gastrointestinal system

A client with carcinoma of the colon is scheduled for an abdominoperineal resection. What does preparation for the surgery include? Medications to promote diuresis Fluid restriction to 1 L daily Antibiotics to reduce intestinal bacteria Abdominal exercises to facilitate recovery

Antibiotics to reduce intestinal bacteria

After gastrointestinal surgery, a client's condition improves, and a regular diet is prescribed. Which food, included on a regular diet, should the nurse encourage the client to consume to decrease discomfort? Fresh fruit Baked fish Bran cereal Whole milk

Baked fish

A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question? Blood clotting Bone formation Muscle contraction Cellular membranes

Cellular membranes

After the surgical creation of an ileostomy, a client is transferred to a rehabilitation unit. The client asks for help in selecting breakfast. What should the nurse encourage the client to eat or drink? Hot coffee and oranges Shredded wheat and milk Toast and a western omelet Cream of wheat and bananas

Cream of wheat and bananas

An obese client asks the nurse how to lose weight. What should the nurse include in the response that explains when long-term weight loss occurs best? Fats are limited in the diet. Eating patterns are altered. Carbohydrates are restricted. Exercise is a major component.

Eating patterns are altered.

A client is scheduled for gastrointestinal surgery. What is the most important nursing action that should be implemented the evening before surgery? Describing the specific surgical procedure Ensuring the bowel preparation is initiated Encouraging the client to socialize with other clients Providing the client's food preferences for the evening meal

Ensuring the bowel preparation is initiated

A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease? Esophageal pain may imitate the symptoms of a heart attack. GERD may predispose to heart disease. Strenuous exercise may exacerbate both cardiac and reflux problems. Similar changes in laboratory studies may occur in both cardiac and reflux problems.

Esophageal pain may imitate the symptoms of a heart attack.

A client has a permanent sigmoid colostomy as a result of cancer of the rectum. The primary healthcare provider prescribes daily colostomy irrigations. What does the nurse explain is the primary purpose of these irrigations? Prevent straining at passage of stool Establish a regular elimination schedule Decrease the amount of flatus in the bowel Limit the amount of fluid lost from the intestine

Establish a regular elimination schedule

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 avoid? . Football Swimming Ice hockey Track events Cross-country skiing

Football Ice hockey

A client experiences occasional right upper quadrant pain attributed to cholecystitis. The nurse is providing discharge instructions, including a list of foods that cause dyspepsia. Which foods should be on the list the nurse provided the client? Nuts and popcorn Meatloaf and baked potato Chocolate and boiled shrimp Fried chicken and buttered corn

Fried chicken and buttered corn

A nurse provides dietary teaching about a low-sodium diet for a client with hypertension. Which nutrient selected by the client indicates a correct understanding about foods that are low in natural sodium? Milk Meat Fruits Vegetables

Fruits

For which clinical indicator associated with a complication of portal hypertension should the nurse assess the client? Liver abscess Intestinal obstruction Perforation of the duodenum Hemorrhage from esophageal varices

Hemorrhage from esophageal varices

A client develops gastric bleeding and is hospitalized. Which area should the nurse assess most closely during the history? Usual dietary pattern Recent travel to other countries Medications taken routinely or recently A change in the status of family relationships

Medications taken routinely or recently

A client with a 20-year history of excessive alcohol use is admitted to the hospital with jaundice and ascites. What is the priority nursing action during the first 48 hours after the client's admission? Monitor the client's vital signs. Increase the client's fluid intake. Improve the client's nutritional status. Determine the client's reasons for drinking.

Monitor the client's vital signs.

A nurse is assessing a client for dehydration. The client has had diarrhea and vomiting for 48 hours. Which assessment findings alert the nurse that the client is dehydrated? Protruding eyeballs Postural hypotension The client reporting eating an average of three meals daily The skin on the client's forehead remains tented after being pinched Within four days, the client gained two pounds (0.9 kg) of weight

Postural hypotension The skin on the client's forehead remains tented after being pinched

A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, what would the nurse expect to observe? Melena Steatorrhea Hard, dry stool Ribbon-shaped stool

Steatorrhea

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?" What response by the nurse is the best? "It's a good idea to explore other acceptable treatments for your cancer. There is information available for you." "Surgery is the recommended approach. Why don't you discuss this further with the healthcare provider?" "Maybe you will be more confident with a second opinion. I think you need a referral to another healthcare provider." "With your disease your prognosis will improve if you follow the suggestion to have the recommended surgery."

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

Before discharge, a client with a colostomy questions the nurse about resuming prior activities. What is the nurse's best response? "Most sporting activities, except for swimming, can be resumed based on your overall physical condition." "With guidance, a near normal lifestyle, including complete sexual function, is possible." "Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency." "After surgery, drastic changes in lifestyle must be made to accommodate the physiologic changes caused by the operation."

"With guidance, a near normal lifestyle, including complete sexual function, is possible."

A high cleansing enema is prescribed for a client. What is the maximum height at which the container of fluid should be held by the nurse when administering this enema? 30 cm (12 inches) 37 cm (15 inches) 51 cm (20 inches) 66 cm (26 inches)

37 cm (15 inches) For a high colonic enema, the fluid must extend higher in the colon. If the height of the enema fluid container above the anus is increased, the force and rate of flow also increase. 30 cm (12 inches) is too low for a cleansing enema. The heights of 51 cm (20 inches) and 66 cm (26 inches) are too high and may cause mucosal injury.

Immediately after a liver biopsy, a client is placed onto the right side. What rationale does the nurse give for this positioning? Decrease pain to provide comfort Support erythropoiesis to increase red blood cell production Compress blood vessels to prevent bleeding Expel fluid trapped in the biliary ducts to promote drainage

compress blood vessels to prevent bleeding

Immediately after a subtotal gastrectomy, a client is admitted to the postanesthesia care unit (PACU). The nurse irrigates the nasogastric tube and observes small blood clots in the return. Which is the best nursing intervention? Clamp the nasogastric tube Irrigate the tube with iced saline Document this expected response Notify the healthcare provider of this finding

document this expected response

A nurse is caring for a client who just had a liver biopsy. After the procedure, the nurse should monitor for which common complication associated with the biopsy? Hemorrhage Gastroparesis Pulmonary embolism Tension pneumothorax

hemorrhage

A client is admitted to the hospital after taking an overdose of aspirin. A nasogastric tube is inserted for lavage. Which solution should the nurse obtain for the gastric lavage? Normal saline Lactated Ringer Citrate magnesium Sodium bicarbonate

normal saline

The nurse is providing care to a client with ascites secondary to liver failure. What is appropriate to include in this client's care? High protein diet Low sodium diet Daily abdominal girth measurements Encourage increased by mouth fluid intake Daily weights

ow sodium diet Daily abdominal girth measurements Daily weights

An older client comes to the emergency department after three days of diarrhea and is admitted to the hospital for rehydration therapy. In addition to sodium, what electrolyte should the nurse be concerned about most when the client's laboratory results are documented? Calcium Chlorides Potassium Phosphates

potassium

A teenager is admitted with an acute onset of right lower quadrant pain at McBurney point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis? Urinary retention Gastric hyperacidity Rebound tenderness Increased lower bowel motility

rebound tenderness

The mother of a large family asks the home health nurse for inexpensive sources of B vitamins. Which suggestion should the nurse make? "Eat more red meat." "Bake with whole wheat flour." "Include more eggs in the diet." "Sprinkle organic wheat germ on casseroles."

"Bake with whole wheat flour."

A client is experiencing chronic constipation, and the nurse discusses how to include more bulk in the diet. Which statement by the client indicates teaching by the nurse is successful? "Bulk promotes defecation by irritating the bowel wall." "Bulk promotes defecation by stimulating the intestinal mucosa chemically." "Bulk promotes defecation by acting on the microorganisms in the large intestine." "Bulk promotes defecation by absorbing water, which softens stool and promotes peristalsis."

"Bulk promotes defecation by absorbing water, which softens stool and promotes peristalsis."

Discharge planning for a client with chronic pancreatitis includes dietary teaching. Which statement indicates to the nurse that the client needs more teaching? "I must eat foods high in calories." "I should avoid alcoholic beverages." "I will eat more often but in smaller amounts." "I can eat foods high in fat now that the acute stage is over."

"I can eat foods high in fat now that the acute stage is over."

