2137 Exam 4

The nurse assesses a patient who is recovering from an ileostomy placement. Which assessment finding would alert the nurse to immediately contact the primary health care provider?

Pale and bluish stoma

A client has a nasogastric (NG) tube as a result of an upper gastrointestinal (GI) hemorrhage. What comfort measure would the nurse remind assistive personnel (AP) to provide?

Performing frequent oral care

The nurse is caring for a client diagnosed with oral cancer. What is the nurse's priority for client care?

Place the client on Aspiration Precautions.

A client has an open traditional hiatal hernia repair this morning. What is the nurse's priority for client care at this time?

Preventing respiratory complications

The nurse caring for clients with gastrointestinal disorders would recall that omeprazole is a drug in which classification?

Proton pump inhibitor

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride. The client's respiratory rate is 8 breaths/min. What action by the nurse is appropriate?

Provide physical stimulation.

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action would the nurse take?

Recommend that the client have computed tomography.

The nurse is caring for a client with probable colorectal cancer (CRC). What assessment findings would the nurse expect? (Select all that apply.)

Rectal bleeding Anemia Change in stool shape Abdominal discomfort

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is appropriate?

Remind the client that a small amount of bleeding is possible.

The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed?

Semi-Fowler

A client is admitted with a diagnosis of possible strangulated inguinal hernia. For which complication would the nurse monitor?

Sepsis

A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. Which documentation would alert the nurse to urgently contact the primary health care provider for additional prescriptions?

Serum potassium of 2.6 mEq/L (2.6 mmol/L)

A nurse is caring for a client who has been diagnosed with a small bowel obstruction. Which assessment findings would the nurse correlate with this diagnosis? (Select all that apply.)

Serum potassium of 2.8 mEq/L (2.8 mmol/L) Abdominal pain in upper quadrants Serum sodium of 121 mEq/L (121 mmol/L)

The nurse assesses a client who has appendicitis. Which assessment finding would the nurse expect?

Severe, steady right lower quadrant pain

The nurse plans care for a client with Crohn disease who has a heavily draining fistula. Which intervention would be the nurse's priority action?

Skin protection

A client with peptic ulcer disease is in the emergency department and reports gastric pain that has gotten much worse over the last 24 hours. The client's blood pressure when lying down is 112/68 mm Hg and when standing is 98/52 mm Hg. What action by the nurse is most appropriate?

Start a large-bore IV with normal saline.

The nurse is caring for a client who has been diagnosed with peptic ulcer disease. For which complication would the nurse monitor?

Upper gastrointestinal (GI) bleeding

The nurse is caring for a client who had an open traditional esophagectomy. Which assessment findings would the nurse report immediately to the primary health care provider? (Select all that apply.)

Wound dehiscence Fever Tachycardia

An older adult has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best?

"Changes in your liver cause drugs to be metabolized differently."

A client who has peptic ulcer disease is prescribed quadruple drug therapy for Helicobacter pylori infection. What health teaching related to bismuth would the nurse include?

"Do not take aspirin or aspirin products of any kind while on bismuth."

The nurse is caring for a client who is prescribed sulfasalazine. Which question would the nurse ask the client before starting this drug?

"Do you have any allergy to sulfa drugs?"

The nurse teaches a client who has viral gastroenteritis. Which dietary instruction would the nurse include in the health teaching?

"Drink plenty of fluids to prevent dehydration."

A nurse assesses a client who is prescribed alosetron. Which assessment question would the nurse ask this client before starting the drug?

"Have you been experiencing any constipation?"

The nurse is teaching a client who has been treated for acute gastritis. What statement by the client indicates a need for further teaching?

"I can continue smoking cigarettes which is better than chewing tobacco."

After teaching a client who is recovering from a colon resection to treat early-stage colorectal cancer (CRC), the nurse assesses the client's understanding. Which statements by the client indicate understanding of the teaching? (Select all that apply.)

"I might start bicycling and swimming again once my incision has healed." "I will make sure that I make lifestyle changes to prevent constipation." "I will be sure to have the recommended colonoscopies."

A nurse cares for a client with colorectal cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How would the nurse respond?

"I will make a referral to the United Ostomy Associations of America."

