Gastrointestinal NCLEX Review

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? 1. "I should increase the fiber in my diet." 2. "I will need to avoid caffeinated beverages." 3. "I'm going to learn some stress reduction techniques." 4. "I can have exacerbations and remissions with Crohn's disease."

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

The nurse is caring for a client with biliary obstruction. The nurse interprets that obstruction of which passage is related to the client's condition? 1. Cystic duct 2. Liver canaliculi 3. Common bile duct 4. Right hepatic duct

1. Cystic duct The gallbladder receives bile from the liver through the cystic duct. The liver collects bile in the canaliculi, from which bile flows into the right and left hepatic ducts and then into the common hepatic duct. From there, the bile can be transported for storage in the gallbladder through the cystic duct, or it can flow directly into the duodenum by way of the common bile duct.

The nurse is reviewing the prescriptions for a newly admitted client. The nurse sees a prescription for intravenous pantoprazole but does not see any gastrointestinal conditions in the medical record. How should the nurse interpret this prescription? 1. It is used as a prophylactic measure. 2. It is inaccurate and should be questioned. 3. It is likely that the client has a new gastrointestinal disorder. 4. It is used before surgery, so the client will probably require surgery.

1. It is used as a prophylactic measure. Pantoprazole is a proton pump inhibitor and is commonly used as a gastrointestinal prophylactic measure to prevent stress ulcers. The other options are incorrect.

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective? 1."Baked foods such as chicken or fish are all right to eat." 2."Citrus fruits and raw vegetables need to be included in my daily diet." 3."I can drink beer as long as I consume only a moderate amount each day." 4."I can drink coffee or tea as long as I limit the amount to 2 cups daily."

1."Baked foods such as chicken or fish are all right to eat." Dietary modifications for the client with peptic ulcer disease include eliminating foods that can cause irritation to the gastrointestinal (GI) tract. Items that should be eliminated or avoided include highly spiced foods, alcohol, caffeine, chocolate, and citrus fruits. Other foods may be taken according to the client's level of tolerance for that food.

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching? 1."I eat at least 3 large meals each day." 2."I eat while lying in a semi recumbent position." 3."I have eliminated taking liquids with my meals." 4."I eat a high-protein, low- to moderate-carbohydrate diet."

1."I eat at least 3 large meals each day." Dumping syndrome describes a group of symptoms that occur after eating. It is believed to result from rapid dumping of gastric contents into the small intestine, which causes fluid to shift into the intestine. Signs and symptoms of dumping syndrome include diarrhea, abdominal distention, sweating, pallor, palpitations, and syncope. To manage this syndrome, clients are encouraged to decrease the amount of food taken at each sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid consumption of high-carbohydrate meals.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? 1."I need to limit my intake of dietary fiber." 2."I need to drink plenty, at least 8 to 10 cups daily." 3."I need to eat regular meals and chew my food well." 4."I will take the prescribed medications because they will regulate my bowel patterns."

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

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. 1."I will take the cimetidine with my meals." 2."I'll know the medication is working if my diarrhea stops." 3."My episodes of heartburn will decrease if the medication is effective." 4."Taking the cimetidine with an antacid will increase its effectiveness." 5."I will notify my primary health care provider if I become depressed or anxious." 6."Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

1."I will take the cimetidine with my meals." 2."I'll know the medication is working if my diarrhea stops." 4."Taking the cimetidine with an antacid will increase its effectiveness." Cimetidine, a histamine (H2)-receptor antagonist, helps alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results must be followed.

The nurse is completing an admission assessment for a client with suspected esophageal cancer. Which statement made by the client indicates the presence of a risk factor for esophageal cancer? 1."I've been smoking for 20 years now." 2."I eat plenty of fresh fruits and vegetables." 3."I'm 5 feet, 8 inches tall and weigh 160 pounds." 4."My alcohol consumption is about 2 beers per month."

1."I've been smoking for 20 years now." Primary risk factors associated with the development of esophageal cancer are smoking and obesity. The compounds in tobacco smoke may be responsible for the genetic mutations seen in many squamous cell carcinomas of the esophagus. Malnutrition, untreated gastroesophageal reflux disease (GERD), and excessive alcohol intake are also associated with esophageal cancer. Diets that are chronically deficient in fresh fruits and vegetables have also been implicated in the development of squamous cell carcinoma of the esophagus.

The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client on the signs and symptoms associated with dumping syndrome. Which client statement indicates that teaching was effective? 1."It will cause diaphoresis and diarrhea." 2."I have to monitor for hiccups and diarrhea." 3."It will be associated with constipation and fever." 4."I have to monitor for fatigue and abdominal pain."

1."It will cause diaphoresis and diarrhea." Dumping syndrome occurs after gastric surgery because food is not held for as long in the stomach and is dumped into the intestine as a hypertonic mass. This causes fluid to shift into the intestine, causing cardiovascular and gastrointestinal symptoms. Symptoms can typically include weakness, dizziness, diaphoresis, flushing, hypotension, abdominal pain and distention, hyperactive bowel sounds, and diarrhea. The remaining options are not signs of dumping syndrome.

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? 1."The medication will cause constipation." 2."I need to take the medication with meals." 3."I may have increased sensitivity to sunlight." 4."This medication should be taken as prescribed."

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

A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply. 1.Antacids 2.Antibiotics 3.Proton pump inhibitors 4.Cytoprotective therapy 5.Histamine H2-receptor blockers 6.Nonsteroidal anti-inflammatory drugs (NSAIDs)

1.Antacids 2.Antibiotics 3.Proton pump inhibitors 4.Cytoprotective therapy 5.Histamine H2-receptor blockers Medications to treat peptic ulcer disease include antacids, antibiotics, proton pump inhibitors, cytoprotective therapy, and histamine H2-receptor blockers. NSAIDs are contraindicated in peptic ulcer disease because of the risk of bleeding.

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? 1.Assessment of vital signs 2.Completion of abdominal examination 3.Insertion of the prescribed nasogastric tube 4.Thorough investigation of precipitating events

1.Assessment of vital signs The priority nursing action is to assess the vital signs. This would provide information about the amount of blood loss that has occurred and provide a baseline by which to monitor the progress of treatment. The client may be unable to provide subjective data until the immediate physical needs are met. Although an abdominal examination and an assessment of the precipitating events may be necessary, these actions are not the priority. Insertion of a nasogastric tube is not the priority and will require a prescription; in addition, the vital signs should be checked before performing this procedure.

