GI

The physician is performing a paracentesis on a client with cirrhosis. For what potential complications of rapid removal of ascitic fluid should you monitor this client? A. Hypovolemia B. Systemic vasoconstriction C. Increased intra-abdominal pressure D. Rebound hypertension and fluid retention

a Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to hypovolemia and possibly progress to vasodilation and shock.

You are taking the history of a client with a sliding hernia. Which of the following symptoms should you inquire about in this client? A. Reflux B. Bleeding C. Dysphagia D. Early satiety

a Clients with sliding hernias often experience symptoms of reflux; therefore, this client should be evaluated for GERD.

A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately? a. Fever and abdominal pain b. Flatulence and liquid stool c. Loudly audible bowel sounds d. Sleepiness and abdominal cramps

a The patient should be taught to observe for signs of rectal bleeding and peritonitis. Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.

When preparing a patient for a capsule endoscopy study, what should the nurse do? a. Ensure the patient understands the required bowel preparation. b. Have the patient return to the procedure room for removal of the capsule. c. Teach the patient to maintain a clear liquid diet throughout the procedure. d. Explain to the patient that conscious sedation will be used during placement of the capsule.

a A capsule endoscopy study involves the patient performing a bowel prep to cleanse the bowel before swallowing the capsule. The patient will be on a clear liquid diet for 1 to 2 days before the procedure and will remain NPO for 4 to 6 hours after swallowing the capsule. The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric (NG) tube b. Administering oral bicarbonate and testing the patient's gastric pH level c. Performing a fecal occult blood test and administering IV calcium gluconate d. Starting parenteral nutrition and placing the patient in a high-Fowler's position

a A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

The nurse teaches senior citizens at a community center how to prevent food poisoning at their informal social events. The nurse determines that teaching is successful if a community member makes which statement? a. "Pasteurized juices and milk are safe to drink." b. "Alfalfa sprouts are safe if rinsed before eating." c. "Fresh fruits do not need to be washed before eating." d. "Ground beef is safe to eat if cooked until it is brown."

a Drink only pasteurized milk, juice, or cider. Ground beef should be cooked thoroughly. Browned meat can still harbor live bacteria. Cook ground beef until a thermometer reads at least 160° F. If a thermometer is unavailable, decrease risk of illness by cooking the ground beef until there is no pink color in the middle. Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. Persons who are immunocompromised or older should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured.

Which statement regarding the factors responsible for the development of esophageal reflux disease is true? A. Esophageal reflux occurs with decreased lower esophageal sphincter tone. B. Esophageal reflux occurs with increased lower esophageal sphincter tone. C. Esophageal reflux occurs when the lower esophageal sphincter tenses. D. Esophageal reflux occurs with decreased intraabdominal pressure.

a Esophageal reflux can occur when intraabdominal pressure is elevated or when the sphincter tone of the LES is decreased.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect? a. Tremors b. Constipation c. Double vision d. Numbness in fingers and toes

a Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

A patient had a stomach resection for stomach cancer. The nurse should teach the patient about the loss of the hormone that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Which hormone will be decreased with a gastric resection? a. Gastrin b. Secretin c. Cholecystokinin d. Gastric inhibitory peptide

a Gastrin is the hormone activated in the stomach (and duodenal mucosa) by stomach distention that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Secretin inhibits gastric motility and acid secretion and stimulates pancreatic bicarbonate secretion. Cholecystokinin allows increased flow of bile into the duodenum and release of pancreatic digestive enzymes. Gastric inhibitory peptide inhibits gastric acid secretion and motility.

The family of a client with chronic gallbladder inflammation and obstructive jaundice asks you to explain why the client's skin is itchy. What is your best response? A. "Bile salts accumulate on the skin causing it to itch." B. "Liver failure is imminent when metabolic products appear on the skin." C. "The bacteria responsible for inflammation of the gallbladder produce toxins on the skin." D. "The itching is caused by the breakdown of gallstones, which causes a hypersensitivity response."

a In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin.

