Upper GI Review Q's

A client is being treated as an outpatient for Peptic Ulcer Disease. Outpatient education should include that the following sign/symptom be reported to the physician:

stool that is the color and consistency of tar.

A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. b. light amber urine. c. circumoral pallor. d. black, tarry stools.

21. Answer A. Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? a. Sigmoid colon b. Appendix c. Spleen d. Liver

23. Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: a. severe abdominal pain radiating to the shoulder. b. anorexia, nausea, and vomiting. c. eructation and constipation. d. abdominal ascites.

28. Answer B. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

5. Why are antacids administered regularly, rather than as needed, to treat peptic ulcer disease? a. To keep gastric pH at 3.0 to 3.5 b. To promote client compliance c. To maintain a regular bowel pattern d. To increase pepsin activity

5) A - To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

6. A 72-year-old client seeks help for chronic constipation. This is a common problem for elderly clients due to several factors related to aging. Which of the following is one such factor? a. Increased intestinal motility b. Decreased abdominal strength c. Increased intestinal bacteria d. Decreased production of hydrochloric acid

6) B - Decreased abdominal strength, muscle tone of the intestinal wall, and motility all contribute to chronic constipation in the elderly. A decrease in hydrochloric acid causes a decrease in absorption of iron and B12, while an increase in intestinal bacteria actually causes diarrhea.

A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine's onset of action occur? a. 5 to 10 minutes b. 15 to 30 minutes c. 30 to 60 minutes d. 2 to 4 hours

6. Answer B. Meperidine's onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.

7. The nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? a. Kussmaul's respirations b. Increased urine output c. Decreased appetite d. Diaphoresis

7) B - Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. Kussmaul's respirations suggest diabetic ketoacidosis. A decreased appetite and diaphoresis suggest hypoglycemia.

9. A client with recent onset of epigastric discomfort is scheduled for an upper GI series (barium swallow). When teaching the client how to prepare for the test, which instruction should the nurse provide? a. "Eat a low-residue diet for 2 days before the test." b. "Eat a clear liquid diet for 2 days before the test." c. "Take a potent laxative the day before the test." d. "Avoid eating or drinking anything for 6 to 8 hours before the test."

9) D - The client must refrain from eating or drinking for 6 to 8 hours before an upper GI series. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative (along with an oral liquid preparation).

The nurse is preparing the discharge teaching plan for a client who has recently been diagnosed with his first episode of acute pancreatitis. Which of the following is it essential to include?

Alcohol restriction.

The nurse is caring for a client with acute pancreatitis. Which of the following statements is true regarding the care of this patient?

An elevated serum lipase and amylase levels are diagnostic signs.

A patient with an acute upper GI bleed had the following VS 1 hour ago: B/P 132/70, HR 90, RR 18. Now they are: B/P 88/60, HR 129, RR 26. Which nursing action would be most therapeutic?

Position the patient supine with legs elevated.

The nurse is caring for a client acute pancreatitis. Which of the following is an appropriate intervention while waiting for orders to be written?

Prepare for TPN.

Patient admitted to ER has profuse bright-red hematemesis. During intial care of the patient, the nurse's first priority is to: a. perform a nursing assessment of patient's status b. establish 2 IV sites c. obtain a thorough health history d. perform a gastric lavage with cool tap water in prep for endoscopic exam

a. perform a nursing assessment of patient's status

Most effective means of suppressing pancreatic secreation during an episode of pancreatitis is the use of: a. antibiotics b. NPO status c. antispasmotics d. H2R blockers

b. NPO status

The nurse is caring for a client with a diagnosis of rheumatoid arthritis being treated with nonsteroidal anti-inflammatory drugs (NSAIDS). The nurse determines that additional teaching is needed when the client states:

"If I take an antibiotic everyday I will eliminate the risk of developing peptic ulcer disease."

Which of the following factors can cause hepatitis A? a. Contact with infected blood b. Blood transfusions with infected blood c. Eating contaminated shellfish d. Sexual contact with an infected person

30. Answer C. Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.

The nurse is caring for a client receiving antacids via a nasogastric tube every 4 hours. There is an order to check the gastric pH every 4 hours. Which of the following responses is true regarding the gastric pH in this particular patient?

