Evolve GI

A client has circumgastric banding, a bariatric surgical procedure. The nurse provides discharge teaching about signs and symptoms of dumping syndrome and includes what physiological response?

Palpitations

A client is admitted to the hospital after two days of painful abdominal spasms and severe diarrhea. The nurse uses an appropriate sequence to examine the client's abdomen, starting with "inspection" followed by:

Auscultation, palpation, percussion

A nurse is caring for a client who had major abdominal surgery one day ago. What factor increases the risk of this client developing a wound dehiscence?

Obesity

The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. The priority nursing intervention is to:

Observe the client for increasing confusion

When caring for a client who is recovering from a gastrectomy, a nurse is concerned about the potential development of pernicious anemia. What should the nurse conclude may be the cause of this complication?

Parietal cells of the stomach secrete the intrinsic factor.

The menu for a client with malabsorption syndrome must be limited because of a sensitivity to gluten. Which foods cannot be served to this client? (Select all that apply.)

Roast beef sandwich, chicken noodle soup, and spaghetti and meatballs.

A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? (Select all that apply.)

Screening of blood donors and Maintaining a monogamous sexual relationship

On the third postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action?

Obtain the client's vital signs.

Which statement by an older adult most strongly supports the nurse's conclusion that the client is impacted with stool?

"I feel like I have to go and just can't."

An older female client with diarrhea is admitted to the hospital from a nursing home. A stool specimen confirms a diagnosis of a methicillin-resistant Staphylococcus aureus (MRSA) infection. The daughter of the client asks why her mother has been placed in a room with another client who is on isolation. How should the nurse respond?

"It is safe to place people with the same infection in one room."

A nurse obtains daily stool specimens for a client with chronic bowel inflammation. The nurse concludes that these stool examinations were prescribed to determine:

Occult Blood

A client with a parotid tumor expresses anxiety about the surgery to remove the tumor. The client states that perhaps surgery should be performed soon, even if the preoperative radiotherapy is not completed. The best response by the nurse is:

"You are concerned about the delay of surgery?"

An abdominal cholecystectomy is performed on a client with gangrene of the gallbladder. During the first 24 hours postoperatively, analgesics should be administered:

As prescribed by the health care provider

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care?

Encouraging expression of concerns

When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. For what response should the nurse critically assess this client?

Fluid deficit

When assessing a client who had abdominal surgery, the nurse determines that peristalsis has returned when the client:

Passes flatus

A nurse is caring for a client with cirrhosis of the liver. Which laboratory test should the nurse monitor that, when abnormal, might identify a client who may benefit from neomycin enemas?

Ammonia level

A client had surgery for a ruptured appendix. Postoperatively, the health care provider prescribes an antibiotic to be administered intravenously twice a day. The nurse administers the prescribed antibiotic via a secondary line into the primary infusion of 0.9% sodium chloride. During the administration of the antibiotic, the client becomes restless and flushed, and begins to wheeze. What should the nurse do after stopping the antibiotic infusion?

Assess the client's respiratory status

A nurse is providing education about excellent food sources of vitamin A for a client who is deficient in this vitamin. Which foods should the nurse include in the teaching? (Select all that apply.)

Carrots and Leafy Greens

A financially struggling, large family is instructed by the home health nurse about ways to increase the dietary intake of calcium. Which suggestion should the nurse make?

Collards or kale in one meal a day

A low-residue diet is recommended for a client. Which food should the nurse encourage the client to select from a menu?

Creamed potatoes

A client with Crohn's disease is admitted to the hospital with a history of chronic, bloody diarrhea, weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level, and signs of negative nitrogen balance. The nurse concludes that the client's health status is related to a major deficiency of:

Protein

A nurse is teaching menu planning to a client who has a high triglyceride level. Which nutrient avoided by the client indicates that teaching about foods that are high in fat was understood?

Red meat

A client is being discharged after an acute episode of hepatitis. The nurse expects the primary health care provider to prescribe which type of diet for this client?

High calorie, high protein, high carbohydrate, moderate fat

What diet should the nurse anticipate will be prescribed for a client who just had a cholecystectomy?

High in protein and calories to promote healing.