Which client would be at highest risk for the development of colorectal cancer? A. 55-year-old woman whose father was treated for colon cancer B. 45-year-old woman with irritable bowel syndrome C. 33-year-old man who drinks four cups of coffee daily D. 70-year-old man with peptic ulcer disease

a Individuals with a first-degree relative diagnosed with colorectal cancer have a three- to fourfold risk of developing the disease. In addition, 95% of colorectal cancers are diagnosed in people over the age of 50.

What postoperative nursing intervention would be a priority for the client who has undergone an abdominal-perineal resection for a rectal tumor? A. Monitoring of perineal wound drainage B. Assisting the client with a bowel training program C. Administering corticosteroids to prevent rectal itching D. Providing a high-fiber diet to ease the passage of stools

a Monitoring of drainage from the perineal wound and cavity is of primary importance in detecting infection or abscess formation.

A client who underwent removal of a benign colonic polyp asks you why a follow-up colonoscopy is necessary. What would be your best response? A. "You are at risk for developing more polyps in the future." B. "You may have other cancerous lesions that could not be seen right now." C. "A regular colonoscopy will prevent the development of malignant polyps." D. "This test will ensure healing has occurred where the polyp has been removed."

a Once a person has developed a polyp, there is a risk of multiple polyps occurring.

A client is being treated for an intestinal obstruction with decompression with a Cantor tube. What nursing intervention would be indicated in the care of this client? A. Reposition the client every 2 hours to assist with advancement of the tube. B. Tape the Cantor tube to the client's nose to prevent dislodgement. C. Instill normal saline into the Cantor tube to keep it patent. D. Withdraw 10 mL of air if drainage from the tube stops.

a The Cantor tube has a mercury-filled tip. To assist in progression of the tube, the nurse repositions the client every 2 hours.

You are preparing a teaching plan for a client with gastroesophageal reflux. Which of the following instructions should you include in a dietary guide for this client? A. "Eat four to six small meals each day." B. "Eat a small evening snack 1 to 2 hours before bed." C. "Drink carbonated beverages between meals only." D. "You may include orange or tomato juice with your breakfast."

a The client is instructed to eat four to six small meals rather than three larger meals to avoid pressure in the stomach and delayed gastric emptying, which can increase reflux. Evening snacks, carbonated beverages, and acidic foods also should be avoided.

Which assessment should you perform for a client experiencing regurgitation? A. Auscultation for crackles B. Inspection of the oral cavity C. Palpation of the cervical lymph nodes D. Culture of the throat for bacterial infection

a The client with regurgitation is at risk of aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for crackles, an indication of aspiration.

Which nursing diagnosis would be considered a priority in planning the care of a client with esophageal cancer? A. Imbalanced Nutrition: Less than Body Requirements B. Anticipatory Grieving C. Risk of Aspiration D. Acute Pain

a The priority for care of a client with esophageal cancer is Imbalanced Nutrition: Less than Body Requirements related to impaired swallowing. Fear of choking and inability to take adequate nutrition because of tumor obstruction contributes to weight loss.

Twenty-four hours after a client has had a hemicolectomy and temporary colostomy placement, you note the client's stoma to appear dry and dark red in color. What would be your best action? A. Notify the surgeon. B. Document the finding as the only action. C. Place a colostomy pouch system over the stoma. D. Place petroleum gauze dressing over the stoma.

a The stoma should appear reddish pink and moist. If the stoma takes on a dark red or purple hue and becomes dry, firm, or flaccid, the stoma has signs of ischemia. The surgeon should be notified immediately.

You are performing an assessment of a client with acute pancreatitis. Upon inspection of the client's skin, you note the presence of Turner's sign. What is your interpretation of this finding? A. The client has pancreatic enzymes leaking into the skin. B. The client is experiencing intra-abdominal bleeding. C. The client has an intestinal obstruction. D. The client has portal hypertension.

a Turner's sign is a gray-blue discoloration of the flanks caused by the leakage of pancreatic enzymes into the cutaneous tissue.

The physician has ordered vasopressin to control hemorrhage in a client with bleeding esophageal varices. By what mechanism does vasopressin control bleeding? A. By constriction of preportal splanchnic arterioles B. By inducing the release of clotting factors II, VII, IX, and X C. By increasing portal pressure, thus decreasing portal blood flow D. By decreasing contraction of smooth muscle in the vascular bed

a Vasopressin acts to cause contraction of smooth muscle in the vascular bed, constricting preportal splanchnic arterioles, decreasing blood flow to the abdominal organs, which in turn reduces portal pressure and portal blood flow.

