GI

The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stools." c. "I may not need to wear a drainage pouch if I irrigate it daily." d. "Limiting my fluid intake should decrease the amount of output."

"*I should only have to change the pouch every 4 to 7 days* Because ileostomy drainage is a liquid to thin paste, the patient will need to wear a drainage bag at all times. The patient should use an open-ended drainable pouch. It is worn for 4 to 7 days. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear an ostomy pouch.

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that a. the gallbladder is unable to contract to release stored bile. b. bilirubin is not being conjugated and excreted into the bile by the liver. c. the Kupffer cells in the liver are unable to remove bilirubin from the blood. d. there is an obstruction in the biliary tract preventing flow of bile into the small intestine.

*bilirubin is not being conjugated and excreted into bile by the liver* Bilirubin is a pigment derived from the breakdown of hemoglobin and is insoluble in water. Bilirubin is bound to albumin for transport to the liver and is referred to as unconjugated. An indirect bilirubin determination is a measurement of unconjugated bilirubin, and the level may be elevated in hepatocellular and hemolytic conditions.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? a. Osteoarthritis b. History of colorectal polyps c. History of lactose intolerance d. Use of herbs as dietary supplements

*history of colorectal polyps* A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

A hospitalized patient has just been diagnosed with diarrhea due to Clostridium difficile. Which nursing interventions should be included in the patient's plan of care? (*select all that apply*) a. Initiate contact isolation precautions. b. Place the patient on a clear liquid diet. c. Disinfect the room with 10% bleach solution. d. Teach any visitors to wear gloves and gowns. e. Use hand sanitizer before and after patient or bodily fluid contact.

*initiate contact isolation precautions* *disinfect the room with 10% bleach solution* *teach any visitors to wear gloves and gowns* Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. has localized cramping pain. d. frequently develops peritonitis.

*often has no symptoms* Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.

Corticosteroid medications are associated with the development of peptic ulcers because of which probable pathophysiologic mechanism? a. The enzyme urease is produced. b. Secretion of hydrochloric acid is increased. c. The rate of mucous cell renewal is decreased. d. The synthesis of mucus and prostaglandins is inhibited.

*rate of mucous cell renewal is decreased* Corticosteroids decrease the rate of mucous cell renewal. H. pylori produces the enzyme urease. Alcohol ingestion increases the secretion of hydrochloric acid. Aspirin and NSAIDs inhibit the synthesis of mucus and prostaglandins.

Assessment findings suggestive of peritonitis include (*select all that apply*) a. rebound tenderness. b. a soft, distended abdomen. c. dull, intermittent abdominal pain. d. shallow respirations with bradypnea. e. observing that the patient is lying still.

*rebound tenderness* *observing that the patient is lying still* With peritoneal irritation, the abdomen is hard, and the patient has severe continuous abdominal pain that is worse with any sudden movement. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness. The patient lies very still and takes shallow breaths. Abdominal distention, tachypnea, fever, and tachycardia may occur.

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the *priority* action by the nurse? a. Notify the physician. b. Auscultate for bowel sounds. c. Reposition the tube and check for placement. d. Remove the tube and replace it with a new one.

*reposition the tube and check for placement* The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The physician does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms? a. Drink 10 to 12 oz of water with each meal. b. Space six small meals a day between breakfast and bedtime. c. Sleep with the head of the bed elevated on 4- to 6-inch blocks d. Perform daily exercises of toe-touching, sit-ups, and weight lifting.

*sleep with the head of the bed elevated on 4-to-6 inch blocks* The use of blocks to elevate the head of the bed facilitates gastric emptying by gravity and is strongly recommended to prevent nighttime reflux. Liquids should be taken between meals to prevent gastric distention with meals. Small meals should be eaten frequently but patients should not eat at bedtime or lie down for 2 to 3 hours after eating. Activities that involve increasing intraabdominal pressure, such as bending over, lifting, or wearing tight clothing, should be avoided.

An older adult patient reports difficulty swallowing. Which age-related change does the nurse teach the patient about? a. Xerostomia b. Esophageal cancer c. Decreased taste buds d. Thinner abdominal wall

*xerostomia* 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.

The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement? a. "I should stop all my medications if I develop any side effects." b. "I should continue my treatment regimen as long as I have pain." c. "I have learned some relaxation strategies that decrease my stress." d. "I can buy whatever antacids are on sale because they all have the same effect."

"*I have learned some relaxation strategies that decrease my stress*." Increased vagal stimulation from emotional stress causes hypersecretion of hydrochloric acid and stress reduction is an important part of the patient's management of peptic ulcers, especially duodenal ulcers. If side effects to medications develop, the patient should notify the health care provider before altering the drug regimen. Although effective treatment will promote pain relief in several days, the treatment regimen should be continued until there is evidence that the ulcer has healed completely. Interchanging brands and preparations of antacids and histamine (H2)- receptor blockers without checking with health care providers may cause harmful side effects and patients should take only prescribed medications.

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? a. "I will be able to regulate when I have stools." b. "I will be able to wear the pouch until it leaks." c. "The drainage from my stoma can damage my skin." d. "Dried fruit and popcorn must be chewed very well."

"*I will be able to regulate when I have stools*" An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? a. "It will increase bulk in the stool." b. "It will lubricate the intestinal tract to soften feces." c. "It will increase fluid retention in the intestinal tract." d. "It will increase peristalsis by stimulating nerves in the colon wall."