It should be kept between 5-7.

The preferred immediate treatment for acute episode of constipation is: a. soapsud enema b. stimulant cthartics c. stool sofenting cathartic d. tap water or hypertonic enemas

d. tap water or hypertonic enemas

1. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST) d. Increased lactate dehydrogenase (LD)

1) B - Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client's BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. vitamin A b. vitamin D c. vitamin E d. vitamin K

1. Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.

10. A client with mild diarrhea, fever, and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD). Which statement about IBD is true? a. Diarrhea is the most common sign of IBD. b. Transmural inflammation with fistula formation occurs in ulcerative colitis, one form of IBD. c. Abscesses may occur in IBD as poor nutrition causes breakdown of cells in the GI tract. d. Bowel cancer is common in clients with a history of Crohn's disease, one form of IBD.

10) A - IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. The pathophysiology of ulcerative colitis involves vascular congestion, hemorrhage, and edema — usually affecting the rectum and left colon. Although abscesses may occur in IBD, they result from buildup of lymphocytes and cellular debris in crypts, which may serve as abscess sites. Only about 3% of clients with a long history of Crohn's disease develop bowel cancer.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: a. meperidine provides a better, more prolonged analgesic effect. b. morphine may cause spasms of Oddi's sphincter. c. meperidine is less addictive than morphine. d. morphine may cause hepatic dysfunction.

10. Answer B. For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn't associated with hepatic dysfunction.

Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? a. Hopelessness b. Powerlessness c. Chronic low self esteem d. Deficient knowledge

11. Answer C. Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn't result from a knowledge deficit, such as one regarding good nutrition.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. Endoscopy b. Upper GI series c. Hemoglobin (Hb) levels and hematocrit (HCT) d. Arteriography

12. Answer A. Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren't always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? a. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex."

13. Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

14. Answer B. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. d. cryoprecipitate and fresh frozen plasma.

15. Answer D. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.

To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? a. "Lie down after meals to promote digestion." b. "Avoid coffee and alcoholic beverages." c. "Take antacids with meals." d. "Limit fluid intake with meals."

16. Answer B. To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. Administering pain medication b. Obtaining a blood sample for laboratory studies c. Preparing to insert a nasogastric (NG) tube d. Administering I.V. fluids

17. Answer D. I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.

A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? a. Notify the physician b. Reposition the tube c. Irrigate the tube d. Increase the suction level

19. Answer A. An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST) d. Increased lactate dehydrogenase (LD)

20. Answer B. Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client's BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.

Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a sedentary lifestyle and smoking. b. a history of hemorrhoids and smoking. c. alcohol abuse and a history of acute renal failure. d. alcohol abuse and smoking.

22. Answer D. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: a. call the physician. b. place saline-soaked sterile dressings on the wound. c. take a blood pressure and pulse. d. pull the dehiscence closed.

24. Answer B. The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.

The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? a. Antiarrhythmic drugs b. Anticholinergic drugs c. Anticoagulant drugs d. Antihypertensive drugs

25. Answer B. Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren't known to interact with paregoric.

A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: a. place the client in a private room. b. wear a mask when handling the client's bedpan. c. wash the hands after touching the client. d. wear a gown when providing personal care for the client.

29. Answer C. To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.

3. When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitisis is best described as: a. a canker sore of the oral soft tissues. b. an acute stomach infection. c. acid indigestion. d. an early sign of peptic ulcer disease.

3) A - Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.

A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? a. Lying on the right side with legs straight b. Lying on the left side with knees bent c. Prone with the torso elevated d. Bent over with hands touching the floor

3. Answer B. For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.

4. The nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a. restrict fluid intake to 1 qt (1,000 ml)/day. b. drink liquids only with meals. c. don't drink liquids 2 hours before meals. d. drink liquids only between meals.

4) D - A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

8. A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? a. Blood supply to the stoma has been interrupted. b. This is a normal finding 1 day after surgery. c. The ostomy bag should be adjusted. d. An intestinal obstruction has occurred.

8) A - An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion, which may result from interruption of the stoma's blood supply and may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.