A client had a cholecystectomy and asks whether there will be any dietary restrictions after the client's discharge. The nurse evaluates that the dietary teaching is understood when the client makes what comment to a family member? "I should avoid fatty foods for the rest of my life." "I should not eat those foods that upset me before I had surgery." "I need to eat a high-protein diet for several months, and I should follow a sodium restriction diet." "I need to eat smaller amounts of food at a time, and they should contain low to moderate fats."

"I need to eat smaller amounts of food at a time, and they should contain low to moderate fats."

A client with cancer of the colon had surgery for a resection of the tumor and the creation of a colostomy. During the six-week postoperative checkup, the nurse teaches the client about nutrition. Which response by the client indicates learning has taken place? "I should follow a diet that is rich in protein." "I should follow a diet that is low in sodium content." "I should follow a diet that is as close to usual as possible." "I should follow a diet that is higher in calories than before."

"I should follow a diet that is as close to usual as possible."

The nurse provides dietary teaching for a client with a colostomy. Which response by the client is indicative of successful learning? "I will eat food low in fiber so that there is less stool." "I will eat bland foods so that my intestines do not become irritated." "I will eat everything I ate before the operation and avoid foods that cause gas." "I will eat soft foods that are more easily digested and absorbed by my large intestine."

"I will eat everything I ate before the operation and avoid foods that cause gas."

The nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which statement by the client indicates a good understanding of preventing dumping syndrome after meals? "I will eat a bland diet." "I will not drink fluids when I eat meals." "I will avoid sweetened and spicy foods." "I will eat a low-protein, high-carbohydrate diet." "I will eat small, frequent meals instead of three large meals a day."

"I will not drink fluids when I eat meals." "I will avoid sweetened and spicy foods." "I will eat small, frequent meals instead of three large meals a day."

A nurse is teaching a client about gastroesophageal reflux disease (GERD). Which statement made by the client indicates correct understanding of GERD management? "Three meals per day is the best regimen to avoid GERD symptoms." "I can reduce my GERD symptoms through a high-carbohydrate, low-fat diet." "A snack at bedtime will help reduce the acidity of my stomach during the night." "I will place a 6-inch (15 cm) block under the head of my bed to help with digestion."

"I will place a 6-inch (15 cm) block under the head of my bed to help with digestion."

An older 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? "The other person's infection is not contagious." "This is the usual practice when antibiotic therapy is started." "It is safe to place people with the same infection in one room." "As soon as a private room becomes available we will move her."

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

During a health symposium a nurse teaches the group how to prevent food poisoning. Which statement by one of the participants indicates the teaching is understood? "Meats and cream-based foods need to be refrigerated." "Once most food is cooked, it does not need to be refrigerated." "Poultry should be stuffed and then refrigerated before cooking." "Cooked food should be cooled before being put into the refrigerator."

"Meats and cream-based foods need to be refrigerated."

A client with cirrhosis is scheduled for a liver biopsy. The client asks if there are any risks after the procedure. Which response by the nurse is the best? "There are relatively no risks associated with this procedure." "The major risk is infection at the biopsy site." "The major risk is bleeding postprocedure." "The major risk is liver failure postprocedure."

"The major risk is bleeding postprocedure."

A client who had a severe weight loss is told the importance of eating more protein to provide the essential amino acids. The client asks the nurse why these substances in protein foods are "essential." How should the nurse respond? "They will give you the added energy you need." "They contain the necessary nitrogen you need for healing." "They are essential for rebuilding your body tissue protein." "They must come from your food because your body cannot make them."

"They must come from your food because your body cannot make them."

A client who was admitted with severe abdominal pain and vomiting states, "I know I am very sick. Do you think I have cancer?" What is the best response by the nurse? "You must be upset to think that you have cancer." "Did you receive information about what therapy will be prescribed?" "Your primary healthcare provider will need to talk with you about that." "What are your feelings about the diagnosis of cancer?"

"What are your feelings about the diagnosis of cancer?"

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." "Surgery will temporarily decrease your sexual impulses." "Your sexual activity must be curtailed for several weeks." "Partners should be told about the surgery before any sexual activity."

"You will be able to resume usual sexual relationships." Surgery on the bowel has no direct anatomic or physiologic effect on sexual performance. However, psychologic factors may hamper this function, and the nurse should encourage verbalization. Although it may take several months to resume satisfying sexual relationships, the surgery has no direct physiologic effect. There is no reason why sexual activity must be curtailed. Although a partner should understand the nature of the surgery, the focus at this time should be on the client.

In the immediate postoperative period after a gastrectomy, the client's nasogastric tube is draining a light-red liquid. How long should the nurse expect this type of drainage? 1 to 2 hours 3 to 4 hours 10 to 12 hours 24 to 48 hours

10 to 12 hours

The diet prescribed for a client allows for 190 grams of carbohydrates, 90 grams of fat, and 100 grams of protein. The nurse calculates that this diet contains approximately how many calories? 920 1970 2470 2970

1970

A client who is about to have a blood transfusion asks the nurse, "Which type of hepatitis is most frequently transmitted thru food?" The nurse should respond, "The type of hepatitis associated with food is hepatitis: A." B." C." D."

A

A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease? An ache radiating to the left side An intermittent colicky flank pain A gnawing sensation relieved by food A generalized abdominal pain intensified by moving

A gnawing sensation relieved by food

The postoperative diet prescription for a client who had a colostomy states, "Diet as tolerated." Which principle should the nurse include in the teaching plan to help guide the client with food choices? Specific foods will cause most clients the same discomfort. A low-residue diet should be followed to avoid overstimulating the intestine. More rigid dietary rules limiting food choices are needed to provide security. A return to a regular diet as soon as possible promotes physical rehabilitation.

A return to a regular diet as soon as possible promotes physical rehabilitation.

A nurse is caring for a client who had a gastroscopy. What response indicates a major complication associated with this surgery? Projectile vomiting Increased gastrointestinal (GI) motility Abdominal distention Difficulty swallowing

Abdominal distention

A nurse is caring for a client who had surgery for the formation of a continent urostomy. The nurse engages the client in early postoperative ambulation to prevent what complication? Wound infection Urinary retention Abdominal distention Incisional evisceration

Abdominal distention

A client with cancer of the colon is admitted to the hospital for a hemicolectomy. What does the nurse expect the preoperative plan of care to include? Giving oil-retention enemas daily for two days preoperatively Administering cleansing enemas and then neomycin Having a Sengstaken-Blakemore tube at the bedside A high-protein and high-carbohydrate regular diet for two days preoperatively

Administering cleansing enemas and then neomycin

A client is admitted to the hospital for the implantation of radon seeds in the oral cavity. Which intervention is most important when the nurse is caring for this client after the procedure? Providing a regular diet within two days Administering nursing care in a short period Giving frequent mouth care at least four times daily Having a member of the family stay with the client continually

Administering nursing care in a short period

A nurse is providing teaching to a client who is learning how to self-administer gastrostomy tube feedings. What should the teaching include? Administering water after the feeding is completed Maintaining the supine position during the feeding Heating the feeding to slightly above body temperature Determining tube placement by instilling water before the feeding

Administering water after the feeding is completed

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 Culture and sensitivity White blood cell count Alanine aminotransferase (ALT) level

Ammonia level

What should the nurse do when caring for a client with an ileostomy? Teach the client to eat foods high in residue. Explain that drainage can be controlled with daily irrigations. Expect the stoma to start draining on the third postoperative day. Anticipate that any emotional stress can increase intestinal peristalsis.

Anticipate that any emotional stress can increase intestinal peristalsiis

Following surgery, a client asks the nurse to help with measuring intake and output. What is the best nursing response? Determine the client's willingness to really help Identify the client's reason for wanting to do this task Assess the client's ability to measure the intake and output Explain that measuring intake and output is the responsibility of the nurse

Assess the client's ability to measure the intake and output

A client is admitted to the hospital after two days of painful abdominal spasms and severe diarrhea. What appropriate sequence does the nurse use to examine the client's abdomen, starting with "inspection"? Percussion, palpation, auscultation Palpation, percussion, auscultation Auscultation, palpation, percussion Auscultation, percussion, palpation

Auscultation, percussion, palpation

A primary healthcare provider prescribes three stool specimens for occult blood for a client who complains of blood-streaked stools and a 10-pound (4.5 kg) weight loss in one month. To ensure valid test results, what instructions should the nurse give the client? Avoid eating red meat before testing Test the specimen while it is still warm Discard the day's first stool and use the next three stools Take three specimens from different sections of the fecal sample

Avoid eating red meat before testing

A client with a recent colostomy expresses concern about the inability to control the passage of gas. What precaution should the nurse teach the client to take? Eliminate foods high in cellulose Decrease fluid intake at mealtimes Avoid foods that in the past caused flatus Adhere to a bland diet before social events

Avoid foods that in the past caused flatus

A client, experiencing an exacerbation of Crohn disease, is admitted to the hospital for intravenous steroid therapy. The nurse should not assign this client to a room with a roommate who has which illness? Pancreatitis Thrombophlebitis Bacterial meningitis Acute cholecystitis

Bacterial meningitis The bacteria that cause meningitis are transmitted via air currents; the client should be in a private room with airborne precautions to protect other people. Pancreatitis is not a communicable disease; it is most often caused by autodigestion of pancreatic tissue by its own enzymes. Thrombophlebitis is not a communicable disease; it is inflammation of a vein (phlebitis) associated with thrombus formation. Cholecystitis is not a communicable disease; it is inflammation of the gallbladder.