The nurse is caring for a client who is planning to have a laparoscopic colon resection for colorectal cancer tomorrow. Which statement by the client indicates a need for further teaching?

"I will probably be in the hospital for 3 to 4 days after surgery."

After teaching a client who has diverticulitis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching?

"I will take a laxative nightly at bedtime to avoid becoming constipated."

After teaching a client who is prescribed adalimumab for severe ulcerative colitis (UC), the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching?

"I will take this medication with my breakfast each morning."

The nurse is teaching a client diagnosed with stomatitis about special mouth care. Which statement by the client indicates a need for further teaching?

"I will use a more firm toothbrush to keep my mouth clean."

The nurse teaches a client about how to prevent transmission of gastroenteritis. Which statement by the nurse indicates a need for further teaching?

"I'll cook all the meals for my family."

A nurse teaches a client who is at risk for colorectal cancer. Which dietary recommendation would the nurse teach the client?

"Add vegetables such as broccoli and cauliflower to your diet."

. The nursing is teaching a client diagnosed with gastroesophageal reflux disease (GERD) who is planning to have an endoscopic radiofrequency (Stretta) procedure. What preprocedure health teaching would the nurse include? (Select all that apply.)

"Avoid taking any NSAIDs like ibuprofen for 10 days before the procedure." "Contact the primary health care provider after the procedure if you have increased pain."

The primary health care provider documents that a client has a bruit over the abdominal aorta. What teaching will the nurse provide for assistive personnel (AP) based on this assessment finding?

"Avoid washing the client's abdomen too aggressively."

The nurse is teaching a client about the use of viscous lidocaine for oral pain. What health teaching would the nurse include?

"Be sure to check food temperatures before eating."

What action(s) by the nurse is (are) appropriate to promote nutrition in a client who had a partial gastrectomy? (Select all that apply.)

Administer vitamin B12 injections. Ask the primary health care provider about folic acid replacement. Provide iron supplements for the client.

A client is admitted with a large oral tumor. What assessment by the nurse takes priority?

Airway

The nurse recalls that the risk factors for acute gastritis include which of the following? (Select all that apply.)

Alcohol Caffeine Corticosteroids Nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse is teaching a client about risk factors for esophageal cancer. Which risk factors would the nurse include? (Select all that apply.)

Alcohol intake Obesity Smoking Lack of fresh fruits and vegetables Untreated GERD

The nurse is caring for a client who has a postoperative paralytic ileus following abdominal surgery. What drug is appropriate to manage this nonmechanical bowel obstruction?

Alvimopan

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to which organ functions or dysfunctions? (Select all that apply.)

Ammonia: liver Lipase: pancreas

The nurse notes that the primary health care provider documented the presence of mucosal erythroplasia in a client. What does the nurse understand that this most likely means for this client?

Early sign of oral cancer

The nurse is caring for a client who has been prescribed lubiprostone for irritable bowel syndrome (IBS-C). What health teaching will the nurse include about taking this drug?

"Be sure to take this drug with food and water to help manage constipation."

The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk?

Electrolyte imbalance

A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching?

"It's a good thing I love orange and cherry gelatin."

A nurse cares for a young client with a new ileostomy. The client states, "I cannot go to prom with an ostomy." How would the nurse respond?

"Let's talk to the ostomy nurse about options for ostomy supplies and dress styles."

A nurse cares for a client who states, "My husband is repulsed by my colostomy and refuses to be intimate with me." How would the nurse respond?

"Let's talk to the ostomy nurse to help you and your husband work through this."

A nurse cares for a client with a new ileostomy. The client states, "I don't think my friends will accept me with this ostomy." How would the nurse respond?

"Tell me more about your concerns."

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, "The stool in my pouch is still liquid." How would the nurse respond?

"The stool will always be liquid with this type of colostomy."

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions would the nurse include in this client's assessment? (Select all that apply.)

"Which food types cause an exacerbation of symptoms?" "Where is your pain or discomfort and what does it feel like?"

A client has a recurrence of gastric cancer and is crying. What response by the nurse is most appropriate?

"Would you tell me what you are feeling now."

A client is preparing to have a fecal occult blood test (FOBT). What health teaching would the nurse include prior to the test?

"You need to avoid red meat and NSAIDs for 48 hours before the test."

A client is preparing to have a laparoscopic restorative proctocolectomy with ileo pouch-anal anastomosis (RCA-IPAA). Which preoperative health teaching would the nurse include?

"You should be able to have better bowel continence after healing occurs."

A nurse cares for a client who has a family history of colorectal cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer?" How would the nurse respond?

"You should have a colonoscopy more frequently to identify abnormal polyps early."

The nurse teaches a community group ways to prevent Escherichia coli infection. Which statements would the nurse include in this group's teaching? (Select all that apply.)

-"Wash your hands after any contact with animals." -"Use separate cutting boards for meat and vegetables."

A nurse cares for an older adult who is admitted to the hospital with complications of diverticulitis. Which actions would the nurse include in the client's plan of care? (Select all that apply.)

-Administer pain medications as prescribed. -Palpate the abdomen for distention. -Assess for sudden changes in mental status. -Evaluate stools for occult blood.

A nurse assesses a patient who has celiac disease. Which signs and symptoms would the nurse expect? (Select all that apply.)

-Anorexia -Constipation -Abdominal pain

The nurse is caring for a client who just had a minimally invasive inguinal hernia repair. Which nursing actions would the nurse implement? (Select all that apply.)

-Apply ice to the surgical area for the first 24 hours after surgery. -Encourage ambulation with assistance within the first few hours after surgery. -Encourage deep breathing after surgery but teach the client to avoid coughing. -Assess vital signs frequently for the first few hours after surgery. -Teach the client to rest for several days after surgery when at home. -Teach the client not to lift more than 10 lb (4.5 kg) until allowed by the surgeon.

After teaching a patient who has a permanent ileostomy, a nurse assesses the client's understanding. Which dietary items chosen for dinner indicate that the client needs further teaching? (Select all that apply.)

-Corn -String beans -Wheat rice

A nurse prepares to discharge a client who is newly diagnosed with a chronic inflammatory bowel disease. Which questions would the nurse ask in preparation for discharge? (Select all that apply.)

-Does your gym provide yoga classes? -When should you contact your provider? -What do you plan to eat for dinner? -How many bathrooms are in your home?

The nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.)

-Lower gastrointestinal bleeding—erosion of the bowel wall -Abscess formation—localized pockets of infection develop in the ulcerated bowel lining -Nonmechanical bowel obstruction—paralysis of colon resulting from colorectal cancer

The nurse is teaching a client who had a descending colostomy 2 days ago about the ostomy stoma. Which changes in the stoma would the nurse teach the client to report to the primary health care provider? (Select all that apply.)

-Stoma becomes dark and dull. -Skin around the stoma becomes excoriated. -Skin around stoma becomes protruded. -Stoma becomes retracted into the abdomen.

A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer?

A 72-year-old who eats fast food frequently.

A nurse is preparing to administer pantoprazole intravenously to prevent stress ulcers during surgery. What action(s) by the nurse is (are) most appropriate? (Select all that apply.)

Administer the drug through a separate IV line. Infuse pantoprazole using an IV pump. Use an in-line IV filter when infusing.

. Which of the following is (are) (a) risk factor(s) for gastric cancer? (Select all that apply.)

Achlorhydria Chronic atrophic gastritis H. pylori infection Pernicious anemia

The nurse reviews the laboratory results for a client who has possible appendicitis. Which laboratory test finding would the nurse expect?

Elevated leukocyte count

The nurse is caring for a client with sialadenitis. What comfort measures are appropriate for this client? (Select all that apply.)

Applying warm compresses Offering fluids every hour

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.)

Apricots Potato soup

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate?

Arrange a dietary consult.

The nurse is caring for a client who has a nasogastric tube (NGT). Which actions would the nurse take for client care? (Select all that apply.)

Assess for proper placement of the tube every 4 hours or per agency policy. Disconnect suction when auscultating bowel peristalsis. Monitor the client's skin around the tube site for irritation.

A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is appropriate?

Assess the client's gag reflex.

The nurse is caring for a client who has perineal surgical wound. Which actions would the nurse take to promote comfort and wound healing? (Select all that apply.)

Assist the client into a side-lying position. Apply warm compresses three to four times a day. Place an absorbent dressing over the wound.

