GASTROINTESTINAL

(12) Which disease is the client diagnosed with GERD at greater risk for developing? (A) Hiatal hernia. (B) Gastroenteritis. (C) Esophageal cancer. (D) Gastric cancer.

(A) A hiatal hernia places the client at risk for GERD; GERD does not predispose the client for developing a hiatal hernia. (B) Gastroenteritis is an inflammation of the stomach and intestine, usually caused by a virus. (C) BARRETT'S ESOPHAGUS RESULTS FROM LONG-TERM EROSION OF THE ESOPHAGUS AS A RESULT OF REFLUX OF STOMACH CONTENTS SECONDARY TO GERD. THIS IS A PRECURSOR TO ESOPHAGEAL CANCER. (D) The problems associated with GERD result from the reflux of acidic stomach contents into the esophagus, which is not a precursor to gastric cancer. (Test-taking hint: The test taker may associate hiatal hernia with GERD. One can be a result of the other, and this can confuse the test taker. If the test taker did not have any idea of the correct answer, option "3" has the word "esophageal" in it, as does the stem of the question, and therefore the test taer should select this as the correct answer.)

(27) Which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease? (A) History of side effects experienced from all medications. (B) Use of nonsteroidal anti-inflammatory drugs (NSAIDs). (C) Any known allergies to drugs and environmental factors. (D) Medical histories of at least 3 generations.

(A) A history of problems the client has experienced with medications is taken during the admission interview. This information does not specifically address peptic ulcer disease. (B) USE OF NSAIDS PLACES THE CLIENT AT RISK FOR PEPTIC ULCER DISEASE AND HEMORRHAGE. NSAIDS SUPPRESS THE PRODUCTION OF PROSTAGLANDIN IN THE STOMACH, WHICH IS A PROTECTIVE MECHANISM TO PREVENT DAMAGE FROM HYDROCHLORIC ACID. (C) Allergies are included for safety, but this is not specific for peptic ulcer disease. (D) Information needs to be obtained about past generations so the nurse can analyze any potential health problems, but this is not specific for peptic ulcer disease. (Test-taking hint: The words "specific data" indicate there will be appropriate data in 1 or more of the answer options but only 1 is specific to peptic ulcer disease.)

(30) The nurse is caring for a client diagnosed with hemorrhaging duodenal ulcer. Which collaborative interventions should the nurse implement? Select all that apply. (A) Perform a complete pain assessment. (B) Assess the client's vital signs frequently. (C) Administer a proton pump inhibitor intravenously. (D) Obtain permission and administer blood products. (E) Monitor the intake of a soft, bland diet.

(A) A pain assessment is an independent intervention the nurse should implement frequently. (B) Evaluating vital signs in an independent intervention the nurse should implement. If the client is able, BPs should be taken lying, sitting, and standing to assess for orthostatic hypotension. (C) THIS IS A COLLABORATIVE INTERVENTION THE NURSE SHOULD IMPLEMENT. IT REQUIRES AN ORDER FROM THE HCP. (D) ADMINISTERING BLOOD PRODUCTS IN COLLABORATIVE, REQUIRING AN ORDER FROM THE HCP. (E) The diet requires an order by the healthcare provider, but a diet will not be ordered since the client is NPO. (Test-taking hint: Descriptive words such as "collaborative" or "independent" can be the deciding factor when determining if an answer option is correct or incorrect. These are key words the test taker should identify.)

(20) The client diagnosed with ulcerative colitis has an ileostomy. Which statement indicates the client needs more teaching concerning the ileostomy? (A) "My stoma should be pink and moist." (B) "I will irrigate my ileostomy every morning." (C) "If I get a red, bumpy, itchy rash I will call my HCP." (D) "I will change my pouch if it starts leaking."

(A) A pink and moist stoma indicates viable tissue and adequate circulation. A purple stoma indicates necrosis. (B) AN ILEOSTOMY WILL DRAIN LIQUID ALL THE TIME AND SHOULD NOT ROUTINELY BE IRRIGATED. A SIGMOID COLOSTOMY MAY NEED DAILY IRRIGATION TO EVACUATE FECES. (C) A red, bumpy, itchy rash indicates infecition with the yeast Candida albicans, which should be treated with medication. (D) The ileostomy drainage has enzymes and bile salts, which are irrigating and harsh to the skin; therefore, the pouch should be changed if any leakage occurs. (Test-taking hint: This is an "except" question, and the test taker must identify which option is not a correct action for the nurse to implement. Sometimes flipping the question - "Which interventions indicate the client understands the teaching?" - can assist in identifying the correct answer.)

(28) Which physical examination should the nurse implement first when assessing the client diagnosed with peptic ulcer disease? (A) Auscultate the client's bowel sounds in all 4 quadrants. (B) Palpate the abdominal area for tenderness. (C) Percuss the abdominal borders to identify organs. (D) Assess the tender area progressing to nontender.

(A) AUSCULTATION SHOULD BE USED PRIOR TO PALPATATION OR PERCUSSION WHEN ASSESSING THE ABDOMEN. MANIPULATION OF THE ABDOMEN CAN ALTER BOWEL SOUNDS AND GIVE FALSE INFORMATION. (B) Palpation gives appropriate information the nurse needs to collect, but if done prior to auscultation, the sounds will be altered. (C) Percussion of the abdomen does not give specific information about peptic ulcer disease. (D) Tender areas should be assessed last to prevent guarding and altering the assessment. This includes palpation, which should be done after auscultation. (Test-taking hint: The word "first" requires the test taker to rank in order the interventions needing to be performed. The test taker should visualize caring for the client. This will assist the test taker in making the correct choice.)

(133) The client being admitted from the emergency department is diagnosed with a fecal impaction. Which nursing intervention should be implemented? (A) Administer an antidiarrheal medication every day and PRN. (B) Perform bowel training every 2 hours. (C) Administer an oil retention enema. (D) Prepare for an upper gastrointestinal (UGI) series x-ray.