Which of the following alterations in laboratory data should you expect in a client admitted with pancreatitis as a result of chronic cholecystitis? A. Elevated serum and urine amylase levels B. Elevated serum amylase; decreased serum lipase C. Decreased direct and indirect serum bilirubin levels D. Elevated serum alkaline phosphatase; decreased AST

a With pancreatic involvement, serum and urine amylase levels are elevated.

A 90-year-old healthy man is suffering from dysphagia. The nurse explains what age-related change of the GI tract is the most likely cause of his difficulty? a. Xerostomia b. Esophageal cancer c. Decreased taste buds d. Thinner abdominal wall

a Xerostomia, decreased volume of saliva, leads to dry oral mucosa and dysphagia. Esophageal cancer is not an age-related change. Decreased taste buds and a thinner abdominal wall do not contribute to difficulty swallowing.

A client with a gastric ulcer develops a sudden, sharp pain in the mid-epigastric region. Upon assessment, you note the abdomen is tender and rigid. What is your best first action? A. Increase the IV fluid rate. B. Notify the health care provider. C. Place the client in a knee-chest position. D. Prepare to administer an H2 antagonist.

b A client with a gastric or duodenal ulcer who is presenting with sudden onset of sharp mid-epigastric pain and a tender and board-like abdomen has most likely developed perforation, a surgical emergency. Notify the health care provider immediately.

A client with portal-systemic encephalopathy (PSE) is placed on a protein-restricted diet. The client asks you why this change in diet has been ordered. What is your best response? A. "A low-protein diet will help to restore your liver function." B. "A low-protein diet will help reduce the amount of ammonia in your blood." C. "Proteins in the diet make the liver work harder. This diet will give your liver a chance to rest." D. "Once your albumin level is normal, you need less protein to prevent fluid from leaking into the abdomen."

b A low-protein diet is ordered when serum ammonia levels elevate and/or the client shows signs of PSE. A low-protein diet helps reduce the excessive breakdown of protein into ammonia by intestinal bacteria.

Which of the following clients is most at risk for gastroesophageal influx? A. A client who drinks decaffeinated beverages B. A client who has a nasogastric tube placed C. A client taking oral hypoglycemic agents D. A client who eats small, frequent meals

b A nasogastric tube keeps the cardiac sphincter open allowing acidic contents from the stomach to enter the esophagus.

A client is brought to the emergency unit with a strangulated obstruction. What complication of this type of obstruction should you be alert for in this client? A. Pulmonary edema B. Bacterial peritonitis C. Deep vein thrombosis D. Acute tubular necrosis

b A strangulated obstruction compromises blood flow to the area. Bacteria in intestinal contents stagnate and form an endotoxin, which is released into the peritoneum and circulatory system causing septic shock.

A client who has undergone a fundoplication wrap for hernia repair has returned from the postanesthesia care unit with a nasogastric tube draining dark brown fluid. What is your best action at this time? A. Notify the physician. B. Document the finding as the only action. C. Clamp the nasogastric tube for 30 minutes. D. Irrigate the nasogastric tube with normal saline.

b After fundoplication, drainage from the nasogastric tube is initially dark brown with old blood. This finding is expected and requires only documentation. The drainage should become yellow-green within 8 hours after surgery.

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? a. "You'll need to drink at least two to three glasses of milk daily." b. "It would likely be beneficial for you to eliminate drinking alcohol." c. "Many people find that a minced or pureed diet eases their symptoms of PUD." d. "Your medications should allow you to maintain your present diet while minimizing symptoms."

b Alcohol increases the amount of stomach acid produced so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? a. Tinnitus b. Drowsiness c. Reduced hearing d. Sensation of falling

b Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

Which nursing measure would be best for reducing the discomfort and pain associated with acute pancreatitis? A. Placing the client in a semi-Fowler's position, at 30 degrees B. Maintaining NPO status during the acute period C. Administering a prn order for morphine sulfate D. Giving small, frequent feedings as tolerated

b Because abdominal pain is the key feature of acute pancreatitis, nursing measures to reduce GI activity and decrease pancreatic enzyme production are employed. Fasting helps to rest the pancreas, so foods and fluids are withheld during the acute period.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? a. Barium swallow b. Endoscopic biopsy c. Capsule endoscopy d. Endoscopic ultrasonography

b Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.