Nurse determines teaching need when patient with dumping syndrome says a. "i should eat bread with every meal" b. "i should avoid drinking fluids with meals" c. i should eat small meals about 6x day" d. "i need t olie down for 30-60 min after meals"

a. "i should eat bread with every meal"

Regardless of precipitating factor, the injury to mucosal cells in PUD is caused by: a. acid back-diffusion into the mucosa b. ammonia formation in the mucus wall c. breakdown of gastric mucosal barrier d. release of histamine for cells

a. acid back-diffusion into the mucosa

Patient with an ulcer of the posterior portion of duodenum experiences: a. pain that occurs after not eating all day b. back pain that occurs 2-4 hrs after eating c. midepigastric pain unrelieved with antacids d. high epigastric burning relieved with food intake

b. back pain that occurs 2-4 hrs after eating

In teaching patients at risk for upper GI bleeding to prevent bleeding episodes, the nurse stresses that: a. all stools and vomit must be tested for blood b. the use of over the counter meds of any kind should be avoided c. antacids should be taken with all prescribed meds dd. Cytotec should be used to protect gastric mu

b. the use of over the counter meds of any kind should be avoided

the nurse determines tha further discharge instruction is needed whne the patient with acute pancreatititis states: a. "i should observe for fat in my stools" b. "I must not use alcohol to prevent future attacks" c. "I shouldn't eat salty foods" d. "I will need to continue to monitor my blood glucose levels until my pancreas is healed"

c. "I shouldn't eat salty foods"

Teaching is effective when atient with PUD states: a. " I should stop all meds if i develop side effects" b. "i should cintinue treatemnt as long as i have pain" c. "i have learned some relaxation strategies that decrease my stress" d. "i can buy whatever antacids are on sale"

c. "i have learned some relaxation strategies that decrease my stress"

Patient asks nurse if his risks for colon cancer are increased due to a polyp. the best response is: a. it is very rare for polyps ot become malignant b. individuals with polyps have a 100% lifetime risk of developing colorectal cancer c. all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present d. all polyps are premalignant and source of most colon cancer. get colonoscpy q 6 months.

c. all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present

Nurse teaches a patient with newly diagnosed PUD to a. maintain bland diet b. use alcohol and caffeine in moderation c. eat as normally as possible, eliminating foods that cause pain d. avoid milk and milk products

c. eat as normally as possible, eliminating foods that cause pain

Nurse teaches patient with diverticulosis to a. use anticholinergic drugs routinely to prevent bowel spasm b. have a nannual colonoscopy to detect malignant changes c. maintain a high fiber diet and use bulk laxatives to increase fecal volume d. exclude whole grains

c. maintain a high fiber diet and use bulk laxatives to increase fecal volume

A patient is returned to the surgical unit following a laparoscopic fundoplication for repair of hiatal hernia with an IV, NG tube t osuction, and several small abdominal incisions. to prevent disruption of the surgical site, it is most important for the nurse to: a. monitor for return of perstalsis b. position the patient on the right side c. maintain the patency of the NG tube d. assess abdominal wounds

c. maintain the patency of the NG tube

Combined with clinical manifestations, the lab finding that is most commonly used to diagnose acute prancreatitis is: a. increased serum lipase c c. increased urinary amylase d. decreased renal amylase creatine clearance

c. severe midepigastric of LUQ pain

When assessing a patient with pancreatitits, nurse would expect to find: a. hyperactive bowel sounds b. hypertension and tachycardia c. severe midepigastric of LUQ pain d. temp greater than 102º

c. severe midepigastric of LUQ pain

the nurse teaches the patient with a hiatal hernia or GERD to control symptoms by: a. drinking 10-12 oz of water with meals b. spacing six small meals a day c. sleeping wit hthe head of the bed elevated 4-6 inches d. perfrming aily exercises of toe touching

c. sleeping wit hthe head of the bed elevated 4-6 inches

A patient who has been vomiting for several dasy from an unknown cause is admitted to hospital. the nurse anticipates collaborative care to indlude: a. oral admin of broth and tea b. admin of paretneral antiemetics c. insertion of NG tube to suction d. IV replacement of fluid and electrolytes

d. IV replacement of fluid and electrolytes

Zofran is prescribed for a patient with cancer chemo induced vomiting. The nurse understands this drug: a. is a derivative of cannabis b. has a strong antihistamine effect that provides sedation and slee c. is used only when othertherapies are ineffective d. relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying

d. relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying

A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: a. "Tell me about your husband's alcohol usage." b. "Is your husband being treated for tuberculosis?" c. "Has your husband recently fallen or injured his chest?" d. "Describe spices and condiments your husband uses on food."