(A) An antidiarrheal medication would slow down the peristalsis in the colon, worsening the problem. (B) The client has an immediate need to evacuate the bowel, not a need for bowel training. (C) OIL RETENTION ENEMAS WILL HELP TO SOFTEN THE FECES AND EVACUATE THE STOOL. (D) A UGI series adds barium to the already hardened stool in the colon. Barium enemas x-ray the colon; a UGI series x-rays the stomach and jejunum. (Test-taking hint: If the test taker understands fecal impaction is the opposite of diarrhea, then answer option "1" can be eliminated. Knowledge of anatomy and physiology eliminates option "4" because stool is formed in the colon and transported to the anus, part of the lower gastrointestinal tract.)

(21) The client diagnosed with IBD is prescribed sulfasalazine (Asulfidine), a sulfaonamidic antibiotic. Which statement best describes the rationale for administering this medication? (A) It is administered rectally to help decrease colon inflammation. (B) This medication slows gastrointestinal motility and reduces diarrhea. (C) This medication kills the bacteria causing the exacerbation. (D) It acts topically on the colon mucosa to decrease inflammation.

(A) Asulfidine cannot be administered rectally. Corticosteroids may be administered by enema for the local effect of decreasing inflammation while minimizing the systemic effects. (B) Antidiarrheal agents slow the gastrointestinal motility and reduce diarrhea. (C) IBD is not caused by bacteria. (D) ASULFIDINE IS POORLY ABSORBED FROM THE GASTROINTESTINAL TRACT AND ACTS TOPICALLY ON THE COLONIC MUCOSA TO INHIBIT THE INFLAMMATORY PROCESS. (Test-taking hint: If the test taker doesn't know the answer, then the test taker could eliminate options "2" and "3" because they do not contain the word "inflammation"; IBD is inflammatory bowel disease.)

(134) The nurse is caring for a client who uses carthartics frequently. Which statement made by the client indicates an understanding of the discharge teaching? (A) "In the future I will eat a banana every time I take the medication." (B) "I don't have to have a bowel movement every day." (C) "I should limit the fluids I drink with my meals." (D) "If I feel sluggish, I will eat a lot of cheese and dairy products."

(A) Bananas are encouraged for clients with potassium loss from diuretics; a banana is not needed for harsh laxative (cathartic) use. Harsh laxatives should be discouraged because they cause laxative dependence and a narrowing of the colon with long-term use. (B) IT IS NOT NECESSARY TO HAVE A BOWEL MOVEMENT EVERY DAY TO HAVE NORMAL BOWEL FUNCTIONING. (C) Limiting fluids will increase the problem; the client should be encouraged to increase the fluids in the diet. (D) If the client is feeling "sluggish" from not being able to have a bowel movement, these foods increase constipation because they are low in residue (fiber). (Test-taking hint: The test taker must understand words such as "cathartic." Limiting fluids is used for clients in renal failure or congestive heart failure, but increasing fluids is recommended for most other conditions.)

(135) The client has been experiencing difficulty and straining when expelling feces. Which intervention should the nurse discuss with the client? (A) Explain some blood in the stool will be normal for the client. (B) Instruct the client in manual removal of feces. (C) Encourage the client to use a cathartic laxative on a daily basis. (D) Place the client on a high-fiber diet.

(A) Blood may indicate a hemorrhoid, but it is not normal to expel blood when having a bowel movement. (B) Nurses manually remove feces; it is not a self-care activity. (C) Cathartic use on a daily basis creates dependence and a narrowing of the lumen of the colon, creating a much more serious problem. (D) A HIGH-FIBER (RESIDUE) DIET PROVIDES BULK FOR THE COLON TO USE IN REMOVING THE WASTE PRODUCTS OF METABOLISM. BULK LAXATIVES AND FIBER FROM VEGETABLES AND BRAN ASSIST THE COLON TO WORK MORE EFFECTIVELY. (Test-taking hint: Blood is not normal in any circumstance. It may be expected but it is not "normal" unless inside a vessel.)

(138) The dietitian and the nurse in a long-term care facility are planning the menu for the day. Which foods should be recommended for the immobile clients for whom swallowing is not an issue? (A) Cheeseburger and milkshake. (B) Canned peaches and a sandwich on whole-wheat bread. (C) Mashed potatoes and mechanically ground red meat. (D) Biscuits and gravy with bacon.

(A) Cheeseburgers and milk shakes are low-residue foods and can make constipation worse. (B) CANNED PEACHES ARE SOFT AND CAN BE CHEWED AND SWALLOWED EASILY WHILE PROVIDING SOME FIBER; WHOLE-WHEAT BREAD IS HIGHER IN FIBER THAN WHITE BREAD. THESE FOODS WILL BE HELPFUL FOR CLIENTS WHOSE GASTRIC MOTILITY IS SLOWED AS A RESULT OF LACK OF EXERCISE OR IMMOBILITY. (C) Mashed potatoes and mechanically ground meat do not provide high fiber. (D) Biscuits, gravy, and bacon are refined flour foods or processed meat (fat). These will not help clients to prevent constipation. (Test-taking hint: The test taker must realize the consequences of immobility include constipation.)

(1) The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? (A) "How much weight have you gained recently?" (B) "What have you done to alleviate the heartburn?" (C) "Do you consume many milk and dairy products?" (D) "Have you been around anyone with a stomach virus?"

(A) Clients with heartburn are frequently diagnosed as having GERD, GERD can occasionally cause weight loss, but not weight gain. (B) MOST CLIENTS WITH GERD HAVE BEEN SELF-MEDICATING WITH OVER-THE-COUNTER MEDICATIONS PRIOR TO SEEKING ADVICE FROM A HEALTHCARE PROVIDER. IT IS IMPORTANT TO KNOW WHAT THE CLIENT HAS BEEN USING TO TREAT THE PROBLEM. (C) Milk and dairy products contain lactose, which are important if considering lactose intolerance, but are not important for "heartburn." (D) Heartburn is not a symptom of a viral illness. (Test-taking hint: Clients will use common terms such as "heartburn" to describe symptoms. The nurse must be able to interpret or clarify the meaning of terms used with the client. Part of the assessment of a symptom requires determining what aggravates and alleviates the symptom.)

(34) The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective? (A) A decrease in alcohol intake. (B) Maintaining a bland diet. (C) A return to previous activities. (D) A decrease in gastric distress.

