UNIT 5: LOWER GI (NCLEX)

During a home care visit, an adult client complains of chronic constipation. What should the nurse tell the client to do? A: Increase potassium in the diet. B: Include rice and bananas in the diet. C: Increase fluid and dietary fiber intake. D: Increase the intake of sugar-free products.

C

The nurse has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement? A: Fleet enema B: Fecal disimpaction C: Glycerin suppository D: Soap solution enema (SSE)

C The least amount of invasiveness needed to produce a bowel movement is best. Use of glycerin suppositories is the least invasive method and usually stimulates bowel evacuation within a half-hour. Enemas may be needed on an every-other-day basis, but they are used cautiously (even if not contraindicated) because the Valsalva maneuver can increase intracranial pressure. Fecal disimpaction is done only when the client's rectum has become impacted from constipation as a result of inattention or failure of other measures. Stool softeners may be prescribed on a regular schedule for some clients to avoid hard, dry stools, but oral medication is not administered to an unconscious client.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? A: Nausea and vomiting B: Hyperactive bowel sounds C: Firmly distended abdomen D: Abrasions on all extremities

C Firmly distended abdomen Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

The nurse is caring for a client with pancreatitis. Which finding should the nurse expect to note when reviewing the client's laboratory results? A: Elevated level of pepsin B: Decreased level of lactase C: Elevated level of amylase D: Decreased level of enterokinase

C The serum level of amylase, an enzyme produced by the pancreas, increases with pancreatitis. Amylase normally is responsible for carbohydrate digestion. Pepsin is produced by the stomach and is used in protein digestion. Lactase and enterokinase are enzymes produced by the small intestine; lactase splits lactose into galactose and fructose, and enterokinase activates trypsin

The client with a small bowel obstruction asks the nurse to explain the purpose of the nasogastric tube attached to continuous gastric suction. The nurse determines that teaching has been effective if the client makes which statement? A: "It will help to provide me with nourishment." B: "It will help to relieve the congestion from excess mucus." C: "It is used to remove gastric contents for laboratory testing." D: "It will help to remove gas and fluids from my stomach and intestine."

D

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? A: White bread, cheese, and green beans B: Fresh tomatoes, pears, and corn flakes C: Oranges, baked potatoes, and raw carrots D: Dried beans, All Bran (100%)cereal, and raspberries

D *Dried beans, all Bran cereal, and raspberries* A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively? A: Low fiber B: Low calorie C: High protein D: High carbohydrate

A For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food.

The nurse is caring for a client with common bile duct obstruction. The nurse should anticipate that the health care provider (HCP) will prescribe which diet for this client? A: Low fat B: High protein C: High carbohydrate D: Low in water-soluble vitamins

A Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum. Bile acids or bile salts are produced by the liver to emulsify or break down fats

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A: 7:00 AM, 10:00 AM, and 1:00 PM B: 8:00 AM, 12:00 PM, and 4:00PM C: 9:00 AM, 3:00 PM D: 9:00 AM, 12:00 PM, and 3:00 PM

B *8AM, 12PM, 4PM* A nasogastric tube should be checked for patency routinely at 4-hour intervals.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? A: Osteoarthritis B: History of colorectal polyps C: History of lactose intolerance D: Use of herbs as a dietary supplement

B *History of colorectal polyps* A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? A: Blood in the stool B: Chalky gray stool C: Loose, watery stool D: Dry, hard, constipated stool

C

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system? A: Ileum B: Cecum C: Rectum D: Jejunum

B

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs *more* teaching? A: "I will be able to regulate when I have stools." B: "I will be able to wear the pouch until it leaks." C: "The drainage from my stoma can damage my skin." D: "Dried fruit and popcorn must be chewed very well."

A * "I will be able to regulate when I have stools." * An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? A: "I need to limit my intake of dietary fiber." B: "I need to drink plenty, at least 8 to 10 cups daily." C: "I need to eat regular meals and chew my food well." D: "I will take the prescribed medications because they will regulate my bowel patterns."