A primary health care provider has written a prescription for ranitidine 300 mg once daily. The client indicates understanding of use of this medication by stating that the prescribed dose is best taken at what time? 1.At bedtime 2.After lunch 3.With supper 4.Before breakfast

1.At bedtime Ranitidine is a histamine H2-receptor antagonist and should be taken at bedtime, when it is given as a single daily dose. This allows for prolonged effect and provides the greatest protection of the gastric mucosa both during sleep and around the clock.

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the primary health care provider (PHCP)? 1.Dark red drainage 2.Dark brown drainage 3.Green-tinged drainage 4.Light yellowish-brown drainage

1.Dark red drainage For the first 12 hours after gastric surgery, the nasogastric tube drainage may be dark brown to dark red. Later, the drainage should change to a light yellowish-brown color. The presence of bile may cause a green tinge. The PHCP should be notified if dark red drainage, a sign of hemorrhage, is noted 24 hours postoperatively.

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? 1.Decreased diarrhea 2.Decreased cramping 3.Improved intestinal tone 4.Elimination of peristalsis

1.Decreased diarrhea Diphenoxylate hydrochloride with atropine sulfate is an antidiarrheal product that decreases the frequency of defecation, usually by reducing the volume of liquid in the stools. The remaining options are not associated therapeutic effects of this medication.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions should the nurse include in the instructions? Select all that apply. 1.Eat yogurt. 2.Take loperamide to treat diarrhea. 3.Use stress management techniques. 4.Avoid foods such as cabbage and broccoli. 5.Decrease fiber intake to less than 15 g/day.

1.Eat yogurt. 2.Take loperamide to treat diarrhea. 3.Use stress management techniques. 4.Avoid foods such as cabbage and broccoli. IBS is a common, chronic functional disorder, meaning that no organic cause is currently known. Treatment is directed at psychological and dietary factors and medications to regulate stool output. Options 1, 2, 3, and 4 are correct, as clients diagnosed with IBS whose primary symptoms are abdominal distention and flatulence should be advised to avoid common gas-producing foods such as broccoli and cabbage and to consume yogurt, as it may be better tolerated than milk. In addition, the probiotics found in yogurt may be beneficial because alterations in intestinal bacteria are believed to exacerbate IBS. The client should be advised to take loperamide, a synthetic opioid that slows intestinal transit and treats diarrhea when it occurs. Also, psychological stressors are associated with development and exacerbation of IBS, so stress management techniques are important. Option 5, decrease fiber intake, is incorrect, as clients should be encouraged to have a dietary fiber intake of at least 20 g/day.

A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. Which finding indicates that the client is experiencing optimal effects of the medication? 1.Heartburn is relieved. 2.Muscle twitching stops. 3.The serum calcium level increases. 4.The serum phosphorus level decreases.

1.Heartburn is relieved. Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as a calcium supplement (serum calcium level increases) or to bind phosphorus in the gastrointestinal tract with chronic kidney disease (serum phosphorus level decreases). Although adequate calcium levels are needed for proper neurological function, a reduction in muscle twitching is not an expected outcome when taking the medication for duodenal ulcer.

An older client takes a stimulant laxative for ongoing management of chronic constipation. Which findings should the nurse expect to note when reviewing the client's laboratory results? 1. Hypokalemia 2. Hyperkalemia 3. Hyponatremia 4. Hypernatremia

1.Hypokalemia Hypokalemia can result from long-term use of a stimulant laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. The remaining options are not specifically associated with the use of this medication.

The nurse is caring for a client with common bile duct obstruction. The nurse should anticipate that the primary health care provider (PHCP) will prescribe which diet for this client? 1.Low fat 2.High protein 3.High carbohydrate 4.Low in water-soluble vitamins

1.Low fat Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum. Bile acids or bile salts are produced by the liver to emulsify or break down fats. The diets listed in the remaining options are incorrect.

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively? 1.Low fiber 2.Low calorie 3.High protein 4.High carbohydrate

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

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply. 1.Nuts 2.Corn 3.Liver 4.Apples 5.Lentils 6.Bananas

1.Nuts 3.Liver 5.Lentils Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans, citrus fruits, green leafy vegetables, and yeast.

A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome? 1.Remove fluids from the meal tray. 2.Give the client 2 large meals per day. 3.Ask the client to sit up for 1 hour after eating. 4.Provide concentrated, high-carbohydrate foods.

1.Remove fluids from the meal tray. Factors to minimize dumping syndrome after gastric surgery include having the client lie down for at least 30 minutes after eating; giving small, frequent meals; having the client maintain a low-Fowler's position while eating, if possible; avoiding liquids with meals; and avoiding high-carbohydrate food sources. Antispasmodic medications also are prescribed as needed to delay gastric emptying.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1.Sweating and pallor 2.Bradycardia and indigestion 3.Double vision and chest pain 4.Abdominal cramping and pain

1.Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? 1.This is a normal, expected event. 2.The client is experiencing early signs of ischemic bowel. 3.The client should not have the nasogastric tube removed. 4.This indicates inadequate preoperative bowel preparation.

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

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information should the nurse include in the teaching plan? 1.Use 500 to 1000 mL of warm tap water. 2.Suspend the irrigant 36 inches above the stoma. 3.Insert the irrigation cone ½ inch into the stoma. 4.If cramping occurs, open the irrigation clamp farther.

1.Use 500 to 1000 mL of warm tap water. The usual procedure for colostomy irrigation includes using 500 to 1000 mL of warm tap water. The solution is suspended 18 inches above the stoma. The cone is inserted 2 to 4 inches into the stoma but should never be forced. If cramping occurs, the client should decrease the flow rate of the irrigant as needed by closing the irrigation clamp. This practice is not common because of odor-proof pouches.