(A) Decreasing the alcohol intake indicates the client is making some lifestyle changes. (B) The client with PUD is prescribed a regular diet, but the type of diet does not determine if the medication is effective. (C) The return to previous activities indicates the client has not adapted to the lifestyle changes and has returned to the previous behaviors which precipitated the peptic ulcer disease. (D) ANTIBIOTICS, PROTON PUMP INHIBITORS, AND PEPTO-BISMOL ARE ADMINISTERED TO DECREASE THE IRRITATION OF THE ULCERATIVE AREA AND CURE THE ULCER. A DECREASE IN GASTRIC DISTRESS INDICATES THE MEDICATION IS EFFECTIVE. (Test-taking hint: To determine the effectiveness of a medication, the test taker must know the scientific rationale for administering the medication. Peptic ulcer disease causes gastric distress. If gastric distress is relieved, then the medication if effective.)

(33) Which oral medication should the nurse question before administering to the client with peptic ulcer disease? (A) E-mycin, an antibiotic. (B) Prilosec, a proton-pump inhibitor. (C) Flagyl, an antimicrobial agent. (D) Tylenol, a nonnarcotic analgesic.

(A) E-MYCIN IS IRRITATING TO STOMACH, AND ITS USE IN A CLIENT WITH PEPTIC ULCER DISEASE SHOULD BE QUESTIONED. (B) Prilosec, a proton pump inhibitor, decreases gastric acid production, and its use should not be questioned by the nurse. (C) Flagyl, an antimicrobial, is administered to treat peptic ulcer disease secondary to H. pylori bacteria. (D) Tylenol can be safely administered to a client with peptic ulcer disease. (Test-taking hint: The test taker needs to understand how medications work, adverse effects of medications, when to question administering a specific medication, and how to administer the medication safely. By learning classifications, the test taker should be able t make a knowledgeable selection in most cases.)

(23) The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? (A) Grilled hamburger on a wheat bun and fried potatoes. (B) A chicken salad sandwich and lettuce and tomato salad. (C) Roast pork, white rice, and plain custard. (D) Fried fish, whole grain pasta, and fruit salad.

(A) Fried potatoes, along with pastries and pies, should be avoided. (B) Raw vegetables should be avoided because this is roughage. (C) A LOW-RESIDUE DIET IS A LOW-FIBER DIET. PRODUCTS MADE OF REFINED FLOUR OR FINELY MILLED GRAINS, ALONG WITH ROASTED, BAKED, R BROILED MEATS, ARE RECOMMENDED. (D) Fried foods should be avoided, and whole grain is high in fiber. Nuts and fruits with peels should be avoided. (Test-taking hint: The test taker must know about therapeutic diets prescribed by healthcare providers. Remember, low-residue is the same as low-fiber.)

(139) The client diagnosed with AIDS is experiencing voluminous diarrhea. Which interventions should the nurse implement. Select all that apply. (A) Monitor diarrhea, charting amount, character, and consistency. (B) Assess the client's tissue turgor every day. (C) Encourage the client to drink carbonated soft drinks. (D) Weigh the client daily in the same clothes and at the same time. (E) Assist the client with a warm sitz bath PRN.

(A) IT IS IMPORTANT TO KEEP TRACK OF THE AMOUNTS, COLOR, AND OTHER CHARACTERISTICS OF BODY FLUIDS EXCRETED. (B) Skin turgor should be assessed at least every 6-8 hours, not daily. (C) Carbonated soft drinks increase flatus in the GI tract, and the increased sugar will act as an osmotic laxative and increase diarrhea. (D) DAILY WEIGHTS ARE THE BEST METHOD OF DETERMINING FLUID LOSS AND GAIN. (E) SITZ BATHS WILL ASSIST IN KEEPING THE CLIENT'S PERIANAL AREA CLEAN WITHOUT HAVING TO RUB. THE WARM WATER IS SOOTHING, PROVIDING COMFORT. (Test-taking hint: The test taker should not the time frame for any answer option. "Every day" is not often enough to assess for dehydration in a cleint who is experiencing massive "voluminous") fluid loss. If the test taker were not aware of the definition, then an associated word, "volume," would be a hint.)

(8) The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? (A) The client's Bernstein esophageal test was positive. (B) The client's abdominal x-ray shows a hiatal hernia. (C) The client's WBC count is 14,000/mm^3. (D) The client's hemoglobin is 13.8 g/dL.

(A) In a Bernstein test, acid is instilled into the distal esophagus, causing immediate heartburn for a client diagnosed with GERD. This would not warrant notifying the HCP. (B) Hiatal hernias are frequently the cause of GERD; therefore, this finding would not warrant notifying the HCP. (C) THE CLIENT'S WBC COUNT IS ELEVATED, INDICATING A POSSIBLE INFECTION, WHICH WARRANTS NOTIFYING THE HCP. (D) This is a normal hemoglobin result and would not warrant notifying the HCP. (Test-taking hint: When the test taker is deciding when to notify a healthcare provider, the answer should be data not normal for the disease process or signaling a potential or life-threatening complication.)

(36) The client with a history of peptic ulcer disease is admitted into the intensive care unit with frank gastric bleeding. Which priority intervention should the nurse implement? (A) Maintain a strict record of intake and output. (B) Insert a nasogastric tube and begin saline lavage. (C) Assist the client with keeping a detailed calorie count. (D) Provide a quiet environment to promote rest.

(A) Maintaining a strict record of intake and output is important to evaluate the progression of the client's condition, but it is not the most important intervention. (B) INSERTING A NASOGASTRIC TUBE AND LAVAGING THE STOMACH WITH SALINE IS THE MOST IMPORTANT INTERVENTION BECAUSE THIS DIRECTLY STOPS THE BLEEDING. (C) A calorie count is important information assisting in the prevention and treatment of a nutritional deficit, but this intervention does not address the client's immediate and life-threatening problem. (D) Promoting a quiet environment aids in the reduction of stress, which can cause further bleeding, but this will not stop the bleeding. (Test-taking hint: The test taker is required to rank the importance of interventions in the question. Using Maslow's hierarchy of needs to rank physiological needs first, the test taker should realize inserting a nasogastric tube and beginning lavage is solving a circulation or fluid deficit problem.)

