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A nurse is preparing a community education program about hepatitis B. Which of the following statements should the nurse include in the teaching?

"A hepatitis B immunization is given to infants and children."

A client has been diagnosed with mild gastroesophageal reflux disease and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this client? A. "Avoid caffeine-containing foods and beverages." B. "Eat three meals each day and avoid snacking between meals." C. "Peppermint lozenges help to reduce stomach upset." D. "Sleep on your left side with a pillow between your knees."

"Avoid caffeine-containing foods and beverages." Teach the client to limit or eliminate foods that decrease lower esophageal sphincter (LES) pressure and that irritate inflamed tissue, causing heartburn, such as peppermint, chocolate, alcohol, fatty foods (especially fried), caffeine, and carbonated beverages. Large meals increase the volume of and pressure in the stomach and delay gastric emptying. Remind the client to eat four to six small meals each day rather than three large ones. Peppermint decreases LES pressure and increases the risk of symptoms. Clients should be taught to elevate the head by 6 to 12 inches for sleep to prevent nighttime reflux.

A client who has been diagnosed recently with esophageal cancer states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response? A. "I understand your concerns, but you can't give up your normal activities. You should go anyway and try not to worry about it." B. "Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." C. "Why not take one of your antianxiety pills before going? That will keep you from worrying about everything so much." D. "You need to talk to your doctor about your concerns. The doctor may recommend that you join a support group for cancer survivors."

"Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." Suggesting that the client invite people over for a meal provides psychosocial support to the client and assists the client in finding a solution to the problem. Telling the client not to worry about it or to call the provider is evasive and unhelpful; it is used to placate the client and does not address the client's concerns. The client should use problem-solving and coping skills before resorting to the use of medication.

The nurse is teaching a client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? A. "I will need to avoid sweetened fruit juice beverages." B. "I can eat ice cream in moderation." C. "I cannot drink alcohol at all." D. "It is okay to have a serving of sugar-free pudding."

"I can eat ice cream in moderation." Milk products such as ice cream must be eliminated from the diet of the client with dumping syndrome. The client with dumping syndrome can no longer consume sweetened drinks. Alcohol must be eliminated from the diet. The client can eat sugar-free pudding, custard, and gelatin with caution.

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "I should avoid alcohol and tobacco." D. "I should eat small meals about six times a day."

"I should avoid alcohol and tobacco." The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia. The client should not eat six small meals daily. This practice may actually stimulate gastric acid secretion.

A client with peptic ulcer disease asks the nurse whether a maternal history of gastric cancer will cause the client to develop gastric cancer. What is the nurse's best response? A. "Yes, it is known that a family history of gastric cancer will cause someone to develop gastric cancer." B. "If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." C. "Have you spoken to your health care provider about your concerns?" D. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."

"If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." Genetic counseling will help the client determine whether he or she is at exceptionally high risk to develop gastric cancer. The client cannot know for certain whether family history places him or her at exceptionally high risk to develop gastric cancer unless specific testing is done. Asking the client what the provider has said is an evasive answer by the nurse and does not help answer the client's question. Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.

The nurse is teaching a client with peptic ulcer disease about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

"Nizatidine (Axid) needs to be taken three times a day to be effective." Nizatidine is most effective if administered once daily. A dose of ranitidine at bedtime should decrease acid production throughout the night. Sucralfate should be taken 1 hour before a

A client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your provider told you about participating in hospice?" C. "I can speak to your provider about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

"Pain control is a major component of the care provided by hospice and its staff members." Telling the client that pain control is a major component of hospice care correctly describes the services provided by hospice and its staff members, and reassures the client about their expertise in pain management. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's concerns. The nurse does not need to speak to the provider because pain control is an integral part of hospice services. It is inappropriate to tell a terminally ill client in need of pain control that he or she may become too dependent on pain medication.

A client with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? A. "Consume carbonated beverages if you experience stomach upset." B. "Remain on a soft diet for about a week and avoid raw fruits and vegetables." C. "You may resume running and weight lifting if you wish." D. "You may stop taking your anti-reflux medications after 1 week."

"Remain on a soft diet for about a week and avoid raw fruits and vegetables." After LNF, clients should be taught to remain on a soft diet for 1 week. Carbonated beverages should be avoided. Clients may walk, but should avoid heavy lifting. Anti-reflux medications should be taken for 1 month after the procedure.

The nurse has placed a nasogastric (NG) tube in a client with upper gastrointestinal (GI) bleeding to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? A. "Saline goes down the tube to help clean out your stomach." B. "Medication goes down the tube to help clean out your stomach." C. "The provider requested the tube to be placed just in case it was needed." D. "We'll start feeding you through it once your stomach is cleaned out."

"Saline goes down the tube to help clean out your stomach." Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots. It does not involve the instillation of medication. An NG tube is not typically placed in a client without a particular purpose in mind. Gastric lavage does not involve enteral feeding.

A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

"These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." Although licorice and slippery elm may be helpful in managing PUD, the client should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The client should not use over-the-counter medications without first discussing it with his or her provider.

An older female client is diagnosed with gastric cancer. Which statement made by the client's family demonstrates a correct understanding of the disorder? A. "This may be related to her recurring ulcer disease." B. "This is probably curable with surgery." C. "Gastric cancer has a strong genetic component." D. "Thank goodness she won't have to undergo surgery."

"This may be related to her recurring ulcer disease." Infection with Helicobacter pylori is the largest risk factor for gastric cancer because it carries the cytotoxin-associated antigen A (CagA) gene. Clients with chronic ulcers are probably infected with this organism. Surgery is not curative; most gastric cancers do not present with symptoms until late in the disease and have a high fatality rate. There is no strong genetic predisposition to gastric cancer. Surgery is part of the treatment.

A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching?

"This procedure can determine how well the lower part of your esophagus works."

A client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

"We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. It is not known to be a direct cause of the disease. Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease process in and of itself. Asking the client what the doctor has said is an evasive response on the part of the nurse and does not help answer the client's question.

A client has been diagnosed with terminal esophageal cancer. The client is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Haven't you received adequate pain management in the hospital?" B. "Would you like me to get a nurse from hospice to come talk with you?" C. "Do you want me to call the hospital chaplain to explain hospice to you?" D. "Talk to your health care provider about hospice services."

"Would you like me to get a nurse from hospice to come talk with you?" The best way to alleviate the client's concerns would be to have a hospice nurse talk with the client and answer any questions. Suggesting that the client has had adequate pain management sounds defensive. Referring the client to the chaplain or the health care provider is evasive and attempts to shift responsibility away from the nurse.

GERD-therapeutic procedures

*Stretta* procedure uses radiofrequency energy, applied by an endoscope, to decrease vagus nerve activity. This causes the LES muscle tissue to contract and tighten. *Fundoplication* Fundoplication can be indicated for clients who fail to respond to other treatments. The fundus of the stomach is wrapped around and behind the esophagus through a laparoscope to create a physical barrier.

Which statements should the nurse include when teaching patients and their families regarding prevention of gastritis? Select all that apply.

-"Eating a well-balanced diet is important." -"Alcoholic beverages in excessive amounts should be avoided." -"Excessive intake of coffee or even decaffeinated drinks should be avoided." -"Protection against exposure to toxic substances in the workplace should be practiced."

A patient with peptic ulcer disease (PUD) asks the nurse whether a maternal history of gastric cancer will cause the patient to develop gastric cancer. What is the nurse's best response?

-"If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing."

A patient asks the nurse how an infection such as H. pylori can cause gastric ulcers. What does the nurse tell the patient about this organism?

-"It produces an enzyme that alters the pH of the gastric environment."

A patient with chronic gastritis who is ordered to take vitamin B 12 asks the nurse why this vitamin is necessary. What does the nurse tell the patient about vitamin B 12?

-"It will prevent a type of anemia."

The nurse is teaching a patient with peptic ulcer disease about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge?

-"Nizatidine needs to be taken three times a day to be effective."

The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response?

-"Saline goes down the tube to help clean out your stomach."

A patient who currently takes phenytoin has been started on a multidrug regimen for treatment of peptic ulcer disease. What does the nurse tell this patient about taking these medications?

-"Take the phenytoin 1 to 2 hours before or after the antacid."

The nurse is teaching a patient about the use of ranitidine and sucralfate to treat gastritis. What does the nurse include in this teaching?

-"Take the ranitidine at bedtime."

A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response?

-"These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen."

The nurse is teaching a patient about self-management of gastritis. Which piece of education is appropriate?

-"Use complementary and alternative therapies."

A patient has undergone an esophagogastroduodenoscopy (EGD) procedure. Which is a priority nursing assessment for this patient?

-Ability to swallow secretions

The endoscopy of a patient reveals a reddened and thick mucosal membrane around the stomach with prominent rugae. What condition does the patient have?

-Acute gastritis

The nurse finds a patient vomiting coffee ground-type emesis. On assessment, the patient has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority?

-Administering intravenous (IV) fluids

The nurse is caring for a patient with peptic ulcer disease (PUD). What signs and symptoms in the patient suggest a surgical emergency? Select all that apply.

-Assuming the knee-chest position -Tender, rigid, board-like abdomen -Sudden, sharp pain in the mid-epigastrium

Which disorder in older adults may have a direct association with mucosa-associated lymphoid tissue (MALT) lymphoma?

-Atrophic gastritis

Which self-management measure will the nurse teach the patient with gastritis?

-Avoid exposure to lead

The nurse assesses that a patient experiences regular epigastric discomfort that usually goes away after eating. Which initial nursing action is correct?

-Contact the provider to report these symptoms

A patient with extensive burns reports severe abdominal pain and blood-tinged vomitus. Which ulcers might be the reason behind the patient's condition?

-Curling's ulcer

A patient with peptic ulcer disease has developed a pyloric obstruction, and the provider orders placement of a nasogastric (NG) tube. The NG tube is used for which purpose in this patient?

-Decompression of the stomach

EVL

-Endoscopic variceal ligation -banding therapy -used for acute bleeding -varices are rubber banded during endoscopy -necrosis of tissue occurs w/eventual sloughing of varix -significant ↓ in re-bleeding and ↓ mortality post procedure

The nurse is caring for a patient who has granular dark vomitus that resembles coffee grounds. Which type of ulcer does the nurse suspect in this patient?

-Gastric

A patient being evaluated for a gastric ulcer reports sharp, burning left-sided upper epigastric pain, which increases with food. The nurse notes epigastric tenderness, a soft abdomen, and normally active bowel sounds. Based on these findings, which condition does the nurse suspect?

-Gastric ulcer

Which ulcers usually develop due to H. pylori infection?

-Gastric ulcers and duodenal ulcers

A patient has been diagnosed with gastritis. What statement about this disorder is accurate?

-Gastritis is the inflammation of gastric mucosa.

The patient presents to the emergency department with acute gastritis. The nurse suspects which organism is most likely the culprit?

-Helicobacter pylori

Which is the most serious complication of peptic ulcer disease that a nurse should check for in an older patient?

-Hemorrhage

Which area of the body is a location for gastric ulcers?

-In the antrum of the stomach

The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124/min, and respiratory rate 26/min. Which admission request does the nurse implement first?

-Infuse lactated Ringer's solution at 200 mL/hr

What statement about type A gastritis is most accurate?

-It is associated with pernicious anemia.

The laboratory report of a patient with acute gastritis states there are traces of blood in the stool. What term does the nurse use to document this finding?

-Melena

A patient who has peptic ulcer disease has developed pyloric obstruction. The nurse monitors the patient's laboratory values closely to assess for which complication?

-Metabolic alkalosis

The nurse is reviewing the medications prescribed for a patient with peptic ulcer disease (PUD). Which drug is the patient taking to treat Helicobacter pylori infection?

-Metronidazole

The nurse is caring for a patient and is monitoring the patient regularly for acute gastritis with bleeding. Which medication class most likely causes the nurse to believe the patient is at risk for this disorder?

-NSAIDS

A patient is admitted with chronic peptic ulcer disease (PUD). What sign or symptom is suggestive of a pyloric obstruction?

-Nausea and vomiting

The nurse caring for a patient with a duodenal ulcer finds the patient lying in the fetal position. The patient reports experiencing a sudden onset of sharp pain. Which action by the nurse is correct?

-Notify the provider immediately

proton pump inhibitors

-PPIs -pantoprazole -omeprazole -esomeprazole -rabeprazole -lansoprazole -reduce gastric acid by inhibiting cellular pump of gastric parietal cells necessary for gastric acid secretion

The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which characteristic is most significant in determining whether the patient's ulceration is gastric or duodenal in origin?

-Pain occurs 1½ to 3 hours after a meal, usually at night.

A patient who has chronic gastritis is at increased risk for which condition?

-Pernicious anemia

What are the key features of chronic gastritis? Select all that apply.

-Pernicious anemia -Nausea and vomiting -Intolerance to fatty food

The nurse is reviewing orders for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which order does the nurse implement first?

-Place a nasogastric (NG) tube, and connect to suction

A nutritionist is asked to assist in forming a plan for a patient with peptic ulcer disease (PUD). Which recommendation is most helpful for this patient?

-Reducing caffeine intake

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN?

-Reinforce the teaching about avoiding alcohol and caffeine for a patient with chronic gastritis

The nurse is assessing a patient who reports episodes of pain in the abdomen. What feature suggests the possibility of a duodenal ulcer?

-The patient has type O blood. (Patients with duodenal ulcers most often have type O blood. They are usually 50 years or older and are often well-nourished. Another key feature of a duodenal ulcer is a high secretion of gastric acid; abdominal pain due to a duodenal ulcer is therefore relieved by the ingestion of food. Pain usually occurs again about 90 minutes to 3 hours after eating food.)

Which patient assessment data frequently correlates with a diagnosis of chronic gastritis?

-Treatment with radiation therapy

Which pathologic changes can occur in a patient with gastritis? Select all that apply.