After performing an initial abdominal assessment on a client with nausea and vomiting, the nurse should expect to note which finding? 1.Waves of loud gurgles auscultated in all 4 quadrants 2.Low-pitched swishing auscultated in 1 or 2 quadrants 3.Relatively high-pitched clicks or gurgles auscultated in all 4 quadrants 4.Very high-pitched, loud rushes auscultated especially in 1 or 2 quadrants

1.Waves of loud gurgles auscultated in all 4 quadrants Although frequency and intensity of bowel sounds vary depending on the phase of digestion, normal bowel sounds are relatively high-pitched clicks or gurgles. Loud gurgles (borborygmi) indicate hyperperistalsis and are commonly associated with nausea and vomiting. A swishing or buzzing sound represents turbulent blood flow associated with a bruit. Bruits are not normal sounds. Bowel sounds are very high-pitched and loud (hyperresonance) when the intestines are under tension, such as in intestinal obstruction. Therefore, options 2, 3, and 4 are incorrect.

The nurse is teaching an older client about measures to prevent constipation. Which statement by the client indicates a need for further teaching? 1. "I walk 1 to 2 miles every day." 2. "I need to decrease fiber in my diet." 3. "I have a bowel movement every other day." 4. "I drink 6 to 8 glasses of water every day."

2. "I need to decrease fiber in my diet." An older client has an increased tendency to experience constipation because of decreased stomach-emptying time and a lowered basal metabolic rate. Adequate dietary fiber is an important factor in aiding bowel function. Dietary fiber increases fecal weight and water content and accelerates the transit of fecal mass through the gastrointestinal tract. The retention of water by the fiber has the ability to soften stools and promote regularity. Fluid intake and exercise also facilitate bowel elimination.

The ambulatory care nurse is providing instructions to a client who is scheduled for a small bowel biopsy. What should the nurse tell the client? 1. Clear liquids only are allowed on the day of the test. 2. A signed informed consent form will need to be obtained. 3. A tube will be inserted through the rectum to obtain the tissue sample. 4. A full liquid diet will need to be maintained for 48 hours after the procedure.

2. A signed informed consent form will need to be obtained. A signed informed consent form is required for this procedure. The client is instructed to maintain a clear liquid diet for 24 to 48 hours before the biopsy and to withhold all food and fluids after the evening meal before the day of the scheduled biopsy. A small bowel biopsy involves removal of a tissue specimen from the small intestine for examination and aids in the diagnosis of diseases of the small intestine. A small biopsy tube is passed through the client's mouth and is monitored fluoroscopically until it reaches the desired location in the jejunum. A normal diet may be resumed after the procedure as soon as the gag reflex returns.

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication? 1. On arising 2. After meals 3. On an empty stomach 4. 30 minutes before meals

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

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication? 1. Stroke 2. Pernicious anemia 3. Bacterial meningitis 4. Peripheral arterial disease

2. Pernicious anemia Billroth I surgery involves removing one half to two thirds of the stomach and reanastomosing the remaining segment of the stomach to the duodenum. With the loss of this much of the stomach, development of pernicious anemia is not uncommon. Pernicious anemia is a macrocytic anemia that most commonly is caused by the lack of intrinsic factor. During a Billroth I procedure, a large portion of the parietal cells, which are responsible for producing intrinsic factor (a necessary component for vitamin B12 absorption), are removed. In this anemia, the red blood cell is larger than usual and hence does not last as long in the circulation as normal red blood cells do, causing the client to have anemia with resultant fatigue. Vitamin B12 also is necessary for normal nerve function. Because of the lack of the necessary intrinsic factor, persons with pernicious anemia also experience paresthesias, impaired gait, and impaired balance. Although the symptoms could possibly indicate the other options listed, pernicious anemia is the most logical based on the surgery the client underwent.

The nurse notes that a client is taking lansoprazole. Which question by the nurse helps to determine that this medication is effective? 1."Has your appetite increased?" 2."Are you experiencing any heartburn?" 3."Do you have any problems with vision?" 4."Do you experience any leg pain when walking?"

2."Are you experiencing any heartburn?" Lansoprazole is a gastric acid proton pump inhibitor that is used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat problems with appetite, visual problems, or leg pain.

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective? 1."I should be sure to eat at least 1 cucumber every day." 2."Beet greens, parsley, or yogurt will help to control the colostomy odor." 3."I will need to increase my egg intake and try to eat ½ to 1 egg per day." 4."Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."

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

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching? 1."I need to lie down after eating." 2."I need to drink liquids with meals." 3."I need to avoid concentrated sweets." 4."I need to eat small meals 6 times daily."

2."I need to drink liquids with meals." The client with dumping syndrome should avoid drinking liquids with meals. The client should be placed on a high-protein, moderate-fat, high-calorie diet and should lie down after eating. The client should avoid concentrated sweets, and frequent small meals are encouraged.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which primary health care provider (PHCP) prescription documented in the client's medical record? 1.Apply a cold pack to the abdomen. 2.Administer 30 mL of milk of magnesia (MOM). 3.Maintain nothing by mouth (NPO) status. 4.Initiate an intravenous (IV) line for the administration of IV

2.Administer 30 mL of milk of magnesia (MOM). Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain. Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible surgery.

The nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply. 1.Antidiarrheal 2.Antimicrobial 3.Corticosteroid 4.Aminosalicylate 5.Biological therapy 6.Immunosuppressant

2.Antimicrobial 3.Corticosteroid 4.Aminosalicylate 5.Biological therapy 6.Immunosuppressant Pharmacological treatment for IBD aims to decrease the inflammation to induce and then maintain a remission. Five major classes of medications used to treat IBD are antimicrobials, corticosteroids, aminosalicylates, biological and targeted therapy, and immunosuppressants. Medications are chosen based on the location and severity of inflammation. Depending on the severity of the disease, clients are treated with either a "step-up" or "step-down" approach. The step-up approach uses less toxic therapies (e.g., aminosalicylates and antimicrobials) first, and more toxic medications (e.g., biological and targeted therapy) are started when initial therapies do not work. The step-down approach uses biological and targeted therapy first. Option 1, antidiarrheals, is incorrect. Although an antidiarrheal may be used to treat the symptoms of IBD, it does not treat the disease (the inflammation) or induce remission. In addition, antidiarrheals should be used cautiously in IBD because of the danger of toxic megacolon (colonic dilation greater than 5 cm).