(144) The nurse is caring for clients on a medical unit. Which client information should be brought to the attention of the HCP immediately? (A) A serum sodium of 128 mEq/L in a client diagnosed with obstipation. (B) The client diagnosed with fecal impaction who had 2 hard formed stools. (C) A serum potassium level of 3.8 mEq/L in a client diagnosed with diarrhea. (D) The client with diarrhea who had 2 semi-liquid stools totaling 300 mL.

(A) NORMAL SERUM SODIUM LEVELS ARE 135-152 MEQ/L, SO THE CLIENT'S 128 MEQ/L VALUE REQUIRES INTERVENTION. (B) The client diagnosed with a fecal impaction is beginning to move the stool; this indicates an improvement. (C) Normal potassium levels are 3.5-5.5 mEq/L. A level of 3.8 mEq/L is within normal limits and does not require intervention. (D) This client has been having diarrhea and now is having semiliquid stools, so this client is getting better. (Test-taking hint: The test taker must determine if the client is experiencing a potentially life-threatening complication, such as potential for seizures. Answer options "2," "3," and "4" are expected for the disease process and are normal or show improvement.)

(6) The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? (A) Adult-onset asthma. (B) Pancreatitis. (C) Peptic ulcer disease. (D) Increased gastric emptying.

(A) OF ADULT-ONSET ASTHMA CASES, 80-90% ARE CAUSED BY GASTROESOPHAGEAL REFLUX DISEASE (GERD). (B) Pancreatitis is not related to GERD. (C) Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levels of gastric acid, but it is not related to reflux. (D) GERD is not related to increased gastric emptying. Increased gastric emptying would be a benefit to a client with decreased functioning of the lower esophageal sphincter. (Test-taking hint: Some questions are knowledge-based. There are no test-taking strategies for knowledge-based questions.)

(11) The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicated GERD? (A) Pyrosis, water brash, and flatulence. (B) Weight loss, dysarthria, and diarrhea. (C) Decreased abdominal fat, proteinuria, and constipation. (D) Midepigastric pain, positive H. pylori test, and melena.

(A) PYROSIS IS HEARTBURN, WATER BRASH IS THE FEELING OF SALIVA SECRETION AS A RESULT OF REFLUX, AND FLATULENCE IS GAS - ALL SYMPTOMS OF GERD. (B) Gastroesophageal reflux disease does not cause weight loss. (C) There is no change in abdominal fat, no proteinuria (the result of a filtration problem in the kidney), and no alteration in bowel elimination for the client diagnosed with GERD. (D) Midepigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease. (Test-taking hint: Frequently, incorrect answer options will contain the symptoms of a disease of the same organ system.)

(10) Which statement made by the client indicates to the nurse the client may be experiencing GERD? (A) "My chest hurts when I walk up the stairs in my home." (B) "I take antacid tablets with me wherever I go." (C) "My spouse tells me I snore very loudly at night." (D) "I drink 6-7 soft drinks every day."

(A) Pain in the chest when walking up stairs indicates angina. (B) FREQUENT USE OF ANTACIDS INDICATES AN ACID REFLUX PROBLEM. (C) Snoring loudly could indicate sleep apnea, but not GERD. (D) Carbonated beverages increase stomach pressure. 6-7 soft drinks a day would not be tolerated by a client with GERD. (Test-taking hint: The stem of the question indicates an acid problem. The drug classification of antacid, or "against acid." provides the test taker a hint as to the correct answer.)

(7) The nurse is administering morning medications at 0730. Which medication should have priority? (A) A proton pump inhibitor. (B) A nonnarcotic analgesic. (C) A histamine receptor antagonist. (D) A mucosal barrier agent.

(A) Proton pump inhibitors can be administered at routine dosing times, usually 0900 or after breakfast. (B) Pain medication is important, but a nonnarcotic medication, such as Tylenol, can be administered after a medication which must be timed. (C) A histamine receptor antagonist can be administered at routine dosage times. (D) A MUCOSAL BARRIER AGENT MUST BE ADMINISTERED ON AN EMPTY STOMACH FOR THE MEDICATION TO COAT THE STOMACH. (Test-taking hint: Basic knowledge of how medications work is required to administer medications for peak effectiveness. There are very few medications requiring a specific time. The test taker should memorize these specific medications.)

(9) The charge nurse is making assignments. Staffing includes a registered nurse with 5 years of medical-surgical experience, a newly graduated registered nurse, and 2 unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? (A) The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. (B) The 54-year-old client diagnosed with Barrett's esophagus who is scheduled to have an endoscopy this morning. (C) The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all 5 lobes. (D) The 68-year-old client who is 3 days postoperative for hiatal hernia and needs to be ambulated 4 times today.

(A) Pyrosis is heartburn and is expected in a client diagnosed with GERD. The new graduate can care for this client. (B) Barrett's esophagus is a complication of GERD; new graduates can prepare a client for a diagnostic procedure. (C) THIS CLIENT IS EXHIBITING SYMPTOMS OF ASTHMA, A COMPLICATION OF GERD. THIS CLIENT SHOULD BE ASSIGNED TO THE MOST EXPERIENCED NURSE. (D) This client can be cared for by the new graduate, and ambulating can be delegated to the unlicensed assistive personnel (UAP). (Test-taking hint: The most experienced nurse should be assigned to the client whose assessment and care require more experience and knowledge about the disease process, potential complications, and medications. The term "most experienced" in the stem is the key to answering this question.)

(14) The client with type 2 diabetes is prescribed prednisone, a steroid, for an acute exacerbation of inflammatory bowel disease. Which intervention should the nurse discuss with the client? (A) Take this medication on an empty stomach. (B) Notify the HCP is experiencing a moon face. (C) Take the steroid medication as prescribed. (D) Notify the HCP if the blood glucose is over 160.

(A) Steroids can cause erosion of the stomach and should be taken with food. (B) A moon face is an expected side effect of steroids. (C) THIS MEDICATION MUST BE TAPERED OFF TO PREVENT ADRENAL INSUFFICIENCY; THEREFORE, THE CLIENT MUST TAKE THIS MEDICATION AS PRESCRIBED. (D) Steroids may increase the client's blood glucose, but diabetic medications regimens are usually not altered for the short period of time the client with an acute exacerbation is prescribed steroids. (Test-taking hint: The test taker should know few medications must be taken on an empty stomach, which would cause option "1" to be eliminated. All medications should be taken as prescribed - don't think the answer is too easy.)