A nurse is caring for a client who is admitted to the hospital with ascites and a diagnosis of cirrhosis of the liver. The nurse concludes that the probable cause of ascites is:

Impaired portal venous return

Steroid therapy is prescribed for a client with an exacerbation of ulcerative colitis. The nurse evaluates that teaching is effective when the client says, "I should take this medicine:

In the early morning with food."

A day after surgery to create an ileostomy, a 68-year-old male client remarks to the nurse, "It will be difficult for my wife to care for a helpless old man." Which conflict of Erikson's developmental stages is reflected by this comment?

Integrity versus despair

A nurse is assessing two clients. One client has ulcerative colitis and the other client has Crohn's disease. Which is more likely to be identified in the client with ulcerative colitis than the client with Crohn's disease?

Involvement starting distally with rectal bleeding that spreads continuously up the colon

A client with liver dysfunction states, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs additional Vitamin:

K

A nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. For which risk factor commonly associated with cancer of the tongue should the nurse assess when collecting the client's history?

Large consumption of alcohol

A client who recently experienced a brain attack (CVA) and who has limited mobility complains of constipation. What is most important for the nurse to determine when collecting information about the constipation?

Length of time this problem has existed

After having a transverse colostomy, the client asks what physical effect the surgery will have on future sexual relationships. Which information should the nurse include in a teaching plan for this client?

"You will be able to resume usual sexual relationships."

A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which patient history item?

Black tarry stools

A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client?

Blakemore-Sengstaken

A client who is receiving total parenteral nutrition (TPN) reports experiencing nausea, thirst, and a headache. Which clinical factor should the nurse monitor initially to further assess the client's status?

Blood glucose

When a client develops steatorrhea, the nurse documents this stool as:

Bulky and foul smelling

A nurse is teaching a client about the differences between the terms saturated and unsaturated, when used in reference to fats. Which important factor in relation to these types of fats should the nurse include in the teaching?

Density

A clienA nurse is teaching a client about a diet that permits 190 g of carbohydrates, 90 g of fat, and 100 g of protein. How many calories per day should the client eat? Record your answer using a whole number and no punctuation. __________ caloriest is recovering from an acute episode of alcoholism that included esophageal involvement. What are the components of a therapeutic diet that are most appropriate for the nurse to include in the teaching plan for this client? (Select all that apply.)

Soft Diet, High Protein Diet, High Carbohydrate Diet

A nurse is teaching a class about hepatitis, specifically hepatitis A. Which food should the nurse explain most likely will remain contaminated with the hepatitis A virus after being cooked?

Steamed lobster

A nurse is caring for a client who is cachectic. What information about the function of adipose tissue in fat metabolism is necessary to better address the needs of this client?

Stores triglycerides for energy reserves

After abdominal surgery a client is to receive a progressive postsurgical diet. The nurse explains to the client that this diet is characterized by progressive alterations in the:

Texture and digestibility of food

The nurse is caring for a client with ascites who is scheduled for a paracentesis. The client teaching will include:

The need to empty the bladder immediately before the procedure

A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse?

There are medications to help reduce viral load and liver inflammation

A client is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver. The nurse suspects what type of toxicity?

Vitamin A

The mother of a large family asks the home health nurse for inexpensive sources of B vitamins. What suggestion should the nurse make?

"Bake with whole-wheat flour."

A nurse is reviewing preoperative instructions with a client who is scheduled for orthopedic surgery at 8 AM the next day. The nurse advises the client to:

"Consume a light evening meal tonight and then no food or fluids after midnight."

A client was recently diagnosed with a cancerous lesion of the mouth. What should the nurse ask when analyzing the client's need for health education in relation to this health problem?

"Have you noticed any change in your appetite?"

A client is to be discharged after a laparoscopic cholecystectomy. What statement indicates to the nurse that the client understands the discharge instructions?

"I may have mild shoulder pain for about a week."

A client has a new colostomy. The nurse has provided teaching related to when the client should irrigate the colostomy. Which client statement indicates correct understanding of the teaching?

"I plan to irrigate it in the late morning, the same time I had a bowel movement every day before I had my surgery."