A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client? 1.Folate 2.Biscodyl 3.Ferrous sulfate 4.Cyanocobalamin

2.Biscodyl The client with an ileostomy is prone to dehydration because of the location of the ostomy in the gastrointestinal tract and should not take laxatives. Laxatives will compound the potential risk for the client. These clients are at risk for deficiencies of folate, iron, and cyanocobalamin and should receive them as supplements if necessary.

The nurse is giving instructions to a client with cholecystitis about food to exclude from the diet. Which food item identified by the client indicates that the educational session was successful? 1.Fresh fruit 2.Brown gravy 3.Fresh vegetables 4.Poultry without skin

2.Brown gravy The client with cholecystitis should decrease overall intake of dietary fat. Foods that should be avoided include sausage, gravies, fatty meats, fried foods, products made with cream, and desserts. Appropriate food choices include fruits and vegetables, fish, and poultry without skin.

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system? 1.Ileum 2.Cecum 3.Rectum 4.Jejunum

2.Cecum The appendix, sometimes referred to as the vermiform appendix, is attached to the apex of the cecum. The other locations listed are incorrect.

The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food? 1.Rice 2.Corn 3.Broiled chicken 4.Cream of wheat

2.Corn The client with irritable bowel should take in a diet that consists of 30 to 40 g of fiber daily because dietary fiber will help produce bulky, soft stools and establish regular bowel habits. The client should also drink 8 to 10 glasses of fluid daily and chew food slowly to promote normal bowel function. Foods that are irritating to the intestines need to be avoided. Corn is high in fiber but can be very irritating to the intestines and should be avoided. The food items in the other options are acceptable to eat.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1.Diarrhea 2.Heartburn 3.Flatulence 4.Constipation

2.Heartburn Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

The nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a primary health care provider prescription for which type of suction? 1.High and intermittent 2.Low and intermittent 3.High and continuous 4.Low and continuous

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

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1.Administer the prescribed pain medication. 2.Notify the primary health care provider (PHCP). 3.Call and ask the operating room team to perform surgery as soon as possible. 4.Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

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

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the primary health care provider? 1.Stoma is beefy red and shiny 2.Purple discoloration of the stoma 3.Skin excoriation around the stoma 4.Semiformed stool noted in the ostomy pouch

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

A client who uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? 1.Resolved diarrhea 2.Relief of epigastric pain 3.Decreased platelet count 4.Decreased white blood cell count

2.Relief of epigastric pain The client who uses NSAIDs is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence in clients taking NSAIDs frequently. Diarrhea can be a side effect of the medication but is not an intended effect. Options 3 and 4 are unrelated to the purpose of misoprostol.

A calcium carbonate antacid has been prescribed for a client, and the nurse provides instructions to the client about the medication. The nurse should tell the client that it is best to take the antacid with which item? 1.Milk 2.Water 3.Yogurt 4.Cheese

2.Water Calcium carbonate antacids should not be taken with milk, milk products, or foods or supplements high in vitamin D because milk-alkali syndrome (headache, urinary frequency, anorexia, nausea, vomiting, and fatigue) can occur. The best item to consume when taking calcium carbonate is water.

A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching? 1.Rice 2.Whole milk 3.Broiled fish 4.Baked chicken

2.Whole milk Bile acids or bile salts are produced by the liver to emulsify or break down fats. Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum, thus preventing breakdown of fatty intake. Knowledge of this should direct you to the option of whole milk. Dairy products, such as whole milk, ice cream, butter, and cheese, are high in cholesterol and fat and should be avoided.

A client with a new colostomy is concerned about the odor from stool in the ostomy drainage bag. The nurse should teach the client to include which food in the diet to reduce odor? 1.Eggs 2.Yogurt 3.Broccoli 4.Cucumbers

2.Yogurt The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas-forming food as well. Broccoli, cucumbers, and eggs are gas-forming foods. There are also optional charcoal filters that can deodorize the colostomy.

A client diagnosed with peptic ulcer disease is prescribed an over-the-counter antacid suspension containing aluminum hydroxide, magnesium hydroxide, and simethicone. What should the nurse include in the client instructions for time of administration of this medication? 1. Just before each meal 2. An hour before breakfast 3. 1 and 3 hours after meals 4. Immediately after each meal

3. 1 and 3 hours after meals Antacids are alkaline compounds that neutralize stomach acid. The objective of peptic ulcer therapy is to promote healing in addition to relieving pain. Consequently, antacids should be taken on a regular schedule, not just in response to discomfort. In the usual dosing schedule, antacids are administered 7 times a day: 1 and 3 hours after each meal and at bedtime. Thus, option 4 is the correct option. Options 1, 2, and 4 are incorrect because they are either not the correct timing or not often enough as recommended.

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially? 1. Call the surgeon to report the problem. 2. Reposition the NG tube to the proper location. 3. Check the suction device to make sure it is working. 4. Irrigate the NG tube with saline to remove the obstruction.

3. Check the suction device to make sure it is working. After gastric surgery, the client will have an NG tube in place until bowel function returns. It is important for the NG tube to drain properly to prevent abdominal distention and vomiting. The nurse must ensure that the NG tube is attached to suction at the level prescribed and that the suction device is working correctly. The tip of the NG tube may be placed near the suture line. Because of this possibility, the nurse should never reposition the NG tube or irrigate it. If the NG tube needs to be repositioned, the nurse should call the surgeon, who would do this repositioning under fluoroscopy.

The client with peptic ulcer disease is prescribed medication therapy. The nurse explains the medications to the client and explains that sucralfate will help to heal the ulcer by doing what? 1. Reduce gastric acidity. 2. Treat bacterial infection. 3. Enhance mucosal defenses. 4. Eradicate Helicobacter pylori.

3. Enhance mucosal defenses. Medication therapy is used to treat peptic ulcer disease by 3 mechanisms: eradicating H. pylori (or other bacterial infections), reducing gastric acidity, and enhancing mucosal defenses. Sucralfate works by enhancing mucosal defenses. Antibiotics treat infection and eradicate H. pylori. Antisecretory agents, misoprostol, and antacids work by reducing gastric acidity.