A *"I need to limit my intake of dietary fiber"* IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for *further instruction*? A: "I should increase the fiber in my diet." B: "I will need to avoid caffeinated beverages." C: "I'm going to learn some stress reduction techniques." D: "I can have exacerbations and remissions with Crohn's disease."

A *"I should increase the fiber in my diet"* Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? A: "The tube will help to drain the stomach contents and prevent further vomiting." B: "The tube will push past the area that is blocked and thus help to stop the vomiting." C: "The tube is just a standard procedure before many types of surgery to the abdomen." D: "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

A *"The tube will help to drain the stomach contents and prevent further vomiting."* The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? A: Fecal impaction B: Perineal hygiene C: Dietary fiber intake D: Antidiarrheal agent use

A *Fecal impaction* Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

Two days after a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? A: Impaired peristalsis B: Irritation of the bowel C: NG auctioning D: Inflammation of the incision site

A *Impaired peristalsis* Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? A: Maintain a high intake of fluid and fiber in the diet. B: D/C intake of medications causing constipation C: Eat several small meals per day to maintain bowel motility D: Sit upright during meal to increase bowel motility by gravity.

A *Maintain a high intake of fluid and fiber in the diet* Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? A: Notify the health care provider (HCP). B: Administer the prescribed pain medication. C: Call and ask the operating room team to perform surgery as soon as possible. D: Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

A *Notify the HCP* On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? A: This is a normal, expected event. B: The client is experiencing early signs of ischemic bowel. C: The client should not have the nasogastric tube removed. D: This indicates inadequate preoperative bowel preparation.

A As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy.

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? A: Decreased diarrhea B: Decreased cramping C: Improved intestinal tone D: Elimination of peristalsis

A Diphenoxylate hydrochloride with atropine sulfate is an antidiarrheal product that decreases the frequency of defecation, usually by reducing the volume of liquid in the stools.

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this client? A: NPO (nothing by mouth) status B: Ambulation at least 4 times daily C: Cholinergic medications to reduce pain D: Coughing and deep breathing every 2 hours

A During the acute phase of diverticulitis, the goal of treatment is to rest the bowel and allow the inflammation to subside. The client remains NPO and is placed on bed rest. Pain occurs from bowel spasms, and increased intra-abdominal pressure (coughing and deep breathing) may precipitate an attack. Ambulation and cholinergics will increase peristalsis.

After performing an initial abdominal assessment on a client with nausea and vomiting, the nurse should expect to note which finding? A: Waves of loud gurgles auscultated in all 4 quadrants B: Low-pitched swishing auscultated in 1 or 2 quadrants C: Relatively high-pitched clicks or gurgles auscultated in all 4 quadrants D: Very high-pitched, loud rushes auscultated especially in 1 or 2 quadrants

A Rationale: Although frequency and intensity of bowel sounds vary depending on the phase of digestion, normal bowel sounds are relatively high-pitched clicks or gurgles. Loud gurgles (borborygmi) indicate hyperperistalsis and are commonly associated with nausea and vomiting. A swishing or buzzing sound represents turbulent blood flow associated with a bruit. Bruits are not normal sounds. Bowel sounds are very high-pitched and loud (hyperresonance) when the intestines are under tension, such as intestinal obstruciton

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? A: "The medication will cause constipation." B: "I need to take the medication with meals." C: "I may have increased sensitivity to sunlight." D: "This medication should be taken as prescribed."

A Sulfasalazine is an antiinflammatory sulfonamide. Constipation is not associated with this medication. It can cause photosensitivity, and the client should be instructed to avoid sun and ultraviolet light. It should be administered with meals, if possible, to prolong intestinal passage. The client needs to take the medication as prescribed and continue the full course of treatment even if symptoms are relieved

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis? A: "Does the pain in your stomach radiate to your back?" B: "Does the pain in your lower abdomen radiate to your hip?" C: "Does the pain in your lower abdomen radiate to your groin?" D: "Does the pain in your stomach radiate to your lower middle abdomen?"