A client is admitted to the hospital for a needle biopsy of the liver. A diagnosis of cancer of the liver is suspected. What should the nurse include in the client's preoperative teaching plan? Midline abdominal incision will be used. Bed rest must be maintained after the procedure. General anesthesia will be used during the biopsy. Supine position will be maintained after the procedure.

Bed rest must be maintained after the procedure.

A client has a surgically created colostomy. What is the most effective nursing intervention initially to help the client accept the colostomy? Provide literature containing factual data about colostomies. Ask a member of a support group to come to speak with the client. Begin to teach self-care of the colostomy by introducing equipment. Point out the number of important people who have had colostomies.

Begin to teach self-care of the colostomy by introducing equipment.

The nurse providing immediate postoperative care to a client who had an abdominoperineal resection should assess for which clinical indicator of complications? Blood in the NG tube Return of bowel sounds Absence of output from the stoma Bloody drainage on the abdominal and rectal dressings

Bloody drainage on the abdominal and rectal dressings

A client just has returned from the postanesthesia care unit after having a laparotomy. Which initial sign or symptom indicates to the nurse that peristalsis has begun to return? Stool is evacuated. Nausea is no longer present. Borborygmi are auscultated. Abdomen is no longer tender.

Borborygmi are auscultated.

The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess? Urine Stool Hands Breath

Breath

A client develops steatorrhea with malabsorption syndrome. How will the nurse document this finding in the client's medical record? Dry and rock-hard Clay-colored and pasty Bulky and foul-smelling Black and blood-streaked

Bulky and foul-smelling

A client had a laparoscopic 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? Wash the puncture sites with strong soap and hot water daily. Call the healthcare provider if you have a fever of 100 o F (37.8 oC) or more for two days. Remove the tape-strips over the puncture sites one week after surgery. Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage. Ease the discomfort from the gas used to insufflate the abdomen during surgery by applying a heating pad to the left shoulder.

Call the healthcare provider if you have a fever of 100 o F (37.8 oC) or more for two days. Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage.

A client is admitted via the emergency department with the tentative diagnosis of diverticulitis. Which test commonly is prescribed to assess for this problem? Computed tomography (CT) scan Gastroscopy Colonoscopy Barium enema

Computed tomography (CT) scan A CT scan with contrast is the test of choice for diverticulitis because it effectively reflects the involved colon. A gastroscopy assesses the upper, not lower, gastrointestinal tract. Colonoscopy is contraindicated because of the possibility of perforation and peritonitis. Barium enema is contraindicated because of the possibility of perforation and peritonitis.

The nurse is caring for a client in the postanesthesia care unit immediately after the client had a subtotal gastrectomy. The nurse identifies small blood clots in the client's gastric drainage. What action should the nurse take? Clamp the tube. Consider this an expected event. Instill the tube with iced normal saline. Notify the surgeon immediately.

Consider this an expected event.

Following a cholecystectomy to remove a cancerous gallbladder, the client has a T-tube in place. The T-tube drains 300 mL of bile-colored fluid during the first 24 hours after surgery. What should the nurse do? Clamp the tube intermittently to slow the drainage. Increase the rate of intravenous fluids to compensate for this loss. Empty the portable drainage system and reestablish negative pressure. Consider this an expected response after surgery and record the results.

Consider this an expected response after surgery and record the results. The T-tube provides an outlet for bile produced by the liver and is expected to drain 300 to 500 mL in the first day. Clamping the tube during the early postoperative period may cause a buildup of pressure and leakage of bile into the peritoneum. The healthcare provider prescribes the rate of fluid administration. Drainage from the T-tube is by gravity; negative pressure is not applied.

A nurse is caring for a client with severe gastritis who vomited a large amount of blood. A lavage is prescribed by the healthcare provider. Which response does the nurse expect when using a room temperature irrigating solution? Coagulation of blood Neutralization of acids Constriction of blood vessels Stimulation of the vagus nerve

Constriction of blood vessels

A nurse is providing instructions to a client who is scheduled for a colonoscopy. What drink does the client indicate should be avoided several days before the test if these instructions are understood? Ginger ale Apple juice Cranberry juice Lemon-lime soda

Cranberry juice

A low-residue diet is recommended for a client. Which food should the nurse encourage the client to select from a menu? Steamed broccoli Creamed potatoes Raw spinach salad Baked sweet potato

Creamed potatoes

Which client response during the insertion of a nasogastric tube indicates to the nurse that the client is experiencing serious difficulty with the insertion? Choking Redness Gagging Cyanosis

Cyanosis

The nurse understands that research demonstrates that malnutrition occurs in as many as 50% of hospitalized clients. The nurse should assess a postoperative client with anorexia for what sign of malnutrition? Dependent edema Spoon-shaped nails Loose, decayed teeth Delayed wound healing

Delayed wound healing

A client with a history of food intolerance has abdominal pain, abdominal distention, and a feeling of fullness. The client is admitted to the hospital for diagnostic testing. What specific information should the nurse collect when performing the nursing admission history and physical? Client's food preferences Presence of clay-colored stools Amount of splinting by the client Detailed characteristics of the pain

Detailed characteristics of the pain

A nurse is providing discharge teaching for a client who recently had surgery for an abdominal perineal resection of the colon and the creation of a colostomy. Which condition will the nurse share with the client for when to call the healthcare provider immediately? Intestinal cramps during fluid inflow Difficulty inserting the irrigation tube Passage of flatus during expulsion of feces An inability to complete the procedure in one hour

Difficulty inserting the irrigation tube

A client has had two weeks of bile drainage from a T-tube following the client's cholecystectomy. To monitor for a lack of fat-soluble vitamins, the nurse should observe for what symptom? Easy bruising Muscle twitching Excessive jaundice Tingling of the fingers

Easy bruising Phytonadione, a precursor for prothrombin, cannot be absorbed without bile. Muscle twitching is commonly related to electrolyte imbalances, not fat-soluble vitamin deficiency. Jaundice results from a backup of bile, not a deficiency of fat-soluble vitamins. Tingling of the fingers may be related to electrolyte imbalances or deficiency of B vitamins, which are water soluble.

A client with cancer of the stomach is admitted to the hospital and scheduled for a subtotal gastrectomy. The nurse is providing preoperative teaching. What should the nurse teach the client to do postoperatively to minimize the complication of dumping syndrome? Ambulate after every meal. Remain on a diet low in fat. Eat 5 or 6 small meals a day. Increase fluid intake when eating food.

Eat 5 or 6 small meals a day.

Following a subtotal gastrectomy, the client reports perspiration and epigastric discomfort that occurs approximately 30 minutes after eating a meal. The client states the symptoms disappear within a few minutes. What would be appropriate for the nurse to include in the client teaching to prevent this complication? Rest before eating each meal. Increase fluids with each meal. Avoid spicy, gas-forming meals. Eat small, low-carbohydrate meals.

Eat small, low-carbohydrate meals.

A client with the diagnosis of ulcerative colitis has surgery for the creation of an ileostomy. Postoperatively, for which potential life-threatening complication should the nurse assess the client? Wound infection Ischemia of the stoma Electrolyte imbalances Excoriation of skin around the stoma

Electrolyte imbalances

A healthcare provider schedules a paracentesis. What should the nurse instruct the client to do to prepare for the procedure? Empty the bladder before the procedure. Take a laxative the evening before the procedure. Ingest nothing by mouth for eight hours before the procedure. Self-administer a low soapsuds enema two hours before the procedure.

Empty the bladder before the procedure.

A client who had surgery for a ruptured appendix develops peritonitis. Which clinical findings related to peritonitis should the nurse expect the client to exhibit? . Fever Hyperactivity Extreme hunger Urinary retention Abdominal muscle rigidity

Fever Abdominal muscle rigidity

A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn disease. Which expected outcome is most important for this client? Does skin care Takes oral fluids Experiences less abdominal cramping Gains a half pound (0.2 kilograms) per week

Gains a half pound (0.2 kilograms) 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 Bowel puncture Abdominal infection Postoperative flatulence

Graft leakage During the first 24 hours after surgery, a sudden increase in abdominal girth most likely is graft related and needs to be investigated. Bowel puncture is a remote possibility but will present with classic signs (e.g., boardlike abdomen, abdominal pain) other than increasing abdominal girth. It is too early for an infection to manifest signs and symptoms. It is too early for postoperative flatulence to occur.

A client is instructed to avoid straining on defecation postoperatively. Which food item chosen by the client indicates successful learning? Ripe bananas Milk products Green vegetables Creamed potatoes

Green vegetables

During a client's paracentesis, 1500 mL of fluid is removed. The nurse monitors the client for which sign of a potentially severe response? Abdominal girth decrease Mucous membranes becoming drier Heart rate increases from 80 to 135 Blood pressure rises from 130/70 to 190/80

Heart rate increases from 80 to 135

A nurse is caring for several postoperative clients who had abdominal surgery. What independent nursing intervention can help prevent the development of thrombophlebitis? Encouraging adequate fluids Massaging the client's legs gently Applying sequential compression devices Helping the client to perform in-bed exercises

Helping the client to perform in-bed exercises

A client is admitted to the hospital with a diagnosis of peptic ulcer. Which most common complication should the nurse assess for in this client? Perforation Hemorrhage Pyloric obstruction Esophageal varices

Hemorrhage

An older client's colonoscopy reveals the presence of extensive diverticulosis. Which type of diet should the nurse encourage the client to follow? Low-fat High-fiber High-protein Low-carbohydrate

High-fiber

A client is being considered for bariatric surgery. Which client health problem does the nurse identify as consistent with morbid obesity? Dumping syndrome Compartment syndrome Hypoventilation syndrome Inappropriate antidiuretic hormone syndrome (ADH)

Hypoventilation syndrome

What information from a client's history should the nurse identify as risk factors for the development of colon cancer? Hemorrhoids Increased age High-fiber diet Ulcerative colitis Low hemoglobin level

Increased age Ulcerative colitis

The nurse provides education related to the relationship between aerobic exercise and weight loss to an obese client. The nurse evaluates that teaching is effective when the client states which effect of exercise? Decreases my appetite Decreases my metabolic rate Increases my lean body mass Increases my resting heart rate

Increases my lean body mass

A client has been diagnosed with cholelithiasis. Which fact about cholelithiasis should the nurse recall when assessing this client for risk factors? Men are more likely to be affected than women. Young people are affected more frequently than older people. Individuals who are obese are more prone to this condition than those who are thin. People who are physically active are more apt to develop this condition than those who are sedentary.

Individuals who are obese are more prone to this condition than those who are thin.

A client with a history of Crohn disease develops an intestinal obstruction. A nasogastric tube is inserted and connected to low continuous suction. The nurse monitors the client for fluid volume deficit. What clinical finding does the nurse expect if the client becomes dehydrated? Restlessness Constipation Inelastic skin turgor Increased blood pressure

Inelastic skin turgor

A nurse designs a health education program specifically for a client who had a gastrectomy. What should this plan include? Information about how to limit and prevent dumping syndrome An explanation of the therapeutic effect of a high-roughage diet A list of foods that cause gas in the intestine and how to avoid them Encouragement to resume previous eating habits as soon as possible

Information about how to limit and prevent dumping syndrome

A client admitted to the hospital with a small bowel obstruction is to have an intestinal tube inserted. When preparing the client for the procedure, what action should the nurse take? Place the client in the right side-lying position Instruct the client about techniques for mouth breathing Spray the client's oropharynx with a local anesthetic solution Reassure the client that the procedure will not cause discomfort

Instruct the client about techniques for mouth breathing

A client develops a gallstone that becomes lodged in the common bile duct and is scheduled for an endoscopic sphincterotomy. The client asks about what type of anesthesia will be used for the procedure. What type of anesthesia does the nurse describe? Spinal anesthetic Epidural block General anesthesia Intravenous sedative

Intravenous sedative

A client with an acute episode of ulcerative colitis is admitted to the hospital. Blood studies reveal that the chloride level is low. What should the nurse be prepared to administer? A low-residue diet Intravenous therapy Total parenteral nutrition An oral electrolyte solution

Intravenous therapy

A nurse is assisting a healthcare provider to perform a sigmoidoscopy. In which position should the nurse place the client for this procedure? Sims Prone Lithotomy Knee-chest

Knee-chest Knee-chest position maximally exposes the rectal area and facilitates entry of the sigmoidoscope. The Sims position does not expose the rectal area to the same extent as does the knee-chest position; it can be used for a sigmoidoscopy if a client is unable to maintain the knee-chest position. Although prone refers to a facedown position, the rectal area is not exposed. The lithotomy position is appropriate for gynecologic examinations.

A nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. Which risk factor commonly associated with cancer of the tongue should the nurse assess when collecting the client's history? Nail biting Poor dental habits Frequent gum chewing Large consumption of alcohol

Large consumption of alcohol

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? . Halitosis Leukoplakia Bleeding gums Substernal pain Alterations in taste Enlarged cervical lymph nodes

Leukoplakia Alterations in taste Enlarged cervical lymph nodes

A client is admitted to the hospital with jaundiced skin and acute abdominal pain. What is the nurse's most therapeutic response when the client refuses all visitors? Listen to the client's fears Encourage the client to socialize Grant the client's request about visitors Darken the client's room by pulling the drapes

Listen to the client's fears

The nurse is providing postoperative care for a client who had an extensive surgical revision of the head of the pancreas. To decrease the risk of hemorrhage at the operative site, what action should the nurse take? Keep the client in the supine position. Maintain patency of the nasogastric tube. Replace fat-soluble vitamins as necessary. Administer prescribed tube feedings to the client slowly.

Maintain patency of the nasogastric tube.

A client is admitted to the hospital with a diagnosis of Crohn disease. What is most important for the nurse to include in the teaching plan for this client? Controlling constipation Meeting nutritional needs Preventing increased weakness Anticipating a sexual alteration

Meeting nutritional needs To avoid gastrointestinal pain and diarrhea, these clients often refuse to eat and become malnourished. The consumption of a high-calorie, high-protein diet is advised. Diarrhea, not constipation, is a problem with Crohn disease. Preventing an increase in weakness is a secondary concern that results from malnutrition; correcting the malnutrition will increase strength. Anticipating a sexual alteration generally is not a problem with Crohn disease.

A client is hospitalized after four days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, Pco 2 50 mm Hg, bicarbonate 58 mEq/L (58 mmol/L), chloride 55 mEq/L (55 mmol/L), sodium 132 mEq/L (132 mmol/L), and potassium 3.8 mEq/L (3.8 mmol/L). What condition does the nurse determine the results to indicate? Hypernatremia Hyperchloremia Metabolic alkalosis Respiratory acidosis

Metabolic alkalosis

After a client has a total gastrectomy, the nurse plans to include in the discharge teaching the need for what treatment? Monthly injections of cyanocobalamin Regular daily use of a stool softener Weekly injections of iron dextran Daily replacement therapy of pancreatic enzymes

Monthly injections of cyanocobalamin

A nurse is caring for a postoperative client who has a nasogastric tube attached to low continuous suction. Which assessment findings indicate that the client may be experiencing hypokalemia? Tingling of the fingertips and toes Dry and sticky mucous membranes Abdominal cramping and irritability Muscle weakness and cardiac dysrhythmias

Muscle weakness and cardiac dysrhythmias

a client is diagnosed with celiac disease. Which foods should the nurse teach the client to avoid? . Corn Cheese Oatmeal Rye bread Fruit juice

Oatmeal Rye bread

A client is admitted to the hospital for the surgical repair of an incarcerated indirect inguinal hernia. What is the primary preoperative nursing intervention for this client? Placing the client in the supine position Observing the client's bowel movements Monitoring the client's serum enzyme levels Teaching the client about the need to cough postoperatively

Observing the client's bowel movements

A client is admitted to the hospital with jaundice. After numerous diagnostic tests, the healthcare provider makes the diagnosis of cancer of the pancreas. What does the nurse conclude is the most likely cause of the client's jaundice? Necrosis of the parenchyma caused by the neoplasm Excessive serum bilirubin caused by red blood cell destruction Obstruction of the common bile duct by the pancreatic neoplasm Impaired liver function, resulting in incomplete bilirubin metabolism

Obstruction of the common bile duct by the pancreatic neoplasm

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? Assist the client to ambulate. Obtain the client's vital signs. Administer the prescribed analgesic. Encourage using the incentive spirometer.

Obtain the client's vital signs.

Twelve hours after a subtotal gastrectomy, a nurse identifies large amounts of bloody drainage from the client's nasogastric (NG) tube. Which action should the nurse take? Obtain vital signs Clamp the NG tube Instill 30 mL of iced normal saline into the NG tube Record the observations and continue monitoring the client

Obtain vital signs

A client is diagnosed with gastric cancer, and a subtotal gastrectomy is performed. After surgery the client begins to hemorrhage. What clinical findings support the nurse's conclusion that the client is experiencing hypovolemic shock? . Oliguria Bradypnea Diaphoresis Tachycardia Hypertension

Oliguria Diaphoresis Tachycardia

A nurse is caring for a client with chronic inflammation of the bowel. Which most serious complication should the nurse monitor for in this client? Ileus Pain Perforation Obstruction

Perforation

Which is the priority intervention for the dependent client with peptic ulcer disease (PUD) who is vomiting bright red blood? Apply oxygen Place the client in a side-lying position Prepare to administer packed red blood cells Assess the client's pulse and blood pressure

Place the client in a side-lying position

After a subtotal gastrectomy a client is returned to the surgical unit. Which is the best nursing action to prevent pulmonary complications? Ambulating the client to increase respiratory exchange Promoting frequent turning and deep breathing to mobilize secretions Maintaining a consistent oxygen flow rate to increase oxygen saturation Keeping a plastic airway in place to ensure patency of the client's airway

Promoting frequent turning and deep breathing to mobilize secretions

A nurse assists a client who had bariatric surgery to be more mobile. What complication is the nurse attempting to prevent? Incisional pain Wound dehiscence Anastomosis leakage Pulmonary embolism

Pulmonary embolism Immobility contributes to venous stasis, which can cause deep vein thrombosis and pulmonary embolism. Insufficient mobility does not contribute to incisional pain; incisional pain contributes to immobility. Stressors commonly associated with wound dehiscence include obesity, infection, and poor wound healing, not immobility. Anastomosis leakage occurs when gastrointestinal contents leak into the abdominal cavity; it is caused by leakage around, or separation of, sutures or staples where the stomach is stapled or the loop of jejunum is anastomosed to a new outlet from the stomach, or where it is attached to the proximal jejunum.

A client is admitted to the hospital with the diagnosis of intestinal obstruction and has an intestinal tube inserted. The plan of care includes a prescription to instill 30 mL of normal saline into the tube as needed to maintain patency. When considering the normal saline that is instilled, how should the nurse proceed? Subtract the 30 mL from the gastric output Record the 30 mL on the intake and output record Understand that the amount instilled equals insensible losses Consider the amount too small to document on the intake and output record

Record the 30 mL on the intake and output record

A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first? Clamp the nasogastric tube. Irrigate the tube gently with normal saline. Record the observation and continue to monitor the drainage from the tube. Reduce the pressure of the suction and record observations of the drainage characteristics.

Record the observation and continue to monitor the drainage from the tube.

A client has a hiatal hernia. The client is 5 feet 3 inches tall (163 cm) and weighs 160 pounds (72.6 kg). Which information should the nurse include when discussing prevention of esophageal reflux? Increase your intake of fat with each meal. Lie down after eating to help your digestion. Reduce your caloric intake to foster weight reduction. Drink several glasses of fluid during each of your meals.

Reduce your caloric intake to foster weight reduction.

A nurse is caring for a client with acute pancreatitis. Which elevated laboratory test result is most indicative of acute pancreatitis? Blood glucose Serum lipase Serum bilirubin level White blood cell count

Serum lipase

A client has an abdominoperineal resection. Which position should the nurse encourage the client to assume to promote perineal wound healing? Sims Side-lying Knee-chest Dorsal recumbent

Side-lying The left or right side-lying position puts the least strain or pressure on the perineal suture line. Flexion of one hip and knee will increase tension on the perineal suture line; depending on placement of the stoma, one of the Sims positions will cause the client to lie on the new colostomy, which may be traumatic. Knee-chest is difficult to maintain and will place stress on the suture line. Dorsal recumbent position places undue stress on the suture line.

A client is admitted to the ambulatory surgery unit for a liver biopsy. The nurse recalls that which assessment finding will be a cause for the biopsy to be postponed? Signs of bruising Visible hyperactivity Lethargy on the morning of the test Foods high in phytonadione consumed on the day before the test

Signs of bruising

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? Low-residue, bland diet Fluid intake below 500 mL Small, frequent feeding schedule Low-protein, high-carbohydrate diet

Small, frequent feeding schedule

A client is experiencing persistent vomiting, and serum electrolytes have been prescribed. The nurse should monitor which laboratory results? Sodium and chloride levels Bicarbonate and sulfate levels Magnesium and protein levels Calcium and phosphate levels

Sodium and chloride levels

After many years of coping with ulcerative colitis, a client makes the decision to have a colectomy as advised by the primary healthcare provider. Which is most likely the significant factor that impacted on the client's decision? It is temporary until the colon heals. Surgical treatment cures ulcerative colitis. Ulcerative colitis can progress to Crohn disease. Without surgery, eating table foods is contraindicated.

Surgical treatment cures ulcerative colitis.

A nurse is providing discharge teaching to a client who had an ileostomy. Which instruction should the nurse emphasize? Informing the client about the ileostomy association Telling the client whom to contact if assistance is needed Encouraging the client to return to the workplace as soon as possible Teaching the client the importance of irrigations to regulate bowel movements

Telling the client whom to contact if assistance is needed

An older adult is hospitalized for weight loss and dehydration because of nutritional deficits. What should the nurse consider when planning care for this client? Financial resources usually are unrelated to nutritional status. An older adult's daily fluid intake must be markedly increased. The client's diet should be high in carbohydrates and low in proteins. The nutritional needs of an older adult are basically unchanged except for a decreased need for calories.

The nutritional needs of an older adult are basically unchanged except for a decreased need for calories.

A client has cholelithiasis with possible obstruction of the common bile duct. The nurse performs a nutritional assessment. What is the primary goal for this assessment? To determine if follows a high fatty diet To determine if deficient in vitamins A, D, and K To determine if eats adequate amounts of dietary fiber To determine if consumes excessive amounts of protein

To determine if deficient in vitamins A, D, and K

A client with a history of gastrointestinal varices develops severe hematemesis, and insertion of a Sengstaken-Blakemore tube has been scheduled. What information about the design and purpose of the tube does the nurse provide the client? Single-lumen for gastric lavage Double-lumen for intestinal decompression Triple-lumen to compress the esophagus Multilumen for gastric and intestinal decompression

Triple-lumen to compress the esophagus

A client is transferred to the postanesthesia care unit after abdominal surgery. The client begins vomiting. What nursing action is most important when caring for this client? Turning the client onto the side Measuring the amount of vomitus Checking the wound for dehiscence Administering the prescribed antiemetic to the client

Turning the client onto the side

Which complication should the nurse assess in a client who had a bilateral herniorrhaphy? Hydrocele Paralytic ileus Urinary retention Thrombophlebitis

Urinary retention

A nurse is caring for a client who is positive for hepatitis A. Which precautions should the nurse take? Wear a gown when entering the client's room. Use caution when bringing in the client's food. Use gloves when removing the client's bedpan. Wear a protective mask when entering the client's room.

Use gloves when removing the client's bedpan.

A client is admitted to the surgical unit from the postanesthesia care unit with a Salem sump nasogastric tube that is to be attached to wall suction. Which nursing action should the nurse implement when caring for this client? Use normal saline to irrigate the tube. Employ sterile technique when irrigating the tube. Withdraw the tube quickly when decompression is terminated. Allow the client to have small sips of ice water unless nauseated.

Use normal saline to irrigate the tube.

A client with cancer of the tongue has radon seeds implanted. The plan of care states that the client is to receive meticulous oral hygiene. How can the nurse best implement the plan? Offering a firm-bristled toothbrush Providing an antiseptic mouthwash Using a gentle spray of normal saline Swabbing the mouth with a moistened gauze square

Using a gentle spray of normal saline

A primary nurse is leaving the unit for lunch and gives a verbal report to another nurse on the unit. The primary nurse states that a client has a prescription for morphine 2 mg intravenously (IV) every 3 hours for abdominal pain because the client had major abdominal surgery that morning. While the primary nurse is still at lunch, the client complains of pain on a level 8 on a pain scale of 1 to 10. What is the first thing the covering nurse should do? Determine when the pain medication was last given. Verify the pain medication prescription in the clinical record. Employ nonpharmacological measures initially to relieve the pain. Explain that the primary nurse will be back from lunch in a few minutes.

Verify the pain medication prescription in the clinical record.

A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "What is a pseudocyst?" Which information should the nurse include in a response to this question? Malignant growth Pocket of undigested food particles Sac filled with pus from necrotic pancreatic tissue Walled-off space of pancreatic enzymes and exudate

Walled-off space of pancreatic enzymes and exudate A pseudocyst of the pancreas is a walled-off space that contains fluid, pancreatic enzymes, tissue debris, and inflammatory exudate. A malignant growth is cancer. A pseudocyst is not a pocket of undigested food particles. A pancreatic abscess is a sac filled with pus from necrotic pancreatic tissue.

Three days after surgery for cancer of the colon, a nurse introduces the client to colostomy care. Which should the nurse teach the client about skin care around the stoma? Apply liberal amounts of Vaseline for 3 inches (7.6 centimeters) around the stoma Wash the area with soap and water and then apply a protective ointment Pour saline over the stoma and rub the area to remove hard fecal matter Rinse the area with peroxide before applying fresh gauze bandages

Wash the area with soap and water and then apply a protective ointment

A client is admitted to the hospital with a diagnosis of intestinal obstruction. The healthcare provider prescribes intestinal suction via a nasoenteric decompression tube. The loss of which constituents associated with intestinal suctioning is most important to consider when caring for this client? Protein enzymes Energy carbohydrates Vitamins and minerals Water and electrolytes

Water and electrolytes

A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery? Vitamins Whole bran Cod liver oil Amino acids

Whole bran

Discharge teaching for a client with hypercholesterolemia includes nutritional instructions for a diet low in saturated fat. Which items included by the client on a list of foods to avoid support the nurse's conclusion that teaching is effective? High-fiber foods Canned vegetables Citrus fruits and juices Whole milk and hard cheeses

Whole milk and hard cheeses

A client is admitted to the hospital with severe back and abdominal pain, nausea and occasional vomiting, and an oral temperature of 101° F (38.3° C). The client reports drinking six to eight beers a day. A diagnosis of acute pancreatitis is made. Based on the data presented, what symptom is the primary nursing concern for this client? Acute pain Inadequate nutrition Electrolyte imbalance Disturbed self-concept

acute pain

A nurse is caring for a client who is having difficulty digesting fatty foods. To what deficiency does the nurse attribute this difficulty? Bile Lipase Amylase Cholesterol

bile

A nurse is instructing a client with peptic ulcer disease (PUD) about the diet that should be followed during the acute phase. Which type of diet should the nurse stress? Bland foods Regular diet Gluten-free foods Low-carbohydrate foods

bland foods

A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan? A C D E

c

For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? . Dark urine Yellow skin Pain on urination Clay-colored stool Coffee-ground vomitus

Dark urine Yellow skin Clay-colored stool

A nurse is eliciting a health history from a client with ulcerative colitis. Which factor does the nurse consider to be most likely associated with the client's colitis? Food allergy Infectious agent Dietary components Genetic predisposition

Genetic predisposition

A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice? Yellow sclera Pain on urination Dark brown stools Coffee-ground emesis

Yellow sclera

A client recovering from hepatitis A asks the nurse about returning to work. Which is the best response by the nurse? "As soon as you're feeling less tired, you may go back to work." "Unfortunately, few people fully recover from hepatitis in less than six months." "Gradually increase your activities because relapses may occur in those who return to full activity too soon." "You cannot return to work for six months because the virus will still be in your stools, and you still are communicable."

"Gradually increase your activities because relapses may occur in those who return to full activity too soon."

A client has a colostomy as a result of surgery for cancer of the colon. Which nurse's statement will most effectively minimize the client's stress the first time self-irrigation is done? "If you are still a little nervous because this is the first time, I'll be happy to do it for you, and you can do it next time." "You have to learn how to do this yourself before discharge. The best place to start is to assemble all the equipment needed for the irrigation." "I'll draw the curtain and assemble all the equipment. Would you like me to stay, or do you prefer to try it yourself and call me if you need help?" "You have a gown on, so I won't draw the curtain unless you want me to. Do you feel comfortable doing the irrigation, or do you want me to do it instead?"

"I'll draw the curtain and assemble all the equipment. Would you like me to stay, or do you prefer to try it yourself and call me if you need help?"

Which statement by a client scheduled for bariatric surgery indicates to the nurse that further preoperative teaching is necessary? "I need to eat more high-protein foods." "I'm going to have a figure like a model in about a year." "I'm going to be out of bed and sitting in a chair the first day after surgery." "I will be limiting my intake to 600 to 800 calories a day once I start eating again."

"I'm going to have a figure like a model in about a year."

A client with a history of ulcerative colitis is admitted to the hospital because of severe rectal bleeding. The client appears to be angry and demanding. One day the unlicensed assistive personnel (UAP) tells the nurse, "I've had it with that client's demands. I'm not going in that room again." Which response by the nurse is best? "The client is frightened. Let's think about the best approach we can take." "You need to try to be patient with the client, who is going through a lot right now." "I'll talk with the client. Maybe I can figure out the best way for us to handle this situation." "Just ignore the client and get on with the rest of your work. Let someone else take a turn."

"The client is frightened. Let's think about the best approach we can take."

A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment? Platelet count Amylase level Red blood cell count Erythrocyte sedimentation rate

Amylase level

The nurse is caring for a 76-year-old obese client with a history of epigastric distress, esophageal burning, binge drinking, and frequent episodes of bronchitis. A diagnosis of hiatal hernia is made. Which health problems most likely contributed to the development of the hiatal hernia? Aging Obesity Bronchitis Esophagitis Binge drinking

Aging Obesity

A client is scheduled for an abdominal surgery. What is the priority preoperative nursing objective when caring for this client? Recording accurate vital signs Alleviating the client's anxiety Teaching about early ambulation Maintaining the client's nutritional status

Alleviating the client's anxiety

Optimal discharge teaching with regard to dumping syndrome following gastroduodenostomy should include what information? Encouraging the client to plan for a light walk immediately after meals Encouraging the client to drink adequate fluids with and between meals Instructing the client to follow a high carbohydrate, low fat, low protein diet Assuring the client that symptoms generally resolve within a year of surgery

Assuring the client that symptoms generally resolve within a year of surgery

A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Adhering to a low-carbohydrate diet Avoiding aspirin and aspirin-containing products Limiting alcohol consumption to two drinks weekly Avoiding acetaminophen and products containing acetaminophen Avoiding coughing, sneezing, and straining to have a bowel movement

Avoiding aspirin and aspirin-containing products Avoiding acetaminophen and products containing acetaminophen Avoiding coughing, sneezing, and straining to have a bowel movement

A nurse assesses a client who had a gastric resection. During the first 24 hours after surgery, what symptom should the nurse expect to identify? Vomiting Gastric distention Intermittent periods of diarrhea Bloody nasogastric drainage

Bloody nasogastric drainage

A nurse assesses a client with the diagnosis of an intestinal obstruction in the descending colon. When auscultating the midabdomen, what should the nurse expect to hear? Tympany Borborygmi Abdominal bruit Pleural friction rub

Borborygmi Borborygmi are rapid, high-pitched bowel sounds that are indicative of the hyperperistalsis that occurs behind an intestinal obstruction. Tympany is not auscultated but percussed, and it is described as high pitched or musical because of the presence of gas. An aortic bruit is auscultated above the umbilicus; a renal bruit is heard laterally above the umbilicus. Neither bruit can be auscultated at the midabdomen, and neither is related to an intestinal obstruction. A pleural friction rub is heard in the chest; it is associated with inflamed lung pleura.

Which represents appropriate nursing management of the client's nasogastric (NG) tube in the immediate postoperative period following gastroduodenostomy? Advancing the tube to the original insertion depth if the tube becomes dislodged. Obtaining a prescription to vigorously irrigate the nasogastric tube if clogging is noted. Carefully monitoring the nasogastric tube to ensure that the tube is patent and the suction is working. Reporting the presence of bright red gastric aspirant in the suction canister during the immediate postoperative period.