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result? 1. The client reports some pain before meals. 2. The client frequently is awakened at 2 a.m. with heartburn. 3. The client has eliminated any irritating foods from the diet. 4. The client's pain is minimal with histamine H2-receptor antagonists.

3. The client has eliminated any irritating foods from the diet. Expected outcomes for the client with PUD who is experiencing pain include elimination of irritating foods from the diet, effectiveness of prescribed medications to eliminate pain, self-reporting of absence of pain with medication, and an ability to sleep through the night without pain. The client who continues to be awakened by pain requires further modification of medication therapy, which may include adjustment of timing of histamine H2-receptor antagonist administration or an additional dose of antacid before the time when pain usually awakens the client.

The clinic nurse is performing an abdominal assessment on a client and preparing to auscultate bowel sounds. The nurse should place the stethoscope in which quadrant first?

3. RLQ To auscultate bowel sounds, the nurse should begin in the right lower quadrant, at the ileocecal valve area, because normally bowel sounds are always present there. The diaphragm endpiece is used because bowel sounds are relatively high pitched. The stethoscope is held lightly against the skin because pressing too hard can stimulate more bowel sounds.

The client has begun taking misoprostol. Which statement by the client indicates that the misoprostol is effective? 1."I have fewer joint aches." 2."My joint mobility has improved." 3."I no longer have pain above my stomach." 4."I am no longer experiencing constipation."

3."I no longer have pain above my stomach." Misoprostol is a gastric protectant and is given specifically to prevent gastric mucosal injury. Constipation is not associated with the use of this medication. Fewer joint aches and improved joint mobility are incorrect and are not intended effects of the medication.

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement? 1."I know I must sign the consent form." 2."I hope the throat spray keeps me from gagging." 3."I'm glad I don't have to lie still for this procedure." 4."I'm glad some intravenous medication will be given to relax me."

3."I'm glad I don't have to lie still for this procedure." The client does have to lie still for ERCP, which takes about 1 hour to perform. The client also has to sign a consent form. Intravenous sedation is given to relax the client, and an anesthetic spray is used to help keep the client from gagging as the endoscope is passed.

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching? 1."It is normal to feel gassy or bloated after the procedure." 2."The abdominal muscles may be tender from the procedure." 3."It is all right to drive once I've been home for an hour or so." 4."Intake should be light at first and then progress to regular intake."

3."It is all right to drive once I've been home for an hour or so." The client should not drive for several hours after discharge because of the sedative medications used during the procedure. Important decisions also should be delayed for at least 12 to 24 hours for the same reason. The client may experience gas, bloating, or abdominal tenderness for a short while after the procedure, and this is normal. The client should resume intake slowly and progress as tolerated.

The nurse provides medication instructions to a client who has a prescription for sucralfate to be taken 4 times daily. Which statement by the client indicates teaching was effective? 1."I can stop the medication if my pain is relieved." 2."I may get terrible diarrhea from the medication, and if I do I need to stop taking it." 3."Side effects are minimal and I need to take it an hour before meals and at bedtime." 4."I need to take the medication halfway between meals and at bedtime on an empty stomach."

3."Side effects are minimal and I need to take it an hour before meals and at bedtime." Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is scheduled so that it has time to bind to the base of ulcers and erosions and form a protective coating before food intake stimulates chemical and mechanical irritation in the stomach. Medication should not be stopped. Side effects are minimal, and diarrhea is not associated with the medication.

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1."My ulcer will heal because these medications will kill the bacteria." 2."These medications are only taken when I have pain from my ulcer." 3."The medications will kill the bacteria and stop the acid production." 4."These medications will coat the ulcer and decrease the acid production in my stomach."

3."The medications will kill the bacteria and stop the acid production." Triple therapy for H. pylori infection usually includes 2 antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period? 1."When I can tolerate food without vomiting." 2."When my gastrointestinal system is healed enough." 3."When my bowels begin to function again, and I begin to pass gas." 4."When my primary health care provider says the tube can come out."

3."When my bowels begin to function again, and I begin to pass gas." NG tubes are discontinued when normal function returns to the gastrointestinal (GI) tract. Food would not be administered unless bowel function returns. The tube will be removed before GI healing. Although the primary health care provider (PHCP) determines when the NG tube will be removed, it does not determine effectiveness of teaching and the need for the NG tube.

The nurse is caring for a postoperative client who has just returned from surgery for creation of a colostomy. The nurse inspects the colostomy stoma and recognizes that which is a normal assessment finding for this client? 1.A pale color 2.A purple color 3.A brick-red color 4.A large amount of red drainage

3.A brick-red color Normal characteristics of a stoma include a rose to brick-red color indicating viable mucosa, mild to moderate edema during the initial postoperative period, and a small amount of oozing blood from the stoma mucosa (because of its high vascularity) when it is touched. A pale color may indicate anemia. A stoma that is dark red to purple indicates inadequate blood supply to the stoma or bowel due to adhesions, low blood flow state, or excessive tension on the bowel at the time of construction. A small amount of bleeding is considered normal, but a moderate to large amount of bleeding from the stoma mucosa could indicate coagulation factor deficiency, stomal varices secondary to portal hypertension, or lower gastrointestinal bleeding.

A client with gastritis asks the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse should tell the client that which medication is unlikely to cause epigastric distress? 1.Ibuprofen 2.Indomethacin 3.Acetaminophen 4.Naproxen sodium

3.Acetaminophen Analgesics, such as acetaminophen, are unlikely to cause epigastric distress. Ibuprofen, indomethacin, and naproxen sodium are nonsteroidal anti-inflammatory medications (NSAIDs) and are irritating to the gastrointestinal tract, so they should be avoided in clients with gastritis.

A client is taking lansoprazole. The nurse anticipates that the primary health care provider will advise the client to take which product if needed for a headache? 1.Naproxen 2.Ibuprofen 3.Acetaminophen 4.Acetylsalicylic acid

3.Acetaminophen Lansoprazole is a proton pump inhibitor and is commonly used to treat a gastrointestinal disorder. The client with gastrointestinal disease should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), which include naproxen and ibuprofen. The client should be advised to take acetaminophen for a headache.

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How should the nurse schedule the medications for administration? 1.Drink 8 ounces of water between taking each medication. 2.Administer the cimetidine and magnesium hydroxide at the same time twice daily. 3.Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide. 4.Collaborate with the primary health care provider (PHCP), as the client should not be receiving both medications.