(35) Which assessment data indicate to the nurse the client's gastric ulcer has perforated? (A) Complaints of sudden, sharp, substernal pain. (B) Rigid, boardlike abdomen with rebound tenderness. (C) Frequent, clay-colored, liquid stool. (D) Complaints of vague abdominal pain in the right upper quadrant.

(A) Sudden sharp pain felt in the substernal area indicates angina or myocardial infarction. (B) A RIGID, BOARDLIKE ABDOMEN WITH REBOUND TENDERNESS IS THE CLASSIC SIGN/SYMPTOM OF PERITONITIS, WHICH IS A COMPLICATION OF A PERFORATED GASTRIC ULCER. (C) Clay-colored stools indicate liver disorders, such as hepatitis. (D) Clients with gallbladder disease report vague to sharp abdominal pain in the right upper quadrant. (Test-taking hint: The only 2 answer options that refer to the abdomen are options "2" and "4." Therefore, the test taker should select 1 of these 2 because a gastric ulcer involves the stomach.)

(2) The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." Which intervention should be included for this problem? (A) Teach the client to sleep with a foam wedge under the head. (B) Encourage the client to decrease the amount of smoking. (C) Instruct the client to take over-the-counter medication for relief of pain. (D) Discuss the need to attend Alcoholics Anonymous to quit drinking.

(A) THE CLIENT SHOULD ELEVATE THE HEAD OF THE BED ON BLOCKS OR USE A FOAM WEDGE TO USE GRAVITY TO HELP KEEP THE GASTRIC ACID IN THE STOMACH AND PREVENT REFLUX INTO THE ESOPHAGUS. BEHAVIOR MODIFICATION IS CHANGING ONE'S BEHAVIOR. (B) The client should be encouraged to quit smoking altogether. Referral to support groups for smoking cessation should be made. (C) The nurse should be careful when recommending OTC medications. This is not the most appropriate intervention for a client with GERD. (D) The client should be instructed to discontinue using alcohol, but the stem does not indicate the client is an alcoholic. (Test-taking hint: Clients are encouraged to quit, not decrease, smoking. Current research indicates smoking is damaging to many body systems, including the gastrointestinal system. The test taker should not assume anything not in the stem of a question.)

(13) Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis? (A) 20 bloody stools a day. (B) Oral, temperature of 102F. (C) Hard, rigid abdomen. (D) Urinary stress incontinence.

(A) THE COLON IS ULCERATED AND UNABLE TO ABSORB WATER, RESULTING IN BLOODY DIARRHEA. 10-20 BLOODY DIARRHEA STOOLS IN THE MOST COMMON SYMPTOMS OF ULCERATIVE COLITIS. (B) Inflammation usually causes an elevated temperature but is not expected in the client with ulcerative colitis. (C) A hard, rigid abdomen indicates peritonitis, which is a complication of ulcerative colitis but not an expected symptom. (D) Stress incontinence is not a symptom of colitis. (Test-taking hint: If the test taker is not sure of the answer, the test taker should use knowledge of anatomy and physiology to help identify the correct answer. The colon is responsible for absorbing water, and if the colon can't do its job, then water will not be absorbed, causing diarrhea (option "1"). Colitis is inflammation of the colon; therefore, option "4" referring to the urinary system can be eliminated.)

(24) The client with ulcerative colitis is scheduled for an ileostomy. The nurse is aware the client's stoma will be located in which area of the abdomen? D_C _ _ _ A_B (A) A (B) B (C) C (D) D

(A) THE CURE FOR ULCERATIVE COLITIS IS A TOTAL COLECTOMY, WHICH IS REMOVING THE ENTIRE LARGE COLON AND BRINGING THE TERMINAL END OF THE ILEUM UP THE ABDOMEN IN THE RIGHT LOWER QUADRANT. THIS IS AN ILEOSTOMY. (B) This site is the left-lower quadrant. (C) This site is the transverse colon. (D) This site is the right upper quadrant. (Test-taking hint: The test taker must identify the area by using the computer mouse. These are called "hot spots" on the NCLEX-RN.)

(26) The nurse is caring for a client diagnosed with rule-out peptic ulcer disease. Which test confirms this diagnosis? (A) Esophagogastroduodenoscopy. (B) Magnetic resonance imaging. (C) Occult blood test. (D) Gastric acid stimulation.

(A) THE ESOPHAGOGASTRODUODENOSCOPY (EGD) IS AN INVASIVE DIAGNOSTIC TEST WHICH VISUALIZES THE ESOPHAGUS, STOMACH, AND DUODENUM TO ACCURATELY DIAGNOSE AN ULCER AND EVALUATE THE EFFECTIVENESS OF THE CLIENT'S TREATMENT. (B) Magnetic resonance imaging (MRI) shows cross-sectional images of tissue or blood flow. (C) An occult blood test shows the presence of blood, but not the source. (D) A gastric acid stimulation test is used to understand the pathophysiology of ulcer disease, but it has limited usefullness. (Test-taking hint: If the test taker has no idea what the correct answer is, knowledge of anatomy can help identify the answer. A peptic ulcer is an ulcer in the stomach, and in option "1" the word "esophagogastroduodenoscopy" has "gastro," which refers to the stomach. Therefore, this would be best option to select as the correct answer.)

(22) The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client supports this diagnosis? (A) "My pain goes away when I have a bowel movement." (B) "I have bright red blood in my stool all the time." (C) "I have episodes of diarrhea and constipation." (D) "My abdomen is hard and rigid and I have a fever."

(A) THE TERMINAL ILEUM IS THE MOST COMMON SITE FOR REGIONAL ENTERITIS, WHICH CAUSES RIGHT LOWER QUADRANT PAIN THAT IS RELIEVED BY DEFECATION. (B) Stools are liquid or semiformed and usually do not contain blood. (C) Episodes of diarrhea and constipation may be a sign/symptom of colon cancer, not Crohn's disease. (D) A fever and hard rigid abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease. (Test-taking hint: The test taker should eliminate option "2" because of the word "all," which is an absolute. There are very few absolutes in the healthcare arena.)