Carefully monitoring the nasogastric tube to ensure that the tube is patent and the suction is working.

After abdominal surgery, a client is transferred to the postanesthesia care unit (PACU) with a nasogastric tube in place. What action should the nurse take initially when the client vomits 90 mL of bile-colored fluid? Elevate the head of the bed. Check the patency of the tube. Administer the prescribed antiemetic. Encourage the client to take several deep breaths.

Check the patency of the tube.

A client is placed on a heart-healthy diet to control the intake of saturated fats and cholesterol. Which information should the nurse include in a teaching plan to explain best the dietary nature of this diet? Polyunsaturated fats come from animal foods such as meat. Plant sources of cholesterol must be limited in the daily diet. Saturated fats come from plant foods, such as seeds and grains. Cholesterol is a necessary body constituent and cannot be eliminated.

Cholesterol is a necessary body constituent and cannot be eliminated.

A client is admitted to the hospital for surgery for a laparoscopic cholecystectomy. To monitor the flow of bile to the gastrointestinal tract, what symptom should the nurse assess? Color of the stool Presence of peristalsis Bleeding at the operative site Presence of cholesterol intolerance

Color of the stool

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 who is allowed to visit. To support the client at this time, which action should the nurse take? Comply with the client's wishes Ask the client why other visitors should be restricted Have the spouse explain to the client that everything will be okay Promote communication to find out how the client really feels

Comply with the client's wishes

After a gastrectomy, a client has a nasogastric tube to low continuous suction. The client begins to hyperventilate. How does the nurse anticipate that this breathing pattern will alter the client's arterial blood gases? Increase the PO 2 level Decrease the pH level Increase the HCO 3 level Decrease the Pco 2 level

Decrease the Pco 2 level Hyperventilation results in the increased elimination of carbon dioxide from the blood. The PO 2 level is not affected. The pH level will increase. The carbonic acid level will decrease.

A dehydrated older adult is admitted to the hospital from a nursing home. The transfer form documents a history of liquid fecal incontinence. Which intervention by the nurse promotes identification of the cause of this incontinence? Abdominal percussion Digital rectal examination Urine culture and sensitivity test Pelvic and abdominal ultrasound

Digital rectal examination

Which should the nurse identify as a risk factor for hyponatremia? Inadequate fluid intake Drainage from a T-tube Total parenteral nutrition Hypertonic tube feedings

Drainage from a T-tube

Which instruction should the nurse provide the client who is concerned about contracting amebic dysentery during foreign travel? Apply insect repellent. Drink only bottled water. Avoid drinking pasteurized milk. Obtain vaccine prior to foreign travel.

Drink only bottled water.

Six weeks after discharge, a client with a jejunoileal bypass for morbid obesity returns to the outpatient clinic reporting palpitations, abdominal cramps, diarrhea, and dizziness 30 minutes after meals. What complication should the nurse consider that the client is most likely experiencing? Gastric reflux Reflux gastritis Dumping syndrome Abdominal peritonitis

Dumping syndrome

A client with advanced bone cancer is experiencing cachexia. The nurse discusses the nutritional aspect of palliative care with the family. What is the importance of the nurse explaining these nutritional interventions to the family? Enhances the quality of the client's life Reduces the likelihood of a respiratory infection Prevents the malabsorption syndrome from occurring Cures the cachexia that results from bone cancer and chemotherapy

Enhances the quality of the client's life

Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? Irritability Dysrhythmias Muscle weakness Abdominal cramps Tingling of the fingertips

Dysrhythmias Muscle weakness Dysrhythmias are a sign of potassium depletion in cardiac muscles. Other cardiovascular effects include irregular, rapid, weak pulse; decreased blood pressure; flattened and inverted T waves, prominent U waves, depressed ST segments, peaked P waves, and prolonged QT intervals. Muscle weakness is a symptom of potassium depletion in skeletal muscles; potassium facilitates the conduction of nerve impulses and muscle activity. Irritability, as a result of heightened neuromuscular activity, is a sign of hyperkalemia. Abdominal cramps, as a result of heightened neuromuscular activity, is a symptom of hyperkalemia. Tingling of the fingertips, as a result of a lowered threshold of excitation of peripheral sensory nerve fibers, is a symptom of hypocalcemia.

A client progresses to a regular diet after a gastrectomy for gastric cancer. After eating lunch the client becomes diaphoretic and has palpitations. What probable cause of this response does the nurse recognize? Intolerance to fatty foods Dehiscence of the surgical incision Extracellular fluid shift into the bowel Diminished peristalsis in the small intestine

Extracellular fluid shift into the bowel

During change of shift report the night nurse indicates that a client cannot tolerate the prescribed intermittent tube feedings. Which action should the receiving nurse take first? Suggest that an antiemetic be prescribed Change the feeding schedule to omit nights Request that the type of solution be changed Gather more data from the night nurse about the technique used

Gather more data from the night nurse about the technique used

The nurse teaches the client about foods to help prevent constipation after pelvic surgery. Which foods selected by the client indicate that the teaching is understood? Ripe bananas Milk products Green vegetables Steamed cabbage Whole grain bread

Green vegetables Steamed cabbage Whole grain bread

A client with the diagnosis of Crohn disease tells the nurse that her boyfriend dates other women. She believes that this behavior causes an increase in her symptoms. What should the nurse do first when counseling this client? Help the client explore attitudes about herself Educate the client's boyfriend about her illness Suggest the client should not see her boyfriend for a while Schedule the client and her boyfriend for a counseling session

Help the client explore attitudes about herself

While receiving a blood transfusion, a client develops flank pain, chills, and fever. What type of transfusion reaction does the nurse conclude that the client probably is experiencing? Allergic Pyrogenic Hemolytic Anaphylactic

Hemolytic A hemolytic transfusion reaction results from a recipient's antibodies that are incompatible with transfused red blood cells; it is called a type II hypersensitivity. The clinical findings are a result of red blood cell hemolysis, agglutination, and capillary plugging. An allergic transfusion reaction is the result of an immune sensitivity to foreign serum protein; it is called a type I hypersensitivity, and associated clinical findings include urticaria, wheezing, dyspnea, and shock. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; associated clinical findings include fever and chills, but not flank pain. An anaphylactic reaction may occur with an allergic transfusion reaction.

A client with a history of alcoholism and cirrhosis is admitted with severe dyspnea as a result of ascites. Which process that most likely caused the ascites should the nurse consider when planning care? Increased secretion of bile salts Increased pressure in the portal vein Increased interstitial osmotic pressure Increased production of serum albumin

Increased pressure in the portal vein

A nurse is caring for a client who had a pancreaticoduodenectomy for cancer of the pancreas. The nurse provides education about hypoinsulinism, a long-term complication related to this type of surgery. The nurse evaluates that the teaching is understood when the client states that he will seek medical supervision if he experiences which symptom? Oliguria Anorexia Weight gain Increased thirst

Increased thirst Polydipsia is characteristic of hypoinsulinism (diabetes mellitus) because excessive urine is excreted related to glycosuria. Polyuria, not oliguria, is characteristic of diabetes mellitus because the kidneys excrete excess fluid with the glucose. Increased appetite is characteristic of diabetes mellitus because of impaired metabolism. Weight loss characterizes diabetes mellitus because of the use of body mass as a source of energy.

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? Promotes the formation of calculi in the cystic duct Stimulates the pancreas to secrete more insulin than it can immediately produce Alters the composition of enzymes so they are capable of damaging the pancreas Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct. The backflow of enzymes into the pancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Although blockage of the bile duct with calculi may precipitate pancreatitis, this is not associated with alcohol. Alcohol does not deplete insulin stores; the demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged.

When inserting a catheter to irrigate a client's colostomy, the nurse meets some resistance. What should the nurse do? Probe with the irrigating catheter to determine the contour of the bowel Obtain a more rigid tip for the irrigating catheter to insert into the stoma Apply pressure to the irrigating catheter to overcome the spasm of the bowel Instill a small amount of solution from the irrigating container into the stoma

Instill a small amount of solution from the irrigating container into the stoma

A nurse is discussing the regaining of bowel control with a client who recently had surgery for a colostomy in the descending colon. What is most important to emphasize in this teaching? Irrigation routine Management of fluid intake Progressive exercise program Maintenance of a low-residue diet

Irrigation routine

A client is admitted with the diagnosis of acute pancreatitis. Which clinical manifestations should a nurse assess in the client? . Jaundice Acute pain Hypertension Hypoglycemia Increased amylase

Jaundice Acute pain Increased amylase

A client is admitted to the hospital for surgery for a total abdominoperineal resection. What position should the nurse encourage the client to maintain when in bed to promote perineal wound healing after surgery? Knee-chest Dorsal recumbent Left or right Sims Left or right side-lying

Left or right side-lying

A nurse is caring for a client with a T-tube after an open cholecystectomy. What specific action should the nurse include in the plan of care? Monitor the color of the stool. Teach ankle pumping exercises. Restrict intake of refined carbohydrates. Compress the drainage container after emptying.