-Vascular congestion -Acute inflammatory cell infiltration -Degenerative changes in the superficial epithelium of the stomach lining

esophageal varices health promotion

-avoid alcohol -avoid heavy lifting -avoid straining with bowel mvt -chew food completely -avoid salicylates and other meds that can irritate esophagus

diet

-avoid offending foods -avoid large meals -remain upright after eating -avoid eating before bed -consume 4-6 small meals -avoid clothing that is tight at waist -lose weight -elevate HOB 15.2-20.3 cm with blocks

diagnostic tests

-barium swallow w/fluoroscopy -EGD -CT scan with contrast

TIPS complications

-bleeding -sepsis -HF -organ perforation -liver failure

GERD expected findings

-classic report of dyspepsia after eating -radiating pain (neck, jaw, back) -feeling of having heart attack -pyrosis -dysphagia or odynophagia -pain worsens with position -pain occurs after eating; lasts 20 min to 2 hours -throat irritation; hypersalivation; bitter taste -↑ flautus and eructation -pain relived by drinking water, sitting upright, taking antacids -occurs 4-5 times/wk consistently -tooth erosion

GERD

-common condition -gastric content and enzyme backflow into esophagus (excessive) -incompetent sphincter LES -pyloric stenosis -hiatal hernia -excessive intra abdominal or intragastric pressure -motility problems -corrosive problems irritate esophageal tissue

aspiration of gastric secretion

-complication of GERD -reflux of gastric fluids aspirated -asthma exacerbations from inhaled aerosolized acid -frequent upper resp, sinus, ear infections -aspiration pneumonia

hiatal hernia

-diaphragmatic hernia -protrustion of stomach above diaphragm into thoracic cavity -sliding (more common) -paraesophageal (rolling)

endoscopic sclerotherapy

-during endoscopy, sclerosing agent injected into varices resulting in thrombosis COmplications -bleeding -perforation of esophagus -aspiration pneumonia -esophageal stricture -sedation -antacids, H2 blockers, PPIs given to protect esophagus and prevent reflux

GERD contributing factors

-excessive ingestion of foods that relax LES -prolonged frequent abd distention from overeating or delayed emptying -inc abd pressure -meds that relax LES -↑ gastric acid from Meds & stress -debilitation resulting in weakened LES tone -hiatal hernia -lying flat

fundoplication

-fail to respond to other treatments -fundus wrapped around esophagus through laparoscope to create physical barrier -temporary dysphagia -gas bloat syndrome -atelectasis/pneumonia

Foods that relax LES

-fatty/fried -chocolate -caffeinated -peppermint -spicy -tomatoes -citrus fruits -alochol

paraesophageal hernia findings

-fullness after eating -sense of breathlessness/suffocation -chest pain -worsening of symptoms when reclining -pharyngitis -inspiratory/expiratory wheeze

sliding hernia findings

-heartburn -reflux -chest pain -dysphagia -belching

obstruction

-hernia complication -paraesophageal hernia -blockage of food in herniated portion of stomach

volvulus

-hernia complication -twisting of esophagus or stomach

HGD

-high grade dysplasia in esophagus -squamous mucosa replaced by columnar epithelium -30% ↑ chance of getting cancer

untreated GERD

-inflammation -breakdown -long term complications such as barrett's esophagus or adenocarcinoma of esophagus

esophageal varices surgery

-last resort -TIPS has been replaced by many surgical measures -high mobidity and mortality rates with surgery -bypass procedures est venous shunt -splenorenal -mesocaval -portacaval -commonly have NG tube inserted during surgery to monitor for hemorrhage

health promotion

-less than 30 BMI -stop smoking -limit or avoid alcohol and tobacco -low fat -avoid foods that lower LES pressure -avoid eating/drinking 2hr before bed -avoid tight fitting clothes -elevate HOB 6-8 inches

prokinetics

-metoclopramide -↑ motility of esophagus and stomach -monitor for EPS

PPI nursing

-monitor electrolytes and hypoglycemia in DM -long term use has been related to community acquired pneumonia and C. diff -older adults long term use assoc with fractures

esophageal varices expected findings

-no symptoms until bleeding -hematemesis -melena -general deterioration of physical and mental status -precipitated by valsalva -lifting heavy objects -coughing -sneezing -alcohol consumption

GERD risk factors

-obesity -older age from delayed gastric emptying and weakened LES tone) -sleep apnea -nasogastric tube

↑ abdominal pressure

-obesity -pregnancy -bending at waist -ascites -tight clothing at waist

vasoconstrictors

-octreotide is synthetic form of hormone somatostatin -↓ bleeding but does not affect blood pressure -vasopressin causes constriction of esophageal and proximal gastric veins and reduces portal pressure

strangulation

-paraesophageal hernia complication -compression of blood vessels to herniated portion of stomach

iron deficiency anemia

-paraesophageal hernia complication -resulting from bleeding into the gastric mucosa due to obstruction

esophageal varices risk factors

-portal HTN -alcoholic cirrhosis -viral hepatitis -impaired circulation of blood through liver -collateral circulation develops creating varices in upper stomach and esophagus -varices are fragile and can bleed easily

sliding hernia

-portion of stomach and gastroesophageal junction move above diaphragm -generally occurs with ↑ in intra abdominal pressure or supine

barrett's epithelium

-premalignant -reflux leads to esophagitis -chronic esophagitis continuously heals inflamed tissue -eventually replacing normal epithelium with premalignant or malignant (adenocarcinoma)

GERD treatment

-primary is diet and lifestyle -antacids -H2 receptor antagonists -proton pump inhibitors -surgery

nonselective beta blockers

-propanolol to ↓ HR and reduce hepatic venous pressure -used prophylactically in esophageal varices

stretta

-radio frequency energy applied by endoscope -↓ vagus nerve activity -causes LES muscle tissue to contract and tighten

histamine 2 receptor antagonist

-ranitidine -famotidine -nizatidine -reduce secretion of acid -onset longer than antacids; longer duration -use cautiously in kidney dz -take with meals and bedtime -separate dose from antacids by 1 hr

paraesophageal hernia

-rolling hernia -part of fundus moves above diaphragm although the gastroesophageal junction remains below

antacids

-separate from other meds by at least 1 hour

bleeding varices symptoms

-shock -hypotension -tachycardia -cool clammy skin -est IV with large bore -VS and Hct -type/cross match for possible transfusion -monitor for overt and occult bleeding

EVL complications

-superficial ulceration -dysphagia -temporary chest discomfort -esophageal strictures (rare)

esophageal varices

-swollen, fragile blood vessels -generally found in submucosa of lower esophagus -can develop higher -result of portal hypertension -usually from cirrhosis -hemorrhage is medical emergency with high mortality rate

meds that relax LES

-theophylline -nitrates -calcium channel blockers -anticholinergics -diazepam

TIPS

-transjugular intrahepatic portal systmic shunt -treat acute episode of bleeding when EVL and drugs not controlling bleeding -rapidly lowers portal pressure -costly and used only when nothing else works -under sedation or general anesthesia -catheter placed into liver via jugular -stent placed between portal and hepatic vein bypassing liver -portal HTN relieved

103. Which nursing problem is priority for the 76-year-old client diagnosed with gastroenteritis from staphylococcal food poisoning? 1. Fluid volume deficit. 2. Nausea. 3. Risk for aspiration. 4. Impaired urinary elimination.

. 1. Fluid volume deficit secondary to diarrhea is the priority because of the potential for metabolic acidosis and hypokalemia, which are both life threatening, especially in the elderly

99. The client is diagnosed with salmonellosis secondary to eating some slightly cooked hamburger meat. Which clinical manifestations would the nurse expect the client to report? 1. Abdominal cramping, nausea, and vomiting. 2. Neuromuscular paralysis and dysphagia. 3. Gross amounts of explosive bloody diarrhea. 4. Frequent "rice water stool" with no fecal odor.

. 1. Symptoms develop 8-48 hours after ingesting the Salmonella bacteria and include diarrhea, abdominal cramping, nausea, and vomiting, along with low-grade fever, chills, and weakness.

2.The nurse caring for a client diagnosed with gastroesophageal reflux disease (GERD) writes the nursing problem of "behavior modification." Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking.

. 1. The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. Behavior modification is changing one's behavior

136. The client has had a stool that is dark, watery, and shiny in appearance. Which intervention should be the nurse's first action? 1. Check for a fecal impaction. 2. Encourage the client to drink fluids. 3. Check the chart for sodium and potassium levels. 4. Apply a protective barrier cream to the perianal area.

. 1. This is a symptom of diarrhea moving around an impaction higher up in the colon. The nurse should assess for an impaction when observing this finding.

A nurse is reinforcing nutrition teaching with a client who has pancreatitis. Which of the following statements by the client indicates understanding? Select all that apply 1. "I plan to eat small frequent meals." 2. "I will eat easy to digest foods with limited spice." 3. "I will use skim milk when cooking." 4. "I plan to drink regular cola." 5. "I will limit alcohol intake to two drinks per day."

1, 2 and 3 The client should drink caffeine free beverages to reduce GI stimulation. The client should also avoid all alcohol.

The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply 1. Alterations in mood 2. Agitation 3. Decreased deep tendon reflexes 4. Insomnia 5. Complaints of headache

1, 2 and 4

A nurse is caring for a client who has cirrhosis. Which of the following medications should the nurse expect to administer to this client? Select all that apply 1. Diuretic 2. Beta blocking agent 3. Opioid analgesic 4. Lactulose 5. Sedative

1, 2 and 4 The liver metabolizes opioids and sedatives. A client with cirrhosis should not take these medications.

A nurse is reinforcing teaching with a client who has hepatitis B about home care. Which of the following instructions should the nurse include? Select all that apply 1. Limit physical activity 2. Avoid alcohol 3. Take acetaminophen for comfort 4. Wear a mask when in public places 5. Eat small frequent meals

1, 2 and 5

The nurse is preparing a care plan for a patient with hepatic cirrhosis. Which of the following nursing diagnosis are appropriate? Select all that apply 1. Disturbed body image related to changes in appearance, sexual dysfunction and role function 2. Risk for injury related to altered clotting mechanisms 3. Urinary incontinence related to general debility and muscle wasting 4. Altered nutrition, more than body requirements, related to decreased activity and bedrest 5. Activity intolerance related to fatigue, general debility, muscle wasting and discomfort

1, 2 and 5

A patient admitted with severe epigastric abdominal pain radiating to the back is vomiting and complaining of difficulty breathing. Upon assessment, the nurse determines that the patient is experiencing tachycardia and hypotension. Which of the following actions is a priority intervention for this patient? Select all that apply 1. Administer pain relieving medication 2. Assist the patient to a semi Fowler's position 3. Administer plasma 4. Administer a low-fat diet 5. Administer electrolytes

1, 2, 3 and 5 The treatment goals for acute pancreatitis focus on relieving pain, maintaining circulatory and fluid volume and decreasing production of pancreatic enzymes. IV fluid replacement should be done immediately. Plasma should be administered to maintain BP within an acceptable range. Low serum calcium and magnesium levels may occur and require prompt treatment. Semi Fowler's will decrease pressure on the diaphragm.

6. The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying.

1. Rationale: Of adult-onset asthma cases, 80% to 90% are caused by gastroesophageal reflux disease (GERD).

11. The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena.

1. Rationale: Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD.

2. The nurse caring for a client diagnosed with GERD writes the client problem of"behavior modification." Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking.

1. Rationale: The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. Behavior modification is changing one's behavior.

A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: 1. "Tell me about your husband's alcohol usage." 2. "Is your husband being treated for tuberculosis?" 3. "Has your husband recently fallen or injured his chest?" 4. "Describe spices and condiments your husband uses on food."

1. "Tell me about your husband's alcohol usage." A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? 1. "You may have eaten contaminated restaurant food." 2. "You could have gotten it by using I.V. drugs." 3. "You must have received an infected blood transfusion." 4. "You probably got it by engaging in unprotected sex."

1. "You may have eaten contaminated restaurant food."

Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks the contents for pH. The nurse verifies correct tube placement if which pH value is noted? 1. 3.5 2. 7.0 3. 7.35 4. 7.5

1. 3.5

66. Which assessment data should the nurse expect to find for the client who had an upper gastrointestinal (UGI) series? 1. Chalky white stools. 2. Increased heart rate. 3. A firm hard abdomen. 4. Hyperactive bowel sounds.

1. A UGI requires the client to swallow barium, which passes through the intestines, making the stools a chalky white color.

62. The client two (2) hours postoperative laparoscopic cholecystectomy is complaining of severe pain in the right shoulder. Which nursing intervention should the nurse implement? 1. Apply a heating pad to the abdomen for 15 to 20 minutes. 2. Administer morphine sulfate intravenously after diluting with saline. 3. Contact the surgeon for an order to x-ray the right shoulder. 4. Apply a sling to the right arm that was injured in surgery.

1. A heating pad should be applied for 15 to 20 minutes to assist the migration of the CO2 used to insufflate the abdomen.

58. The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when teaching ways to prevent an acute exacerbation of diverticulosis? Select all that apply. 1. Eat a high-fiber diet. 2. Increase fluid intake. 3. Elevate the HOB after eating. 4. Walk 30 minutes a day. 5. Take an antacid every two (2) hours.

1. A high-fiber diet will help to prevent constipation, which is the primary reason for diverticulitis. 2. Increased fluids will help keep the stool soft and prevent constipation. 4. Exercise will help prevent constipation

39. The 85-year-old male client diagnosed with cancer of the colon asks the nurse, "Why did I get this cancer?" Which statement is the nurse's best response? 1. Cancer of the colon is associated with a lack of fiber in the diet. 2. Cancer of the colon has a greater incidence among those younger than age 50 years. 3. Cancer of the colon has no known risk factors. 4. Cancer of the colon is rare among male clients.

1. A long history of low-fiber, high-fat, highprotein diets results in a prolonged transit time. This allows the carcinogenic agents in the waste products to have a greater exposure to the lumen of the colon.

The nurse is planning care for a patient following an incisional cholecystectomy for cholelithiasis. Which of the following interventions is the highest nursing priority for this patient? 1. Assisting the patient to turn, cough and deep breathe every two hours 2. Assisting the patient to ambulate the evening of the operative day 3. Performing range of motion leg exercises hourly while the patient is awake 4. Teaching the patient to choose low-fat foods from the menu

1. Assisting the patient to turn, cough and deep breathe every two hours

28. When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first? 1. Auscultate the client's bowel sounds in all four quadrants. 2. Palpate the abdominal area for tenderness. 3. Percuss the abdominal borders to identify organs. 4. Assess the tender area progressing to nontender

1. Auscultation should be used prior to palpation or percussion when assessing the abdomen. If the nurse manipulates the abdomen, the bowel sounds can be altered and give false information

82. The client has end-stage liver failure secondary to alcoholic cirrhosis. Which complication indicates the client is at risk for developing hepatic encephalopathy? 1. Gastrointestinal bleeding. 2. Hypoalbuminemia. 3. Splenomegaly. 4. Hyperaldosteronism

1. Blood in the intestinal tract is digested as a protein, which increases serum ammonia levels and increases the risk of developing hepatic encephalopathy

A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices is most likely to trigger cholecystitis? 1. Brownie with nuts 2. Bowl of mixed fruit 3. Grilled turkey 4. Baked potato

1. Brownie with nuts A low calorie, liquid protein diet can trigger it. Also rapid weight loss can trigger it

Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? 1. Change the tube feeding solutions and tubing at least every 24 hours. 2. Maintain the head of the bed at a 15-degree elevation continuously. 3. Check the gastrostomy tube for position every 2 days. 4. Maintain the client on bed rest during the feedings

1. Change the tube feeding solutions and tubing at least every 24 hours. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration.

64. When assessing the client recovering from an open cholecystectomy, which signs and symptoms should the nurse report to the health-care provider? Select all that apply. 1. Clay-colored stools. 2. Yellow-tinted sclera. 3. Dark yellow urine. 4. Feverish chills. 5. Abdominal pain.

1. Clay-colored stools are caused by recurring stricture of the common bile duct, which is a sign of post-cholecystectomy syndrome. 2. Yellow-tinted sclera and skin indicate residual effects of stricture of the common bile duct, which is a sign of post-cholecystectomy syndrome. 3. Dark yellow urine indicates a residual effect of a stricture of the common bile duct, which is a sign of post-cholecystectomy syndrome. 4. Fever and chills indicate residual or recurring calculi, inflammation, or stricture of common bile duct, which is a sign of postcholecystectomy syndrome. 5. Abdominal pain indicates a residual effect of a stricture of common bile duct, inflammation, or calculi, which is a sign of postcholecystectomy syndrome.

40. The nurse is planning the care of a client who has had an abdominal perineal resection for cancer of the colon. Which interventions should the nurse implement? Select all that apply. 1. Provide meticulous skin care to stoma. 2. Assess the flank incision. 3. Maintain the indwelling catheter. 4. Irrigate the J-P drains every shift. 5. Position the client semi-recumbent.

1. Colostomy stomas are portions of the large intestines pulled through the abdominal wall through which feces exits the body. Feces can be irritating to the abdominal skin, so careful and thorough skin care is needed. 3. Because of the perineal wound, the client will have an indwelling catheter to keep urine out of the incision. 5. The client should not sit upright because this would cause pressure on the perineum.

Which of the following would be the most important nursing assessment in a patient diagnosed with ascites? 1. Daily weight and measurement of abdominal girth 2. Auscultation of abdomen 3. Assessment of oral cavity for foul smelling breath 4. Palpation of abdomen for a fluid shift

1. Daily weight and measurement of abdominal girth

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record? 1. Diarrhea 2. Chronic constipation 3. Constipation alternating with diarrhea 4. Stools constantly oozing from the rectum

1. Diarrhea Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity.

33. Which medication should the nurse question before administering to the client with peptic ulcer disease? 1. E-mycin, an antibiotic. 2. Prilosec, a proton pump inhibitor. 3. Flagyl, an antimicrobial agent. 4. Tylenol, a nonnarcotic analgesic

1. E-mycin is irritating to stomach, and its use in a client with peptic ulcer disease should be questioned.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? 1. Endoscopy 2. Upper GI series 3. Hemoglobin (Hb) levels and hematocrit (HCT) 4. Arteriography

1. Endoscopy Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren't always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

112. The client has a large abdominal wound that has eviscerated. Which intervention should the nurse implement? 1. Apply sterile normal saline dressing. 2. Use sterile gloves to replace protruding parts. 3. Place the client in the reverse Trendelenburg position. 4. Administer intravenous antibiotic stat.

1. Evisceration is a life-threatening condition in which the abdominal contents have protruded through the ruptured incision. The nurse must protect the bowel from the environment by placing a sterile normal saline dressing on it. The saline prevents the intestines from drying out and necrosing.

A female client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? 1. Fast for 8 hours before the test 2. Eat a regular supper and breakfast 3. Continue to take all oral medications as scheduled 4. Monitor own bowel movement pattern for constipation

1. Fast for 8 hours before the test A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Most oral medications also are withheld before the test.

57. The client with acute diverticulitis has a nasogastric tube draining green liquid bile. Which action should the nurse implement? 1. Document the findings as normal. 2. Assess the client's bowel sounds. 3. Determine the client's last bowel movement. 4. Insert the N/G tube at least 2 more inches.

1. Green bile contains hydrochloric acid and should be draining from the N/G tube; therefore the nurse should take no action and should document the findings

Peptic ulcer disease may be caused by which of the following? 1. Helicobacter pylori 2. Clostridium difficile 3. Candida albicans 4. Staphylococcus aureus

1. Helicobacter pylori

Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

1. Hepatitis A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

90. The public health nurse is discussing hepatitis B with a group in the community. Which health promotion activities should the nurse discuss with the group? Select all that apply. 1. Do not share needles or equipment. 2. Use barrier protection during sex. 3. Get the hepatitis B vaccines. 4. Obtain immune globulin injections. 5. Avoid any type of hepatotoxic medications.

1. Hepatitis B can be transmitted by sharing any type of needles, especially those used by drug abusers. 2. Hepatitis B can be transmitted through sexual activity; therefore the nurse should recommend abstinence, mutual monogamy, or barrier protection 3. Three doses of hepatitis B vaccine provide immunity in 90% of healthy adults.

Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take? 1. Hold the feeding 2. Reinstill the amount and continue with administering the feeding 3. Elevate the client's head at least 45 degrees and administer the feeding 4. Discard the residual amount and proceed with administering the feeding

1. Hold the feeding Unless specifically indicated, residual amounts more than 100 mL require holding the feeding.

77. The client diagnosed with liver failure is experiencing pruritus secondary to severe jaundice. Which action by the unlicensed assistant warrants intervention by the primary nurse? 1. Assisting the client to take a hot soapy shower. 2. Applying an emollient to the client's legs and back. 3. Putting mittens on both hands of the client. 4. Patting the client's skin dry with a clean towel.

1. Hot water increases pruritus, and soap will cause dry skin, which increases pruritus; therefore, the nurse should discuss this with the assistant.

The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? 1. Increase fluid intake 2. Place heat on the abdomen 3. Perform the irrigation in the evening 4. Reduce the amount of irrigation solution

1. Increase fluid intake To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and to take other measures to prevent constipation.

A patient has become very depressed postoperatively after receiving colostomy for GI cancer. He does not participate in his colostomy care or look at the stoma. An appropriate nursing diagnosis for this situation is: 1. Ineffective Individual Coping 2. Knowledge Deficit 3. Impaired Adjustment 4. Anxiety

1. Ineffective Individual Coping

While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes cloggeD. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do? 1. Irrigate the tube with cola 2. Advance the tube into the intestine 3. Apply intermittent suction to the tube 4. Withdraw the obstruction with a 30-ml syringe

1. Irrigate the tube with cola The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it's inexpensive, and it's readily available in most homes.

139. The client diagnosed with AIDS is experiencing voluminous diarrhea. Which interventions should the nurse implement? Select all that apply. 1. Monitor diarrhea, charting amount, character, and consistency. 2. Assess the client's tissue turgor every day. 3. Encourage the client to drink carbonated soft drinks. 4. Weigh the client daily in the same clothes and at the same time. 5. Assist the client with a warm sitz bath PRN.

1. It is important to keep track of the amounts, color, and other characteristics of all body fluids lost. 4. Daily weights are the best method of determining fluid loss and gain. 5. Sitz baths will assist in keeping the client's perianal area clean without having to rub. The warm water is soothing, providing comfort.

A patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon Tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals? 1. Maintaining the airway 2. Controlling bleeding 3. Maintaining fluid volume 4. Relieving the patient's anxiety

1. Maintaining the airway

Young patient with anorexia, fatigue and Jandus is diagnosed with hepatitis B and has just been admitted to the hospital. The patient asked the nurse how long she needs to stay in the hospital. In planning care for the patient, the nurse identifies impaired psychosocial issues and assigns the highest priority to which of the following patient outcomes? 1. Minimizing social isolation 2. Establishing a stable home environment 3. Identifying the source of exposure to hepatitis 4. Reducing the spread of the disease

1. Minimizing social isolation

A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? 1. Notify the physician 2. Reposition the tube 3. Irrigate the tube 4. Increase the suction level

1. Notify the physician An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

6.The nurse is caring for an adult client diagnosed with gastroesophageal reflux disease (GERD). Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying.

1. Of adult-onset asthma cases, 80%-90% are caused by gastroesophageal reflux disease (GERD).

A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from the patient's abdomen. The procedure trey contains the following equipment: trocar, syringe, needles and drainage tube. The patient is placed in a high Fowlers position and a blood pressure cuff is secured around the arm in preparation for which of the following procedures? 1. Paracentesis 2. Dialysis 3. Abdominal ultrasound 4. Liver biopsy

1. Paracentesis

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: 1. Pork 2. Milk 3. Chicken 4. Broccoli

1. Pork The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes.

11. The nurse is performing an admission assessment on a client diagnosed with gastroesophageal reflux disease (GERD). Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Mid-epigastric pain, positive H. pylori test, and melena.

1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD.

Your patient's ABG reveal an acidic pH, an acidic CO2 and a normal bicarbonate level. Which of the following indicates this acid-base disturbance? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

1. Respiratory acidosis

Which of the following laboratory values would be the most important to monitor for a patient with pancreatic cancer? 1. Serum glucose 2. Radioimmunoassay (RIA) 3. Creatine phosphokinase (CPK) 4. Carcinoembryonic antigen (CEA)

1. Serum glucose In pancreatitis, hypersecretion of the insulin from a tumor may affect the islets of Langerhans, resulting in hyperinsulinemia, a complication of pancreatic cancer.

A nursing instructor is explaining the pathophysiology and clinical manifestations of pancreatitis to a group of nursing students. The instructor evaluates the teaching as effective when a student correctly identifies which of the following symptoms as the most common complaint of patients with pancreatitis? 1. Severe, radiating abdominal pain 2. Tarry black stools and dark urine 3. Increased and painful urination 4. Increased appetite and weight gain

1. Severe, radiating abdominal pain

92. The nurse writes the client problem "imbalanced nutrition: less than body requirements" for the client diagnosed with hepatitis. Which intervention should the nurse include in the plan of care? 1. Provide a high-calorie intake diet. 2. Discuss total parenteral nutrition (TPN). 3. Instruct the client to decrease salt intake. 4. Encourage the client to increase water intake.

1. Sufficient energy is required for healing. Adequate carbohydrate intake can spare protein. The client should eat approximately 16 carbohydrate kilocalories for each kilogram of ideal body weight daily.

93. The female nurse sticks herself with a dirty needle. Which action should the nurse implement first? 1. Notify the infection control nurse. 2. Cleanse the area with soap and water. 3. Request post-exposure prophylaxis. 4. Check the hepatitis status of the client.

1. Sufficient energy is required for healing. Adequate carbohydrate intake can spare protein. The client should eat approximately 16 carbohydrate kilocalories for each kilogram of ideal body weight daily.

The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? 1. Sweating and pallor 2. Bradycardia and indigestion 3. Double vision and chest pain 4. Abdominal cramping and pain

1. Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

17. The client diagnosed with IBD is prescribed total parental nutrition (TPN). Which intervention should the nurse implement? 1. Check the client's glucose level. 2. Administer an oral hypoglycemic. 3. Assess the peripheral intravenous site. 4. Monitor the client's oral food intake.

1. TPN is high in dextrose, which is glucose; therefore the client's blood glucose level must be monitored closely.

26. The client has been seen by the health-care provider and the suspected diagnosis is peptic ulcer disease. Which diagnostic test would confirm this diagnosis? 1. Esophagogastroduodenoscopy (EGD). 2. Magnetic resonance imaging (MRI). 3. Occult blood test. 4. Gastric acid stimulation.

1. The EGD is an invasive diagnostic test that visualizes the esophagus and stomach to accurately diagnose an ulcer and evaluate the effectiveness of the client's treatment.

115. The client who has had an abdominal surgery has a Jackson Pratt (JP) drainage tube. Which assessment data would warrant immediate intervention by the nurse? 1. The bulb is round and has 40 mL of fluid. 2. The drainage tube is pinned to the dressing. 3. The JP insertion site is pink and has no drainage. 4. The JP bulb has suction and is sunken in.

1. The JP bulb should be depressed, which indicates suction is being applied. A round bulb indicates that the bulb is full and needs to be emptied and suction reapplied.

125. The client diagnosed with anorexia nervosa is admitted to the hospital. The client is 67 inches tall and weighs 40 kg. Which client problem has the highest priority? 1. Altered nutrition. 2. Low self-esteem. 3. Disturbed body image. 4. Altered sexuality

1. The client is 67 inches tall (5'7 ) and weighs 88 pounds (40 kg 2.2 88). This client is severely underweight and nutrition is the priority.

128. The client who is morbidly obese has undergone gastric bypass surgery. Which immediate postoperative intervention has the greatest priority? 1. Monitor respiratory status. 2. Weigh the client daily. 3. Teach a healthy diet. 4. Assist the client in behavior modification.

1. The client that is morbidly obese will have a large abdomen that prevents the lungs from expanding and predisposes the client to respiratory complications

13. The client is diagnosed with ulcerative colitis. When assessing this client, which sign/symptom would the nurse expect to find? 1. Twenty bloody stools a day. 2. Oral temperature of 102F. 3. Hard, rigid abdomen. 4. Urinary stress incontinence.

1. The colon is ulcerated and unable to absorb water, resulting in bloody diarrhea. Ten (10) to twenty bloody diarrhea stools is the most common symptom of ulcerative colitis.

24. The client with ulcerative colitis is scheduled for an ileostomy. The nurse is aware that the client's stoma will be located in which area of the abdomen? 1. A-Lower right 2. B-Lower left 3. C-Upper middle 4. D-Upper right

1. The cure for ulcerative colitis is a total colectomy, which is removing the entire large colon and bringing the terminal end of the ileum up to the abdomen in the right lower quadrant. This is an ileostomy.

86. Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis D.

1. The hepatitis A virus is in the stool of infected people up to two (2) weeks before symptoms develop.

42. The nurse caring for a client one (1) day postoperative sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention should the nurse implement first? 1. Mark the drainage on the dressing with the time and date. 2. Change the dressing immediately using sterile technique. 3. Notify the health-care provider immediately. 4. Reinforce the dressing with a sterile gauze pad.

1. The nurse should mark the drainage on the dressing to determine if active bleeding is occurring because dark reddish-brown drainage indicates old blood. This allows the nurse to assess what is actually happening.

You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate? 1. The patient demonstrates an increase in level of consciousness. 2. The patient exhibits improved skin integrity. 3. The patient experiences no evident signs of bleeding. 4. The patient verbalize decreased episodes of pain.

1. The patient demonstrates an increase in level of consciousness.

22. The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client would support this diagnosis? 1. "My pain goes away when I have a bowel movement." 2. "I have bright red blood in my stool all the time." 3. "I have episodes of diarrhea and constipation." 4. "My abdomen is hard and rigid and I have a fever."

1. The terminal ileum is the most common site for regional enteritis and causes right lower quadrant pain that is relieved by defecation.

55. The client diagnosed with acute diverticulitis is complaining of severe abdominal pain. On assessment, the nurse finds a hard, rigid abdomen and T 102F. Which intervention should the nurse implement? 1. Notify the health-care provider. 2. Prepare to administer a Fleet's enema. 3. Administer an antipyretic suppository. 4. Continue to monitor the client closely.

1. These are signs of peritonitis, which is life threatening. The health-care provider should be notified immediately.

121. The female client presents to the clinic for an examination because she has not had a menstrual cycle for several months and wonders if she could be pregnant. The client is 5'10 tall and weighs 45 kg. Which assessment data should the nurse obtain first? 1. Ask the client to recall what she ate for the last 24 hours. 2. Determine what type of birth control the client has been using. 3. Reweigh the client to confirm the data. 4. Take the client's pulse and blood pressure.

1. This client is 510 tall and weighs 99 pounds (45 kg 2.2 99). Menses will cease if the client is severely emaciated. This occurs in clients diagnosed with anorexia nervosa; the nurse should attempt to determine how much the client eats. A 24-hour dietary recall is a step toward assessing the client's eating patterns.

142. The client presents to the emergency department experiencing frequent watery, bloody stools after eating some undercooked meat at a fast food restaurant. Which intervention should be implemented first? 1. Provide the client with a specimen collection hat to collect a stool sample. 2. Initiate antibiotic therapy intravenously. 3. Have the laboratory draw a complete blood count. 4. Administer the antidiarrheal medication Lomotil.

1. This client may have developed an infection from the undercooked meat. The nurse should try to get a specimen for the laboratory to analyze and for the nurse to be able to assess. The client's complaint of "bloody diarrhea" needs to be investigated by the nurse, who should observe the amount, color, and characteristics of the stool.

70. Which laboratory value would the nurse expect to find indicating a chronic inflammation in the client with cholecystitis? 1. An elevated white blood cell (WBC) count. 2. A decreased lactate dehydrogenase (LDH) 3. An elevated alkaline phosphatase. 4. A decreased direct bilirubin level.

1. This value would be elevated in clients with chronic inflammation.

A nursing intervention for a patient with hepatitis B would include which of the following types of isolation. 1. Universal precautions 2. Blood transfusions 3. Enteric isolation 4. Strict isolation

1. Universal precautions

79. The client is in end-stage liver failure and has vitamin K deficiency. Which interventions should the nurse implement? Select all that apply. 1. Avoid rectal temperatures. 2. Use only a soft toothbrush. 3. Monitor the platelet count. 4. Use small-gauge needles. 5. Assess for asterixis.

1. Vitamin K deficiency causes impaired coagulation; therefore rectal thermometers should be avoided to prevent bleeding. 2. Soft toothbrushes will help prevent bleeding of the gums. 3. Platelet count, PTT/PT, and INR should be monitored to assess coagulation status. 4. Injections should be avoided, if at all possible, because the client is unable to clot, but if they are absolutely necessarily, the nurse should use small-gauge needles.

The nurse can expect a 60-year old patient with ischemic bowel to report a history of: 1. diabetes mellitus 2. asthma 3. Addison's Disease 4. cancer of the bowel

1. diabetes mellitus

A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: 1. increasing fluid intake to prevent dehydration 2. wearing an appliance pouch only at bedtime 3. consuming a low-protein, high-fiber diet 4. taking only enteric-coated medications

1. increasing fluid intake to prevent dehydration Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake.

A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate relief of pain would place the patient in a: 1. knee-chest position 2. semi-Fowler's position 3. recumbent position 4. low-Fowler's position

1. knee-chest position Flexion of the trunk lessens the pain and decreases restlessness.

You observe changes in mentation, irritability, restlessness, and decreased concentration in a patient with cancer of the liver. Hepatic encephalopathy is suspected and the patient is ordered neomycin enemas. Which of the following information in the patient's history would be a contraindication of this order? 1. left nephrectomy 2. glaucoma in both eyes 3. myocardial infarction 4. peripheral neuropathy

1. left nephrectomy Neomycin prevents the release of ammonia from the intestinal bacteria flora and from the breakdown of red blood cells. Common side-effects of this drug are nephrotoxicity and ototoxicity.

A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following nursing assessment data would support this? 1. oliguria and azotemia 2. metabolic alkalosis 3. decreased urinary concentration 4. weight gain of less than 1 pound per week

1. oliguria and azotemia

The nurse must be alert for complications with *Sengstaken-Blakemore* intubation including: 1. pulmonary obstruction 2. pericardiectomy syndrome 3. pulmonary embolization 4. cor pulmonale

1. pulmonary obstruction

Nitrosocarcinogen production can be inhibited with intake of: 1. vitamin C. 2. vitamin E. 3. carbohydrates. 4. fiber.

1. vitamin C.

A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: 1. yellow sclera 2. light amber urine 3. circumoral pallor 4. black, tarry stools

1. yellow sclera

Duodenal ulcer

1.5 to 3 hr after a meal. Often occurs at night. Pain may be relieved by ingestion of food or antacid.

118. The client has a nasogastric tube. The health-care provider orders IV fluid replacement based on the previous hour's output plus the baseline IV fluid ordered of 125 mL/hr. From 0800 to 0900 the client's N/G tube drained 45 mL. At 0900, what rate should the nurse set the IV pump?_______

170 mL/hr.

A nurse is reviewing discharge instructions with a client who is postoperative following open cholecystectomy with a T tube placement. Which of the following instructions should the nurse include in the teaching? Select all that apply 1. Take baths rather than showers 2. Clamp T tube for one hour before and after meals 3. Replace the drainage system daily 4. Expect to have the T tube removed three days postoperatively 5. Expect brown green drainage from the tube

2 and 5 The tube will be in place for 1 to 3 weeks. The drainage does not have to be changed, only emptied. Clamping the tube one hour before and after meals allows bile needed for digestion of food to remain in the body.

A nurse is preparing a patient for an endoscopic retrograde cholangiopancreatography ERCP. The patient ask what the test is used for. Which of the following statements made by the nurse explains how an ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply 1. It can assess for ecchymosis in the body 2. It can assess the anatomy of the pancreas and the pancreatic and biliary ducts 3. It can evaluate the presence and location of ductal stones and aid in stone removal. 4. It can detect unhealthy tissue in the pancreas and assess for abscesses and pseudocyst 5. It is used in the diagnostic evaluation of acute pancreatitis

2, 3 and 4

A nurse is collecting data from a client who has advanced cirrhosis. Which of the following findings indicates the client is experiencing hepatic encephalopathy? Select all that apply 1. Anorexia 2. Change in orientation 3. Asterixis 4. Ascites 5. Fetor hepaticus

2, 3 and 5

10. Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. "My spouse tells me I snore very loudly at night." 4. "I drink six (6) to seven (7) soft drinks every day."

2. Rationale: Frequent use of antacids indicates an acid reflux problem.

1. The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? 1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?"

2. Rationale: Most clients with GERD have been self-medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem.

To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? 1. "Lie down after meals to promote digestion." 2. "Avoid coffee and alcoholic beverages." 3. "Take antacids with meals." 4. "Limit fluid intake with meals."

2. "Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating.

A nurse is reviewing preoperative teaching with a client scheduled for a laparoscopic cholecystectomy. Which of the following should the nurse include? 1. "The scope will be passed through your rectum." 2. "You might have shoulder pain after surgery." 3. "You will have a Jackson Pratt drain in place after the surgery." 4. "You should limit how often you walk for 1 to 2 weeks."

2. "You might have shoulder pain after surgery."

A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur? 1. 5 to 10 minutes 2. 15 to 30 minutes 3. 30 to 60 minutes 4. 2 to 4 hours

2. 15 to 30 minutes Meperidine onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.

116. The post-anesthesia care nurse is caring for a client who has had abdominal surgery. The client is complaining of nausea. Which intervention should the nurse implement first? 1. Medicate the client with a narcotic analgesic IVP. 2. Assess the nasogastric tube for patency. 3. Check the temperature for elevation. 4. Hyperextend the neck to prevent stridor.

2. A client who has had abdominal surgery usually has a nasogastric tube (NGT) in place. If the NGT is not patent, this will cause nausea. Irrigating the NGT may relieve nausea.

35. Which assessment data would indicate to the nurse that the client's gastric ulcer has perforated? 1. Complaints of sudden, sharp, substernal pain. 2. Rigid, boardlike abdomen with rebound tenderness. 3. Frequent, clay-colored, liquid stool. 4. Complaints of vague abdominal pain in the right upper quadrant.

2. A rigid boardlike abdomen with rebound tenderness is the classic sign and symptom of peritonitis, which is a complication of a perforated gastric ulcer.

89. Which instruction should the nurse discuss with the client who is in the icteric phase of hepatitis C? 1. Decrease alcohol intake. 2. Encourage rest periods. 3. Eat a large evening meal. 4. Drink diet drinks and juices.

2. Adequate rest is needed for maintaining optimal immune function.

111. The client is one (1) day postoperative major abdominal surgery. Which client problem is priority? 1. Impaired skin integrity. 2. Fluid and electrolyte imbalance. 3. Altered bowel elimination. 4. Altered body image.

2. After abdominal surgery, the body distributes fluids to the affected area as part of the healing process. These fluids are shifted from the intravascular compartment to the interstitial space, which causes potential fluid and electrolyte imbalance.

63. The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching was effective? 1. "I will take my lipid-lowering medicine at the same time each night." 2. "I may experience some discomfort when I eat a high-fat meal." 3. "I need someone to stay with me for about a week after surgery." 4. "I should not splint my incision when I deep breathe and cough."

2. After removal of the gallbladder, some clients experience abdominal discomfort when eating fatty foods.

20. The client diagnosed with ulcerative colitis has had an ileostomy. Which statement indicates the client needs more teaching concerning the ileostomy? 1. "My stoma should be pink and moist." 2. "I will irrigate my ileostomy every morning." 3. "If I get a red, bumpy, itchy rash I will call my HCP." 4. "I will change my pouch if it starts leaking."

2. An ileostomy will drain liquid all the time and should not routinely be irrigated; only specially trained nurses are allowed to irrigate an ileostomy. A sigmoid colostomy may need daily irrigation to evacuate feces.

The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? 1. Antiarrhythmic drugs 2. Anticholinergic drugs 3. Anticoagulant drugs 4. Antihypertensive drugs

2. Anticholinergic drugs

The nurse completing a plan of care for a patient with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which of the following is an appropriate nursing intervention for this problem? 1. Re-position the patient every four hours 2. Arrange for a low air loss bed 3. Performed passive range of motion exercises four times daily 4. Re-strict dietary protein intake

2. Arrange for a low air loss bed

Which of the following interventions should be included in the plan of care for a patient who has undergone a cholecystectomy? 1. Placing the patient in the semi Fowler's position immediately following surgery 2. Assessing the color of the sclera every shift 3. Clamping the T tube immediately after surgery 4. Placing the patient on NPO status for two days following surgery

2. Assessing the color of the sclera every shift

The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? 1. Irrigating the drain 2. Avoiding coughing 3. Maintaining bed rest 4. Restricting pain medication

2. Avoiding coughing Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure.

94. The client diagnosed with liver problems asks the nurse, "Why are my stools claycolored?" On which scientific rationale should the nurse base the response? 1. There is an increase in serum ammonia level. 2. The liver is unable to excrete bilirubin. 3. The liver is unable to metabolize fatty foods. 4. A damaged liver cannot detoxify vitamins.

2. Bilirubin, the byproduct of red blood cell destruction, is metabolized in the liver and excreted via the feces, which is what gives the feces the dark color. If the liver is damaged, the bilirubin is excreted via the urine and skin.

The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? 1. Sexual dysfunction 2. Body image, disturbed 3. Fear related to poor prognosis 4. Nutrition: more than body requirements, imbalanced

2. Body image, disturbed Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch).

123. The nurse is caring for a client diagnosed with bulimia nervosa. Which nursing intervention should the nurse implement after the client's evening meal? 1. Praise the client for eating all the food on the tray. 2. Stay with the client for 45 minutes to an hour. 3. Allow the client to work out on the treadmill. 4. Place the client on bed rest until morning

2. By having someone stay with the client for 45 minutes to one (1) hour after a meal, the client will be prevented from inducing vomiting and ridding the body of the meal before it can be metabolized.

138. The dietician and nurse in a long-term care facility are planning the menu for the day. Which foods would be recommended for the immobile clients for whom swallowing is not an issue? 1. Cheeseburger and milk shake. 2. Canned peaches and a sandwich on whole-wheat bread. 3. Mashed potatoes and mechanically ground red meat. 4. Biscuits and gravy with bacon.

2. Canned peaches are soft and can be chewed and swallowed easily while providing some fiber, and whole-wheat bread is higher in fiber than white bread. These foods will be helpful for clients whose gastric motility is slowed as a result of lack of exercise or immobility.

Which foods should be avoided following acute gallbladder inflammation? 1. Mashed potatoes 2. Cheese 3. Cooked fruits 4. Coffee

2. Cheese The patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas forming vegetables and alcohol.

A very ill patient with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which of the following terms? 1. Choledochoduodenostomy 2. Cholecystectomy 3. Choledochostomy 4. Cholecystostomy

2. Choledochostomy

132. The client is being admitted to the outpatient psychiatric clinic diagnosed with bulimia. While assessing the client, which question should the nurse ask to identify behaviors that suggest bulimia? 1. "When was the last time you exercised?" 2. "What over-the-counter medications do you take?" 3. "How long have you had a positive self-image?" 4. "Do you eat a lot of high-fiber foods for bowel movements?"

2. Clients diagnosed with bulimia frequently take cathartic laxatives to prevent absorption of calories from the food consumed.

69. Which assessment data indicate that the client recovering from an open cholecystectomy requires pain medication? 1. The client's pulse is 65 beats per minute. 2. The client has shallow respirations. 3. The client's bowel sounds are 20 per minute. 4. The client uses a pillow to splint when coughing.

2. Clients having abdominal pain frequently have shallow respirations. When assessing clients for pain, the nurse should discuss pain medication with any client who has shallow respirations.

37. The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included in the presentation? 1. Wear a high filtration mask when around chemicals. 2. Eat several servings of cruciferous vegetables daily. 3. Take a multiple vitamin every day. 4. Do not engage in high-risk sexual behaviors.

2. Cruciferous vegetables, such as broccoli, cauliflower, and cabbage, are high in fiber. One of the risks for cancer of the colon is a high-fat, low-fiber, and high-protein diet. The longer the transit time (the time from ingestion of the food to the elimination of the waste products) the greater the chance of developing cancer of the colon.

The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? 1. Limit oral fluid 2. Elevate the scrotum 3. Apply heat to the abdomen 4. Remain in a low-fiber diet

2. Elevate the scrotum Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? 1. Elevated hemoglobin level 2. Elevated serum bilirubin level 3. Elevated blood urea nitrogen level 4. Decreased erythrocyte sedimentation rate

2. Elevated serum bilirubin level Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia.

What laboratory finding is the primary diagnostic indicator for pancreatitis? 1. Elevated blood urea nitrogen (BUN) 2. Elevated serum lipase 3. Elevated aspartate aminotransferase (AST) 4. Increased lactate dehydrogenase (LD)

2. Elevated serum lipase Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas.

Which dietary modification is utilized for a patient diagnosed with acute pancreatitis? 1. High fat diet 2. Elimination of coffee 3. High protein diet 4. Low carbohydrate diet

2. Elimination of coffee Patients with acute pancreatitis should not have coffee or spicy foods as it increases gastric secretions. A high carbohydrate, low-fat, low protein diet should be implemented.

78. The nurse identifies the client problem as "excess fluid volume" for the client in liver failure. Which short-term goal would be most appropriate for this problem? 1. The client will not gain more that two (2) kg a day. 2. The client will have no increase in abdominal girth. 3. The client's vital signs will remain within normal limits (WNL). 4. The client will receive a low-sodium diet.

2. Excess fluid volume could be secondary to portal hypertension. Therefore, no increase in abdominal girth would be an appropriate short-term goal, indicating no excess of fluid volume

10. Which statement made by the client would alert the nurse that the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. "My spouse tells me I snore very loudly at night." 4. "I drink six (6) to seven (7) soft drinks every day."

2. Frequent use of antacids indicates an acidreflux problem.

Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output and monitor electrolyte levels? 1. High glucose levels in the blood 2. Frequent vomiting leading to a loss of fluid volume 3. Dry mouth which makes the patient thirsty 4. Acetone in the urine

2. Frequent vomiting leading to a loss of fluid volume

130. The 22-year-old female who is obese is discussing weight loss programs with the nurse. Which information should the nurse teach? 1. Jog for two (2) to three (3) hours every day. 2. Lifestyle behaviors must be modified. 3. Eat one large meal every day in the evening. 4. Eat 1000 calories a day and don't take vitamins

2. If lifestyle behaviors, patterns of eating, and daily exercise are not modified, the client who loses weight will regain the weight and usually more.

36. The client with a history of peptic ulcer disease has been admitted into the hospital intensive care unit with frank gastric bleeding. Which priority intervention should the nurse implement? 1. Maintain a strict record of intake and output. 2. Insert a nasogastric tube and begin saline lavage. 3. Assist the client with keeping a detailed calorie count. 4. Provide a quite environment to promote rest.

2. Inserting a nasogastric tube and lavaging the stomach with saline is the most important intervention because this directly stops the bleeding.

134. Which statement made by the client admitted with electrolyte imbalance from frequent cathartic use demonstrates an understanding of the discharge teaching? 1. "In the future I will eat a banana every time I take the medication." 2. "I don't have to have a bowel movement every day." 3. "I should limit the fluids I drink with my meals." 4. "If I feel sluggish, I will eat a lot of cheese and dairy products."

2. It is not necessary to have a bowel movement every day to have normal bowel functioning.

15. The client diagnosed with inflammatory bowel disease has a serum potassium level of 3.4 mEq/L. Which action should the nurse implement first? 1. Notify the health-care provider. 2. Assess the client for leg cramps. 3. Request telemetry for the client. 4. Prepare to administer potassium IV.

2. Leg cramps are a sign of hypokalemia; hypokalemia can lead to cardiac dysrhythmias and can be life threatening. Assessment is priority for a potassium level that is just below normal level, which is 3.5 to 5.5 mEq/L.

A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? 1. Lying on the right side with legs straight 2. Lying on the left side with knees bent 3. Prone with the torso elevated 4. Bent over with hands touching the floor

2. Lying on the left side with knees bent

31. When planning the care for a client diagnosed with peptic ulcer disease, which expected outcome should the nurse include? 1. The client's pain is controlled with the use of NSAIDs. 2. The client maintains lifestyle modifications. 3. The client has no signs and symptoms of hemoptysis. 4. The client takes antacids with each meal.

2. Maintaining lifestyle changes such as following an appropriate diet and reducing stress indicates that the client is complying with the medical teachings. Such compliance is the goal of treatment to prevent complications.

A nurse is planning care for a patient with acute pancreatitis. Which of the following patient outcomes does the nurse assigned as the highest priority? 1. Maintaining satisfactory pain control 2. Maintenance of normal respiratory function 3. Developing no acute complications from the pancreatitis 4. Adequate fluid and electrolyte balance

2. Maintenance of normal respiratory function Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion and inadequate lung ventilation.

91. The client with hepatitis asks the nurse, "I went to an herbalist, who recommended I take milk thistle. What do you think about that?" Which statement is the nurse's best response? 1. "You are concerned about taking an herb." 2. "The herb has been used to treat liver disease." 3. "I would not take anything that is not prescribed." 4. "Why would you want to take any herbs?"

2. Milk thistle has an active ingredient, silymarin, which has been used to treat liver disease for more than 2000 years. It is a powerful oxidant and promotes liver cell growth.

1.The male client in a health-care provider's office tells the nurse that he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? 1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?"

2. Most clients with GERD have been selfmedicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem

The nurse identifies a potential collaborative problem of electrolyte in balance for a patient with severe acute pancreatitis. Which of the following assessment findings would alert the nurse to an electrolyte imbalance associated with acute pancreatitis? 1. Hypotension 2. Muscle twitching and finger numbness 3. Elevated blood glucose levels 4. Paralytic ileus and abdominal distention

2. Muscle twitching and finger numbness Hypocalcemia is a potential complication of acute pancreatitis. Calcium may be prescribed to prevent tetany

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? 1. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture 2. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix 3. The appendix may develop gangrene and rupture, especially in a middle-aged client 4. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage

2. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion.

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? 1. Instruct the client to chew the medication before swallowing 2. Offer 8 ounces of water following medication administration 3. Administer the medication 30 minutes before meals 4. Sprinkle the contents on peanut butter

2. Offer 8 ounces of water following medication administration This medication should not be chewed to reduce irritation and slow the release. It should be taken with every meal and snack. It should be sprinkled on non-protein food if administered with foods

A patient has undergone a liver biopsy. Following the procedure, the nurse should place the patient in which of the following positions? 1. Trendelenburg 2. On the right side 3. On the left side 4. High Fowler's

2. On the right side

107. Which nursing interventions should be included in the care plan for the 84-year-old client diagnosed with acute gastroenteritis? Select all that apply. 1. Assess the skin turgor on the back of the client's hands. 2. Monitor the client for orthostatic hypotension. 3. Record the frequency and characteristics of sputum. 4. Use standard precautions when caring for the client. 5. Institute safety precautions when ambulating the client.

2. Orthostatic hypotension indicates fluid volume deficit, which can occur in an elderly client who is having many episodes of diarrhea, which occurs with acute gastroenteritis. 4. Standard precautions, including wearing gloves and hand washing, help prevent the spread of the infection to others. 5. The elderly client is at risk for orthostatic hypotension; therefore safety precautions should be instituted to ensure the client doesn't fall as a result of a decrease in blood pressure.

The nurse is teaching a patient who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the patient chooses which of the following food choices from the menu? 1. Omelette with green peppers, onions, mushrooms and cheese with milk 2. Pancakes with butter honey and orange juice 3. Baked chicken with sweet potato french fries, corn bread and tea 4. Ham and cheese sandwich, baked beans, potatoes and coffee

2. Pancakes with butter honey and orange juice Patients should select a diet high in carbohydrates with protein consistent with liver function. Moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure. The patient with acute hepatic encephalopathy is placed on low protein to decrease ammonia levels. All the other options also have high sodium and the ascites requires a low sodium diet.

The patient is admitted to the healthcare center with hyperglycemia, a 15 pound weight loss and complaints of vague upper and mid abdominal pain that increases in intensity at night. His health history record indicates that he is an alcoholic, smokes a pack a cigarettes daily and has had diabetes for the past 20 years. On examination, the nurse finds swelling in his feet and abdominal ascites. Based on the clinical manifestations, which of the following is most likely to be the diagnosis? 1. Acute pancreatitis with edema 2. Pancreatic carcinoma 3. Pancreatic pseudocyst 4. Cholecystitis

2. Pancreatic carcinoma Pain, jaundice and weight loss are classic signs of pancreatic carcinoma. Symptoms of insulin deficiency are in important sign at the onset of symptoms.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? 1. Appendicitis 2. Pancreatitis 3. Cholecystitis 4. Gastric ulcer

2. Pancreatitis Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis.

Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction? 1. Angiography 2. Radioisotope liver scan 3. EEG 4. MRI

2. Radioisotope liver scan

What is the primary nursing diagnosis for a 4th to 10th day postoperative liver transplant patient? 1. Excess Fluid Volume 2. Risk for Rejection 3. Impaired Skin Integrity 4. Decreased Cardiac Output

2. Risk for Rejection

A nurse is teaching a patient about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the patient correctly identifies which of the following conditions as a cause of acute pancreatitis? 1. Use of loop diuretics to increase the incidence of pancreatitis 2. Self digestion of the pancreas by its own proteolytic enzymes 3. Calcification of the pancreatic duct leading to its blockage 4. Fibrosis and atrophy of the pancreatic gland

2. Self digestion of the pancreas by its own proteolytic enzymes Trypsin is the predominant enzyme that causes acute pancreatitis.

A patient comes to the emergency department with severe abdominal pain, nausea and vomiting. The physician plans to rule out possible acute pancreatitis. The nurse would expect the diagnosis to be confirmed with which of the following elevated laboratory test? 1. Serum potassium 2. Serum amylase 3. Serum bilirubin 4. Serum calcium

2. Serum amylase

To inhibit pancreatic secretions, which pharmacologic agent would you anticipate administering to a patient with acute pancreatitis? 1. Nitroglycerin 2. Somatostatin 3. Pancrelipase 4. Pepcid

2. Somatostatin Somatostatin, a treatment for acute pancreatitis, inhibits the release of pancreatic enzymes.

87. Which type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne precautions. 2. Standard precautions. 3. Droplet precautions. 4. Exposure precautions.

2. Standard Precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood.

The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? 1. Notify the physician 2. Stop the irrigation temporarily 3. Increase the height of the irrigation 4. Medicate for pain and resume the irrigation

2. Stop the irrigation temporarily If cramping occurs during a colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure.

105. The 79-year-old client diagnosed with acute gastroenteritis is admitted to the medical unit. Which nursing task would be most appropriate for the nurse to delegate to the unlicensed nursing assistant? 1. Evaluate the client's intake and output. 2. Take the client's vital signs. 3. Change the client's intravenous solution. 4. Assess the client's perianal area.

2. The assistant can take the vital signs for a client who is stable; the nurse must interpret and evaluate the vital signs.

60. The client is admitted to the medical floor with acute diverticulitis. Which collaborative intervention would the nurse anticipate the health-care provider ordering? 1. Administer total parenteral nutrition. 2. Maintain NPO and nasogastric tube. 3. Maintain on a high-fiber diet and increase fluids. 4. Obtain consent for abdominal surgery.

2. The bowel must be put at rest. Therefore, the nurse should anticipate orders for maintaining NPO and a nasogastric tube

A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? 1. The client doesn't exhibit rectal tenesmus 2. The client is free from esophagitis and achalasia 3. The client reports diminished duodenal inflammation 4. The client has normal gastric structures

2. The client is free from esophagitis and achalasia

97. The female client came to the clinic complaining of abdominal cramping and has had at least 10 episodes of diarrhea every day for the last 2 days. The client reported that she had been in Mexico on a mission trip and just returned yesterday. Which intervention should the nurse implement? 1. Instruct the client to take a cathartic laxative daily. 2. Encourage the client to drink lots of Gatorade. 3. Discuss the need to increase protein in the diet. 4. Explain that the client should weigh herself daily.

2. The client probably has traveler's diarrhea, and oral rehydration is the preferred choice for replacing fluids lost as a result of diarrhea. An oral glucose electrolyte solution, such as Gatorade, All-Sport, or Pedialyte, is recommended.

16. The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1. Provide a low-residue diet. 2. Monitor intravenous fluids. 3. Assess vital signs daily. 4. Administer antacids orally.