3.Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide. Antacids, such as magnesium hydroxide, can decrease absorption of cimetidine. At least 1 hour should separate administration of an antacid and cimetidine. The remaining options are incorrect.

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1.Constipation 2.Abdominal pain 3.An episode of diarrhea 4.Hematest-positive nasogastric tube drainage

3.An episode of diarrhea Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1.Constipation 2.Abdominal pain 3.An episode of diarrhea 4.Hematest-positive nasogastric tube drainage

3.An episode of diarrhea Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the primary health care provider (PHCP). The nurse should contact the PHCP to question which prescription if noted in the client's record? 1.Maintain a semi-Fowler's position. 2.Maintain on NPO (nothing by mouth) status. 3.Apply a heating pad to the lower abdomen for comfort. 4.Initiate an intravenous (IV) line with the administration of IV fluids.

3.Apply a heating pad to the lower abdomen for comfort. Appendicitis should be suspected in a client with an elevated WBC count who is complaining of acute right lower quadrant abdominal pain. A semi-Fowler's position is maintained for comfort. The client would be on NPO status and given IV fluids in preparation for possible surgery. Heat should never be applied to the abdomen because this may increase circulation to the appendix, potentially leading to increased inflammation and perforation.

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1.Tremors 2.Dizziness 3.Confusion 4.Hallucinations

3.Confusion Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

The nurse instructs a client taking aluminum hydroxide that a common side or adverse effect associated with administration of this medication is which effect? 1.Cramping 2.Headache 3.Constipation 4.Muscle weakness

3.Constipation Aluminum-containing antacids are constipating, so the client should be instructed to take a stool softener or additional bulk-type laxatives to relieve this uncomfortable side effect. Cramping, headache, and muscle weakness are not side or adverse effects of this medication.

The nurse is caring for a client postoperatively after creation of a colostomy. What is an appropriate potential client problem? 1.Fear 2.Sexual dysfunction 3.Disturbed body image 4.Imbalanced nutrition: more than body requirements

3.Disturbed body image Disturbed body image for a client who is postoperative after creation of a colostomy relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). There are no data in the question to support sexual dysfunction or fear. Imbalanced nutrition: less (not more) than body requirements is the more likely client problem.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? 1.Clamp the T-tube. 2.Irrigate the T-tube. 3.Document the findings. 4.Notify the primary health care provider.

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

The medication history of a client with peptic ulcer disease reveals intermittent use of several medications. The nurse would teach the client that which of these medications are not a part of the treatment plan because of its irritating effects on the lining of the gastrointestinal tract? 1.Nizatidine 2.Sucralfate 3.Ibuprofen 4.Omeprazole

3.Ibuprofen

During a home care visit, an adult client complains of chronic constipation. What should the nurse tell the client to do? 1.Increase potassium in the diet. 2.Include rice and bananas in the diet. 3.Increase fluid and dietary fiber intake. 4.Increase the intake of sugar-free products.

3.Increase fluid and dietary fiber intake. Increase of fluid intake and dietary fiber will help change the consistency of the stool, making it easier to pass. Increasing the intake of rice and bananas will increase constipation. Increasing sugar-free products and potassium in the diet will not assist in alleviating constipation.

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, should the nurse question? 1.Digoxin 2.Furosemide 3.Indomethacin 4.Propranolol hydrochloride

3.Indomethacin Indomethacin is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Digoxin is a cardiac medication. Furosemide is a loop diuretic. Propranolol hydrochloride is a beta-adrenergic blocking agent. Digoxin, furosemide, and propranolol are not contraindicated in clients with gastric disorders.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? 1.Leg exercises 2.Early ambulation 3.Irrigating the nasogastric tube 4.Coughing and deep-breathing exercises

3.Irrigating the nasogastric tube In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the primary health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? 1.Ambulate following a meal. 2.Eat high-carbohydrate foods. 3.Limit the fluids taken with meals. 4.Sit in a high-Fowler's position during meals.

3.Limit the fluids taken with meals. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? 1.Blood in the stool 2.Chalky gray stool 3.Loose, watery stool 4.Dry, hard, constipated stool

3.Loose, watery stool Crohn's disease is characterized by nonbloody diarrhea of usually not more than 4 or 5 stools daily. Over time, the episodes of diarrhea increase in frequency, duration, and severity. Options 1, 2, and 4 are not characteristics of the stool in Crohn's disease.

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client? 1.Maintain a high-carbohydrate diet. 2.Increase fluid intake, particularly at mealtime. 3.Maintain a low-Fowler's position while eating. 4.Ambulate for at least 30 minutes following each meal.

3.Maintain a low-Fowler's position while eating. The client at risk for dumping syndrome should be instructed to maintain a low-Fowler's position while eating and lie down for at least 30 minutes after eating. The client also should be told that small, frequent meals are best and to avoid liquids with meals. Avoiding high-carbohydrate food sources also will assist in minimizing dumping syndrome.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the primary health care provider prescribing? 1.Enteral feedings 2.Fluid restrictions 3.Oral corticosteroids 4.Activity restrictions

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

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which manifestation of duodenal ulcer? 1.Weight loss 2.Nausea and vomiting 3.Pain relieved by food intake 4.Pain radiating down the right arm

3.Pain relieved by food intake A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the primary health care provider (PHCP)? 1.Hypotension 2.Bloody diarrhea 3.Rebound tenderness 4.A hemoglobin level of 12 mg/dL (120 mmol/L)

3.Rebound tenderness Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the PHCP.

A client is taking docusate sodium. Which finding by the nurse indicates that treatment has been effective? 1.Reduction in steatorrhea 2.Hematest-negative stools 3.Regular bowel movements 4.Absence of abdominal pain

3.Regular bowel movements Docusate sodium is a stool softener that promotes absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not decrease the amount of fat in the stools, stop gastrointestinal bleeding, or relieve abdominal pain.

A client who is taking a stimulant laxative develops abdominal cramps. The nurse interprets that this clinical manifestation most likely indicates the presence of which problem? 1.The client has peptic ulcer disease. 2.The client is experiencing a case of influenza. 3.This is a common side effect of this medication. 4.The client may have a partial bowel obstruction.