"*It will increase peristalsis by stimulating nerves in the colon wall*" Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk- forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse is preparing to administer famotidine to a postoperative patient with a colostomy. The patient states they do not have heartburn. What response by the nurse would be the *most* appropriate? a. "It will reduce the amount of acid in the stomach." b. "It will prevent air from accumulating in the stomach, causing gas pains." c. "It will prevent the heartburn that occurs as a side effect of general anesthesia." d. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

"*It will reduce the amount of acid in the stomach*" Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

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. "It would be beneficial for you to eliminate drinking alcohol." b. "You'll need to drink at least two to three glasses of milk daily." c. "Many people find that a minced or pureed diet eases their symptoms of PUD." d. "Taking medication will allow you to keep your present diet while minimizing symptoms."

"*It would be beneficial for you to eliminate drinking alcohol.*" 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.

Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."

"*The best time to take an antacid is 1 to 3 hours after meals*." Patients who use an as-needed antacid should do so 1 to 3 hours after eating. Teach patients that the increased saliva production associated with chewing gum will help with GERD symptoms. The patient should not eat meals within 3 hours of bedtime. Some foods, such as red wine, decrease lower esophageal sphincter pressure and aggravate symptoms. Milk increases gastric acid secretion. There is no need for the patient to limit protein intake.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is *most* appropriate? a. "The tube will help to drain the stomach contents and prevent further vomiting." b. "The tube will push past the area that is blocked and thus help to stop the vomiting." c. "The tube is just a standard procedure before many types of surgery to the abdomen." d. "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

"*The tube will help to drain the stomach contents and prevent further vomiting*" The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

The nurse is teaching a group of college students how to prevent food poisoning. Which comment shows an understanding of foodborne illness protection? a. "Eating raw cookie dough from the package is a great snack when you do not have time to bake." b. "Since we only have one cutting board, we can cut up chicken and salad vegetables at the same time." c. "To save refrigerator space, leftover food can be kept on the counter if it is in sealed containers." d. "When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."

"*When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate*." 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°F and could be contaminated with bacteria. Improperly storing cooked foods, 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.

A 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."

"*my tongue swells when I eat shrimp*" 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.

The nurse teaches senior citizens at a community center how to prevent food poisoning at social events. Which community member statement reflects accurate understanding? 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."

"*pasteurized juices and milk are safe to drink*" 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 the 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.

A 40-year-old severely obese female patient with type 2 diabetes wants to lose weight. After learning about the surgical procedures, she thinks a combination of restrictive and malabsorptive surgery would be best. Which procedure should the nurse teach her about? A. Lipectomy B. Roux-en-Y gastric bypass C. Adjustable gastric banding D. Vertical sleeve gastrectomy

*Roux-en-Y gastric bypass* The Roux-en-Y gastric bypass is a common combination of restrictive (limiting the size of the stomach) and malabsorptive (less food is absorbed) surgery. Lipectomy is used to remove unsightly flabby folds of adipose tissue. Adjustable gastric banding is the most common restrictive procedure. Vertical sleeve gastrectomy is a restrictive procedure that preserves stomach function.

In preparing a patient for a colonoscopy, the nurse explains that a. a signed permit is not necessary. b. sedation will be used during the procedure. c. one cleansing enema is necessary for preparation. d. light meals should be eaten for 3 days before the procedure.

*Sedation will be used during the procedure* Sedation is induced during a colonoscopy. A signed consent form is necessary for a colonoscopy. The patient should follow either a low-residue or a full liquid diet the day before the procedure until bowel cleansing begins. Bowel cleansing should follow a split-dose regimen. The evening before the procedure the patient should drink 2 L of oral polyethylene glycol (PEG) lavage solution. The second 2 L dose should begin 4 to 6 hours before the procedure. Some patients may receive less solution and a cleansing enema, but this does not occur in all patient situations.

A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is a. applying a truss to the hernia site. b. allowing the patient to stand to void. c. supporting the incision during coughing. d. applying a scrotal support with an ice bag.

*applying a scrotal support with ice bag* Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.

Two days after a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event a. Impaired peristalsis b. Irritation of the bowel c. Nasogastric suctioning d. Inflammation of the incision site

*impaired peristalsis* Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to a.. sympathetic inhibition. b. mixing and propulsion. c. sympathetic stimulation. d. parasympathetic stimulation.

*parasympathetic stimulation* Parasympathetic and sympathetic branches of the autonomic nervous system (ANS) innervate the GI tract. The parasympathetic (cholinergic) system is mainly excitatory. The sympathetic (adrenergic) system is mainly inhibitory. For example, *parasympathetic stimulation increases peristalsis* and sympathetic stimulation decreases it.

Which laboratory findings should the nurse expect in the patient with persistent vomiting? a. ↓ pH, ↑ sodium, ↓ hematocrit b. ↑ pH, ↓ chloride, ↓ hematocrit c. ↑ pH, ↓ potassium, ↑ hematocrit d. ↓ pH, ↓ potassium, ↑ hematocrit

*↑ pH, ↓ potassium, ↑ hematocrit* The loss of gastric hydrochloric acid causes metabolic alkalosis and an increase in pH; loss of potassium, sodium, and chloride; and loss of fluid, which increases the hematocrit.

A patient is given a bisacodyl suppository and asks the nurse how long it will take to work. What is the best response by the nurse a. 2 to 5 minutes b. 15 to 60 minutes c. 2 to 4 hours d. 6 to 8 hours

*15 to 60 minutes* Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

The nurse is performing an abdominal assessment for a patient. Which assessment technique by the nurse is most accurate? 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.

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

After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected? a. Tinnitus b. Drowsiness c. Reduced hearing d. Sensation of falling

*drowsiness* 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.

A patient had a gastric resection for stomach cancer. The nurse plans to teach the patient about decreased secretion of which hormone? a. Gastrin b. Secretin c. Cholecystokinin d. Gastric inhibitory peptide

*gastrin* 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, cholecystokinin, and gastric inhibitory peptide are all secreted from the duodenal mucosa.