The nurse cares for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention? a. Offer the patient a herbal supplement such as ginseng. b. Apply a cool washcloth to the forehead and provide mouth care. c. Take the patient for a walk in the hallway to promote peristalsis. d. Discontinue any medications that may cause nausea or vomiting.

b Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily withheld until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.

Which of the following statements made by the client indicates an understanding of the management of hiatal hernia? A. "I will lie flat for 30 minutes after each meal." B. "I will remain upright for several hours after each meal." C. "I will have my blood count done in 2 weeks to check for anemia." D. "I will sleep at night lying on my left side to prevent nighttime reflux."

b Clients with a sliding hernia experience GERD, and positioning, for these clients, is an important intervention. The client should be taught to sleep with the head of the bed elevated, to remain upright after meals, and to avoid straining or restrictive clothing.

You note that a client with extensive peritonitis has developed evidence of decreased circulatory volume. What physiologic parameter should you monitor as a result of this alteration? A. Heart rate B. Urine output C. Pedal pulses D. Temperature

b Decreased circulatory volume is the result of the shunting of fluid from the vascular space into the peritoneal cavity, GI tract, and connective tissue resulting in insufficient kidney perfusion and a low urine output.

The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice does the nurse understand would be most appropriate? a. Iced tea b. Dry toast c. Hot coffee d. Plain hamburger

b Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot or cold liquids and fatty foods are generally not well tolerated.

What assessment finding would you expect to note in a client with cirrhosis who is exhibiting fetor hepaticus? A. Purpuric lesions on the extremities B. A fruity or musty breath odor C. Warm and bright red palms D. Jaundice of the sclera

b Fetor hepaticus is a distinctive breath odor present with chronic liver disease. There is a fruity or musty odor to the client's breath.

A client with acute cholecystitis resulting from obstruction of the cystic duct by gallstones has been admitted with fever and increased right quadrant pain. For what complication of this problem should you remain alert? A. Reflux of bile into the esophagus B. Perforation of the gallbladder C. Hepatomegaly D. Malabsorption

b In acute cholecystitis, trapped bile acts as a chemical irritant. Coupled with a distended gallbladder, edema, and impaired circulation, tissue sloughing and gangrene can occur leading to perforation.

A client with an esophagogastric tube suddenly experiences acute respiratory distress. What immediate action should you take? A. Call the physician. B. Cut the balloon ports and remove the tube. C. Place the client in an upright position, and apply oxygen. D. Reduce the balloon pressure slightly using the sphygmomanometer.

b In case of respiratory compromise in a client with an esophagogastric tube, the nurse should immediately cut both ports with a pair of scissors that is kept at the bedside and remove the tube.

An older adult client with diverticulitis is being prepared for discharge. Which of the following statements made by the client indicates a need for further teaching? A. " I will avoid straining when bending." B. "I will use a laxative to avoid constipation." C. "I will increase the amount of fiber in my diet." D. "I will notify the doctor if I notice blood in my stools."

b Laxatives and enemas increase intraluminal pressure and are therefore discouraged.

A client is admitted with Laënnec's cirrhosis. What data in the client's past history should you inquire about in taking a current history from this client? A. History of gallstones B. History of alcohol abuse C. History of viral hepatitis D. History of heart disease

b Laënnec's cirrhosis, also know as alcoholic cirrhosis, is caused by the toxic effect of alcohol on the liver. The nurse should ask the client about a history of alcohol use.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? a. Diarrhea b. Heartburn c. Constipation d. Lower abdominal pain

b Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.