(142) The client presents to the emergency department experiencing frequent watery, bloody stools after eating some undercooked meat at a fast-food restaurant. Which intervention should be implemented first? (A) Obtain a stool sample from the client. (B) Initiate antibiotic therapy intravenously. (C) Have the laboratory draw a complete blood count. (D) Administer the antidiarrheal medication Lomotil.

(A) THIS CLIENT MAY HAVE DEVELOPED AN INFECTION FROM THE UNDERCOOKED MEAT. THE NURSE SHOULD OBTAIN A STOOL SPECIMEN FOR THE LABORATORY TO ANALYZE. (B) Antibiotic therapy is initiated in only the most serious cases of infectious diarrhea, the diarrhea must be assessed first. A specimen for culture should be obtained before beginning medication. (C) A complete blood count will provide an estimate of blood loss, but it is not the first intervention. (D) An antidiarrheal medication would be administered after the specimen collection. (Test-taking hint: All options in a priority-setting question may be interventions the nurse could implement, but the right answer will be the 1 implemented first. Collecting a stool sample is assessment, which is the first step in the nursing process.)

(136) The client has dark, watery, and shiny-appearing stool. Which intervention should the nurse implement first? (A) Check for a fecal impaction. (B) Encourage the client to drink fluids. (C) Check the chart for sodium and potassium levels. (D) Apply a protective barrier cream to the perianal area.

(A) THIS IS A SYMPTOM OF DIARRHEA MOVING AROUND AN IMPACTION HIGHER UP IN THE COLON. THE NURSE SHOULD ASSESS FOR AN IMPACTION WHEN OBSERVING THIS FINDING. (B) Encouraging the client to drink fluids should be done, but not the first intervention. (C) The sodium level is usually not a problem for clients experiencing diarrhea, but the potassium level may be checked. However, again, this is not the first intervention. (D) A protective cream can be applied to an excoriated perineum, but first the nurse should assess the situation. (Test-taking hint: The first step of the nursing process is assessment, after which a nursing diagnosis and interventions follow. The nurse should assess first.)

(17) The client diagnosed with IBD is prescribed total parental nutrition (TPN). Which intervention should the nurse implement? (A) Check the client's glucose level. (B) Administer an oral hypoglycemic. (C) Assess the peripheral intravenous site. (D) Monitor the client's oral food intake.

(A) TPN IS HIGH IN DEXTROSE, WHICH IS GLUCOSE; THEREFORE, THE CLIENT'S BLOOD GLUCOSE LEVEL MUST BE MONITORED CLOSELY. (B) The client may be on sliding-scale regular insulin coverage for the high glucose level. (C) The TPN must be administered via a subclavian line because of the high glucose level. (D) The client is NPO to put the bowel at rest, which is the rationale for administering the TPN. (Test-taking hint: The test taker may want to select option "3" because it has the word "assess," but the test taker should remember to note the adjuective "peripheral," which makes this option incorrect. Remember, the words "check" and "monitor" are words meaning "assess.")

(15) The client diagnosed with inflammatory bowel disease has a serum potassium level of 3.4 mEq/L. Which action should the nurse implement for? (A) Notify the healthcare provider. (B) Assist the client for muscle weakness. (C) Request telemetry for the client. (D) Prepare to administer potassium IV.

(A) The HCP should be notified so potassium supplements can be ordered, but this is not the first intervention. (B) MUSCLE WEAKNESS MAY BE A SIGN OF HYPOKALEMIA; HYPOKALEMIA CAN LEAD TO CARDIAC DYSRHYTHMIAS AND CAN BE LIFE THREATENING. ASSESSMENT IS PRIORITY FOR A POTASSIUM LEVEL JUST BELOW NORMAL LEVEL, WHICH IS 3.5-5.5 MEQ/L. (C) Hypokalemia can lead to cardiac dysrhythmias; therefore, requesting telemetry is appropriate, but it is not the first intervention. (D) The client will need potassium to correct the hypokalemia, but it is not the first intervention. (Test-taking hint: When the question asks which action should be implemented first, remember assessment is the first step in the nursing process. If the answer option addressing assessment is appropriate for the situation in the question, then the test taker should select it as the correct answer.)

(3) The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understand the discharge instructions? (A) "I should not eat for at least 1 day following this procedure." (B) "I can lie down whenever I want after a meal. It won't make a difference." (C) "The stomach contents won't bother my esophagus but will make me nauseous." (D) "I should avoid orange juice and eating tomatoes until my esophagus heals."

(A) The client is allowed to eat as soon as the gag reflex has returned. (B) An esophagogastroduodenoscopy is a diagnostic procedure, not a cure. Therefore, the client still has GERD and should be instructed to stay in an upright position for 2-3 hours after eating. (C) Stomach contents are acidic and will erode the esophageal lining. (D) ORANGE JUICE AND TOMATOES ARE ACIDIC, AND THE CLIENT DIAGNOSED WITH GERD SHOULD AVOID ACIDIC FOODS UNTIL THE ESOPHAGUS HAS HAD A CHANCE TO HEAL. (Test-taking hint: This question assumes the test taker has knowledge of diagnostic procedures for specific disease processes.)

(5) The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? (A) Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. (B) Have the client remain upright at all times and walk for 30 minutes 3 times a week. (C) Instruct the client to maintain a right lateral side-lying position and take antacids before meals. (D) Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client.

(A) The client is encouraged to lie with the head of the bed elevated, but this is difficult to achieve when on the stomach. NSAIDs inhibit prostaglandin synthesis in the stomach, which paces the client at risk for developing gastric ulcers. The client is already experiencing gastric acid difficulty. (B) The client will need to lie down at some time, and walking will not help with GERD. (C) If lying on the side, the left-side lying position, not the right side, will allow less chance of reflux into the esophagus. Antacids are taken 1 and 3 hours after a meal. (D) THE HEAD OF THE BED SHOULD BE ELEVATED TO ALLOW GRAVITY TO HELP IN PREVENTING REFLUX. LIFESTYLE MODIFICATIONS OF LOSING WEIGHT, MAKING DIETARY MODIFICATIONS, ATTEMPTING SMOKING CESSATION, DISCONTINUING THE USE OF ALCOHOL, AND NOT STOOPING OR BENDING AT THE WAIST ALL HELP TO DECREASE REFLUX. (Test-taking hint: Option "2" has an "all," which should alert the test taker to eliminate this option. If the test taker has no idea of the answer, lifestyle modifications are an educated guess for most chronic problems.)