When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is a. "What is your usual bowel elimination pattern?" b. "What percentage of your income is spent on food?" c. "Have you traveled to a foreign country in the last year?" d. "Do you have diarrhea when you are under a lot of stress?"

*"Have you traveled to a foreign country in the last year?"* When assessing gastrointestinal function in relation to the health perception-health management pattern, the nurse should ask about the patient's health practices related to the GI system, such as maintenance of normal body weight, proper dental care, adequate nutrition, and effective elimination habits. *Query the patient about recent foreign travel with possible exposure to hepatitis or parasitic infestation*. Ask about risk behaviors for hepatitis exposure. Document whether the patient has received hepatitis A and B vaccination. Assess the patient for habits that directly affect GI functioning. The intake of alcohol in large quantities or for long periods has detrimental effects on the stomach mucosa. Chronic alcohol exposure causes fatty infiltration of the liver and can cause damage, leading to cirrhosis and hepatocellular carcinoma. Obtain a history of cigarette smoking. Nicotine is irritating to the GI tract mucosa. Cigarette smoking is related to GI cancers (especially mouth and esophageal cancers), esophagitis, and ulcers. Smoking delays the healing of ulcers. Family history is an important component of this health pattern. About one third of cases of colorectal cancer occur in patients with a family history. Because of the relationship 841between colorectal and breast cancer, inquire about a history of either type of cancer in the family.

A patient was involved in a motor vehicle crash and reports an inability to have a bowel movement. What is the *best* response by the nurse? a. "You are just too nervous to eat or drink, so there is no stool." b. "Your parasympathetic nervous system is now working to slow the GI tract." c. "The circulation in the GI system has been increased, so less waste is removed." d. "Your sympathetic nervous system was activated, so there is slowing of the GI tract".

*"Your sympathetic nervous system was activated, so there is slowing of the GI tract"* The constipation is most likely related to the sympathetic nervous system activation from the stress related to the accident. Sympathetic nervous system 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 gastrointestinal system is decreased with stress.

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

*32 y/o receiving ciprofloxacin for 3 weeks* 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 may lead to Vincent's infection. Use of tobacco products leads to stomatitis, not candidiasis.

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

*Candida albicans* 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.

A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will be included in collaborative care? a. Oral administration of broth and tea b. IV replacement of fluid and electrolytes c. Administration of parenteral antiemetics d. Insertion of a nasogastric (NG) tube for suction

*IV replacement of fluid and electrolytes* The patient with severe or persistent vomiting requires IV replacement of fluids and electrolytes until able to tolerate oral intake to prevent serious dehydration and electrolyte imbalances. Oral fluids are not given until vomiting has been relieved and parenteral antiemetics are often not used until a cause of the vomiting can be established. Nasogastric (NG) intubation may be indicated in some cases but fluid and electrolyte replacement is the first priority.

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.

*NG will have bloody drainage and it should not be repositioned* The patient will have bloody drainage from the nasogastric (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.

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? a. A nursing assistant on the unit who also has hospice experience b. A licensed practical nurse that has worked on the unit for 10 years c. A registered nurse with 6 months of experience on the surgical unit d. A registered nurse who has floated to the surgical unit from pediatrics

*RN with 6 months experience on the surgical unit* The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs.

*a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa* Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lost; the loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin is depleted, and a deficiency state exists. Because cobalamin is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications.

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

*absorption* Substances that interface with the absorptive surfaces of the gastrointestinal 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 t

The nurse is reviewing the home medication list for a patient admitted with suspected hepatic failure. Which medication reviewed by the nurse could cause hepatotoxicity? a. Digoxin b. Nitroglycerin c. Ciprofloxacin d. Acetaminophen

*acetaminophen* Many chemicals and drugs are potentially hepatotoxic and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs may be hepatotoxic.

Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers? a. Acid back diffusion into the mucosa b. The release of histamine from GI cells c. Ammonia formation in the mucosal wall d. Breakdown of the gastric mucosal barrier

*acid back diffusion into the mucosa* The ultimate damage to the tissues of the stomach and duodenum, precipitating ulceration, is acid back diffusion into the mucosa. The gastric mucosal barrier is protective of the mucosa but without the acid environment and damage, ulceration does not occur. Ammonia formation by H. pylori and release of histamine impair the barrier but are not directly responsible for tissue injury.

Which type of gastritis is most likely to occur in a college student who has an isolated drinking binge? a. Acute gastritis b. Chronic gastritis c. Helicobacter pylori gastritis d. Autoimmune metaplastic atrophic gastritis

*acute gastritis* Acute gastritis is most likely to occur with an isolated drinking binge. Chronic gastritis is usually caused by Heliobacter pylori or viral and fungal infections. Autoimmune gastritis is an inherited condition.

A colectomy is scheduled for a patient with ulcerative colitis. The nurse should plan to include which prescribed measure in the preoperative preparation of this patient? a. Instruction on irrigating a colostomy b. Administration of a cleansing enema c. A high-fiber diet the day before surgery d. Administration of IV antibiotics for bowel preparation

*administration of a cleansing enema* Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. Instructions to irrigate the colostomy will be done postoperatively. Oral antibiotics are given preoperatively and an IV antibiotic may be used in the operating room. A clear liquid diet will be used the day before surgery with the bowel cleansing.