A client being treated for peptic ulcer disease reports drinking four cups of decaffeinated coffee each day. What is your best response? A. "You may drink decaffeinated coffee only with meals." B. "You should avoid both caffeinated and decaffeinated coffee." C. "Drinking decaffeinated coffee is correct, but limit your intake to two cups per day." D. "You should drink coffee only within 1 hour of taking your antiulcer medication."

b The client is instructed to eliminate both caffeinated and decaffeinated coffee because they contain peptides that stimulate gastrin release.

You are taking an initial history from a client with chronic persistent hepatitis. What clinical manifestations would you expect in this client? A. The client has symptoms of hepatomegaly. B. The client is asymptomatic. C. The client is confused. D. The client has asterixis.

b The client with chronic persistent hepatitis is asymptomatic and physical assessment findings are usually normal. Liver damage does not progress beyond the initial insult.

The patient had a car accident and was "scared to death." The patient is now reporting constipation. What affecting the gastrointestinal (GI) tract does the nurse know could be contributing to the constipation? a. The patient is too nervous to eat or drink, so there is no stool. b. The sympathetic nervous system was activated, so the GI tract was slowed. c. The parasympathetic nervous system is now functioning to slow the GI tract. d. The circulation in the GI system has been increased, so less waste is removed.

b The constipation is most likely related to the sympathetic nervous system activation from the stress related to the accident. SNS activation can decrease peristalsis. Even without oral intake for a short time, stool will be formed. The parasympathetic system stimulates peristalsis. The circulation to the GI system is decreased with stress.

You are performing the initial postoperative assessment of a client with ulcerative colitis who has undergone a total proctocolectomy with placement of a permanent ileostomy. You note the drainage from the ileostomy appears loose, dark green in color, and contains some blood. What would be your best action? A. Notify the physician. B. Document the finding as the only action. C. Irrigate the ileostomy. D. Send a stool sample for culture and sensitivity.

b The initial drainage from the ileostomy appears loose, dark green, and may contain some blood. The nurse should document this normal finding. The stool consistency and color will change over time to a yellow-green or brown.

A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement? a. I am allergic to bee stings." b. "My tongue swells when I eat shrimp." c. "I have had epigastric pain for 2 months." d. "I have a pacemaker because my heart rate was slow."

b The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium. Having a pacemaker will not affect the patient during this procedure. It would be expected that the patient would have some epigastric pain given the patient's condition.

Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What is the most likely etiology for this abnormal assessment finding? a. Herpesvirus b. Candida albicans c. Vitamin deficiency d. Irritation from ill-fitting dentures

b White, curd-like lesions surrounded by erythematous mucosa are associated with oral candidiasis. Herpesvirus causes benign vesicular lesions in the mouth. Vitamin deficiencies may cause a reddened, ulcerated, swollen tongue. Irritation from ill-fitting dentures will cause friable, edematous, painful, bleeding gingivae.

When assessing a patient's abdomen, what would be most appropriate for the nurse to do? a. Palpate the abdomen before auscultation. b. Percuss the abdomen before auscultation. c. Auscultate the abdomen before palpation. d. Perform deep palpation before light palpation.

c During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.

An 85-year-old woman seen in the primary care provider's office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause? a. Anosmia b. Xerostomia c. Hypochlorhydria d. Salivary gland tumor

b Xerostomia (decreased saliva production), or dry mouth, affects many older adults and may be associated with difficulty swallowing (dysphagia). Anosmia is loss of sense of smell. Hypochlorhydria, a decrease in stomach acid, does not affect swallowing. Salivary gland tumors are not common.

The nurse should recognize that the liver performs which functions (select all that apply)? a. Bile storage b. Detoxification c. Protein metabolism d. Steroid metabolism e. Red blood cell (RBC) destruction

b, c, d The liver performs multiple major functions that aid in the maintenance of homeostasis. These include metabolism of proteins and steroids as well as detoxification of drugs and metabolic waste products. The Kupffer cells of the liver participate in the breakdown of old RBCs. The liver produces bile, but storage occurs in the gall bladder.

The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a a. colectomy b, cholecystectomy c. choledocholithotomy d. choledochojejunostomy

c A choledocholithotomy is an opening into the common bile duct for the removal of stones. A colectomy is the removal of the colon. The cholecystectomy is the removal of the gallbladder. The choledochojejunostomy is an opening between the common bile duct and the jejunum.

