next? a. Assess the 24-hour fluid balance. b. Assess the client's oral cavity. c. Prepare to hang a normal saline bolus. d. Turn up the infusion rate of the TPN.

a. Assess the 24-hour fluid balance.

A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says "I didn't know it would be this hard to live like this." What response by the nurse is best? a. Assess the client's coping and support systems. b. Inform the client that things will get easier. c. Re-educate the client on needed dietary changes. d. Tell the client lifestyle changes are always hard.

a. Assess the client's coping and support systems.

A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? a. Use saliva substitutes, especially when eating dry foods. b. This condition is common but is temporary. c. Use lozenges and hard candies to prevent dry mouth. d. This indicates a complication of therapy.

a. Use saliva substitutes, especially when eating dry foods.

The nurse is caring for four clients. Which is at the highest risk for development of oral cancer? a. 32-year-old client with ankle fracture b. 41-year-old with human papilloma virus (HPV) infection c. 60-year old who quit smoking twenty years ago d. 83-year old that lives in a warm climate during the winter

b. 41-year-old with human papilloma virus (HPV) infection

A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home? a. Oral Cancer Foundation b. American Cancer Society (ACS) c. Client Advocate Foundation d. American Medical Supply Foundation

b. American Cancer Society (ACS)

A nurse is reviewing laboratory values for several clients. Which value causes the nurse to conduct nutritional assessments as a priority? a. Albumin: 3.5 g/dL b. Cholesterol: 142 mg/dL c. Hemoglobin: 9.8 mg/dL d. Prealbumin: 28 mg/dL

b. Cholesterol: 142 mg/dL A cholesterol level below 160 mg/dL is a possible indicator of malnutrition

A nurse cares for a client who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The client states, "When I wake up I am in pain." Which action should the nurse take? a. Administer intravenous morphine while the client sleeps. b. Encourage the client to use the PCA pump upon awakening. c. Contact the provider and request a different analgesic. d. Ask a family member to initiate the PCA pump for the client

b. Encourage the client to use the PCA pump upon awakening.

A morbidly obese client is admitted to a community hospital that does not typically care for bariatric-sized clients. What action by the nurse is most appropriate? a. Assess the client's readiness to make lifestyle changes. b. Ensure adequate staff when moving the client. c. Leave siderails down to prevent pressure ulcers. d. Reinforce the need to be sensitive to the client.

b. Ensure adequate staff when moving the client.

A nurse is caring for a morbidly obese client. What comfort measure is most important for the nurse to delegate to the unlicensed assistive personnel (UAP)? a. Designating "quiet time" so the client can rest b. Ensuring siderails are not causing excess pressure c. Providing oral care before and after meals and snacks d. Relaying any reports of pain to the registered nurse

b. Ensuring siderails are not causing excess pressure

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowler's position with the head of bed elevated.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

c. "The best time to take the enzymes is immediately after I have a meal or a snack."

common type of secondary stomatitis is caused by

candida albicans

fungal infection that is very painful

candidas

Adequate nutrition is required for healing after treatment for recurrent aphthous ulcers (RAU). Which client response indicates that nursing teaching has been effective? a. "I have ordered a snack of milk and pretzels." b. "I will try to drink orange juice twice per day." c. "I ordered my sandwich on a crusty roll." d. "I would like scrambled eggs and a banana for breakfast"

d. "I would like scrambled eggs and a banana for breakfast"

A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer? a. A 26-year-old with a body mass index of 21 b. A 33-year-old who frequently eats sushi c. A 48-year-old who often drinks wine d. A 66-year-old who smokes cigarettes

d. A 66-year-old who smokes cigarettes

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

d. Roasted chicken breast, baked potato with chives, and orange juice

A client is newly diagnosed with tongue and esophageal cancer. Which response to the diagnosis does the nurse expect the client to have? A. Anxiety from knowing that, as a result of cancer and surgery, ingestion of food by mouth might become impossible B. Concern about getting an infection caused by invasive procedures C. Fear about the chance of aspiration after surgery D. Depression about changes in the face and neck after surgery

d. depression about changes in the face and neck after surgery

A client has had a radical neck dissection with a permanent tracheostomy for treatment of oral cancer. In what order should the following orders for postoperative nutritional care be implemented? A. Monitor weight, teach swallowing exercises, assess aspiration risk, provide nasogastric nutrition. B. Teach swallowing exercises, assess aspiration risk, monitor weight, provide nasogastric nutrition. C. Assess aspiration risk, teach swallowing exercises, provide nasogastric nutrition, monitor weight. D. Provide nasogastric nutrition, assess aspiration risk, monitor weight, teach swallowing exercises.

d. provide nasogastric nutrition, assess aspiration risk, monitor weight, teach swallowing exercises

stomatitis can result from

infection, allergy, certain foods, vitamin deficiency, systemic disease, & irritants, such as tobacco & alcohol.