(4) The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? (A) Allow any of the client's favorite foods as long as the amount is limited. (B) Have the client perform eructation exercises several times a day. (C) Eat 4-6 small meals a day and limit fluids during mealtimes. (D) Encourage the client to consume a glass of red wine with 1 meal a day.

(A) The client is instructed to avoid spicy and acidic foods and any food producing symptoms. (B) Eructation means belching, which is a symptoms of GERD. (C) CLIENTS SHOULD EAT SMALL, FREQUENT MEALS AND LIMIT FLUIDS WITH THE MEALS TO PREVENT REFLUX INTO THE ESOPHAGUS FROM A DISTENDED STOMACH. (D) Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux. (Test-taking hint: The word "any" in option "1" should give the test taker a clue that, unless there are absolutely no dietary restrictions, this is an incorrect answer. Option "2" requires knowledge of medical terminology.)

(141) The client is placed on percutaneous endoscopic gastrostomy (PEG) tube feedings. Which occurrence warrants immediate intervention by the nurse? (A) The client tolerates the feedings being infused at 50 mL/hr. (B) The client pulls the nasogastric feedings tube out. (C) The client complains of being thirsty. (D) The client has green, watery stool.

(A) The client is tolerating the feeding change, so there is no need for an immediate action. (B) The client has a PEG tube inserted into the stomach through the abdominal wall. (C) Complaints of being thirsty should be addressed, the client may require some ice chips in the mouth or oral care, but this is not priority over assessing the client's ability to swallow. (D) THIS CLIENT NEEDS TO BE CLEANED IMMEDIATELY, THE ABDOMEN MUST BE ASSESSED, AND A DETERMINATION MUST BE MADE REGARDING THE TYPE OF FEEDING AND THE ADDITIVES AND MEDICATIONS BEING ADMINISTERED AND SKIN DAMAGE OCCURRING. THIS OCCURRENCE IS PRIORITY. (Test-taking hint: The test taker must identify assessment data indicating a complication secondary to the disease process when the stem asks which occurrence warrants immediate intervention.)

(16) The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? (A) Provide a low-residue diet. (B) Rest the client's bowel. (C) Assess vital signs daily. (D) Administer antacids orally.

(A) The client's bowel should be placed on rest and no foods or fluids should be introduced into the bowel. (B) WHENEVER A CLIENT HAS AN ACUTE EXACERBATION OF A GASTROINTESTINAL DISORDER, THE FIRST INTERVENTION IS TO PLACE THE BOWEL ON REST. THE CLIENT SHOULD NPO WITH INTRAVENOUS FLUIDS TO PREVENT DEHYDRATION. (C) The vital signs must be taken more often than daily in a client who is having an acute exacerbation of ulcerative colitis. (D) The client will receive anti-inflammatory and antidiarrheal medications, not antacids, which are used for gastroenteritis. (Test-taking hint: "Acute exacerbation" is the key phrase in the stem of the question. The word "acute" should cause the test taker to eliminate any daily intervention.)

(143) The clinic nurse is talking on the phone to a client who has diarrhea. Which intervention should the nurse discuss with the client? (A) Tell the client to measure the amount of stool. (B) Recommend the client come to the clinic immediately. (C) Explain the client should follow the BRAT diet. (D) Discuss taking an over-the-counter histamine-2 blocker.

(A) The clinic nurse should not ask the client to measure stool at home; this is done in the acute care setting. (B) Unless the client has had diarrhea for longer than 48 hours, the client does not need to be seen in the clinic. (C) THE BRAT (BANANAS, RICE, APPLESAUCE, AND TOAST) DIET IS RECOMMENDED FOR A CLIENT WITH DIARRHEA BECAUSE IT IS LOW RESIDUE AND PRODUCES NUTRITION WHILE NOT IRRITATING THE GI SYSTEM. (D) Histamine-2 blockers decrease gastric acid production and would not be prescribed for a client with diarrhea. (Test-taking hint: The test taker should realize diarrhea involves the gastrointestinal system and selecting an intervention addressing the GI system would be an appropriate choice.)

(19) The client diagnosed with Crohn's disease is crying and tells the nurse, "I can't take it anymore. I never know when I will get sick and end up here in the hospital." Which statement is the nurse's best response? (A) "I understand how frustrating this must be for you." (B) "You must keep thinking about the good things in your life." (C) "I can see you are very upset. I'll sit down and we can talk." (D) "Are you thinking about doing anything like committing suicide?"

(A) The nurse should never tell a client he or she understands what the client is going through. (B) Telling the client to think about the good things is not addressing the client's feelings. (C) THE CLIENT IS CRYING AND IS EXPRESSING FEELINGS OF POWERLESSNESS; THEREFORE, THE NURSE SHOULD ALLOW THE CLIENT TO TALK. (D) The client is crying and states "I can't take it anymore," but this is not a suicidal comment or situation. (Test-taking hint: There are rules applied to therapeutic responses. Do not say "understand" and do not ask "why." The test taker should select an option where some type of feeling is being reflected in the statement.)

(140) The nurse, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task would be most appropriate to assign to the LPN? (A) Assist the UAP to learn to perform blood glucose checks. (B) Monitor the potassium levels of a client with diarrhea. (C) Administer a bulk laxative to a client diagnosed with constipation. (D) Assess the abdomen of a client who has had complaints of pain.

(A) The nurse will be responsible for signing off on the UAP as to being competent to perform the blood glucose. The nurse should do this to determine the competency of the UAP. (B) The laboratory values may require the nurse to interpret and act on the results. The nurse cannot delegate tasks requiring professional judgement. (C) THE LPN CAN ADMINISTER MEDICATIONS SUCH AS A LAXATIVE. (D) The nurse cannot delegate assessment. (Test-taking hint: Nurses cannot delegate any activity requiring professional judgment, assessment, teaching, or evaluation.)

(25) Which assessment data support to the nurse the client's diagnosis of gastric ulcer? (A) Presence of blood in the client's stool for the past month. (B) Reports of a burning sensation moving like a wave. (C) Sharp pain in the upper abdomen after eating a heavy meal. (D) Complaints of epigastric pain 30-60 minutes after ingesting food.