Which statement made by the client indicates an understanding of dietary management for dumping syndrome? A. "I will eat a low-fat, low-carbohydrate, high-protein diet." B. "I will eat a high-fat, high-carbohydrate, low-protein diet." C. "I will eat a high-fat, low-carbohydrate, high-protein diet." D. "I will eat a high-fat, high-carbohydrate, high-protein diet."

c A high-fat, low-carbohydrate, high-protein diet is recommended, because decreasing the carbohydrate content of meals minimizes the early symptoms associated with the syndrome.

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating? a. Malnutrition b. Bile reflux gastritis c. Dumping syndrome d. Postprandial hypoglycemia

c After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

Which of the following alterations in fluids and electrolytes would you expect to find in a client with pancreatic cancer? A. Fluid volume overload B. Increased serum osmotic pressure C. Elevated serum amylase and lipase D. Increased serum sodium; decreased serum potassium levels

c Although there are no specific laboratory tests for the diagnosis of pancreatic cancer, serum amylase and lipase levels are elevated. The extent of the elevation depends upon the amount of pancreatic damage.

Which of the following menus would be most appropriate for you to recommend to a client with cholelithiasis? A. Two eggs, two slices of toast with margarine, and a glass of whole milk B. Grilled cheese sandwich, steamed vegetables with butter, and coffee C. Roast chicken, baked potato, and skim milk D. Baked fish, steamed broccoli, and tea

c Clients with cholelithiasis should avoid foods high in cholesterol, such as whole milk and butter, fried foods, and gas-forming vegetables.

You are preparing a dietary guide for a client with irritable bowel syndrome. Which of the following meals is appropriate for this client? A. Tuna salad on white bread and a diet cola B. Grilled steak, green beans, dinner roll, and coffee C. Broiled chicken, brown rice, salad, and a glass of water D. Fried shrimps, salad, baked potato, and a glass of wine

c Clients with irritable bowel syndrome are advised to eat a high-fiber diet, with 8 to 10 cups of liquid daily. They should avoid alcohol, caffeine, and other gastric irritants.

Which of the following is a complication of Crohn's disease? A. Arthritis B. Weight gain C. Fistula formation D. Gastrointestinal tuberculosis

c Complications of Crohn's disease are fistulas, hemorrhage, and obstruction.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? a. Keep the patient NPO. b. Put the bed in the Trendelenberg position. c. Have the patient eat 4 to 6 smaller meals each day. d. Give various antacids to determine which one works for the patient.

c Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.

The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis? a. Gastric pH b. Blood glucose c. Serum amylase d. Serum potassium

c Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? a. Nausea b. Belching c. Epigastric pain d. Difficulty swallowing

c Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.

A patient who is scheduled for surgery with general anesthesia in 1 hour is observed with a moist, but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water? a. Flat abdomen without movement upon inspection b. Tenderness at left upper quadrant upon palpation c. Easily heard, loud gurgling in the right upper quadrant d. High-pitched, hollow sounds in the left upper quadrant

c If the patient drank water on an empty stomach, gurgling can be assessed without a stethoscope or assessed with auscultation. High-pitched, hollow sounds are tympanic and indicate an empty cavity. A flat abdomen and tenderness do not indicate that the patient drank a glass of water.

You are collecting the initial history from a client with suspected esophageal cancer. What factor in this client's history increases the risk of developing esophageal cancer? A. A high stress occupation B. A preference for high-fat foods C. A 20 pack-year smoking history D. A history of myocardial infarction

c In the United States, the two most important factors in the development of esophageal cancer are tobacco use and alcohol ingestion.

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? a. Decreased blood pressure b. Absence of muscle tremors c. Relief of nausea and vomiting d. No further episodes of diarrhea

c Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? a. Morphine sulfate b. Zolpidem (Ambien) c. Ondansetron (Zofran)* d. Dexamethasone (Decadron)

c Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take? a. Administer the medication subcutaneously for fast absorption. b. Administer the medication into an arterial line to prevent extravasation. c. Administer the medication deep into the muscle to prevent tissue damage. d. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.

c Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.