A The pain that is associated with acute pancreatitis is often severe, is located in the epigastric region, and radiates to the back. The remaining options are incorrect because they are not specific for the pain experienced by the client with pancreatitis.

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information should the nurse include in the teaching plan? A: Use 500 to 1000 mL of warm tap water. B: Suspend the irrigant 36 inches above the stoma. C: Insert the irrigation cone ½ inch into the stoma. D: If cramping occurs, open the irrigation clamp farther.

A The usual procedure for colostomy irrigation includes using 500 to 1000 mL of warm tap water. The solution is suspended 18 inches above the stoma. The cone is inserted 2 to 4 inches into the stoma but should never be forced. If cramping occurs, the client should decrease the flow rate of the irrigant as needed by closing the irrigation clamp.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions should the nurse include in the instructions? Select all that apply. A: Eat yogurt. B: Take loperamide to treat diarrhea. C: Use stress management techniques. D: Avoid foods such as cabbage and broccoli. E: Decrease fiber intake to less than 15 g/day.

A,B,C,D clients diagnosed with IBS whose primary symptoms are abdominal distention and flatulence should be advised to avoid common gas-producing foods such as broccoli and cabbage and to consume yogurt, as it may be better tolerated than milk. In addition, the probiotics found in yogurt may be beneficial because alterations in intestinal bacteria are believed to exacerbate IBS. The client should be advised to take loperamide, a synthetic opioid that slows intestinal transit and treats diarrhea when it occurs. Also, psychological stressors are associated with development and exacerbation of IBS, so stress management techniques are important. Option 5, decrease fiber intake, is incorrect, as clients should be encouraged to have a dietary fiber intake of at least 20 g/day.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. A: Maintain NPO (nothing by mouth) status. B: Encourage coughing and deep breathing. C: Give small, frequent high-calorie feedings. D: Maintain the client in a supine and flat position. E: Give hydromorphone intravenously as prescribed for pain. F: Maintain intravenous fluids at 10 mL/hour to keep the vein open.

A,B,E *NPO, Cough and deep breathing, Hydromorphone* The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is necessary. Because abdominal pain is a prominent symptom of pancreatitis, pain medications such as morphine or hydromorphone are prescribed. Meperidine is avoided, as it may cause seizures. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help to ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted.

A hospitalized patient has just been diagnosed with diarrhea due to Clostridium difficile. Which nursing interventions should be included in the patient's plan of care (select all that apply.)? A: Initiate contact isolation precautions B: Place the patient on a clear liquid diet C: Disinfect the room with 10% bleach solution D: Teach any visitors to wear gloves and gowns E: Use hand sanitizer before and after patient or body fluid contact

A,C,D *Contact isolation, disinfect with 10% bleach, teach visitors to wear gowns and gloves* Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. A: Administer stool softeners as prescribed. B: Instruct the client to limit fluid intake to avoid urinary retention. C: Encourage a high-fiber diet to promote bowel movements without straining. D: Apply cold packs to the anal-rectal area over the dressing until the packing is removed. E: Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

A,C,D *Stool softeners, high fiber, apply ice packs* Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture. Stool softeners and a high-fiber diet will help the client to avoid straining, thereby reducing the chances of rupturing the incision. An ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect interventions.

The nurse is caring for a hospitalized client with pancreatitis. Which findings should the nurse look for and expect to note when reviewing the laboratory results? Select all that apply. A: Elevated lipase level B: Elevated lactase level C: Elevated trypsin level D: Elevated amylase level E: Elevated sucrase level

A,C,D Lipase, trypsin, and amylase are produced in the pancreas and aid in the digestion of fats, starches, and proteins, respectively. Lactase is produced in the small intestine and aids in splitting neutral fats into glycerol and fatty acids. Sucrase is produced in the small intestine and converts sucrose into glucose and fructose.

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for a colectomy? A: How to care for the wound B: How to cough and deep breathe C: The location and care of drains after surgery D: Which medications will be used during surgery

B *How to cough and deep breathe* Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

The nurse should administer an as-needed dose of magnesium hydroxide after noting what information when reviewing a patient's medical record? A: Abdominal pain and bloating B: No bowel movement for 3 days C: decrease in appetite by over 50% in 24 hours D: Muscle tremors and others signs of hypomagnesemia

B *No bowel movement for 3 days* Magnesium hydroxide is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

The nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a health care provider prescription for which type of suction? A: High and intermittent B: Low and intermittent C: High and continuous D: Low and continuous

B Gastric mucosa can be traumatized and pulled into the tube if the suction pressure is placed on high or if the suction is continuous. The suction should be set on low pressure and intermittent suction control.

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? A: Leukopenia with a shift to the left B: Leukocytosis with a shift to the left C: Leukopenia with a shift to the right D: Leukocytosis with a shift to the right

B Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white blood cells).

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective? A: "I should be sure to eat at least 1 cucumber every day." B: "Beet greens, parsley, or yogurt will help to control the colostomy odor." C: "I will need to increase my egg intake and try to eat ½ to 1 egg per day." D: "Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."

B The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley, buttermilk, and yogurt. Spinach also may reduce odor, but it is a gas-forming food and should be avoided. Cucumbers, eggs, and broccoli also are gas-forming foods and should be avoided or limited by the client.

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the health care provider for which type of diet for this client? A: A low-fat diet B: A low-fiber diet C: A high-protein diet D: A high-carbohydrate diet

B low-fiber diet places less strain on the intestines because this type of diet is easier to digest. Clients should avoid high-fiber foods when experiencing acute diverticulitis. As the attack resolves, fiber can be added gradually to the diet.

The nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply. A: Antidiarrheal B: Antimicrobial C: Corticosteroid D: Aminosalicylate E: Biological therapy F: Immunosuppressant

B,C,D,E,F Pharmacological treatment for IBD aims to decrease the inflammation to induce and then maintain a remission. Five major classes of medications used to treat IBD are antimicrobials, corticosteroids, aminosalicylates, biological and targeted therapy, and immunosuppressants. Medications are chosen based on the location and severity of inflammation. Depending on the severity of the disease, clients are treated with either a "step-up" or "step-down" approach. The step-up approach uses less toxic therapies (e.g., aminosalicylates and antimicrobials) first, and more toxic medications (e.g., biological and targeted therapy) are started when initial therapies do not work. The step-down approach uses biological and targeted therapy first. Option 1, antidiarrheals, is incorrect. Although an antidiarrheal may be used to treat the symptoms of IBD, it does not treat the disease (the inflammation) or induce remission. In addition, antidiarrheals should be used cautiously in IBD because of the danger of toxic megacolon (colonic dilation greater than 5 cm).

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? A: Clamp the T-tube. B: Irrigate the T-tube. C: Document the findings. D: Notify the health care provider.

C *Document* Following cholecystectomy, drainage from the T-tube is initially bloody and then turns a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? A: Return the patient to NPO status. B: Place a cool compress on the abdomen. C: Encourage the patient to ambulated as ordered D: Administer a PRN dose of IV morphine sulfate

C *Encourage the patient to ambulate* Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? A: Notify the physician B: Auscultate for bowel sounds C: Reposition the tube and check for placement D: Remove the tube and replace it with a new one

C *Reposition the tube and check for placement* The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The physician does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

The nurse is preparing to administer an intermittent enteral feeding though a nasogastric (NG) tube. Which priority assessment should the nurse perform? A: Observe for digestion of formula. B: Assess fluid and electrolyte status. C: Evaluate absorption of the last feeding. D: Evaluate percussion tone of the stomach.

C All stomach contents are aspirated and measured before a tube feeding is administered. This procedure measures the gastric residual. The gastric residual is assessed to confirm whether undigested formula from a previous feeding remains, thereby evaluating absorption of the last feeding. It is important to assess gastric residual because administration of an enteral feeding to a full stomach could result in overdistention, predisposing the client to regurgitation and possible aspiration

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical record? A: Apply a cold pack to the abdomen. B: Administer 30 mL of milk of magnesia (MOM). C: Maintain nothing by mouth (nil per os [NPO]) status D: Initiate an intravenous (IV) line for the administration of IV fluids.

C Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain. Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible surgery.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the health care provider prescribing? A: Enteral feedings B: Fluid restrictions C: Oral corticosteroids D: Activity restrictions

C Crohn's disease is a form of inflammatory bowel disease that is a chronic inflammation of the gastrointestinal (GI) tract. It is characterized by periods of remission interspersed with periods of exacerbation. Oral corticosteroids are used to treat the inflammation of Crohn's disease, so option 3 is the correct one. In addition to treating the GI inflammation of Crohn's disease with medications, it is also treated by resting the bowel. Therefore, option 1 is incorrect. Option 2 is incorrect, as clients with Crohn's disease typically have diarrhea and would not be on fluid restrictions. Option 4, activity restrictions, is not indicated. The client can do activities as tolerated but should avoid stress and strain.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP). The nurse should contact the HCP to question which prescription if noted in the client's record? A: Maintain a semi Fowler's position. B: Maintain on NPO (nothing by mouth) status. C: Apply a heating pad to the lower abdomen for comfort. D: Initiate an intravenous (IV) line with the administration of IV fluids.

C Heat should never be applied to the abdomen because this may increase circulation to the appendix, potentially leading to increased inflammation and perforation

The nurse is caring for a client admitted to the hospital with suspected acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? A: White blood cell (WBC) count of 4000 mm3 (4 × 109/L) B: WBC count of 8000 mm3 (8 × 109/L) C: WBC count of 18,000 mm3 (18 × 109/L) D: WBC count of 26,000 mm3 (26 × 109/L)

C Laboratory findings do not establish the diagnosis of appendicitis, but there is often a moderate elevation of the WBC count (leukocytosis) to 10,000 to 18,000 mm3 (10 to 18 × 109/L) with an increased number of immature WBCs. An inflammatory process causes a rise in the WBC count. A rise to 26,000 mm3 (26 × 109/L) may indicate a perforated appendix (greater than 20,000 mm3 [20 × 109/L]).

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider? A: Hypotension B: Bloody diarrhea C: Rebound tenderness D: hemoglobin level of 12 mg/dL (120 mmol/L)

C Rebound tenderness may indicate peritonitis.

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication? A: On arising B: After meals C: On an empty stomach D: 30 minutes before meals

C Salicylate compounds, such as sulfasalazine, act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and increase fluid intake throughout the day. The medication needs to be taken after meals to reduce gastrointestinal irritation.

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching? A: "It is normal to feel gassy or bloated after the procedure." B: "The abdominal muscles may be tender from the procedure." C: "It is all right to drive once I've been home for an hour or so." D: "Intake should be light at first and then progress to regular intake."

C The client should not drive for several hours after discharge because of the sedative medications used during the procedure. Important decisions also should be delayed for at least 12 to 24 hours for the same reason. The client may experience gas, bloating, or abdominal tenderness for a short while after the procedure, and this is normal. The client should resume intake slowly and progress as tolerated.

Which clinical manifestations of inflammatory bowel disease does the nurse determine are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply.)? A: Restricted to rectum B: Strictures are common C: Bloody, diarrhea stools D: Cramping abdominal pain E: Lesions penetrate intestine

C,D *Bloody diarrhea, and cramping abdominal pain* Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

The nurse is caring for a client who has just returned from the operating room after the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment? A: Apply ice to the stoma site. B: Apply pressure to the stoma site. C: Notify the health care provider (HCP). D: Document the amount and characteristics of the drainage.