The nurse is assessing a group of patients to determine their risk of vitamin D deficiency. Which of the following patients has the highest risk for vitamin D deficiency? a. A Caucasian female who is 39 weeks gestation b. An African-American female who is breastfeeding c. An Asian female diagnosed with hypoglycemia d. A Hispanic female who has a BMI of 24.1

*an African-American female who is breastfeeding* Vitamin D deficiency is more frequently found among persons of African heritage and has increased in prevalence, especially among the infants of breastfeeding African-American mothers. Caucasian females do not share these risk factors. There is no known risk of hypoglycemia and vitamin D deficiency; however, diabetes increases the risk for vitamin D deficiency. There is no known risk of vitamin D deficiency in normal-weight females of Hispanic heritage; however, obesity is a risk factor.

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? 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)

*antibioitcs, proton pump inhibitor and bismuth* 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.

The nurse is caring 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 an 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.

*apply a cool washcloth to the forehead and provide mouth care* 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.

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (*select all that apply*) a. limiting alcohol intake to one serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.

*avoid taking aspirin and drugs containing aspirin* *only taking drugs prescribed by the HCP* Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease and drug or alcohol abuse can cause upper GI bleeding. Help make the patient and caregiver aware of the consequences of noncompliance with drug therapy. Emphasize that no drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the HCP should be taken. Alcohol should be eliminated because it is a source of irritation and interfere with tissue repair.

Which clinical manifestations of inflammatory bowel disease does the nurse determine are common to both patients with ulcerative colitis (UC) and Crohn's disease (*select all that apply*) a. Restricted to rectum b. Strictures are common c. Bloody, diarrhea stools d. Cramping abdominal pain e. Lesions penetrate intestine

*bloody, diarrhea stools* *cramping abdominal pain* Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A nurse in a home setting is assessing a 79-year-old male patient's risk for malnutrition. The nurse suspects malnutrition when reviewing which laboratory results? (*Select all that apply*) a. Body mass index (BMI) of 17 b. Waist-to-hip ratio of 1.0 c. Weight loss of 6% since last month's visit d. Prealbumin level of 16 mg/dL e. Hematocrit level of 50% f. Hemoglobin level of 8.2 g/dL

*body mass index (BMI) of 17* *weight loss of 6% since last month's visit* *hemoglobin level of 8.2 g/dL* A BMI of 18.5 to 24.9 is normal, and this patient's BMI is below normal; a major weight loss is defined as more than a 2% weight change over 1 week; and the expected hemoglobin level for a man is 14 to 18 g/dL. The patient's values may also indicate dehydration. The expected level for prealbumin is 15 to 36 mg/dL. A hematocrit level of 50% is within normal limits.

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? a. Write an incident report about this untoward event. b. Attempt to have the family convince the patient to take the ordered dose. c. Withhold the medication at this time and try to administer it later in the day. d. Chart the dose as not given on the medical record and explain in the nursing progress notes.

*chart the dose as not given on the medical record and explain in the nursing progress notes* Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

A patient with abdominal pain is being prepared for surgery to make an incision into the common bile duct to remove stones. What procedure will the nurse prepare the patient for? a. Colectomy b. Cholecystectomy c. Choledocholithotomy d. Choledochojejunostomy

*choledocholithotomy* 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 jejunum.

The nurse listens to bowel sounds for 60 seconds and does not hear gurgling. Which action should the nurse take next? a. Document the bowel sounds as hypoactive. b. Continue to listen for at least another 60 seconds. c. Administer the prescribed drug for constipation. d. Review the patient's dietary intake for the past 24 hours.

*continue to listen for at least another 60 seconds* Listen for bowel sounds for at least 2 minutes. If bowel sounds are not heard, note the amount of time listening in each quadrant.

A patient is jaundiced and her stools are clay colored (gray). This is most likely related to a. decreased bile flow into the intestine. b. increased production of urobilinogen. c. increased bile and bilirubin in the blood. d. increased production of cholecystokinin.

*decreased bile flow into the intestine* Bile is produced by the hepatocytes and is stored and concentrated in the gallbladder. When bile is released from the common bile duct, it enters the duodenum. In the intestines, bilirubin is reduced to stercobilinogen and urobilinogen by bacterial action. Stercobilinogen accounts for the brown color of stool. *Stools may be clay-colored if bile is not released from the common bile duct into the duodenum. Jaundice may result if the bilirubin level in the blood is elevated.*

The nurse requests a patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the *most* appropriate action by the nurse? a. Ask family members whether they have discussed the surgical procedure with the physician. b Have the patient sign the form and state the physician will visit to explain the procedure before surgery. c. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. d. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

*delay the patient's signature on the concept and notify the physician about the conversation with the patient* The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent.

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

*detoxification* *protein metabolism* *steroid metabolism* *red blood cell (RBC) destruction* 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 gallbladder.

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? a. Wear a mask to prevent transmission of infection. b. Wipe equipment with ammonia-based disinfectant. c. Instruct visitors to use the alcohol-based hand sanitizer. d. Don gloves and gown before entering the patient's room.

*don gloves and gown before entering the patient room* Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room, and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all of the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? a. White bread, cheese, and green beans b. Fresh tomatoes, pears, and corn flakes c. Oranges, baked potatoes, and raw carrots d. Dried beans, All Bran (100%) cereal, and raspberries

*dried beans, all bran (100%) cereal and raspberries* A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

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 would be most appropriate? a. Iced tea b. Dry toast c. Hot coffee d. Plain yogurt

*dry toast* 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.

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

*dumping syndrome* 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.

A patient is scheduled for surgery with general anesthesia in 1 hour and 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. Easily heard, loud gurgling in abdomen b. High-pitched, hollow sounds in abdomen c. Tenderness in left upper quadrant upon palpation d. Flat abdomen without movement upon inspection

*easily heard, loud gurgling in abdomen* 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.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? a. Return the patient to NPO status. b. Place cool compresses on the abdomen. c. Encourage the patient to ambulate as ordered. d. Administer an as-needed dose of IV morphine sulfate.

*encourage the patient to ambulate as ordered* Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

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

*endoscopic biopsy* Because of this patient's history of excessive alcohol intake, smoking, and 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.

The nurse is preparing a patient for a capsule endoscopy. What should the nurse ensure is included in the preparation? 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 capsule placement.

*ensure the patient understands the required bowel preparation* 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.

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

*epigastric pain* 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. It is not indicated for nausea, belching, and dysphagia.

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

*f/u colonoscopies will be needed to ensure that the cancer does not recur* Stage I colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

Which medications are used to decrease gastric or hydrochloric acid secretion? (*select all that apply*) a. Famotidine (Pepcid) b. Sucralfate (Carafate) c. Omeprazole (Prilosec) d. Misoprostol (Cytotec) e. Amoxicillin/clarithromycin/omeprazole

*famotidine* *omeprazole* *misoprostol* Famotidine (Pepcid) reduces HCl secretion by blocking histamine and omeprazole (Prilosec) decreases gastric acid secretion by blocking adenosine triphosphatase (ATPase) enzyme. Sucralfate (Carafate) coats the ulcer to protect it from acid erosion. Misoprostol (Cytotec) mixture has antisecretory effects. Amoxicillin/clarithromycin/omeprazole are used in patients with verified H. pylori.

Which explanation about weight reduction should be included when teaching the obese patient and her obese husband? a. Weight gain is caused by psychologic factors. b. Daily weighing is recommended to monitor weight loss. c. Fat is not burned until the glycogen-water pool is depleted. d. Men lose weight less quickly than women because they have a higher percentage of metabolically less-active fat.

*fat is not burned until the glycogen-water pool is depleted* With reducing diets that severely restrict carbohydrates, the body's glycogen stores become depleted within a few days. The glycogen normally binds to water in fat cells and it is this water loss that causes weight loss in the first few days. Fat is not burned until the glycogen-water pool is depleted. Although psychosocial components (i.e., using food for comfort or reward and inability to buy high- nutritional quality food) may have an influence on weight gain, these factors along with lack of physical exercise, underestimation of portion size, and genetics contribute to weight gain. Weekly weighing is recommended as a more reliable indicator of weight loss because daily weighing shows frequent fluctuation from retained water (including urine) and elimination of feces. Men are able to lose weight more quickly than women because women have a higher percentage of metabolically less-active fat.

A patient 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

*fever and abdominal pain* 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.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? a. Nausea and vomiting b. Hyperactive bowel sounds c. Firmly distended abdomen d. Abrasions on all extremities

*firmly distended abdomen* Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain (*select all that apply*)? a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

*gastroenteritis* *ectopic pregnancy* *GI bleeding* *IBS* *IBD* All these conditions could cause acute abdominal pain.

A woman calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell woman to a. administer antiemetic drugs and observe skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs. d. offer her mother large quantities of Gatorade to decrease the risk of sodium depletion.

*give her mother sips of water and to elevate the head of her bed to prevent aspiration* Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. The elderly are particularly susceptible to the central nervous system (CNS) side effects of antiemetic drugs; these drugs may produce confusion. Dosages should be reduced and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances. High-protein drinks and high-sodium liquids may be contraindicated.

A patient asks the nurse about taking phentermine and topiramate (Qsymia) for weight loss. To avoid side effects, it is important for the nurse to determine whether the patient has a history of A. Glaucoma B. Hypertension C. Valvular heart disease D. Irritable bowel disease

*glaucoma* Qsymia is a combination of phentermine and topiramate. It must not be used in patients with glaucoma or hyperthyroidism.

An 80-year-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult a. should not experience changes in taste. b. has a loss of taste buds, especially for sweet and salt. c. has some loss of taste but no difficulty chewing food. d. loses the sense of taste because the ability to smell is decreased.

*has a loss of taste buds, especially or sweet and salt* Older adults have decreased numbers of taste buds and a decreased sense of smell. These age-related changes diminish the sense of taste (especially of salty and sweet substances).

A patient has a sliding hiatal hernia. What nursing intervention will reduce the symptoms of heartburn and dyspepsia? a. Keeping the patient NPO b. Putting the bed in the Trendelenburg position c. Having the patient eat 4 to 6 smaller meals each day d. Giving various antacids to determine which one works for the patient

*having the patient eat 4 to 6 smaller meals each day* Eating smaller meals during the day will decrease the gastric pressure and symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenburg position is not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the health care provider's prescription, so this is not a nursing intervention.

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 will determine the medication was effective when which symptom has been resolved? a. Diarrhea b. Heartburn c. Constipation d. Lower abdominal pain

*heartburn* Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal 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.

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? a. Low-pitched and rumbling above the area of obstruction b. High-pitched and hypoactive below the area of obstruction c. Low-pitched and hyperactive below the area of obstruction d. High-pitched and hyperactive above the area of obstruction

*high-pitched and hyperactive above the area of obstruction* Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is assessing a patient 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

*high-pitched sounds on abdominal auscultation* The bowel sounds are higher 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.

What information would have the *highest priority* for the nurse to include in preoperative teaching for a patient scheduled for a colectomy? a. How to care for the wound b. How to deep breathe and cough c. The location and care of drains after surgery d. Which medications will be used during surgery

*how to deep breath and cough* Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to a. increase fluid intake. b. administer an antibiotic. c. administer an antimotility drug. d. quarantine the patient to prevent spread of the virus.

*increase fluid intake* Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting. The major concerns are transmission prevention, fluid and electrolyte replacement, and resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, wash your hands before and after contact with the patient and when handling body fluids of any kind. Flush vomitus and stool down the toilet, and wash contaminated clothing immediately with soap and hot water.

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings. b. extension of the tumor into the aorta. c. leakage of fluids into the mediastinum. d. esophageal perforation with fistula formation into the lung.

*leakage of fluids into the mediastinum* After esophageal surgery, the nurse should observe the patient for signs of leakage into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.

During an examination of the abdomen the nurse should a. position the patient in the supine position with the bed flat and knees straight. b. listen for bowel sounds in the epigastrium and all four quadrants for 2 minutes. c. describe bowel sounds as absent if no sound is heard in a quadrant after 2 minutes. d. use the following order of techniques: inspection, palpation, percussion, auscultation.

*listen for bowel sounds in the epigastrium and all four quadrants for 2 minutes* The nurse should listen in the epigastrium and all four quadrants for bowel sounds for at least 2 minutes. The patient should be in the supine position and should slightly flex the knees; the head of the bed should be raised slightly. During examination of the abdomen, the nurse auscultates before performing percussion and palpation because the latter procedures may alter the bowel sounds. Bowel sounds cannot be described as absent until no sound is heard for 5 minutes in each quadrant.

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? a. Bisacodyl b. Lubiprostone c. Cascara sagrada d. Magnesium hydroxide

*magnesium hydroxide* Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be *most* helpful to prevent further episodes of constipation? a. Maintain a high intake of fluid and fiber in the diet. b. Discontinue intake of medications causing constipation. c. Eat several small meals per day to maintain bowel motility. d. Sit upright during meals to increase bowel motility by gravity.

*maintain a high intake of fluid and fiber in the diet* Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

Nursing management of the patient with chronic gastritis includes teaching the patient to a. take antacids before meals to decrease stomach acidity. b. maintain a nonirritating diet with six small meals a day. c. eliminate alcohol and caffeine from the diet when symptoms occur. d. use nonsteroidal antiinflammatory drugs (NSAIDs) instead of aspirin for minor pain relief.

*maintain a nonirritating diet with six small meals a day* nonirritating diet with six small meals a day is recommended to help control the symptoms of gastritis. Nonsteroidal antiinflammatory drugs (NSAIDs) are often as irritating to the stomach as aspirin and should not be used in the patient with gastritis. Antacids are often used for control of symptoms but have the best neutralizing effect if taken after meals. Alcohol and caffeine should be eliminated entirely because they may precipitate gastritis.

Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing a. beef. b. meat and milk. c. poultry and eggs. d. home-preserved vegetables.

*meat and milk* Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.

Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by a. distention of the smaller stomach by too much food and fluid intake. b. hyperglycemia caused by uncontrolled gastric emptying into the small intestine. c. irritation of the stomach lining by reflux of bile salts because the pylorus has been removed. d. movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine.

*movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine* Because there is no sphincter control of food taken into the stomach following a Billroth II procedure, concentrated food and fluid move rapidly into the small intestine, creating a hypertonic environment that pulls fluid from the bowel wall into the lumen of the intestine, reducing plasma volume and distending the bowel. Postprandial hypoglycemia occurs when the concentrated carbohydrate bolus in the small intestine results in hyperglycemia and the release of excessive amounts of insulin into the circulation, resulting in symptoms of hypoglycemia. Irritation of the stomach by bile salts causes epigastric distress after meals, not dumping syndrome.

The nurse should administer an as-needed dose of magnesium hydroxide after noting what information when reviewing a patient's medical record a. Abdominal pain and bloating b. No bowel movement for 3 days c. A decrease in appetite by 50% over 24 hours d. Muscle tremors and other signs of hypomagnesemia

*no bowel movement for 3 days* Magnesium hydroxide is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

Normal physical assessment findings of the GI system are (*select all that apply*) a. nonpalpable liver and spleen. b. borborygmi in upper right quadrant. c. tympany on percussion of the abdomen. d. liver edge 2 to 4 cm below the costal margin. e. finding of a firm, nodular edge on the rectal examination.

*non-palpable liver and spleen* *tympany on percussion of abdomen* Normal assessment findings of the gastrointestinal system include a *nonpalpable liver and spleen and generalized tympany on percussion*. Normally, bowel sounds are high pitched and gurgling; loud gurgles indicate hyperperistalsis and are called borborygmi (stomach growling). If the patient has chronic obstructive pulmonary disease, large lungs, or a low-set diaphragm, the liver may be palpated 0.4 to 0.8 inch (1 to 2 cm) below the right costal margin. On palpation, the rectal wall should be soft and smooth and should have no nodules.

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. frequently results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.

*often recurs after surgery, whereas ulcerative colitis is curable with a colectomy* Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn's disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.

A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? a. Sucralfate b. Cimetidine c. Omeprazole d. Metoclopramide

*omeprazole* 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.

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. Zolpidem b. Ondansetron c. Dexamethasone d. Morphine sulfate

*ondansetron* 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.

A woman is 5 ft, 6 in (166 cm) tall and weighs 200 lb (90.9 kg) with a waist-to-hip ratio of 0.7. The nurse counsels the patient with the knowledge that the patient is at greatest risk for a. heart disease b. osteoporosis c. diabetes mellitus d. endometrial cancer

*osteoporosis* A patient who is obese (BMI of 32.2) but has a waist-to-hip ratio of less than 0.8, indicating gynoid (pear) obesity, has an increased risk for osteoporosis. The other conditions are risks associated with android obesity.

Duodenal and gastric ulcers have similar as well as differentiating features. What are characteristics unique to duodenal ulcers (select all that apply)? a. Pain is relieved with eating food. b. They have a high recurrence rate. c. Increased gastric secretion occurs. d. Associated with Helicobacter pylori infection. e. Hemorrhage, perforation, and obstruction may result. f. There is burning and cramping in the midepigastric area.

*pain is relieved with eating food* *increased gastric secretion occurs* *there is burning and cramping in the midepigastric area* Duodenal ulcers have increased gastric secretion, which causes the burning and cramping in the midepigastric area, and the pain is relieved with food. The other options occur with both duodenal and gastric ulcers.

The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? a. Pallor and diaphoresis b. Ecchymotic peripheral IV site c. Guaiac-positive diarrhea stools d. Heart rate 90, respiratory rate 20, BP 110/60

*pallor and diaphoresis* A patient with hematemesis has some degree of bleeding from an unknown source. Guaiac-positive diarrhea stools would be an expected finding. When monitoring the patient for stability, the nurse observes for signs of hypovolemic shock such as tachycardia, tachypnea, hypotension, altered level of consciousness, pallor, and cool and clammy skin. An ecchymotic peripheral IV site will require assessment to determine the need for reinsertion. Access would be critical in the immediate treatment of shock, but the ecchymotic site does not represent a decline in condition.

A patient reports severe pain when the nurse assesses for rebound tenderness. What may this assessment finding indicate? a. Hepatic cirrhosis b. Hypersplenomegaly c. Gallbladder distention d. Peritoneal inflammation

*peritoneal inflammation* 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 gallbladder distention do not manifest with rebound tenderness.

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (*select all that apply*) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain.

*persistant abdominal pain* *marked abdominal distention* With lower intestinal obstructions, abdominal distention is markedly increased and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation, not diarrhea.

The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylori. d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.

*promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol* Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients taking corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors are at increased risk for ulcers. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion.

The nurse providing education to a post gastric bypass client indicates the following choices as appropriate for a Step II diet: A. Broth, clear jello, fluids flavored with enhancers B. Pudding, mashed potatoes, cooked cereals C. Protein shakes, sugar free ice cream, creamed soups D. Pureed meats, vegetables, and fruits

*protein shakes, sugar free ice cream, creamed soups* Step I is a clear liquid diet and consists of broth, clear jello and fluids flavored with enhancers. Step II is a full liquid diet and can include protein shakes, sugar free ice cream and creamed soups. Step III consists of soft foods that are easily digestible including pudding, mashed potatoes, cooked cereals and pureed meats, vegetables and fruit.

A patient with a history of peptic ulcer disease has presented to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions 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

*providing IV fluids and inserting a NG tube* 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.

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the a. inhibition of secretin release. b. release of bicarbonate by the pancreas. c. release of pancreatic digestive enzymes. d. release of gastrin by the duodenal mucosa.

*release of bicarbonate by the pancreas* The hormone secretin stimulates the pancreas to secrete fluid with a high concentration of bicarbonate. This alkaline secretion enters the duodenum and neutralizes acid in the chyme.

After administration of a dose of metoclopramide, which patient assessment finding would show the medication was effective? a. Decreased blood pressure b. Absence of muscle tremors c. Relief of nausea and vomiting d. No further episodes of diarrhea

*relief of N/V* 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.

What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation? a. Stop spillage of GI contents into the peritoneal cavity b. Remove excess fluids and undigested food from the stomach c. Feed the patient the nutrients missing from the lack of ingestion d. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty

*remove stimulation for HCl and pepsin secretion by keeping the stomach empty* NG intubation is used with acute exacerbation of peptic ulcer disease to remove the stimulation for hydrochloric acid (HCl) and pepsin secretion by keeping the stomach empty. Stopping the spillage of GI contents into the peritoneal cavity is used for peritonitis. Removing excess fluids and undigested food from the stomach is the rationale for using NG intubation for gastric outlet obstruction.

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

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

*rigid abdomen and vomiting following indigestion* 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 to 4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1 to 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.

Appropriate approaches used by the long-term care nurse to provide education for a 73 year old who has just been diagnosed with diabetes include which of the following? (*Select all that apply*) a. Schedule a visit by another resident who is diabetic. b. Demonstrate food choices using food photographs. c. Avoid discussion of the patient's favorite foods. d. Remind the patient that a lot of damage has already occurred. e. Encourage the patient's family to participate in teaching sessions. f. Ask the patient about past experiences with lifestyle changes.

*schedule a visit by another resident who is diabetic* *demonstrate food choices using food photographs* *encourage the patient's family to participate in teaching sessions* *ask the patient about past experiences with lifestyle changes* Strategies to promote learning in older adults include peer teaching, visual aids, family participation, and relating new learning to past experiences. Discussion of the patient's favorite foods is needed to determine how old favorites can be adapted to the new diet. Reminders about the damage already done will indicate that the changes are not worth the effort.

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu a. scrambled eggs and sausage. b. buckwheat pancakes with syrup. c. oatmeal, skim milk, and orange juice. d. yogurt, strawberries, and rye toast with butter.

*scrambled eggs and sausage* Celiac disease is treated with lifelong avoidance of dietary gluten (wheat, barley, oats, rye products). Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is also found in some medications and in many food additives, preservatives, and stabilizers.

A patient is suspected of having acute pancreatitis after presenting to the emergency department with severe abdominal pain. Which laboratory result would best indicate the presence of acute pancreatitis? a. Gastric pH of 1.4 b. Blood glucose of 104 c. Serum amylase of 420 U/L d. Serum potassium of 3.5 mEq/L

*serum amylase of 420 U/L* Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. The normal serum amylase levels range from 28 to 85 U/L. 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.

A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report? a. Vomiting of bright-red blood b. Projectile vomiting of undigested food c. Sudden, severe upper abdominal pain and back pain d. Hyperactive stomach sounds and upper abdominal swelling

*sudden, severe upper abdominal pain and back pain* Perforation of an ulcer causes sudden, severe abdominal pain that is often referred to the back, accompanied by a rigid, boardlike abdomen and other signs of peritonitis. Vomiting of blood indicates hemorrhage of an ulcer and gastric outlet obstruction is characterized by projectile vomiting of undigested food, hyperactive stomach sounds, and upper abdominal swelling.

The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? a. Take a dose of mineral oil at the same time. b. Add extra salt to food on at least one meal tray. c. Ensure a dietary intake of 10 g of fiber each day. d. Take each dose with a full glass of water or other liquid.

*take each dose with a full glass of water or other liquid* Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

The wound, ostomy, and continence nurse (WOCN) selects the site where the ostomy will be placed. What should be included in site consideration? a. The patient must be able to see the site. b. The site should be outside the rectus muscle area. c. It is easier to seal the drainage bag to a protruding area. d. A waistline site will allow using a belt to hold the appliance in place.

*the patient must be able to see the site* In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance.

The nurse explains to the patient with Vincent's infection that treatment will include a. tetanus vaccinations. b. viscous lidocaine rinses. c. amphotericin B suspension. d. topical application of antibiotics.

*topical application of antibiotics* Vincent's infection is also known as Trench Mouth and is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoidance of tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.

A patient complaining of nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? a. Tremors b. Constipation c. Double vision d. Numbness in fingers and toes

*tremors* Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur with metoclopramide administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

A person of Northern heritage is at an increased risk for which of the following? (*Select all that apply*) a. Vitamin C deficiency b. Type 1 diabetes c. Celiac disease d. Type 2 diabetes e. Hypertension f. Metabolic syndrome

*type 1 diabetes* *celiac disease* Type 1 diabetes and Celiac disease are more common in Northern heritage. African Americans and Hispanics are at increased risk for Type 2 diabetes, hypertension, and metabolic syndrome. Vitamin C deficiency is not a common deficiency related to heritage or ethnicity.

The nurse identifies that which patient is at *highest* risk for developing colon cancer? a. A 28-yr-old man who has a body mass index of 27 kg/m2 b. A 32-yr-old woman with a 12-year history of ulcerative colitis c. A 52-yr-old man who has followed a vegetarian diet for 24 years d. A 58-yr-old woman taking prescribed estrogen replacement therapy

*ulcerative colitis* Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index >5= 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, or hereditary nonpolyposis colorectal cancer syndrome; eating red meat (>5=7 servings/week); cigarette use; and drinking alcohol (>5=4 drinks/week).

The nurse teaching young adults about behaviors that put them at risk for oral cancer includes a. use of chewing gum. b. use of perfumed lip gloss. c. use of smokeless tobacco. d. drinking of carbonated beverages.

*use of smokeless tobacco* Oral cancer has several predisposing risks factors: • Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression • Tongue: tobacco, alcohol, chronic irritation, and syphilis • Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection).

What should a patient be taught after a hemorrhoidectomy? a. Take mineral oil before bedtime. b. Eat a low-fiber diet to rest the colon. c. Administer oil-retention enema to empty the colon. d. Use prescribed pain medication before a bowel movement.

*use prescribed pain medication before a bowel movement* After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Give pain medication before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-retention enema is administered.

The nurse is caring for a patient diagnosed with peptic ulcer disease (PUD). The patient was prescribed the proton pump inhibitor Prevacid (lansoprazole). Which of the following supplements may be prescribed to prevent deficiency? a. Vitamin B12 b. Vitamin C c. Vitamin D d. Omega-3 fatty acids

*vitamin B12* Vitamin B12 deficiency can occur as a result of the reduced gastric acidity associated with use of proton pump inhibitors, and supplementation is often warranted. Vitamin C deficiency is not a known deficiency associated with medications. Vitamin D deficiency may occur in patients who take cholesterol medication, and this link is currently being investigated. Omega-3 fatty acids may be used as monotherapy or in conjunction with cholesterol medication for patients with hyperlipidemia.

A patient with oral cancer is not eating. A small-bore feeding tube was inserted and the patient started on enteral feedings. Which patient goal would indicate improvement? a. Weight gain of 1 kg in 1 week b. Administer tube feeding at 25 mL/hr. c. Consume 50% of clear liquid tray this shift. d. Monitor for tube for placement and gastrointestinal residual.

*weight gain of 1kg in 1 week* The goal for a patient with oral cancer that is not eating would be to note weight gain rather than loss. Consuming 50% of the clear liquid tray is not a realistic goal. Administering feedings, monitoring tube placement, and tolerance are interventions used to achieve the goal.

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources.

*wound and skin care, nutrition, drugs and community resources* Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.

An older adult patient is 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

*xerostomia* 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.

A patient is scheduled to receive "Colace 100 mg PO." The patient asks to take the medication in liquid form, and the nurse obtains an order for the change. The available syrup contains 150 mg/15 mL. Calculate how many milliliters the nurse should administer. _______________ mL

10 mL

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? a. 7:00 AM, 10:00 AM, and 1:00 PM b. 8:00 AM, 12:00 PM, and 4:00 PM c. 9:00 AM and 3:00 PM d. 9:00 AM, 12:00 PM, and 3:00 PM

A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at *8:00 AM, 12:00 PM, and 4:00 PM.*

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse a. Fecal impaction b. Perineal hygiene c. Dietary fiber intake d. Antidiarrheal agent use

Patients with limited mobility are at risk for *fecal impactions* caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.