When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status? a. Ingestion b. Digestion c. Absorption d. Elimination

c Substances that interface with the absorptive surfaces of the GI tract (primarily in the small intestine) diffuse across the intestinal membranes into intestinal capillaries and are then carried to other parts of the body for use in energy production. The cardiac output provides the blood flow for this absorption of nutrients to occur.

The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient? a. Tympany to abdominal percussion b. Aortic pulsation visible in epigastric region c. High-pitched sounds on abdominal auscultation d. Liver border palpable 1 cm below the right costal margin

c The bowel sounds are more high pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. Bowel sounds may also be diminished or absent with an intestinal obstruction. Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.

Which statement made by a client with chronic pancreatitis would indicate a lack of knowledge regarding dietary management of the disease? A. "I will eat small, frequent meals." B. "I will avoid drinking caffeinated beverages." C. "I should eat foods high in fat and calories." D. "I should consume 4000 to 6000 calories per day."

c The client is instructed to consume a total of 4000 to 6000 calories/day of a diet high in carbohydrates and protein, but low in fat. High-fat foods increase diarrhea.

A client who has just undergone a traditional cholecystectomy with T-tube placement is preparing for discharge. What statement made by the client indicates a need for further teaching regarding the care of the T-tube? A. "I will inspect the T-tube drainage site for signs of infection." B. "I will clamp the T-tube for 1 to 2 hours before and after meals." C. "I will irrigate the T-tube with normal saline if the drainage appears too slow." D. "I will call my health care provider if I note a sudden increase in bile output."

c The client should be instructed to never irrigate the T-tube without first consulting with the physician.

What statement made by a client receiving pancreatic enzyme replacement indicates a need for further teaching? A. "I can mix the enzyme-powder in fruit juice." B. "I will wipe my lips after taking the enzyme preparation." C. "I will take the enzymes immediately after my meals." D. "I will not mix the enzyme-powder in foods containing proteins."

c The enzyme preparation should be taken either before or with meals.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? a. Turn, deep breathe, cough, and use spirometer every 4 hours. b. Maintain an upright position for at least 2 hours after eating. c. NG will have bloody drainage, and it should not be repositioned.* d. Keep in a supine position to prevent movement of the anastomosis.

c The patient will have bloody drainage from the NG tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. Turning and deep breathing will be done every 2 hours, and the spirometer will be used more often than every 4 hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.

Which of the following clients would be most at risk for the development of carcinoma of the liver? A. 58-year-old client with a history of diabetes mellitus B. 28-year-old client with a history of blunt liver trauma C. 65-year-old client with a history of cirrhosis D. 80-year-old client with malnutrition

c The risk of contracting a primary carcinoma of the liver is 40 times higher in clients with cirrhosis.

A client is suspected of having pancreatic cancer. Which clinical manifestation of this client is often the presenting sign of pancreatic cancer? A. Ascites B. Fatigue C. Jaundice D. Abdominal pain

c The symptoms of pancreatic cancer are insidious. The initial presenting sign is most often jaundice resulting from gallbladder and liver involvement. Although jaundice may be the first presenting sign that brings the client to seek health care, it is considered a late sign for the disease process.

A 74-year-old female patient with gastroesophageal reflux disease (GERD) takes over-the-counter medications. For which medication, if taken long-term, should the nurse teach about an increased risk of fractures? a. Sucralfate (Carafate) b. Cimetidine (Tagamet) c. Omeprazole (Prilosec) d. Metoclopramide (Reglan)

c There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. Lower doses or shorter duration of therapy should be considered.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? a. Antibiotic(s), antacid, and corticosteroid b. Antibiotic(s), aspirin, and antiulcer/protectant c. Antibiotic(s), proton pump inhibitor, and bismuth d. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

c To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

What statement regarding the symptoms of ulcerative colitis is true? A. The client may have 5 to 6 soft stools per day. B. The client may have 10 to 20 steatorrheal stools per day. C. The client may have 10 to 20 liquid, bloody stools per day. D. The client may have abdominal pain, but stool appearance is normal.

c Ulcerative colitis is characterized by 10 to 20 liquid, bloody stools per day. The colon appears red and hemorrhagic.