4. Answer A. A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn't occur from chest injuries or falls and isn't associated with eating spicy foods.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. Dyspnea and fatigue b. Ascites and orthopnea c. Purpura and petechiae d. Gynecomastia and testicular atrophy

7. Answer C. A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer

8. Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.

While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do? a. Irrigate the tube with cola. b. Advance the tube into the intestine. c. Apply intermittent suction to the tube. d. Withdraw the obstruction with a 30-ml syringe.

9. Answer A. The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it's inexpensive, and it's readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn't long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.

Postop patient has nursing diagnosis of pain r/t to immobility, meds, and decreased motility as evidneced by abdominal pain and distention and inability to pass flatus. An apropriate nursing intervention for the patient is to: a. ambulate patient more frequently b. assess abdomen for bowel sounds c. place patient in high fowlers d. withhold narcotics because they decrease bowel motility

a. ambulate patient more frequently

Management of patient with upper GI bleeding is effective the lab results reveal: a. decreasing BUN b. normal hematocrit c. urine output of 20 ml hr d. specific gravity of 1.03

a. decreasing BUN

Diagnostic testing is planned fr a patient with suspected peptic ulcer. Most reliable test is: a. endoscopy b. gastric analysis c. barium swallow d. serologic test for H pylori

a. endoscopy

A 22 yr old calls the clinic complaining of N&V and RLQ abdominal pain. The nurse advises the patient to: a. have the symptoms evaluated by a MD right away b. use a heating pad c. drink at least 2 qts of juice d. take a laxative to empty the bowel before exam at clinic

a. have the symptoms evaluated by a MD right away

Nursing management of the patient with chronic gastritis includes teaching the patient to: a. maintain a bland diet with six small meals a day b. take antacids before meals c. use NSAIDS instead of aspirin for pain relief d. eliminate alcohol and caffeine from diet

a. maintain a bland diet with six small meals a day

Patient with ulcerative colitis has a total colectomy with formation of a terminal ileum stoma. an important nursing interention for this patient postop is to: a. measure the ileosotmy output to determine the status of patient's fluid balance b. change ileostomy q 3-4 hrs c. emphasize that ostomy is temporary d. teach about high fiber diet required to maintain normal ostomy drainage

a. measure the ileosotmy output to determine the status of patient's fluid balance

During an acute attack of diverticulitis, the patient is: a. monitored for signs of peritonitis b. treated with daily med enemas c. prepared for surgery to resect the involved colon d. provided with heathing pad to apply to LLQ

a. monitored for signs of peritonitis

Patient with inflammatory bwel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements r/t decreased nutritional intake and decreased intestinal absorption. Data to support this is: a. pallor and hair loss b. frequent diarrhea stools c. anorectal excoriation and pain d. hypotension and urine output below 30 ml /hr

a. pallor and hair lossPatient asks nurse if his risks for colon cancer are increased due to a polyp. the best response is:

A patient's vomitus is dark brown and has a coffee-ground appearance. the nurse recognizes that this emsis is charactristic of: a. stomach bleeding b. an intestinal obstruction c. bile reflux d. active bleeding of lower esophagus

a. stomach bleeding

Patient with cancer of stomach undergoes total gastrecotmy with esophagojejunostomy. Postop the nurse teaches the patient to expect: a. rapid healing b. ability to return to normal dietary habits c. close follow up for development of ulcers d. lifelong intramuscular or intranasal admin of cobalamin

d. lifelong intramuscular or intranasal admin of cobalamin

Following a Billroth 2 procedure, atient develops dumping syndrome. The nurse explains that the symptoms associated wti h this problem are caused by: a. distention of smaller stomach by too much food intake b. hyperglycemia caused by uncontrolled gastric emptying into small intestine c. irritation of stomach lining by reflux of bile salts d. movement of fluid into the bowel because concentrated food and fluids move rapidly into the intesting

d. movement of fluid into the bowel because concentrated food and fluids move rapidly into the intesting

A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a. The client doesn't exhibit rectal tenesmus. b. The client is free from esophagitis and achalasia. c. The client reports diminished duodenal inflammation. d. The client has normal gastric structures.