D

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A: Low-pitched and rumbling above the area of obstruction B: High-pitched and hypoactive below the area of obstruction C: Low-pitched and hyperactive below the area of obstruction D: High-pitched and hyperactive able the area of obstruction

D *High-pitched and hyperactive above the area of obstruction* Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the health care provider? A: Stoma is beefy red and shiny D: Purple discoloration of the stoma C: Skin excoriation around the stoma D: Semi-formed stool noted in the ostomy pouch

D *purple stoma* Ischemia of the stoma would be associated with a dusky or bluish or purple color. A beefy red and shiny stoma is normal and expected. Skin excoriation needs to be addressed and treated but does not require as immediate attention as purple discoloration of the stoma. Semi-formed stool is a normal finding.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? A: Folate deficiency B: Malabsorption of fat C: Intestinal obstruction D: Fluid and electrolyte imbalance

D A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

The nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present? A: A sunken and hidden stoma B: A narrow and flattened stoma C: A stoma that is dusky or bluish D: A stoma that is elongated with a swollen appearance

D A prolapsed stoma is one in which the bowel protrudes, causing an elongated and swollen appearance of the stoma. A retracted stoma is characterized by sinking of the stoma. A stoma with a narrow opening is described as being stenosed. Ischemia of the stoma would be associated with a dusky or bluish color.

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis? A: "It's due to insufficient production of vitamin B12 in the colon." B: "Increased production of intrinsic factor in the stomach leads to this type of anemia." C: "Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." D: "Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

D Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the small intestine. This vitamin is not produced or absorbed in the large intestine.

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching? A: "I know I can massage my abdomen." B: "I will continue using antispasmodic medication." C: "One of the best things I can do is use relaxation techniques." D: "The best position for me is to lie supine with my legs straight."

D Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate inflamed intestinal tissues as the abdominal muscles are stretched.

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period? A: "When I can tolerate food without vomiting." B: "When my gastrointestinal system is healed enough." C: "When my health care provider says the tube can come out." D: "When my bowels begin to function again, and I begin to pass gas."

D NG tubes are discontinued when normal function returns to the gastrointestinal (GI) tract. Food would not be administered unless bowel function returns. The tube will be removed before GI healing. Although the health care provider (HCP) determines when the NG tube will be removed, it does not determine effectiveness of teaching and the need for the NG tube.

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis? A: "I have epigastric pain radiating to my neck." B: "I have severe abdominal pain that is relieved after vomiting." C: "My temperature has been running between 96°F (35.5°C) and 97°F (36.1°C)." D: "I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

D Nausea and vomiting are common presenting manifestations of acute pancreatitis. A hallmark symptom is severe abdominal pain that is not relieved by vomiting. The vomitus characteristically consists of gastric and duodenal contents. Fever also is a common sign. Epigastric pain radiating to the neck area is not a characteristic symptom.

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? A: Carrots and ranch dip B: Whole-grain cereal and milk C: A cup of popcorn and a cola drink D: Applesauce and a graham cracker

D The diet for the client with ulcerative colitis should be low fiber (low residue). The nurse should avoid providing foods such as whole-wheat grains, nuts, and fresh fruits or vegetables. Typically, lactose-containing foods also are poorly tolerated. The client also should avoid caffeine, pepper, and alcohol.

The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients? A: Colectomy B: Appendectomy C: Ascending colostomy D: Small bowel resection

D The small intestine is responsible for the absorption of most nutrients. The client who has undergone removal of a segment of the small bowel is the one who has a decreased area with which to absorb nutrients. Decreased absorption is not a likely complication with the surgical procedures identified in the remaining options.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? A: Hypercalcemia B: Hypernatremia C: Frothy, fatty stools D: Decreased hemoglobin

D Ulcerative colitis is an inflammatory disease of the large colon. Findings associated with ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia (not hypercalcemia). Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. A: Diarrhea B: Black, tarry stools C: Hyperactive bowel sounds D: Gray-blue color at the flank E: Abdominal guarding and tenderness F: Left upper quadrant pain with radiation to the back

D, E,F Grayish-blue discoloration at the flank is known as Grey-Turner's sign and occurs as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The client may demonstrate abdominal guarding and may complain of tenderness with palpation. The pain associated with acute pancreatitis is often sudden in onset and is located in the epigastric region or left upper quadrant with radiation to the back. The other options are incorrect.