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? a. Digoxin (Lanoxin) b. Cefotetan (Cefotan) c. Famotidine (Pepcid) d. Promethazine (Phenergan)

d A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a. Chest pain relieved with eating or drinking water b. Back pain 3 or 4 hours after eating a meal c. Burning epigastric pain 90 minutes after breakfast d. Rigid abdomen and vomiting following indigestion

d A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

A client with end-stage cirrhosis admitted with gastrointestinal bleeding becomes combative and confused. What complication of cirrhosis may this client be experiencing? A. Ascites B. Coagulation defects C. Transient ischemic attack D. Portal systemic encephalopathy

d Although the client may already have ascites and coagulation defects, with end-stage cirrhosis a client who develops a GI bleed is at increased risk of portal systemic encephalopathy because this causes an increased protein load in the intestines.

The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen? a. Left lower quadrant b. Left upper quadrant c. Right lower quadrant d. Right upper quadrant

d Although the left lobe of the liver is located in the left upper quadrant of the abdomen, the bulk of the liver is located in the right upper quadrant.

A client with an exacerbation of ulcerative colitis has been placed on total parenteral nutrition (TPN). The client asks you why foods or fluids may not be given by mouth. What is your best response? A. "TPN contains a high percentage of glucose that is more readily absorbed in the bloodstream than in the ulcerated colon." B. "TPN will be given in addition to your meals to help you gain any weight that you may have lost through diarrhea." C. "TPN is considered an elemental formula and, as such, is easier to digest." D. "TPN will be given during this period to allow your bowel to rest."

d Bowel rest during severe exacerbations of ulcerative colitis is part of the nonsurgical management of the disease.

A client admitted with acute cholecystitis is preparing to be discharged home. What dietary teaching would you include in a discharge plan for this client? A. Instruct the client to limit oral intake to 3 meals per day. B. Instruct the client to drink fluids between meals, rather that with meals. C. Instruct the client to limit the dietary intake of fat to 35% of the daily calorie intake. D. Instruct the client to consume a low-fat diet consisting of smaller, more frequent meals.

d Clients with acute cholecystitis are placed on small, frequent low-fat meals to decrease stimulation of the gallbladder, thus decreasing pain, nausea, and vomiting.

The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity? a. Nitroglycerin b. Digoxin (Lanoxin) c. Ciprofloxacin (Cipro) d. Acetaminophen (Tylenol)

d Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) may be hepatotoxic.

Which patients would be at highest risk for developing oral candidiasis? a. A 74-year-old patient who has vitamin B and C deficiencies b. A 22-year-old patient who smokes 2 packs of cigarettes per day c. A 58-year-old patient who is receiving amphotericin B for 2 days d. A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks

d Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies are rare but may lead to Vincent's infection. Use of tobacco products leads to stomatitis.

A client underwent a Billroth II procedure 1 week ago for the treatment of a duodenal ulcer. Which of the following clinical manifestations should alert you to the late manifestations of dumping syndrome? A. Severe abdominal pain and a strong desire to defecate B. Epigastric distention and abdominal cramping C. Mouth dryness and palpitations D. Dizziness and palpitations

d The late manifestations of dumping syndrome include dizziness, lightheadedness, palpitations, diaphoresis, and confusion occurring 90 minutes to 3 hours after eating.

The nurse is teaching a group of high school students about the prevention of food poisoning. Which comment by the student shows understanding of foodborne illness protection? a. "We like to mix up the ingredients so the flavors will melt before we cook our beef stew." b. "For a snack, I like to eat raw cookie dough from the package instead of baking the cookies." c. "We only have one cutting board, so we cut up our chicken and salad vegetables at the same time." d, "When they gave me a pink hamburger I sent it back and asked for a new bun and clean plate."

d The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the pink meat may not have reached 160° and could be contaminated with bacteria. Mixing ingredients and leaving them long enough for the flavors to melt, eating raw cookie dough from a refrigerated package, and only using one cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to food poisoning from contamination.

The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem? a. Hepatic cirrhosis b. Hypersplenomegaly c. Gall bladder distention d. Peritoneal inflammation

d When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness.