Adult 1 test

Common bile duct, pancreatic duct, and biliary tree

A 50-year-old woman is scheduled to have an endoscopic retrograde cholangiopancreatography. Which of the following structures are visualized during this procedure?

Notify the physician.

A client comes to the clinic complaining of not having a bowel movement in several days, abdominal cramping, and nausea. When the nurse puts the client on the stretcher, he vomits a large amount of fecal material. What should the first action by the nurse be?

Gastrostomy tube

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following?

Right lower quadrant

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

• Drink at least 8 to 10 large glasses of fluid every day. • Do not suppress the urge to defecate

A client is being treated for diverticulosis. Which of the following points should the nurse include in this client's teaching plan? Select all that apply.

Increase dietary fiber.

A client is complaining of problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool?

"I'll eat frequent, small, bland meals that are high in fiber."

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?

Notify the physician

A client is receiving continuous tube feedings at 75 mL/hr. The nurse has checked the residual volume 4 hours ago as 250 mL. The nurse now assesses the residual volume as 325 mL. The first action of the nurse is to

Six small meals daily with 120 mL fluid between meals

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?

Client's tolerance for pain and discomfort

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure?

Metabolic alkalosis and hypokalemia

A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances?

The client's natural bowel function may become sluggish.

A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason?

diaphoresis, vomiting, and diarrhea

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:

"You might feel some cramping and gas but these usually go away in about a day."

A client who had a colonoscopy with removal of a polyp is being prepared for discharge. Which of the following would the nurse include in the discharge instructions?

Keeping the head of the bed elevated.

A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort?

Assess patency of the NG tube.

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

Administering morphine I.V. as ordered

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

"Avoid aspirin and products that contain aspirin."

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction?

yellow sclerae.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

Blood supply to the stoma has been interrupted.

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?

Rigid abdomen

A client with peptic ulcer disease complains of sharp mid-epigastric pain. Which assessment finding is most important to the care of this client?

Hemorrhage

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed?

"Eliminating bothersome foods will help."

A client, who has occasional gastric symptoms, is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching?

Omeprazole (Prilosec)

A group of students is reviewing the medications that may be used to treat esophageal reflux. The students demonstrate understanding of the information when they identify which of the following as an example of a proton-pump inhibitor?

The client lying in a lateral position, with the head of bed flat

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?

Early diagnosis and treatment of gastroesophageal reflux disease

A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer?

The early symptoms of gastric cancer are usually not alarming or highly unusual.

A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patient's family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage?

Bloody secretions

A nurse is assessing a client who underwent esophagogastroduodenoscopy (EGD) for postoperative complications. Which sign or symptom is a complication of this procedure?

The client states he feels like he always has a lump in his throat

A nurse is assessing a client with a family history of cancer. Which finding requires immediate follow-up?

Right shoulder

A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the patient's pain, the nurse should anticipate that it may radiate to what region?

Fried chicken

A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?

Administer analgesics to the client.

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic?

The client's right lower leg is red and swollen

A nurse is caring for a client who had gastric bypass surgery 2 days ago. Which assessment finding requires immediate intervention?

• To remove gas from the stomach • To remove toxins from the stomach • To diagnose GI motility disorders

A nurse is caring for a patient who has a gastrointestinal tube in place. Which of the following are indications for gastrointestinal intubation? Select all that apply.

Erosion of the lining of the stomach or intestine

A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer?

Use a combination of at least two accepted methods for confirming placement.

A nurse is creating a care plan for a patient with a nasogastric tube. How should the nurse direct other members of the care team to check correct placement of the tube?

Supine with knees flexed slightly

A nurse is doing a physical assessment on a client with a GI disorder. She is about to assess the client's abdomen. Which position will the nurse most likely ask the client to assume when performing this examination?

"Food seems to be getting stuck in my throat."

A nurse is performing health assessment with a client during an outpatient clinic visit. The most concerning client statement to the nurse is

Watery with blood and mucus

A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patient's stools will have what characteristics?

Pepsin

A nurse is promoting increased protein intake to enhance a patient's wound healing. The nurse knows that enzymes are essential in the digestion of nutrients such as protein. What is the enzyme that initiates the digestion of protein?

Patient will accurately identify foods that trigger symptoms.

A nurse is providing care for a patient who has a diagnosis of irritable bowel syndrome (IBS). When planning this patient's care, the nurse should collaborate with the patient and prioritize what goal?

Cranberry juice

A nurse providing care to a patient who is receiving nasogastric tube feedings finds that the tube is clogged. Which of the following would be least appropriate to use to unclog the tube?

A 39-year-old man with chronic alcoholism

A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should identify which of the following patients as having the highest risk for chronic pancreatitis?

Serum amylase

A patient comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out possible acute pancreatitis. The nurse would expect the diagnosis to be confirmed with which of the following elevated laboratory tests?

Adequate understanding of required lifestyle changes

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?

This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort.

A patient discharged following a laparoscopic cholecystectomy calls the surgeon's office complaining of severe right shoulder pain 24 hours after surgery. Which of the following statements is the correct information for the nurse to provide to this patient?

The tube will allow the gastrointestinal (GI) tract to rest.

A patient has a nasogastric (NG) tube for suction and is NPO following a pancreaticoduodenectomy. Which of the following explanations made by the nurse is the major purpose of this treatment?

"Your appendix doesn't play a major role, so you won't notice any difference after you recovery from surgery."

A patient has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The patient is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond?

Hospice care

A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the patient is most likely to require which of the following?

Colonoscopy

A patient has come to the outpatient radiology department for diagnostic testing. Which of the following diagnostic procedures will allow the care team to evaluate and remove polyps?

Hang a solution of dextrose 10% and water until the new solution is available.

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate?

Bile-stained vomiting

A patient who had developed jaundice 2 months previous is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this patient to have?

The patient has a rigid, "boardlike" abdomen that is tender.

A patient with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the patient has a perforated ulcer?

Increased bilirubin

A patient's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patient's laboratory studies, what finding is most closely associated with this diagnosis?

Acknowledge the patient's reluctance and initiate discussion of the factors underlying it.

A patient's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the patient has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation?

Entry of large amounts of water into the small intestine because of osmotic pressure

A patient's enteral feedings have been determined to be too concentrated based on the patient's development of dumping syndrome. What physiologic phenomenon caused this patient's complication of enteral feeding?

Chemical phlebitis

A patient's health decline necessitates the use of total parenteral nutrition. The patient has questioned the need for insertion of a central venous catheter, expressing a preference for a "normal IV." The nurse should know that peripheral administration of high-concentration PN formulas is contraindicated because of the risk for what complication?

The patient can resume a normal routine immediately.

A patient's sigmoidoscopy has been successfully completed and the patient is preparing to return home. Which of the following teaching points should the nurse include in the patient's discharge education?

ibuprofen (Advil)

A physician plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which of the following medications while collecting stool for the test?

Absent.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as:

Take a stool softener such as docusate sodium (Colace) daily.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make?

Evaluate the client's understanding of the procedure.

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene?

High-calorie diet of her favorite foods

Myrtle Gass, a 79-year-old resident at the long-term care facility where you practice nursing, has developed anorexia and has lost her interest in eating. During the care team meeting with her family and physician, concerns are voiced over her lack of appetite. After discussion, what is an intervention that might successfully increase Mrs. Gass's caloric intake?

Time to mourn, accept, and adjust to the loss

Paul Cavanagh, a 63-year-old retired teacher, had oral cancer and had extensive surgery to excise the malignancy. Although his surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to Mr. Cavanagh and his family?

• Document intake and output. • Weigh the client every day. • Check blood glucose level every 6 hours.

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). The nurse performs the following actions while the client receives PN (select all that apply):

Auscultate lung sounds.

The client has just had a central line inserted for parenteral nutrition. The client is awaiting transport to the Radiology Department for catheter placement verification. The client reports feeling anxious. Respirations are 28 breaths/minute. The first action of the nurse is

• Multiparous • Obese • Older than 40 years

The nurse admits a woman reporting severe right upper quadrant pain after eating Christmas dinner. The nurse suspects gallbladder disease. Statistics show that incidence of gallbladder disease is greater for women who are

Hang 10% dextrose and water

The nurse caring for a patient receiving continuous parenteral nutrition (PN) through a Hickman catheter notices that the patient's solution has run out. No PN solution is currently available from the pharmacy. What should the nurse do?

Hematochezia

The nurse in the ED is admitting a patient with bloody stools. The nurse documents this finding as being which of the following?

Black and tarry appearance

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which of the following characteristics would the nurse be most likely to find?

Leave the tube in its present position

The nurse is assessing placement of a nasogastric tube that the patient has had in place for 2 days. The tube is draining green aspirate. What is the nurse's most appropriate action?

Digestive enzymes and sodium bicarbonate

The nurse is attempting to unclog a patient's feeding tube. Attempts with warm water agitation and milking the tube have been unsuccessful. The nurse uses evidence-based practice principles when she then uses which of the following to unclog the tube?

Bleeding and perforation

The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse should monitor the patient for signs of what complications?

Diuretics

The nurse is caring for an older adult who complains of xerostomia. The nurse evaluates for use of which of the following medications?

Peptic ulcers

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which of the following diseases/conditions?

Red plaque on undersurface of tongue

The nurse is inspecting a patient's tongue. Which of the following findings would the nurse evaluate as an indication of potential oral cancer?

Anal fissure

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which of the following?

Borborygmus

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the patient then experiences diarrhea, the nurse documents the presence of which of the following?

• Smoking history of 20 years • Male gender • Previous treatment for gastroesophageal reflux disease

The nurse is reviewing the chart of a client with swallowing problems. Which of the following factors would raise suspicion that the client has cancer of the esophagus? Choose all that apply.

Put on gloves.

The nurse is standing next to the bed of a client who is experiencing a hemorrhage from the neck area following a neck dissection. The first intervention of the nurse is to:

Change in bowel habits

The nurse is talking with a group of clients that are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider?

Avoid eating or drinking 2 hours before bedtime.

The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the following measures to manage his disease?

Notifying the physician

The nurse working in the recovery room is caring for a patient who had a radical neck dissection. The nurse notices that the patient has a coarse, high-pitched sound on inspiration. Which of the following is the appropriate intervention by the nurse?

Severe abdominal pain

The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is:

They cannot tolerate high-glucose concentration.

Total parental nutrition (TPN) should be used cautiously in patients with pancreatitis due to which of the following?

Carbon dioxide (CO2)

When a client's ventilation is impaired, the body retains which substance?

• Family support • Telephone access • Motivation for learning • Health status

When assessing whether a patient is a candidate for home parenteral nutrition, which of the following would be important to address? Select all that apply.

decreased urine output.

When evaluating a client for complications of acute pancreatitis, the nurse should observe for:

Tip of patient's nose

When preparing to insert a nasogastric tube, the nurse determines the length of the tube to be inserted. The nurse nurse places the distal tip of the tube at which location?

Hemoglobin and hematocrit

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Withholding all oral intake, as ordered, to decrease pancreatic secretions

Which nursing action is most appropriate for a client hospitalized with acute pancreatitis?

Client with blood type O

Which of the following clients is at highest risk for peptic ulcer disease?

Oral

Which of the following is a correct route of administration for potassium?

The clusters of ulcers take on a cobblestone appearance.

Which of the following is a true statement regarding regional enteritis (Crohn's disease)?

Pancreatic necrosis

Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis?

Alcoholism

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?

The client reports engaging in a regular exercise regimen.

Which outcome indicates effective client teaching to prevent constipation?

Xiphoid process

While completing an abdominal assessment, the nurse will use which landmark as the upper boundary for auscultating bowel sounds?

"Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids."

he community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response?