GI (100 Q's) [Test: Thursday May 7th, 2015]

A nurse is caring for a client with pneumonia who has a history of bleeding esophageal varices. Based on this information, the nurse plans care, knowing that it is important to prevent:

Constipation

A nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement would be included in the teaching?

"Be sure to sleep with your head elevated in bed."

A generally healthy 63-year-old man is seen in the health care provider's office for a routine examination. Which statement made by the client is important for the nurse to follow up on?

"Everyone in my immediate family has died from gastrointestinal cancer."

A client is seen in the ambulatory care office for a routine examination. Which statement by the client would be important for the nurse to follow up?

"I just lost a family to gastrointestinal cancer."

A client who has undergone a barium enema is being readied for discharge from the ambulatory care unit. The nurse determines that the client has understood the discharge instructions if the client states:

"I should take a laxative and my stool should return to normal color."

A client being seen in a health care provider's office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test?

"Remove jewelry before the test."

Which statement by the spouse of a client with end-stage liver failure indicates the need for additional teaching by the multidisciplinary team regarding the management of pain?

"This opioid will cause very deep sleep, which is what my husband needs."

A client is admitted to an acute care facility with complications of celiac disease. Which question would be helpful initially in obtaining information for the nursing care plan?

"What is your understanding of celiac disease?"

A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to digest food. The nurse recalls that digestion is best defined as:

A mechanical and chemical process involving the breakdown of foods

A nurse is caring for a client with esophageal varices who is going to have a Sengstaken-Blakemore tube inserted. The nurse brings which priority item to the bedside so that it is available at all times?

A pair of scissors

A client who has undergone a colostomy several days ago is reluctant to leave the hospital and has not yet looked at the ostomy site. Which measures are most likely to promote coping? Select all that apply.

Ask a member of the local ostomy club to visit with the client before discharge. Ask the enterostomal nurse specialist to consult with the client before discharge. Ask the client to begin doing one part of the ostomy care and increase tasks daily.

A nurse notes that the medical record of a client with cirrhosis states that the client has asterixis. To verify this information, the nurse would do which of the following?

Ask the client to extend the arms.

A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken:

30 minutes before meals

A nurse is checking a client for the correct placement of a nasogastric (NG) tube. The nurse aspirates the client's stomach contents and checks their pH level. Which of the following pH values indicates the correct placement of the tube?

4.0

A client with peptic ulcer disease is scheduled for a pyloroplasty and the client asks the nurse about the procedure. The nurse bases the response on which of the following?

A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.

After a liver biopsy, the nurse places the client in which of the following positions?

A right side-lying position with a small pillow or folded towel under the puncture site

A nurse is getting a client who underwent umbilical hernia repair ready for discharge. The nurse tells the client that it is important to continue to do which of the following after discharge?

Avoid coughing.

A client will undergo a barium swallow to determine whether the client has a hiatal hernia. The nurse provides pre-procedure instructions and tells the client to:

Avoid eating or drinking after midnight before the test.

The nurse observes that a client with a nasogastric tube connected to continuous gastric suction is mouth breathing, has dry mucous membranes, and has a foul breath odor. In planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?

Brush the client's teeth frequently. Use diluted mouthwash and water to rinse the mouth.

A client has just undergone gastroscopy. Which of the following is the essential post-procedure nursing intervention?

Check the gag reflex before giving oral foods or fluids.

A client with a Sengstaken-Blakemore tube in place to treat esophageal varices suddenly becomes restless. The client's heart rate and blood pressure increase and the client has difficulty breathing. The important initial nursing action is to:

Cut the tube and pull it out.

A nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to see documented in the record?

Diarrhea

A client with possible hiatal hernia complains of frequent heartburn and regurgitation. The nurse should gather further information about the presence of which signs or symptoms?

Difficulty swallowing

A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse would tell the client to avoid doing which of the following?

Drinking liquids with meals

A nurse is providing dietary instructions to a client with peptic ulcer disease. The nurse tells the client to:

Eat anything that does not aggravate or cause pain.

A nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which of the following would the nurse suggest to the client to prevent swelling?

Elevate the scrotum.

A client is receiving bolus feedings via a nasogastric tube. The nurse plans to place the client's head of the bed (HOB) in which most optimal position once the feeding is completed?

Elevated 30 to 45 degrees with the client in the right lateral position for 60 minutes

A nurse is assigned to care for a client with a Sengstaken-Blakemore tube. The nurse should suspect that the client has which diagnosis?

Esophageal varices

A licensed practical nurse (LPN) is assisting in insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by measuring:

From the tip of the client's nose to the earlobe and then down to the xiphoid process

A nurse has been caring for a client with a Sengstaken-Blakemore tube. The health care provider arrives on the nursing unit and deflates the esophageal balloon. Following deflation of the balloon, the nurse should monitor the client most closely for which of the following?

Hematemesis

A nurse analyzes the results of laboratory studies performed on a client with peptic ulcer disease. Which of the following laboratory values would indicate a complication associated with the disease?

Hemoglobin 10.2 g/dL

After the deflation of the balloon of a client's Sengstaken-Blakemore tube, the nurse monitors the client closely for which esophageal complication?