The nurse is teaching a client about the risk of uncontrolled or untreated the client's gastroesophageal reflux disease (GERD). What complication(s) may occur if the GERD is not successfully managed? (Select all that apply.)

Asthma Laryngitis Dental caries Cardiac disease Cancer

After teaching a patient with diverticular disease, a nurse assesses the client's understanding. Which menu selection indicates the client correctly understood the teaching?

Baked fish with steamed carrots and a glass of apple juice

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching?

Broiled chicken with brown rice, steamed broccoli, glass of apple juice

Which of these client assessment findings is typically associated with oral cancer?

Painless red or raised lesion

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse teaches the client and family about the signs of potential complications which include what problems? (Select all that apply.)

Cholangitis Pancreatitis Perforation Sepsis

A nurse participates in a community screening event for oral cancer. What client is the highest priority for referral to a primary health care provider?

Client who smokes and drinks daily.

A nurse knows that job-related risks for developing oral cancer include which occupations? (Select all that apply.)

Coal miner Metal worker Plumber Textile worker

The nurse is aware of the most recent American Cancer Society Screening Guidelines for colon cancer, which include which accepted testing modalities for people over the age of 50? (Select all that apply.)

Colonoscopy every 10 years Computed tomography (CT) colonography every 5 years Flexible sigmoidoscopy every 5 years

The nurse assesses a client with gastroenteritis. What risk factor would the nurse consider as the most likely cause of this disorder?

Consuming raw seafood

The nurse assists the wound care/ostomy nurse assess a client prior to ostomy surgery. Which assessments would the nurse complete before marking the placement for the ostomy? (Select all that apply.)

Contour of the abdomen when standing Location of the client's belt line Contour of the abdomen when lying Contour of the abdomen when sitting

The nurse is caring for a client with a long history of peptic ulcer disease. What assessment findings would the nurse anticipate if the client experiences upper gastrointestinal (GI) bleeding? (Select all that apply.)

Decreased blood pressure Dizziness Hematemesis Decreased urinary output

The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.)

Decreased hydrochloric acid production Diminished sensation that can lead to constipation Fat not digested as well in older adults Pancreatic vessels become calcified

The nurse is teaching a client how to avoid the formation of hemorrhoids. What lifestyle change would the nurse include?

Decreasing fluid intake

A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspect?

Dumping syndrome

The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease (GERD). What assessment finding(s) would the nurse expect? (Select all that apply.)

Dyspepsia Regurgitation Belching Coughing Chest discomfort Dysphagia

A nurse cares for a client who has a new colostomy. Which action would the nurse take?

Empty the pouch frequently to remove excess gas collection.

The nurse is caring for a client who has frequent gastric pain and dyspepsia. Which procedure would the nurse expect for the client to make an accurate diagnosis?

Esophagogastroduodenoscopy (EGD)

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment would the nurse complete first?

Heart rate and rhythm

The nurse assesses a client who is hospitalized with an exacerbation of Crohn disease. Which assessment finding would the nurse expect?

High-pitched, rushing bowel sounds in the right lower quadrant

The nurse assesses a client who has possible gastritis. Which assessment finding(s) indicate(s) that the client has chronic gastritis? (Select all that apply.)

Intolerance of fatty foods Pernicious anemia

The nurse is interviewing a client who reports having abdominal cramping, bloating, and diarrhea after drinking milk or ingesting other dairy products. What health problem does the client most likely have?

Lactose intolerance

To promote comfort and the passage of flatus after a colonoscopy, in what position does the nurse place the client?

Left lateral

A nurse is assessing a client reporting right upper quadrant (RUQ) abdominal pain. What technique would the nurse use to assess this client's abdomen?

Lightly palpate the RUQ last.

The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ?

Liver

The nurse is caring for a client experiencing upper gastrointestinal (GI) bleeding. What is the priority action for the client's care?

Maintain airway, breathing, and circulation.

During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect?

Melena

A nurse cares for a client who is recovering from a colonoscopy. Which actions would the nurse take? (Select all that apply.)

Obtain vital signs every 15 to 30 minutes until alert. Assess the client for rectal bleeding and severe pain. Confirm the client has a ride home and plans to rest.

The assistive personnel note that a client had a dark stool. What stool test would the nurse obtain for this client?

Occult blood test