A client who had a transurethral resection of the prostate is to be discharged from the outpatient surgical department. Which client statement indicates to the nurse that discharge teaching about self-care is understood?

"I will notify my health care provider if persistent bleeding occurs.

A client newly diagnosed with cancer of the pancreas is scheduled for surgery. The client says to the nurse, "Wouldn't I be better off with some other treatment instead of surgery?" The nurse's best response is:

"Surgery is the recommended approach. Why don't you discuss this further with the health care provider?"

A client with chronic gastritis is being treated with medication and diet. What should the nurse teach the client when discussing the therapeutic regimen?

Avoid using analgesics that contain aspirin

A nurse is caring for a client with Addison disease. What should the nurse teach the client to do regarding an appropriate diet?

Add extra salt to food

An active adolescent is admitted to the hospital for surgery for an ileostomy. When planning a teaching session about self-care, the nurse includes sports that should be avoided by a client with an ileostomy. Which should be included on the list of sports to be avoided? (Select all that apply.)

Football and Ice Hockey

A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn's disease. Which expected outcome is most important for this client?

Gains a half pound per week

A client had a bypass graft because of an abdominal aortic aneurysm. Postoperative prescriptions include measurements of the client's abdominal girth. Which serious problem may be indicated by an increasing abdominal girth?

Graft leakage

A client had a laproscopic cholecystectomy. Postoperatively the client experiences nausea and vomiting and is admitted overnight for observation and hydration. What should the nurse include in the teaching plan when preparing this client for discharge? (Select all that apply.)

Call the health care provider if you have a fever of 100o F or more for two days. Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage.

After an acute episode of gastrointestinal (GI) bleeding, a client is diagnosed with gastric ulcer. The client receives a prescription for ranitidine (Zantac) 150 mg twice a day to be taken with meals. The nurse contacts the health care provider about the prescription because ranitidine:

Can be administered by a variety of routes

A client who has just been transferred to the inpatient unit following surgery for oral carcinoma indicates to the nurse that the client's spouse is the only person that is allowed to visit. To support the client at this time, the nurse should:

Comply with the client's wishes

A client is scheduled for a pyloroplasty and vagotomy because of strictures caused by ulcers unresponsive to medical therapy. What information about the purpose of a vagotomy should the nurse include when reviewing the health care provider's discussion with the client?

Decreases acid in the stomach

Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is bright red. What should the nurse do first?

Determine that this is an expected finding.

A nurse is obtaining a history and performing a physical assessment of a client who has cancer of the tongue. Which clinical findings should the nurse expect to identify? (Select all that apply.)

Leukoplakia, Alterations in taste, Enlarged cervical lymph nodes

A client with a history of ulcerative colitis has a large portion of the large intestine removed and the creation of an ileostomy. For which potential life-threatening complication should the nurse assess the client after this surgery?

Limited water reabsorption caused by removal of intestine

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which most frequently prescribed antidiarrheal drug does the nurse expect the health care provider to prescribe?

Loperamide (Imodium)

A nurse teaches a client that it is not recommended to take bicarbonate of soda regularly. What effect of bicarbonate of soda is the nurse trying to prevent?

Metabolic alkalosis

The nurse is caring for an Asian client who had a laparoscopic cholecystectomy six hours ago. When asked whether there is pain, the client smiles and says, "No." What should the nurse do?

Monitor for nonverbal cues of pain.

A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for signs that strangulation of the intestine may have occurred. What is an early sign of strangulation?

Sharp-abdominal pain

When caring for a client in the early postoperative period after a hemorrhoidectomy, to ensure the client's safety, the nurse would place the client in which position?

Side-lying

A client's serum albumin value is 2.8 g/dL. Which food selected by the client indicates that the nurse's dietary teaching is successful?

Sliced turkey

The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase (Viokase). The nurse evaluates that teaching is understood when the client states, "I will take them:

With meals

A nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which diet should the nurse teach the client to maintain because it will help minimize clinical manifestations of dumping syndrome?

Small, frequent feeding schedule

A nurse is teaching a client about a diet that permits 190 g of carbohydrates, 90 g of fat, and 100 g of protein. How many calories per day should the client eat? Record your answer using a whole number and no punctuation. __________ calories

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