Monitor the color of the stool.

A client with a 20-year history of excessive alcohol use has developed jaundice and ascites and is admitted to the hospital. What is the priority nursing action during the first 48 hours after the client's admission? Monitor vital signs Increase fluid intake Obtain a foam mattress Improve nutritional status

Monitor vital signs

Six hours after major abdominal surgery, a client reports severe abdominal pain and feeling faint. The nurse identifies a thready, rapid pulse. The nurse checks the medication administration record (MAR) (Physiological Aspects of Care record) and determines that the client can receive another injection of pain medication in an hour. Which is the most appropriate action by the nurse? Notify the healthcare provider about the client's symptoms Explain to the client that it is too early to have an injection for pain Reposition the client for greater comfort and turn on the television as a distraction Prepare the injection to administer it to the client early because of the severe pain

Notify the healthcare provider about the client's symptoms

An older adult client who is accustomed to taking enemas periodically to avoid constipation is admitted to a long-term care facility. In addition to medications, the healthcare provider prescribes bed rest and a regular diet. Which action should be implemented initially to help prevent the client from developing constipation? Arrange to have enemas prescribed for the client Obtain a prescription for a daily laxative for the client Place a commode by the bedside to facilitate defecation Offer a large glass of prune juice with warm water each morning

Offer a large glass of prune juice with warm water each morning

The nurse is caring for a client admitted to the hospital for a rubber band ligation of internal hemorrhoids. Which action should the nurse take to reduce discomfort? Offer sitz baths Use water-soluble jelly Use inflatable doughnut Offer medicated suppository

Offer sitz baths

A nurse advises a client receiving furosemide about potassium intake. Which fruits should the nurse encourage the client to eat? Apple Orange Banana Pineapple Dried fruit

Orange Banana Dried fruit

A client with an acute attack of cholecystitis has a cholecystectomy with a choledochostomy. The client returns from surgery with a T-tube connected to a drainage bag. What does the nurse conclude is the purpose of the T-tube? Decrease edema Permit drainage of bile Insert antibiotic medication Provide for irrigation of the gallbladder

Permit drainage of bile

A client is admitted to the hospital with signs and symptoms of obstruction of the common bile duct. Laboratory test results indicate prolonged bleeding and clotting times. What can the nurse conclude these test results indicate? Phytonadione is not being absorbed. Ionized calcium level is decreased. Bilirubin in the plasma is increased. Extrinsic factor is not being absorbed.

Phytonadione is not being absorbed. Phytonadione, a fat-soluble vitamin, is not absorbed from the gastrointestinal tract in the absence of bile; bile enters the duodenum via the common bile duct. Calcium is related to rhythmic muscle contraction, not coagulation. Bilirubin is formed by the breakdown of hemoglobin and red blood cells and is not related to coagulation. The extrinsic factor (cyanocobalamin) is a water-soluble vitamin; bile is not necessary for its absorption.

A nurse is providing dietary teaching for a client who is receiving a high-protein diet while recovering from an acute episode of colitis. What should the nurse include in the rationale for this diet? Repairs tissues Slows peristalsis Corrects the anemia Improves muscle tone

Repairs tissues

A client who had a choledochostomy to explore the common bile duct is returned to the surgical unit with a T-tube in place. What is the priority intervention when caring for this client? Irrigate the T-tube as necessary Protect the abdominal skin from bile drainage Have the client wear a binder when out of bed Empty the T-tube drainage bag every two hours

Protect the abdominal skin from bile drainage

A client with hepatitis B (HBV) develops cirrhosis and is hospitalized. One potential sequela of chronic liver disease is fluid and electrolyte imbalance. The nurse determines that this may be attributed to a decrease in serum albumin level. Which of these conditions results from this imbalance? Hemorrhage with subsequent anemia Diminished resistance to bacterial insult Malnutrition of cells, especially hepatic cells Reduction of colloidal osmotic pressure in the blood

Reduction of colloidal osmotic pressure in the blood

A client was diagnosed with ulcerative colitis. Two months after the diagnosis, the client is readmitted for an exacerbation of the illness. The client is weak, thin, and irritable. The client states, "I am now ready for surgery to create an ileostomy." Which nursing intervention will best meet the client's priority need? Replace the client's fluids and electrolytes Help the client gain weight Teach the client how to use the ileostomy appliance Encourage client interaction with other clients who have an ileostomy

Replace the client's fluids and electrolytes

The nurse is caring for a client one hour after the client had esophageal surgery. Which assessment is the priority for this client? Assessment of the incision Respiratory assessment Determining the level of pain Monitoring the client's nasogastric tube

Respiratory assessment

A nurse is evaluating a client's response to receiving an intermittent gravity flow percutaneous endoscopic gastrostomy (PEG) tube feeding. Which clinical finding indicates that the client is unable to tolerate a continuation of the feeding? Passage of flatus Rise of formula in the tube Rapid inflow of the feeding Tenderness of epigastric area

Rise of formula in the tube

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? . Preventing constipation Screening of blood donors Avoiding shellfish in the diet Limiting hepatotoxic drug therapy Maintaining a monogamous sexual relationship

Screening of blood donors Maintaining a monogamous sexual relationship

One month after abdominal surgery, a client is readmitted to the hospital with recurrent abdominal pain and fever. The medical diagnosis is fistula formation with peritonitis. The nurse should maintain the client in what position? Supine Right Sims Semi-Fowler The position that the client prefers

Semi-Fowler

A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for indicators that strangulation of the intestine may have occurred. What is an early indicator of strangulation? Increased flatus Projectile vomiting Sharp abdominal pain Decreased bowel sounds

Sharp abdominal pain

After a subtotal gastrectomy, a client begins to eat more food in varied forms. After meals the client experiences a cramping discomfort and a rapid pulse with waves of weakness, which often are followed by nausea and vomiting. The nurse concludes that the client is experiencing dumping syndrome, which is caused by what process? Sluggish passage of food into the small intestine Rapid passage of a dilute food mixture into the small intestine Sudden passage of a hyperosmolar food solution into the small intestine Passage of food that is less concentrated than surrounding extracellular fluid in the small intestine

Sudden passage of a hyperosmolar food solution into the small intestine

A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the primary healthcare provider to explore with this client? Intensive psychotherapy Continued medical therapy Surgical therapy (colectomy) Diet therapy (low-residue, high-protein diet)

Surgical therapy (colectomy)

A nurse is preparing a morbidly obese client for gastric bypass surgery. What should the nurse teach the client to do after surgery? Take medications in liquid form. Lie on the right side for one hour after meals. Ingest a high-carbohydrate diet once eating is resumed. Receive patient-controlled analgesia for six days after surgery.

Take medications in liquid form.

The nurse identifies that a client who had extensive abdominal surgery appears depressed. Which nursing action is the most appropriate? Talking with the client and encouraging exploration of feelings Asking the client's primary healthcare provider to prescribe an antidepressant medication Understanding that the client's depression is an expected response to surgery Reassuring the client that feelings of depression will lift after returning home

Talking with the client and encouraging exploration of feelings

The laboratory values of a client with a new diagnosis of cancer of the esophagus include a hemoglobin of 7 g/dL (70 mmol/L), hematocrit of 25%, and red blood cell (RBC) count of 2.5 million/mm 3 (2.5 X 10 12/L). Which priority goal should the nurse add to the plan of care? The client will be free of injury. The client will remain pain free. The client will demonstrate improved nutrition. The client will maintain effective airway clearance.

The client will demonstrate improved nutrition.

A client with esophageal varices has severe hematemesis, and a Sengstaken-Blakemore tube is inserted. What design and purpose does the tube have? Single-lumen; for gastric lavage Double-lumen; for intestinal decompression Triple-lumen; for esophageal compression Multilumen; for gastric and intestinal decompression

Triple-lumen; for esophageal compression