Hemorrhage

Of the following infection control methods, which would be the priority to include in the plan of care to specifically prevent hepatitis B in a client considered to be at high risk for exposure?

Hepatitis B vaccine

A nurse is assisting with the insertion of a nasogastric tube into a client. The nurse places the client in which position for insertion?

High Fowler's position

A nurse is caring for a client after a Billroth II procedure. On review of the postoperative prescriptions, which of the following, if prescribed, would the nurse question and verify?

Irrigating the nasogastric (NG) tube

A nurse should include which of the following in a teaching plan for a client who has peptic ulcer disease?

Learn to use stress reduction techniques.

A nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse assists the client to which of the following positions?

Left Sims' position

A nurse is teaching the client about an upcoming colonoscopy procedure. The nurse would include in the instructions that the client will be placed in which of the following positions for the procedure?

Left Sims' position

The nurse is providing discharge instructions to a client after gastrectomy. Which measure will the nurse instruct the client to follow to help prevent dumping syndrome?

Limit the fluids taken with meals.

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse tells the client to avoid which position that could aggravate the pain?

Lying flat

A nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer should focus interventions on which of the following?

Maintaining a patent nasogastric (NG) tube

A client with acute pancreatitis is experiencing severe pain. After noting an absence of an analgesic prescription on the health care provider prescription sheet, the nurse would suggest contacting the health care provider to request a prescription for which of the following medications?

Meperidine hydrochloride (Demerol)

A client has just undergone a gastroscopy. Which action should be taken by the nurse as the essential post-procedure nursing intervention?

Monitoring for the gag reflex

A client arrives in the emergency department with bleeding esophageal varices, and the health care provider states that a Sengstaken-Blakemore tube will need to be used to try to control the gastrointestinal hemorrhage. The nurse prepares for insertion of the tube via which of the following routes?

Nasogastric

A client with Crohn's disease is seen by the health care provider, and a complete blood count (CBC) has been prescribed. The nurse provides instructions to the client who will be reporting to the laboratory in the morning to have the blood test drawn. The nurse gives the client which of the following information about this test?

No special preparation is necessary.

A client who has been taking indomethacin (Indocin) for gout has a prescription for guaiac testing of the stool. The nurse explains to the client that this test is necessary because it detects which of the following that may be caused or affected by this medication?

Occult blood

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention would be appropriate?

Offer small, frequent meals.

A licensed practical nurse (LPN) is providing follow-up teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately:

One day

A nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. The nurse would plan to include which risk factor for colorectal cancer in the material?

Personal history of ulcerative colitis or gastrointestinal (GI) polyps

A nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The nurse notes that the pH is 5 and determines that the:

Placement of the NG tube is accurate.

A nurse is reviewing the health care provider's prescriptions written for a client admitted with acute pancreatitis. Which health care provider prescription would the nurse verify if noted on the client's chart?

Position the client supine and flat.

A client with peptic ulcer disease has been prescribed misoprostol (Cytotec) and sucralfate (Carafate). The nurse teaches the client that these two medications will work primarily to:

Protect the gastric mucosa.

A nurse provides information to a client following a gastrectomy about the signs and symptoms of pernicious anemia. The nurse understands that:

Regular monthly injections of vitamin B12 are used to treat this disorder.

A nurse reinforces instructions to a client following a gastrectomy about the signs and symptoms of pernicious anemia, knowing that:

Regular monthly injections of vitamin B12 will prevent this complication.

A client is admitted to the hospital with a bowel obstruction secondary to a recurrent malignancy, and the health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, the nurse determines that the best action is to:

Remain with the client and be silent.

A health care provider asks the licensed practical nurse (LPN) to give preprocedure instructions to a client who will undergo a barium swallow (esophagography) in a few days. The LPN includes which of the following items in this discussion?

Remove all metal and jewelry before the test.

An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. The nurse explains to the client that this test:

Requires the client to lie still for short intervals

A nurse has given the client with hepatitis instructions about postdischarge management during convalescence. The nurse determines that the client needs further teaching if the client states to:

Resume full activity level within 1 week.

A nurse assigned to care for a client with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care, knowing that which client position will best assist in facilitating breathing?

Semi-Fowler's

A nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which of the following symptoms indicate this occurrence?

Sweating and pallor

A postoperative client has regained bowel sounds and is ready to start a clear liquid diet. The nurse is told that the health care provider has written a prescription to remove the nasogastric (NG) tube. The nurse assists in the procedure and asks the client to do which of the following during tube removal?

Take a breath and hold it until the tube is out.

A nurse is providing home care instructions to a client following a gastric resection. The nurse includes which of the following in the instructions?

Take actions to prevent dumping syndrome.

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. The LPN would instruct the client to do which of the following?

Take and hold a deep breath.

A client presents to the urgent care center with complaints of abdominal pain. Suddenly the client vomits bright red blood. The nurse takes which immediate action?

Takes the client's vital signs

A client had a Miller-Abbott tube inserted 24 hours ago. The nurse is asked to check the client to determine whether the tube is in the appropriate location at this time. Which of the following findings would indicate adequate location of the tube?

The aspirate from the tube has a pH of 7.45.

A nurse is caring for a client with a nasogastric tube. Which observation is reliable in determining that the tube is correctly placed?

The pH of the aspirate is 5.

A health care provider is about to perform a paracentesis on a client with abdominal ascites. The nurse would assist the client to assume which of the following positions?

Upright

A nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that this client is at risk for which vitamin deficiency?

Vitamin B12

A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client about the need for:

Vitamin B12 injections

A nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. The nurse makes which statement to the client?

"Be sure to sleep with your head elevated in bed."

A client is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP). The nurse includes which intervention in the plan of care for the client?

After the procedure, keep client nothing by mouth (NPO) until the gag reflex returns.

A nurse is collecting data on a client with a diagnosis of peptic ulcer disease. Which of the following is least likely associated with this disease?

History of the use of acetaminophen (Tylenol) for pain and discomfort

A nurse is providing discharge instructions to a client who has had a total gastrectomy. The nurse tells the client about the importance of returning to the health care clinic as scheduled for which priority assessment?

Vitamin B12 and folic acid studies

A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client that which of the following will be prescribed to treat the problem?

Vitamin B12 injections

A nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Choose the interventions that the nurse would expect to be prescribed for the client. Select all that apply.

Administer antacids, as prescribed. Encourage coughing and deep breathing. Administer anticholinergics, as prescribed.

A client arrives at the emergency department and complains of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the health care provider's prescriptions. Which of the following prescriptions would the nurse question if written on the health care provider's prescription form?

Administration of an analgesic

A nurse has a prescription to give 30 mL of an antacid to a client through a nasogastric (NG) tube that is connected to wall suction. The nurse would do which of the following to perform this procedure correctly?

Clamp the NG tube for 30 minutes following administration of the medication.

A client receiving a high cleansing enema complains of pain and cramping. The nurse would take which corrective action?

Clamp the tubing for 30 seconds and restart the flow at a slower rate.

A nurse is reviewing the medication record of a client with acute gastritis. Which of the following medications, if noted on the client's record, would the nurse question?

Ibuprofen (Motrin)

Before administering an intermittent tube feeding through a nasogastric tube, the nurse checks for gastric residual volume. The nurse understands that the rationale for checking gastric residual volume before administering the tube feeding is to:

Evaluate absorption of the last feeding.

A client is admitted to the hospital with acute viral hepatitis. Which signs or symptoms would the nurse expect to note, based upon this diagnosis?

Fatigue

A client is admitted to the hospital with severe jaundice and is having diagnostic testing. Because the client has no complaints of fatigue, the client is encouraged to ambulate in the hall to maintain muscle strength. The client paces around the room but will not enter the hall. Which of the following problems most likely is the reason for the client's reluctance to walk in the hall?

Feeling self-conscious about appearance

A nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse would place the client in which position during and after the feedings?

Fowler's

A client has asymptomatic diverticular disease. What type of diet should the nurse anticipate to be prescribed?

High-fiber diet

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. Which of the following data would further support this diagnosis?

History of alcohol use, smoking, and weight loss

A nurse is preparing to administer an intermittent tube feeding to a client with a nasogastric tube. The nurse checks the residual and obtains an amount of 200 mL. The nurse would:

Hold the feeding.

A nurse is caring for a client with anorexia. The nurse plans care for the client, focusing on which of the following as the primary problem?

Impaired nutritional status

A nurse is caring for a client with acute pancreatitis and a history of alcoholism and is monitoring the client for complications. Which of the following data would be a sign of paralytic ileus?

Inability to pass flatus

A client is admitted to the hospital with viral hepatitis and is complaining of a loss of appetite. In order to provide adequate nutrition, the nurse encourages the client to:

Increase intake of fluids.

A client in the emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse would question a prescription for which of the following?

Milk of magnesia

A nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse should question a prescription for which of the following?

Milk of magnesia

A nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). The nurse would plan to do which of the following first once the client arrives?

Monitor for return of the gag reflex.

A nurse planning care for a client with hepatitis plans to meet the client's safety needs by:

Monitoring prothrombin and partial thromboplastin values

A nurse is caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse should plan to:

Provide frequent oral and nasal care on a regular basis.

A nurse is performing an abdominal assessment on a client. The nurse interprets that which finding is abnormal and should be reported to the registered nurse (RN) or health care provider?

Pulsation between the umbilicus and pubis

A postgastrectomy client who is being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work and I'm really behind. If I don't get my act together, I may lose my job." Based on the client's statement, the nurse determines that at this time, it is appropriate to discuss:

Reducing stressors in life

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse suggests foods that are on which of the following diets?

A low-fiber diet

A client with hepatic encephalopathy is receiving lactulose (Cephulac). The nurse determines that the medication is effective if which of the following is observed?

Client previously oriented to person only; can now state name, year, and present location

A nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. Which of the following is the appropriate nursing action?

Stop the irrigation temporarily.

A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN assists the client into which of the following positions?

Supine with the head raised slightly and the knees slightly flexed