18. Answer B. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

2. When evaluating a client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension.

2) B - Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension.

2. Answer B. Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours. b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings.

5. Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.

A patient with NG tube develops nausea and increased upper abominal bowel sounds. Appropriate action is to: a. check the patency of the NG tube b. place client in recumbant position c. assess vital signs d. ecourage deep breathing

a. check the patency of the NG tube

A knowledge of factors associated with colorectal cancer guides the nurse when obtaining a nursing history to ask specifically about: a. usual diet b. history of smoking c. history of alcohol d. environmental exposure to carcinogens

a. usual die

The nurse is caring for a client who asks why his stools are the color of tar. The nurse responds that "Tarry stools indicates:

an upper or lower gastrointestinal bleed."

Patient with a gunshot wound to the abdomen develops a bacterial peritonitis after surgery to repair the bowel. The nurse explains to the patient htat this problem is caused prirmarily by: a. immobility and loss of perstaliss of the bowel as reuslt of surgery b. penetration of unsteril foreighn bodies into the abdominal cavity c. spillage of bowel contents int othe normally sterile abdominal cavity d. accumulation of blood and fluid in the abdominal cavity as a result of the trauma

c. spillage of bowel contents int othe normally sterile abdominal cavity

A patient is just returning from the endoscopy suite after having an EGD (esophagogastroduodenoscopy). She asks the nurse for a glass of water. The best response by the nurse is:

"Let me check your throat to see if your gag reflex has come back."

The nurse is caring for a client who vomits 200cc of bright red blood. The most appropriate initial. intervention would be:

obtain vital signs.

A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: a. increasing fluid intake to prevent dehydration. b. wearing an appliance pouch only at bedtime. c. consuming a low-protein, high-fiber diet. d. taking only enteric-coated medications.

26. Answer A. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. Regular diet b. Skim milk c. Nothing by mouth d. Clear liquids

27. Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled.

Upon examining a patient 8 hrs after formation of a colostomy the nurse would expect to find a. hypoactive, high pitched bowel sounds b. brickred, puffy stoma that oozes blood c. purplish stoma, shiny and moist d. small amt of liquid fecal drainage from stome

b. brickred, puffy stoma that oozes blood

A patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. During the patient's early postop course the nurse anticpates that the patient may need: a. oral nutritional supplements b. drug therapy to prevent substance withdrawal symptoms c. less pain mes d. counseling

b. drug therapy to prevent substance withdrawal symptoms

Patient with pancreatitis has nursing dx of pain r/t distention of pancreas and peritoneal irritation. In addition to effective use of analgesics the nurse should: a. provide diversional activiies to distract patient b. provide small frequent meals c. position the patient on the side with the head of the bed elevated 45º d. ambulate the patient q 3-4 hours

c. position the patient on the side with the head of the bed elevated 45º

Patient with history of PUD is hospitalized with symptoms of a perforation. During initial assessment nurse would expect to find: a. vomit of bright red blood b. projectile vomiting c. sudden, severe upper abdominal pain and shoulder pain d. hyperactive stomach sounds

c. sudden, severe upper abdominal pain and shoulder pain

On 2nd postop day, patient who had exploratory laparotomy complains if abdominal distention and gas pains. Best response to this is: a. Abdominal distention occurs as a normal response to inflammation and healing b. Gas pains occur when NG tube is not used during surgery c. This is a common complication of abdominl surgery but usualy releived by BM d. This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery

d. This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery

Early screening for detection of cancers of the right side of colon in individuals over 50 yrs old should be done q year to include: a. serum CEA levels b. flexible sigmoidoscopy c. digital rectal exam d. fecal testing for occult blood

d. fecal testing for occult blood