3.This is a common side effect of this medication. Stimulant laxatives commonly cause abdominal cramps as a side effect. The health problems noted in the other options are not determined based on a single symptom.

A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure? 1.Portal vein 2.Celiac artery 3.Vagus nerve 4. Pyloric valve

3.Vagus nerve Vagotomy is a procedure that can reduce innervation to the stomach, thereby reducing the production of gastric acid. The portal vein drains venous blood from the stomach. The celiac artery brings arterial blood to the stomach. The pyloric valve separates the stomach from the duodenum. The pyloric valve may undergo surgical repair if it becomes stenosed; this procedure is known as pyloroplasty.

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching? 1. "I know I can massage my abdomen." 2. "I will continue using antispasmodic medication." 3. "One of the best things I can do is use relaxation techniques." 4. "The best position for me is to lie supine with my legs straight."

4. "The best position for me is to lie supine with my legs straight." Pain associated with Crohn's disease is alleviated by the use of analgesics and antispasmodics and also by practicing relaxation techniques, applying local cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate inflamed intestinal tissues as the abdominal muscles are stretched.

The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed that the nasogastric tube be removed. What is the priority nursing assessment prior to removing the tube? 1. Checking for normal serum electrolyte levels 2. Checking for normal pH of the gastric aspirate 3. Checking for proper nasogastric tube placement 4. Checking for the presence of bowel sounds in all 4 quadrants

4. Checking for the presence of bowel sounds in all 4 quadrants Distention, vomiting, and abdominal pain are a few of the symptoms associated with intestinal obstruction. Nasogastric tubes may be used to remove gas and fluid from the stomach, relieving distention and vomiting. Bowel sounds return to normal as the obstruction is resolved and normal bowel function is restored. Discontinuing the nasogastric tube before normal bowel function may result in a return of the symptoms, necessitating reinsertion of the nasogastric tube. Serum electrolyte levels, pH of the gastric aspirate, and tube placement are important assessments for the client with a nasogastric tube in place but would not assist in determining the readiness for removing the nasogastric tube.

Sucralfate is prescribed for a client. The nurse determines that the client understands the instructions for medication administration if the client states to take the medication at what time? 1. At bedtime 2. One hour after meals 3. At noontime with a meal 4. One hour before meals and again at bedtime

4. One hour before meals and again at bedtime Sucralfate is an antiulcer medication that forms a barrier over the ulcer and protects against acid and pepsin. The medication should be taken 1 hour before meals and at bedtime to allow it to form a protective coating over the ulcer to prevent irritation from food, gastric acid, and mechanical movement. The other time frames are incorrect.

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD? 1. Recently retired from a job 2. Significant other has a gastric ulcer 3. Occasionally drinks 1 cup of coffee in the morning 4. Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

4. Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis Risk factors for PUD include Helicobacter pylori infection, smoking (nicotine), chewing tobacco, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress. When an NSAID is taken as often as is typical for osteoarthritis, it will cause problems with the stomach. Certain medical conditions such as Crohn's disease, Zollinger-Ellison syndrome, and hepatic and biliary disease also can increase the risk for PUD by changing the amount of gastric and biliary acids produced. Recent retirement should decrease stress levels rather than increase them. Ulcer disease in a first-degree relative also is associated with increased risk for an ulcer. A significant other is not a first-degree relative; therefore, no genetic connection is noted in this relationship. Although caffeinated drinks are a known risk factor for PUD, the option states that the client drinks 1 cup of coffee occasionally.

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of a gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis? 1."It's due to insufficient production of vitamin B12 in the colon." 2."Increased production of intrinsic factor in the stomach leads to this type of anemia." 3."Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." 4."Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

4."Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine." Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the small intestine. This vitamin is not produced or absorbed in the large intestine.

The nurse is performing an admission assessment on a client who has been admitted to the hospital with a diagnosis of suspected gastric ulcer. The nurse is asking the client questions about pain. Which client statement supports the diagnosis of gastric ulcer? 1. "The pain doesn't usually come right after I eat." 2. "The pain gets so bad that it wakes me up at night." 3. "The pain that I get is located on the right side of my chest." 4. "My pain comes shortly after I eat, maybe a half hour or so later."

4."My pain comes shortly after I eat, maybe a half hour or so later." Gastric ulcer pain often occurs in the upper epigastrium, with localization to the left of the midline, and may be exacerbated by intake of food. The pain occurs 30 to 60 minutes after a meal and rarely occurs at night. Duodenal ulcer pain is usually located to the right of the epigastrium. The pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often awakens the client at night.

A client has a prescription for sucralfate, orally 4 times daily. The nurse writes which schedule for this medication on the medication administration record? 1.Every 6 hours 2.With meals and at bedtime 3.1 hour after meals and at bedtime 4.1 hour before meals and at bedtime

4.1 hour before meals and at bedtime Sucralfate is prescribed to treat gastric ulcers. It should be scheduled for administration 1 hour before meals and at bedtime to allow it to form a protective coating over the gastric ulcer to prevent irritation by food, gastric acid, and mechanical movement of the stomach. The other options are incorrect.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1.Bradycardia 2.Numbness in the legs 3.Nausea and vomiting 4.A rigid, board-like abdomen

4.A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid-epigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment? 1.Bradycardia 2.Nausea and vomiting 3.Numbness in the legs 4.A rigid, board-like abdomen

4.A rigid, board-like abdomen The client with a large, deep duodenal ulcer is at risk for perforation of the ulcer. If this occurs, the client will experience sudden, sharp, intolerable, and severe pain beginning in the midepigastric area and spreading over the abdomen, which then becomes rigid and board-like. Tachycardia, not bradycardia, may occur as hypovolemic shock develops. Nausea and vomiting may not occur if the pyloric sphincter is intact. Numbness in the legs is not an associated finding.

The nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present? 1.A sunken and hidden stoma 2.A narrow and flattened stoma 3.A stoma that is dusky or bluish 4.A stoma that is elongated with a swollen appearance

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

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? 1.Carrots and ranch dip 2.Whole-grain cereal and milk 3.A cup of popcorn and a cola drink 4.Applesauce and a graham cracker

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

A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure? 1.Assessing pulses 2.Monitoring urine output 3.Monitoring for rectal bleeding 4.Assessing for the presence of the gag reflex

4.Assessing for the presence of the gag reflex Following the procedure, the client remains NPO (nothing by mouth) until the gag reflex returns, which is usually in 1 to 2 hours. The remaining options are not specific assessments related to this procedure.

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan? 1.Monitoring the temperature 2.Monitoring complaints of heartburn 3.Giving warm gargles for a sore throat 4.Assessing for the return of the gag reflex

4.Assessing for the return of the gag reflex The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also important; however, the client's airway is the priority.

The nurse should instruct a client with an ileostomy to include which action as part of essential care of the stoma? 1.Massage the area below the stoma. 2.Take in high-fiber foods such as nuts. 3.Limit fluid intake to prevent diarrhea. 4.Cleanse the peristomal skin meticulously.

4.Cleanse the peristomal skin meticulously. The peristomal skin must receive meticulous cleansing because ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. The area below the ileostomy may be massaged as needed if the ileostomy becomes blocked by high-fiber foods. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. Fluid intake should be at least 6 to 8 glasses of water per day to prevent dehydration.

A client is told by the primary health care provider to take aluminum hydroxide as needed for heartburn. The nurse advises the client to watch for which common side effect of this medication? 1.Dizziness 2.Excitability 3.Restlessness 4.Constipation

4.Constipation Because of the antacid's aluminum base, aluminum hydroxide causes constipation as a side effect. The other side effect is hypophosphatemia, which is noted by monitoring serum laboratory studies. The other options are not side effects of this medication.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? 1.Hypercalcemia 2.Hypernatremia 3.Frothy, fatty stools 4.Decreased hemoglobin

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

The nurse is caring for a client who has just returned from the operating room after the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment? 1.Apply ice to the stoma site. 2.Apply pressure to the stoma site. 3.Notify the primary health care provider (PHCP). 4.Document the amount and characteristics of the drainage.

4.Document the amount and characteristics of the drainage. During the first 24 to 72 hours following surgery, mucus and serosanguineous drainage are expected from the stoma. Applying ice or pressure to the stoma site are inappropriate actions. Notifying the PHCP is unnecessary because this is an expected finding.

A client who has been chronically taking acetylsalicylic acid (aspirin) for arthritis has been given a prescription for misoprostol. The nurse determines that the new medication is effective if the client states relief from which problem? 1.Diarrhea 2.Bleeding 3.Joint aches 4.Epigastric pain

4.Epigastric pain A client who chronically uses aspirin is prone to gastric mucosal injury, which causes epigastric pain as a symptom. Misoprostol is a gastric protectant specifically given to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Bleeding and joint aches are not relieved by misoprostol.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1.Folate deficiency 2.Malabsorption of fat 3.Intestinal obstruction 4.Fluid and electrolyte imbalance

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

A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse determines that which item mentioned by the client is most likely to be responsible for the exacerbation? 1.Sleeping 8 to 10 hours a night 2.Ability to work at home periodically 3.Eating 5 or 6 small meals per day 4.Frequent need to work overtime on short notice

4.Frequent need to work overtime on short notice Psychological or emotional stressors that exacerbate peptic ulcer disease may be found either at home or in the workplace. Of the items listed, the frequent need to work overtime on short notice is potentially the most stressful because it is the item over which the client has the least control. An ability to work at home periodically is not necessarily stressful because it allows increased client control over timing and location of work. Adequate rest and a proper dietary pattern (options 1 and 3) should alleviate symptoms, not worsen them.

A client is experiencing diarrhea. The nurse reviews the client's "as needed" (PRN) medication prescription sheet and should plan to administer which medication for this problem? 1.Psyllium 2.Bisacodyl 3.Sennosides 4.Loperamide

4.Loperamide Loperamide is an antidiarrheal agent. It inhibits peristalsis in the intestinal wall and inhibits intestinal secretion so that the number of stools and water content are decreased. Psyllium, bisacodyl, and sennosides are laxatives.

A client has an as-needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1.Paralytic ileus 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting

4.Nausea and vomiting Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1.With meals and at bedtime 2.Every 6 hours around the clock 3.One hour after meals and at bedtime 4.One hour before meals and at bedtime

4.One hour before meals and at bedtime Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body? 1.Bile 2.Parietal cells 3.Liver enzymes 4.Pancreatic juice

4.Pancreatic juice Pancreatic juice is rich is bicarbonate, which helps to neutralize the gastric acid in food entering the small intestine from the stomach. The duodenal papilla, which is an opening about 10 cm below the level of the pylorus, is responsible for carrying bile and pancreatic juices into the duodenum. Bile, parietal cells, and liver enzymes are not substances rich in bicarbonate and are incorrect.

A client who has undergone creation of a colostomy has a concern about body image. What action by the client indicates the most significant progress toward identified goals? 1.Looking at the ostomy site 2.Reading the ostomy product literature 3.Watching the nurse empty the ostomy bag 4.Practicing proper cutting of the ostomy appliance

4.Practicing proper cutting of the ostomy appliance The client is expected to have body image disturbance after colostomy. The client progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest degree of acceptance when he or she participates in the actual colostomy care. Each incorrect option represents an interest in colostomy care but is a passive activity. The correct option shows the client participating in self-care.

The nurse should anticipate that the primary health care provider (PHCP) will prescribe which treatment for a client with pernicious anemia? 1.Oral iron tablets 2.Blood transfusions 3.Gastric tube feedings 4.Vitamin B12 injections

4.Vitamin B12 injections A lack of the intrinsic factor needed to absorb vitamin B12 occurs in pernicious anemia. Vitamin B12 is needed for the maturation of red blood cells. Iron is used for anemia that results from a lack of iron. Blood transfusions are not needed for pernicious anemia because a lack of red blood cells is not the problem. Gastric tube feedings will not replace vitamin B12. Vitamin B12 needs to be given by injection to ensure absorption.

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1.Intestinal obstruction 2.Peptic ulcer with melena 3.Diverticulitis with perforation 4.Vomiting following cancer chemotherapy

4.Vomiting following cancer chemotherapy Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of vomiting after surgery, chemotherapy, or radiation.