(A) The presence of blood does not specifcally indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer resulting in the presence of blood. (B) A wavelike burning sensation is a symptom of gastroesophageal reflux. (C) Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. (D) IN A CLIENT DIAGNOSED WITH A GASTRIC ULCER, PAIN USUALLY OCCURS 30-60 MINUTES AFTER EATING, BUT NOT AT NIGHT. IN CONTRAST, A CLIENT WITH A DUODENAL ULCER HAS PAIN DURING THE NIGHT OFTEN RELIEVED BY EATING FOOD. PAIN OCCURS 1-3 HOURS AFTER MEALS. (Test-taking hint: This question asks the test taker to identify assessment data specific to the disease process. Many diseases have similar symptoms or their location may help rule out some diseases and provide the healthcare provider with a key to diagnose a specific disease - in this case, peptic ulcer disease. Nurses are usually the major source for information to the healthcare team.)

(32) The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data require further intervention? (A) Bowel sounds auscultated 15 times in 1 minute. (B) Belching after eating a heavy and fatty meal late at night. (C) A decrease in systolic BP of 20 mmHg from lying to sitting. (D) A decreased frequency of distress located in the epigastric region.

(A) The range for normoactive bowel sounds is from 5-35 times per minute. This would require no intervention. (B) Belching after a heavy, fatty meal is a symptom of gallbladder disease. Eating late at night may cause symptoms of esophageal disorders. (C) A DECREASE OF 20 MMHG IN BLOOD PRESSURE AFTER CHANGING POSITION FROM LYING, TO SITTING, TO STANDING IS ORTHOSTATIC HYPOTENSION. THIS COULD INDICATE THE CLIENT IS BLEEDING. (D) A decrease in the quality and quantity of discomfort shows an improvement in the client's condition. This would not require further intervention. (Test-taking hint: When the question asks about further intervention, the test taker should examine the answer options for an unexpected outcome requiring further assessment.)

(29) Which problems should the nurse include in the plan of care for the client diagnosed with peptic ulcer disease to observe for physiological complications? (A) Alteration in bowel elimination patterns. (B) Knowledge deficit in the causes of ulcers. (C) Inability to cope with changing family roles. (D) Potential for alteration in gastric emptying.

(A) There is no indication from the question there is a problem or potential problem with bowel elimination. (B) Knowledge deficit does not address physiological complications. (C) This client may have problems from changing roles within the family, but the question asks for potential physiological complications, not psychosocial problems. (D) POTENTIAL FOR ALTERATION IN GASTRIC EMPTYING IS CAUSED BY EDEMA OR SCARRING ASSOCIATED WITH AN ULCER, WHICH MAY CAUSE A FEELING F "FULLNESS," VOMITING OF UNDIGESTED FOOD, OR ABDOMINAL DISTENTION. (Test-taking hint: This question asks the test taker to identify a physiological problem identifying a complication of the disease process. Therefore, options "2" and "3" could be eliminated because they do not address physiological problems.)

(137) The charge nurse has just received the shift report. Which client should the nurse see first? (A) The client diagnosed with Crohn's disease who had 2 semiformed stools on the previous shifts. (B) The elderly client admitted from another facility who is complaining of constipation. (C) The client diagnosed with AIDS who had a 200 mL diarrhea stool and has elastic skin tissue turgor. (D) The client diagnosed with hemorrhoids who had some spotting of bring red blood on the toilet tissue.

(A) This client is improving; semiformed stools are better than diarrhea. (B) THIS CLIENT HAS JUST ARRIVED, SO THE NURSE DOES NOT KNOW IF THE COMPLAINT IS VALID AND NEEDS INTERVENTION UNLESS ASSESSED. THE ELDERLY HAVE DIFFICULTY WITH CONSTIPATION AS A RESULT OF DECREASED GASTRIC MOTILITY, MEDICATIONS, POOR DIET, AND IMMOBILITY. (C) The client has diarrhea, but only 200 mL, and has elastic tissue turgor indicating the client is not dehydrated. (D) This is not normal, but it is expected for a client with hemorrhoids. (Test-taking hint: The test taker should notice descriptive words such as "elderly," which would alert the test taker to the age range having an implication in answering the question. Answer options "3" and "4" are expected for the disease processes.)

(31) Which expected outcome should the nurse include for a client diagnosed with peptic ulcer disease? (A) The client's pain is controlled with the use of NSAIDs. (B) The client maintains lifestyle modifications. (C) The client has no signs and symptoms of hemoptysis. (D) The client takes antacids with each meal.

(A) Use of NSAIDs increases and causes problems associated with peptic ulcer disease. (B) MAINTAINING LIFESTYLE CHANGES SUCH AS FOLLOWING AN APPROPRIATE DIET AND REDUCING STRESS INDICATE THE CLIENT IS COMPLYING WITH THE MEDICAL REGIMEN. COMPLIANCE IS THE GOAL OF TREATMENT TO PREVENT COMPLICATIONS. (C) Hemoptysis is coughing up blood, which is not a sign or symptom of peptic ulcer disease. This would not be an expected outcome. (D) Antacids should be taken 1-3 hours after meals, not with each meal. (Test-taking hint: Expected outcomes are positive completion of goals; maintaining lifestyle modifications would be an appropriate goal for any client with any chronic illness.)

(18) The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement first? (A) Weigh the client daily and document in the client's chart. (B) Teach coping strategies such as dietary modifications. (C) Record the frequency, amount, and color of stools. (D) Monitor the client's oral fluid intake every shift.

(A) Weighing the client daily will help identify if the client is experiencing malnutrition, but it is not the priority intervention during an acute exacerbation. (B) Coping strategies help develop healthy ways to deal with this chronic disease, which has remissions and exacerbations, but it is not the priority intervention. (C) THE SEVERITY OF THE DIARRHEA HELPS DETERMINE THE NEED FOR FLUID REPLACEMENT. THE LIQUID STOOL SHOULD BE MEASURED AS PART OF THE TOTAL OUTPUT. (D) The client will be NPO when there is an acute exacerbation of IBD to allow the bowel to rest. (Test-taking hint: The test taker can apply Maslow's hierarchy of needs and select the option addressing a physiological need.)