2. The client requires fluids to help prevent dehydration from diarrhea and to replace the fluid lost through normal body functioning

129. The client who is obese presents to the clinic before beginning a weight loss program. Which interventions should the nurse teach? Select all that apply. 1. Walk for 30 minutes three (3) times a day. 2. Determine situations that initiate eating behavior. 3. Weigh at the same time every day. 4. Limit sodium in the diet. 5. Refer to a weight support group.

2. The client should be aware of situations that trigger the consumption of food when the client is not hungry, such as anger, boredom, and stress. Food-seeking behaviors are usually not associated only with hunger in the client who is obese 5. Weight loss support groups such as Weight Watchers or TOPS (Take Off Pounds Sensibly) are helpful to keep the client participating in a weight loss program.

44. The client with a new colostomy is being discharged. Which statement made by the client indicates the need for further teaching? 1. "If I notice any skin breakdown I will call the HCP." 2. "I should drink only liquids until the colostomy starts to work." 3. "I should not take a tub bath until the HCP okays it." 4. "I should not drive or lift more than five (5) pounds."

2. The client should be on a regular diet, and the colostomy will have been working for several days prior to discharge. The client's statement indicates the need for further teaching

54. The nurse is preparing to administer an aminoglycoside antibiotic to the client just admitted with a diagnosis of acute diverticulitis. Which intervention should the nurse implement? 1. Obtain a serum trough level. 2. Ask about drug allergies. 3. Monitor the peak level. 4. Assess the vital signs.

2. The nurse should always ask about allergies to medication when administering medications, but especially when administering antibiotics, which are notorious for allergic reactions.

43. The client complains to the nurse of unhappiness with the health-care provider. Which intervention should the nurse implement next? 1. Call the HCP and suggest he or she talk with the client. 2. Determine what about the HCP is bothering the client. 3. Notify the nursing supervisor to arrange a new HCP to take over. 4. Explain to the client that until discharge, the client will have to keep the HCP

2. The nurse should determine what is concerning the client. It could be a misunderstanding or a real situation where the client's care is unsafe or inadequate.

The nurse is completing a morning assessment on a patient with cirrhosis. Which data obtained by the nurse will be of most concern? 1. The patient complains of nausea and anorexia 2. The patient's hands flap back-and-forth when the arms are extended 3. The patient has gained 2 kg from the previous day 4. The patient's skin on the abdomen has multiple spider shaped blood vessels

2. The patient's hands flap back-and-forth when the arms are extended

84. The client is admitted with end-stage liver failure and is prescribed the laxative lactulose (Chronulac). Which statement indicates the client needs more teaching concerning this medication? 1. "I should have two to three soft stools a day." 2. "I must check my ammonia level daily." 3. "If I have diarrhea, I will call my doctor." 4. "I should check my stool for any blood."

2. There is no instrument that can be used at home to test daily ammonia levels. The ammonia level is a serum level that requires venipuncture and laboratory diagnostic equipment.

137. The charge nurse has completed report. Which client should be seen first? 1. The client diagnosed with Crohn's disease who had two (2) semi-formed stools on the previous shift. 2. The elderly client admitted from another facility who is complaining of constipation. 3. The client diagnosed with AIDS who had a 200-mL diarrhea stool and has elastic skin tissue turgor. 4. The client diagnosed with hemorrhoids who had some spotting of bright red blood on the toilet tissue.

2. This client has just arrived so the nurse does not know if the complaint is valid and needs intervention unless this client is seen and assessed. The elderly have difficulty with constipation as a result of decreased gastric motility, medications, poor diet, and immobility.

119. The nurse is caring for the following clients on a surgical unit. Which client would the nurse assess first? 1. The client who had an inguinal hernia repair and has not voided in four (4) hours. 2. The client who was admitted with abdominal pain who suddenly has no pain. 3. The client four (4) hours postoperative abdominal surgery with no bowel sounds. 4. The client who is one (1) day postoperative appendectomy who is being discharged.

2. This could indicate a ruptured appendix, which could lead to peritonitis, a lifethreatening complication; therefore, the nurse should assess this client first.

101. The client diagnosed with gastroenteritis is being discharged from the emergency department. Which intervention should the nurse include in the discharge teaching? 1. If diarrhea persists for more than 96 hours, contact the physician. 2. Instruct the client to wash hands thoroughly before handling any type of food. 3. Explain the importance of decreasing steroids gradually as instructed. 4. Discuss how to collect all stool samples for the next 24 hours.

2. This should be done by the client at all times, but especially when the client has gastroenteritis. The bacteria in feces may be transferred to other people via food if hands are not washed properly.

A patient is admitted to the healthcare center with severe abdominal pain rated a 10 on a 1 to 10 scale. He has tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow IVP as ordered. The nurse plans for which of the following goals following the administration of this medication? 1. To control blood pressure 2. To increase the patient's pain threshold 3. To control muscle spasms 4. To diagnose the cause of the abdominal pain

2. To increase the patient's pain threshold by depressing the central nervous system

A nurse is reviewing the medical record of a client who has a new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect? 1. Prothrombin time eight seconds 2. Total bilirubin 4.5 mg/dL 3. AST 35 units per liter 4. ALT 15 international units per liter

2. Total bilirubin 4.5 mg/dL All other values are within normal limits

27. When the nurse is conducting the initial interview, which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease? 1. History of side effects experienced from all medication. 2. Use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Any known allergies to drugs and environmental factors. 4. Medical histories of at least three (3) generations.

2. Use of NSAIDs places the client at risk for peptic ulcer disease and hemorrhage. Any client suspected of having peptic ulcer disease should be questioned specifically about the use of NSAIDs

The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? 1. Vitamin A 2. Vitamin B12 3. Vitamin C 4. Vitamin E

2. Vitamin B12 Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.

73. The client diagnosed with end-stage liver failure is admitted to the medical unit diagnosed with esophageal bleeding. The HCP inserts and inflates a triple-lumen nasogastric tube (Sengstaken-Blakemore). Which nursing action should the nurse implement for this treatment? 1. Assess the gag reflex every shift. 2. Stay with the client at all times. 3. Administer the laxative lactulose (Chronulac). 4. Monitor the client's ammonia level.

2. While the balloons are inflated, the client must not be left unattended in case they become dislodged and occlude the airway. This is a safety issue.

A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: 1. severe abdominal pain radiating to the shoulder 2. anorexia, nausea, and vomiting 3. eructation and constipation 4. abdominal ascites

2. anorexia, nausea, and vomiting Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: 1. increased intracranial pressure 2. decreased urine output 3. bradycardia 4. hypertension

2. decreased urine output Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition.

Patients with esophageal varices would reveal the following assessment: 1. increased blood pressure. 2. increased heart rate. 3. decreased respiratory rate. 4. increased urinary output.

2. increased heart rate.

The correct sequence for abdominal assessment is: 1. inspection, percussion, palpation, auscultation. 2. inspection, auscultation, palpation, percussion. 3. inspection, palpation, auscultation, percussion. 4. inspection, percussion, auscultation, palpation.

2. inspection, auscultation, palpation, percussion.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: 1, meperidine provides a better, more prolonged analgesic effect. 2. morphine may cause spasms of Oddi's sphincter. 3. meperidine is less addictive than morphine. 4. morphine may cause hepatic dysfunction.

2. morphine may cause spasms of Oddi's sphincter.

A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: 1. call the physician 2. place saline-soaked sterile dressings on the wound 3. take a blood pressure and pulse 4. pull the dehiscence closed

2. place saline-soaked sterile dressings on the wound The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.

8. The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client's Bernstein esophageal test was positive. 2. The client's abdominal x-ray shows a hiatal hernia. 3. The client's WBC count is 14,000/mm3. 4. The client's hemoglobin is 13.8 g/dL.

3. Rationale: The client's WBC count is elevated, indicating a possible infection, which warrants notifying the HCP.

4. The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day.

3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach.

12. Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer.

3. Rationale: Barrett's esophagus results from longterm erosion of the esophagus as a result of reflux of stomach contents secondary to GERD. This is a precursor to esophageal cancer.

9. The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett's esophagus who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today.

3. Rationale: This client is exhibiting symptoms of asthma, a complication of GERD. This client should be assigned to the most experienced nurse.

Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: 1. 45 units/L 2. 100 units/L 3. 300 units/L 4. 500 units/L

3. 300 units/L The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value.

Ursodeoxycholic acid Has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? 1. 1 to 4 months 2. Over a year 3. 6 to 12 months 4. 4 to 6 months

3. 6 to 12 months

102. Which medication would the nurse expect the health-care provider to order to treat the client diagnosed with botulism secondary to eating contaminated canned goods? 1. An antidiarrheal medication. 2. An aminoglycoside antibiotic. 3. An antitoxin medication. 4. An ACE inhibitor medication.

3. A botulism antitoxin neutralizes the circulating toxin and is prescribed for a client with botulism.

32. The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. When the nurse is evaluating care, which assessment data require further intervention? 1. Bowel sounds auscultated fifteen (15) times in one (1) minute. 2. Belching after eating a heavy and fatty meal late at night. 3. A decrease in systolic BP of 20 mm Hg from lying to sitting. 4. A decreased frequency of distress located in the epigastric region.

3. A decrease of 20 mm Hg in blood pressure after changing position from lying, to sitting, to standing is orthostatic hypotension. This could indicate that the client is bleeding.

108. The nurse has received the A.M. shift report. Which client should the nurse assess first? 1. The 44-year-old client diagnosed with peptic ulcer disease who is complaining of acute epigastric pain. 2. The 74-year-old client diagnosed with acute gastroenteritis who has had four (4) diarrhea stools during the night. 3. The 65-year-old client diagnosed with inflammatory bowel disease who has a hard, rigid abdomen and elevated temperature. 4. The 15-year-old client diagnosed with food poisoning who has vomited several times during the night shift.

3. A hard, rigid abdomen and an elevated temperature are abnormal in any circumstance and the nurse should assess this client first. These are clinical manifestations of peritonitis, a potentially lifethreatening condition

23. The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? 1. Grilled hamburger on a wheat bun and fried potatoes. 2. A chicken salad sandwich and lettuce and tomato salad. 3. Roast pork, white rice, and plain custard. 4. Fried fish, whole grain pasta, and fruit salad.

3. A low-residue diet is a low-fiber diet. Products made of refined flour or finely milled grains, along with roasted, baked, or broiled meats, are recommended.

A patient is admitted with lacerated liver as a result of blunt abdominal trauma. Which of the following nursing interventions would NOT be appropriate for this patient? 1. Monitor for respiratory distress. 2. Monitor for coagulation studies. 3. Administer pain medications as ordered. 4. Administer normal saline, crystalloids as ordered.

3. Administer pain medications as ordered. Pain medication may mask signs and symptoms of hemorrhage, further decrease blood pressure, and interfere with assessment of neurologic status and additional abdominal injury.

A patient complaining of shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? 1. Bilirubin 2. Temperature 3. Albumin 4. Hemoglobin

3. Albumin

110. The client has had abdominal surgery and tells the nurse, "I felt as something just gave way in my stomach." Which action should the nurse implement first? 1. Notify the surgeon immediately. 2. Instruct the client to splint the incision. 3. Assess for serosanguineous wound drainage. 4. Administer pain medication intravenously

3. Assessing the surgical incision is the first intervention because this may indicate the client has wound dehiscence.

12. The client diagnosed with gastroesophageal reflux disease (GERD) is at greater risk for which disease? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer.

3. Barrett's esophagitis results from longterm erosion of the esophagus as a result of reflux of stomach contents secondary to GERD. This is a precursor to esophageal cancer

113. The client is diagnosed with peritonitis. Which assessment data indicate the client's condition is improving? 1. The client is using more pain medication on a daily basis. 2. The client's nasogastric tube is draining coffee-ground material. 3. The client has a decrease in temperature and a soft abdomen. 4. The client has had two (2) soft, formed bowel movements

3. Because the signs of peritonitis are elevated temperature and rigid abdomen, a reversal of these signs would indicate the client is getting better.

122. The occupational health nurse observes the chief financial officer eat large lunch meals. The client disappears into the restroom after a meal for about 20 minutes. Which observation by the nurse would indicate the client has bulimia? 1. The client jogs two (2) miles a day. 2. The client has not gained weight. 3. The client's teeth are a green color. 4. The client has smooth knuckles.

3. Bulimia is characterized by bingeing and purging by inducing vomiting after a meal. Stomach contents are acidic and the acid wears away the enamel on the teeth, leaving the teeth a green color

52. The nurse is discussing the therapeutic diet for the client diagnosed with diverticulosis. Which meal indicates the client understands the discharge teaching? 1. Fried fish, mashed potatoes, and iced tea. 2. Ham sandwich, applesauce, and whole milk. 3. Chicken salad on whole-wheat bread and water. 4. Lettuce, tomato, and cucumber salad and coffee.

3. Chicken and whole-wheat bread are high in fiber, which is the therapeutic diet prescribed for clients with diverticulosis. An adequate intake of water helps prevent constipation.

Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? 1. Hopelessness 2. Powerlessness 3. Chronic low self-esteem 4. Deficient knowledge

3. Chronic low self-esteem Young women with Chronic low self-esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence.

Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: 1. Position the client supine to assist in medication absorption 2. Aspirate the nasogastric tube after medication administration to maintain patency 3. Clamp the nasogastric tube for 30 minutes following administration of the medication 4. Change the suction setting to low intermittent suction for 30 minutes after medication administration

3. Clamp the nasogastric tube for 30 minutes following administration of the medication If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the nasogastric tube will remove the medication just administered.

Which of the following is a clinical manifestation of cholelithiasis? 1. Upper left quadrant abdominal pain 2. Nonpalpable abdominal mass 3. Clay colored stools 4. Epigastric distress prior to a meal

3. Clay colored stools

80. The client is in end-stage liver failure. Which gastrointestinal assessment data would the nurse expect to find when assessing the client? 1. Hypoalbuminemia and muscle wasting. 2. Oligomenorrhea and decreased body hair. 3. Clay-colored stools and hemorrhoids. 4. Dyspnea and caput medusae.

3. Clay-colored stools and hemorrhoids are gastrointestinal effects of liver failure.

4.The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount of the food is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day.

3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach.

A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client? 1. Tea 2. Gelatin 3. Custard 4. Popsicle

3. Custard

Which of the following is an age related change of the hepatobiliary system? 1. Decreased prevalence of gallstones 2. Increased drug clearance capability 3. Decreased blood flow 4. Liver enlargement

3. Decreased blood flow

A 70-year-old patient is admitted with acute pancreatitis. The nurse understands the mortality rate associated with a Q pancreatitis increases with advanced age and attributes this to which of the following gerontological considerations associated with the pancreas? 1. Increases in the bicarbonate output by the kidneys 2. Development of local complications 3. Decreases in the physiologic function of major organs 4. Increases in the rate of pancreatic secretions

3. Decreases in the physiological function of major organs

A nurse in the clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? 1. Serum amylase 80 units per liter 2. White blood cell count 9000 per millimeter cubed 3. Direct bilirubin 2.1 mg/dL 4. Alkaline phosphatase ALP 25 units per liter

3. Direct bilirubin 2.1 mg/dL The bilirubin level should be 0.1 - 1.2

74. The client has had a liver biopsy. Which post-procedure intervention should the nurse implement? 1. Instruct the client to void immediately. 2. Keep the client NPO for eight (8) hours. 3. Place the client on the right side. 4. Monitor blood urea nitrogen (BUN) and creatinine level.

3. Direct pressure is applied to the site, and then the client is placed on the right side to maintain site pressure.

Which of the following factors can cause hepatitis A? 1. Contact with infected blood 2. Blood transfusions with infected blood 3. Eating contaminated shellfish 4. Sexual contact with an infected person

3. Eating contaminated shellfish Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.

120. The 84-year-old client comes to the clinic complaining of right lower abdominal pain. Which question would be most appropriate for the nurse to ask the client? 1. "When was your last bowel movement?" 2. "Did you have a high-fat meal last night?" 3. "How long have you had this pain?" 4. "Have you been experiencing any gas?"

3. Elderly clients usually display a high tolerance to pain and frequently may have a ruptured appendix with minimal pain, therefore the nurse should assess the characteristic and etiology of the pain.

Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system? 1. Ultrasonography. 2. MRI 3. Endoscopic retrograde cholangiopancreatography (ERCP) 4. Computed tomography scan (CT scan)

3. Endoscopic retrograde cholangiopancreatography (ERCP) ERCP permits direct visualization of the pancreatic and common bile ducts. Its therapeutic value is in retrieving gallstones from the distal and common bile ducts and dilating strictures.

59. Which client would be most likely to have the diagnosis of diverticulosis? 1. A 60-year-old male with a sedentary lifestyle. 2. A 72-year-old female with multiple childbirths. 3. A 63-year-old female with hemorrhoids. 4. A 40-year-old male with a family history of diverticulosis.

3. Hemorrhoids would indicate the client has chronic constipation, which is a strong risk factor for diverticulosis. Constipation increases the intraluminal pressure in the sigmoid colon, leading to weakness in the intestinal lining, which, in turn, causes outpouchings, or diverticula.

A patient has an elevated serum ammonia level and is exhibiting mental status change. The nurse should suspect which of the following conditions? 1. Asterixis 2. Portal hypertension 3. Hepatic encephalopathy 4. Cirrhosis

3. Hepatic encephalopathy

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? 1. Bradycardia 2. Polyuria 3. Hypotension 4. Warm moist skin

3. Hypotension

100. The client is diagnosed with gastroenteritis. Which laboratory data would warrant immediate intervention by the nurse? 1. A serum sodium level of 137 mEq/L. 2. An arterial blood gas of pH 7.37, PaO2 95, PaCO2 43, HCO3 24. 3. A serum potassium level of 3.3 mEq/L. 4. A stool sample that is positive for fecal leukocytes.

3. In gastroenteritis, diarrhea often results in metabolic acidosis and loss of potassium. The normal serum potassium level is 3.5-5.5 mEq/L; therefore a 3.3 mEq/L would require immediate intervention. Hypokalemia (a low potassium level) can lead to life-threatening cardiac dysrhythmias.

The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? 1. Digoxin (Lanoxin) 2. Furosemide (Lasix) 3. Indomethacin (Indocin) 4. Propranolol hydrochloride (Inderal)

3. Indomethacin (Indocin) Indomethacin (Indocin) is an NSAID

A nurse is collecting data from a client who has pancreatitis. Which of the following actions should the nurse take to check for the presence of Cullen's sign? 1. Tap lightly at the costovertebral margin on the client's back 2. Palpate the right lower quadrant 3. Inspect the skin around the umbilicus 4. Auscultate the area below the scapula

3. Inspect the skin around the umbilicus

The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? 1. Leg exercises 2. Early ambulation 3. Irrigating the nasogastric tube 4. Coughing and deep-breathing exercises

3. Irrigating the nasogastric tube In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician.

The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? 1. Ambulate following a meal 2. Eat high carbohydrate foods 3. Limit the fluid taken with meal 4. Sit in a high-Fowler's position during meals

3. Limit the fluid taken with meal Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? 1. Palpates the abdomen for size 2. Palpates the liver at the right rib margin 3. Listens to bowel sounds in all four quadrants 4. Percusses the right lower abdominal quadrant

3. Listens to bowel sounds in all four quadrants

The nurse is reviewing the physician's orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client's chart? 1. NPO status 2. Nasogastric tube inserted 3. Morphine sulfate for pain 4. An anticholinergic medication

3. Morphine sulfate for pain Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi.

144. The nurse is caring for clients on a medical unit. Which client information should be brought to the attention of the HCP immediately? 1. A serum sodium of 139 mEq/L in a client diagnosed with obstipation. 2. The client diagnosed with fecal impaction who had two (2) hard formed stools. 3. A serum potassium level of 3.0 mEq/L in a client diagnosed with diarrhea. 4. The client with diarrhea who had two (2) semi-liquid stools totaling 300 mL.

3. Normal potassium levels are 3.5-5.5 mEq/L. The level stated in this option is below normal. Imbalances in potassium levels can be caused by diarrhea and can cause cardiac dysrhythmias.

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? 1. Regular diet 2. Skim milk 3. Nothing by mouth 4. Clear liquids

3. Nothing by mouth Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth.

133. The client being admitted from the emergency department is diagnosed with a fecal impaction. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication, every day and PRN. 2. Perform bowel training every two (2) hours. 3. Administer oil retention enemas. 4. Prepare for an upper gastrointestinal (UGI) series x-ray.

3. Oil retention enemas will help to soften the feces and evacuate the stool.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? 1. Dyspnea and fatigue 2. Ascites and orthopnea 3. Purpura and petechiae 4. Gynecomastia and testicular atrophy

3. Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae.

The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? 1. Hypotension 2. Bloody diarrhea 3. Rebound tenderness 4. A hemoglobin level of 12 mg/dL

3. Rebound tenderness Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis.

A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? 1. Halts stress reactions 2. Heals the gastric mucosa 3. Reduces the stimulus to acid secretions 4. Decreases food absorption in the stomach

3. Reduces the stimulus to acid secretion A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.

106. The emergency department nurse knows the client diagnosed with acute gastroenteritis understands the discharge teaching when the client makes which statement? 1. "I will probably have some leg cramps while I have gastroenteritis." 2. "I should decrease my fluid intake until the diarrhea subsides." 3. "I should reintroduce solid foods very slowly into my diet." 4. "I should only drink bottled water until the abdominal cramping stops."

3. Reintroducing solid foods slowly, in small amounts, will allow the bowel to rest and the mucosa to return to health after acute gastroenteritis states.

Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of a vitamin C deficiency? 1. Night blindness 2. Beriberi 3. Scurvy 4. Hypoprothrombinemia

3. Scurvy

117. The nurse is completing the shift assessment on the client recovering from abdominal surgery who has a PCA pump. The client has shallow respirations and refuses to deep breathe. Which intervention should the nurse implement? 1. Insist that the client take deep breaths. 2. Notify the surgeon to request a chest x-ray. 3. Determine the last time the client used the PCA pump. 4. Administer oxygen 2 L/min via nasal cannula.

3. Shallow respirations and refusal to deep breathe could be the result of abdominal pain. The nurse should assess the client for pain and determine the last time the PCA pump was used.

A patient with hepatic cirrhosis questions the nurse about the possible use of a herbal supplement, milk thistle, to help heal the liver. Which of the following would be the most appropriate response from the nurse? 1. You should not use herbal supplements in conjunction with medical treatment 2. You can use milk thistle instead of the medications you have been prescribed 3. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your PCP of any herbal remedies being used so drug interactions can be evaluated. 4. Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your PCP.

3. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your PCP of any herbal remedies being used so drug interactions can be evaluated.

A patient who is been having recurring attacks of severe abdominal pain over the past few months informs the physician about a 25 pound weight loss in the last year. The nurse attributes which of the following is the most likely cause of the weight loss? 1. Malabsorption 2. Vomiting after having meals 3. Skipping meals out of fear of painful attacks 4. Ingesting a low fat diet to prevent abdominal pains

3. Skipping meals out of fear of painful attacks

A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? 1. Exhale 2. Inhale and exhale quickly 3. Take and hold a deep breath 4. Perform a Valsalva maneuver

3. Take and hold a deep breath When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.

46. The nurse is caring for clients in an outpatient clinic. Which information should the nurse teach regarding the American Cancer Society's recommendations for the early detection of colon cancer? 1. Beginning at age 60, a digital rectal exam should be done yearly. 2. After the client reaches middle age, a yearly fecal occult test should be done. 3. At age 50, a colonoscopy and then once every five (5) to ten (10) years. 4. A flexible sigmoidoscopy should be done yearly after age 40.

3. The American Cancer Society recommends a colonoscopy at age 50 and every five (5) to ten (10) years thereafter and a flexible sigmoidoscopy and barium enema every five (5) years.

76. The client diagnosed with end-stage renal failure with ascites is scheduled for a paracentesis. Which client teaching should the nurse discuss with the client? 1. Explain that the procedure will be done in the operating room. 2. Instruct the client that a Foley catheter will have to be inserted. 3. Tell the client that vital signs will be taken frequently after the procedure. 4. Provide instructions on holding the breath when the HCP inserts the catheter

3. The client is at risk for hypovolemia; therefore, vital signs will be assessed frequently to monitor for signs of hemorrhaging.

19. The client diagnosed with Crohn's disease is crying and tells the nurse, "I can't take it anymore. I never know when I will get sick and end up here in the hospital." Which statement would be the nurse's best response? 1. "I understand how frustrating this must be for you." 2. "You must keep thinking about the good things in your life." 3. "I can see you are very upset. I'll sit down and we can talk." 4. "Are you thinking about doing anything like committing suicide?"

3. The client is crying and is expressing feelings of powerlessness; therefore the nurse should allow the client to talk.

8. The nurse is preparing a client diagnosed with gastroesophageal reflux disease (GERD) for surgery. Which information should be brought to the attention of the health-care provider? 1. The client's Bernstein esophageal test was positive. 2. The client's abdominal x-ray shows a hiatal hernia. 3. The client's WBC count is 14,000 mg/dL. 4. The client's hemoglobin is 13.8 mg/dL.

3. The client's WBC is elevated, indicating a possible infection, which warrants notifying the HCP.

67. The client is one (1) hour post-endoscopic retrograde cholangiopancreatogram (ERCP). Which intervention should the nurse include in the plan of care? 1. Instruct the client to cough forcefully. 2. Encourage early ambulation. 3. Assess for return of a gag reflex. 4. Administer held medications.

3. The endoscopic retrograde cholangiopancreatogram (ERCP) requires that an anesthetic spray be used prior to insertion of the endoscope. If medications, food, or fluid is given orally prior to the return of the gag reflex, the client may aspirate, causing pneumonia that could be fatal.

126. Which diagnostic tests should be monitored for the client diagnosed with severe anorexia nervosa? 1. Liver function tests. 2. Kidney function tests. 3. Cardiac function tests. 4. Bone density scan.

3. The heart is a muscle; in severe anorexia (more than 60% under ideal body weight) muscle tissue is catabolized to provide energy to the body. The client is at risk for death from cardiac complications.

140. The nurse, a licensed practical nurse, and an unlicensed nursing assistant are caring for clients on a medical floor. Which nursing task would be most appropriate to assign to the licensed practical nurse? 1. Assist the unlicensed nursing assistant to learn to perform blood glucose checks. 2. Monitor the potassium levels of a client with diarrhea. 3. Administer a bulk laxative to a client diagnosed with constipation. 4. Assess the abdomen of a client who has had complaints of pain.

3. The licensed practical nurse could administer a laxative

38. The nurse is admitting a male client to a medical floor with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis? 1. The client reports up to 20 bloody stools per day. 2. The client states that he has a feeling of fullness after a heavy meal. 3. The client has diarrhea alternating with constipation. 4. The client complains of right lower quadrant pain with rebound tenderness.

3. The most common symptom of colon cancer is a change in bowel habits, specifically diarrhea alternating with constipation

81. Which assessment question would be priority for the nurse to ask the client diagnosed with end-stage liver failure secondary to alcoholic cirrhosis? 1. How many years have you been drinking alcohol? 2. Have you completed an advanced directive? 3. When did you have your last alcoholic drink? 4. What foods did you eat at your last meal?

3. The nurse must know when the client had the last alcoholic drink to be able to determine when and if the client will experience from alcohol.

51. The client is admitted to the medical unit with a diagnosis of acute diverticulitis. Which health-care provider's order should the nurse question? 1. Insert a nasogastric tube. 2. Start IV D5W at 125 mL/hr. 3. Put client on a clear liquid diet. 4. Place client on bed rest with bathroom privileges.

3. The nurse should question a clear liquid diet because the bowel must be put on total rest, which means NPO.

96. Which task would be most appropriate for the nurse to delegate to the unlicensed nursing assistant? 1. Draw the serum liver function test. 2. Evaluate the client's intake and output. 3. Assist the client to the bedside commode. 4. Help the ward clerk transcribe orders.

3. The nursing assistant can assist a client to the bedside commode.

18. The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement first? 1. Weigh the client daily and document it in the client's chart. 2. Teach coping strategies such as dietary modifications. 3. Record the frequency, amount, and color of stools. 4. Monitor the client's oral fluid intake every shift.

3. The severity of the diarrhea helps determine the need for fluid replacement. The liquid stool should be measured as part of the total output.

143. The nurse is planning the care of a client diagnosed with infectious diarrhea. Which independent problem should be included in the plan of care? 1. Risk for hypovolemic shock. 2. Bacteremia. 3. Fluid volume deficit. 4. Increased knowledge of transmission.

3. The treatment of a fluid volume deficit is an independent nursing problem; the nurse can assess and intervene with oral fluids

A patient has a nasogastric tube for suction and is in Pio following a pancreaticoduodenectomy. Which of the following explanations made by the nurse is the major purpose of this treatment? 1. The tube will help control fluid and electrolyte imbalance 2. The tube will provide relief from nausea and vomiting 3. The tube will allow the G.I. tract to rest 4. The tube will allow the removal of toxins

3. The tube will allow the G.I. tract to rest

48. The client presents with a complete blockage of the large intestine from a large tumor. Which health-care provider's order would the nurse question? 1. Obtain consent for a colonoscopy and biopsy. 2. Start an IV of 0.9% saline at 125 mL/hour. 3. Administer 3 liters of Go-LYTELY. 4. Give tap water enemas until it is clear.

3. This client has an intestinal blockage from a solid tumor blocking the colon. Although the client needs to be cleaned out for the colonoscopy, this would cause severe cramping without a reasonable benefit to the client and could cause a medical emergency

9. The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed nursing assistants. Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett's esophagitis who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days post-op hiatal hernia and needs to be ambulated four (4) times today.

3. This client is exhibiting symptoms of asthma, a complication of GERD; therefore, the client should be assigned to the most experienced nurse.

65. The nurse is caring for the immediate postoperative client who had a laparoscopic cholecystectomy. Which task could the nurse delegate to the unlicensed nursing assistant? 1. Check the abdominal dressings for bleeding. 2. Increase the IV fluid if the blood pressure is low. 3. Document the amount of output on the I & O sheet. 4. Listen to the breath sounds in all lobes.

3. This intervention would be appropriate for the nursing assistant to implement.

30. The client has been admitted to the hospital with hemorrhaging from a duodenal ulcer. Which collaborative interventions should the nurse implement? Select all that apply. 1. Perform a complete pain assessment. 2. Evaluate BP lying, sitting, and standing 3. Administer antibiotics intravenously. 4. Administer blood products. 5. Monitor intake of a soft, bland diet.

3. This is a collaborative intervention that the nurse should implement. It requires an order from the HCP. 4. Administering blood products is collaborative, requiring an order from the HCP.

83. The client is diagnosed with end-stage liver failure. The client asks the nurse, "Why is my doctor decreasing the doses of my medications?" Which statement is the nurse's best response? 1. "You are worried that your doctor has decreased the dosage." 2. "You really should ask your doctor. I am sure there is a good reason." 3. "You may have an overdose of the medication because your liver is damaged." 4. "The half-life is altered because the liver is damaged."

3. This is the main reason the HCP decreases the client's medication dose, and it is an explanation appropriate for the client.

14. The client is prescribed prednisone, a steroid, for an acute episode of inflammatory bowel disease. Which intervention should the nurse discuss with the client? 1. Take this medication on an empty stomach. 2. Notify the HCP if you experience a moon face. 3. Be sure to take this medication as prescribed. 4. Take the medication in the morning only

3. This medication must be tapered off to prevent adrenal insufficiency; therefore, the client must take this medication as prescribed.

The physician has written the following orders, bedrest, NPO and administration of TPN for a new patient admitted with pancreatitis. The nurse attributes which of the following as the cause for NPO status? 1. To prevent the occurrence of fibrosis 2. To drain the pancreatic bed 3. To avoid inflammation of the pancreas 4. To aid opening up the pancreatic duct

3. To avoid inflammation of the pancreas

72. The client is six (6) hours postoperative open cholecystectomy and the nurse finds a large amount of red drainage on the dressing. Which intervention should the nurse implement? 1. Measure the abdominal girth. 2. Palpate the lower abdomen for a mass. 3. Turn client onto side to assess for further drainage. 4. Remove the dressing to determine the source.

3. Turning the client to the side to assess the amount of drainage and possible bleeding is important prior to contacting the surgeon.

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? 1. Nitroglycerin 2. Spironolactone (Aldactone) 3. Vasopressin (Pitressin) 4. Cimetidine (Tagamet)

3. Vasopressin (Pitressin) Vasopressin constricts the splanchnic arterial bed and decreases portal hypertension.

A patient with end stage liver disease is scheduled to undergo a liver transplant and tells the nurse, "I am worried that my body will reject the liver." Which of the following statements is the nurse's best response to the patient? 1. The problem of rejection is not as common liver transplant as another organ transplants 2. It is easier to get a good tissue match with liver transplants than with other types of transplants 3. You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs. 4. You would not be scheduled for a transplant if there was a concern about rejection

3. You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs.

Pain control with peptic ulcer disease includes all of the following except: 1. promoting physical and emotional rest. 2. identifying stressful situations. 3. eating meals when desired. 4. administering medications that decrease gastric acidity.

3. eating meals when desired.

The nurse would anticipate using which medication if sclerotherapy has not been used? 1. neomycin 2. propranolol 3. vasopressin 4. cimetidine

3. vasopressin Vasopressin is the drug of choice when sclerotherapy is contraindicated. Neomycin is used in preventing encephalopathy when blood is broken down. Propranolol may or may not be used to decrease cardiac output and hepatic venous pressure.

A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: 1. place the client in a private room 2. wear a mask when handling the client's bedpan 3. wash the hands after touching the client 4. wear a gown when providing personal care for the client

3. wash the hands after touching the client To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client.

Gastric ulcer

30 to 60 min after a meal Rarely occurs at night Pain exacerbated by ingestion of food

5. The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side-lying position and take antacids before meals. 4. Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client.

4. Rationale: The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux.

7. The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent.

4. Rationale: A mucosal barrier agent must be administered on an empty stomach for the medication to coat the stomach.

3. The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understands the discharge instructions? 1. "I should not eat for at least one (1) day following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid orange juice and eating tomatoes until my esophagus heals."

4. Rationale: Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal.

85. The client is in the preicteric phase of hepatitis. Which signs/symptoms would the nurse expect the client to exhibit during this phase? 1. Clay-colored stools and jaundice. 2. Normal appetite and pruritus. 3. Being afebrile and left upper quadrant pain. 4. Complaints of fatigue and diarrhea.

4. "Flu-like" symptoms are the first complaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously.

109. The male client has had abdominal surgery and is now diagnosed with peritonitis. Which assessment data support the client's diagnosis of peritonitis? 1. Absent bowel sounds and potassium level of 3.9 mEq/L. 2. Abdominal cramping and hemoglobin of 14 gm/dL. 3. Profuse diarrhea and stool specimen shows Campylobacter. 4. Hard, rigid abdomen and white blood cell count 22,000 mm.

4. A hard, rigid abdomen indicates an inflamed peritoneum (abdominal wall cavity) resulting from an infection, which results in an elevated WBC level.

135. The client has been experiencing difficulty and straining when expelling feces. Which intervention should be taught to the client? 1. Explain that some blood in the stool will be normal for the client. 2. Instruct the client in manual removal of feces. 3. Encourage the client to use a cathartic laxative on a daily basis. 4. Place the client on a high-residue diet.

4. A high-residue diet provides bulk for the colon to use in removing the waste products of metabolism. Bulk laxatives and fiber from vegetables and bran assist the colon to work more effectively.

7. The nurse is administering morning medications at 0730. Which medication would have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent.

4. A mucosal barrier agent must be administered on an empty stomach for the medication to coat the stomach.

A nurse is preparing to care for a female client with esophageal varices who just had a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? 1. An obturator 2. Kelly clamp 3. An irrigation set 4. A pair of scissors

4. A pair of scissors When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube.

114. The client has developed a paralytic ileus after abdominal surgery. Which intervention should the nurse include in the plan of care? 1. Administer a laxative of choice. 2. Encourage client to increase oral fluids. 3. Encourage the client to take deep breaths. 4. Maintain a patent nasogastric tube.

4. A paralytic ileus is the absence of peristalsis; therefore the bowel will be unable to process any oral intake. A nasogastric tube is inserted to decompress the bowel until there is surgical intervention or bowel sounds return spontaneously

47. The nurse writes a psychosocial problem of "risk for altered sexual functioning related to new colostomy." Which intervention should the nurse implement? 1. Tell the client that there should be no intimacy for at least three (3) months. 2. Ensure that the client and significant other are able to change the ostomy pouch. 3. Demonstrate with charts possible sexual positions for the client to assume. 4. Teach the client to protect the pouch from becoming dislodged during sex

4. A pouch that becomes dislodged during the sexual act would cause embarrassment for the client whose body image has already been dealt a blow.

The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen

4. A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur.

71. Which nursing diagnosis would be highest priority for the client who had an open cholecystectomy surgery? 1. Alteration in nutrition. 2. Alteration in skin integrity. 3. Alteration in urinary pattern. 4. Alteration in comfort.

4. Acute pain management is the highest priority client problem after surgery because pain may indicate a life-threatening problem.

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? 1. Administering pain medication 2. Obtaining a blood sample for laboratory studies 3. Preparing to insert a nasogastric (NG) tube 4. Administering I.V. fluids

4. Administering I.V. fluids I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next.

A nurse is teaching a patient about the types of chronic liver disease. The patient teaching is determined to be effective based on the correct identification of which of the following types of cirrhosis caused by scar tissue surrounding the portal areas? 1. Compensated cirrhosis 2. Biliary cirrhosis 3. Post necrotic cirrhosis 4. Alcoholic cirrhosis

4. Alcoholic cirrhosis

75. The client diagnosed with end-stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication? 1. Restrict sodium intake to 2 g/day. 2. Limit oral fluids to 1500 mL/day. 3. Decrease the daily fat intake. 4. Reduce protein intake to 60 to 80 g/day.

4. Ammonia is a byproduct of protein metabolism and contributes to hepatic encephalopathy. Reducing protein intake should decrease ammonia levels.

34. The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse that the medications are effective? 1. A decrease in alcohol intake. 2. Maintaining a bland diet. 3. A return to previous activities. 4. A decrease in gastric distress.

4. Antibiotics, proton pump inhibitors, and Pepto-Bismol are administered to decrease the irritation of the ulcerative area and cure the ulcer. A decrease in gastric distress indicates the medication is effective.

98. Which intervention should the nurse include when discussing ways to help prevent potential episodes of gastroenteritis from Clostridium botulism? 1. Make sure that all hamburger meat is well cooked. 2. Ensure that all dairy products are refrigerated. 3. Discuss that campers should drink only bottled water. 4. Discard all canned goods that are damaged.

4. Any food that is discolored or comes from a can or jar that has been damaged or does not have a tight seal should be destroyed without tasting or touching it.

A patient who had developed jaundice two months previous is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptoms would the nurse expect this patient to have? 1. Weight loss 2. Hypertension 3. Warm, dry skin 4. Bile stained vomiting

4. Bile stained vomiting

A patient with acute pancreatitis has been started on TPN. Following the administration of the TPN, which of the following should the nurse plan to monitor? 1. Auscultate the abdomen for bowel sounds every four hours 2. Complaints of nausea and vomiting 3. Measure the abdominal girth every shift 4. Blood glucose levels every 4 to 6 hours

4. Blood glucose levels every 4 to 6 hours

104. Which assessment data would the nurse expect to find in the client diagnosed with acute gastroenteritis? 1. Decreased gurgling sounds on auscultation of the abdominal wall. 2. A hard, firm edematous abdomen on palpation. 3. Frequent, small melena-type liquid bowel movements. 4. Bowel assessment reveals loud, rushing bowel sounds.

4. Borborygmi, or loud, rushing bowel sounds, indicates increased peristalsis, which occurs in clients with diarrhea and is the primary clinical manifestation in a client diagnosed with acute gastroenteritis.

53. The client is two (2) hours post-colonoscopy. Which assessment data would warrant intermediate intervention by the nurse? 1. The client has a soft, nontender abdomen. 2. The client has a loose, watery stool. 3. The client has hyperactive bowel sounds. 4. The client's pulse is 104 and BP is 98/60.

4. Bowel perforation is a potential complication of a colonoscopy. Therefore signs of hypotension—decreased BP and increased pulse—would warrant immediate intervention from the nurse.

When caring for a patient with advanced cirrhosis and hepatic encephalopathy, which of the following assessment findings should the nurse report immediately? 1. Weight loss of 2 pounds in three days 2. Anorexia for more than three days 3. Constipation for more than two days 4. Change in the patient's hand writing and or cognitive performance

4. Change in the patient's hand writing and or cognitive performance

What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus? 1. Grey-Turner's sign 2. Homan's sign 3. Rovsing's sign 4. Cullen's sign

4. Cullen's sign Cullen's sign is associated with pancreatitis when a hemorrhage is suspected. Grey-Turner's sign is ecchymosis in the flank area suggesting retroperitoneal bleed. Homan's sign is calf pain elicited by the dorsiflexion of the foot and suggests deep vein thrombosis. Rovsing's sign is associated with appendicitis when pain is felt with pressure at McBurney's point.

127. The female client is more than 10% over ideal body weight. Which nursing intervention should the nurse implement first? 1. Ask the client why she is eating too much. 2. Refer the client to a gymnasium for exercise. 3. Have the client set a realistic weight loss goal. 4. Determine the client's eating patterns.

4. Determining the client's eating patterns and what triggers the client to eat—stress or boredom, for example—and where and when the client consumes most of the calories—snacking in front of the TV at night, for example—are needed to assist the client to change eating behaviors.

The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? 1. Clamp the T-tube 2. Irrigate the T-tube 3. Notify the physician 4. Document the findings

4. Document the findings Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day.

A nurse is collecting data from a newly admitted client who has pancreatitis. Which of the following findings should the nurse expect? 1. Pain in right upper quadrant radiating to right shoulder 2. Pain that is worse when sitting upright 3. Pain that is worse when in a fetal position 4. Epigastric pain radiating to the left shoulder

4. Epigastric pain radiating to the left shoulder Cholecystitis will report pain in the right upper quadrant radiating to the right shoulder. Pancreatitis will report severe epigastric pain that radiates to the back left flank or left shoulder. Pain Will be relieved in the fetal position or sitting up and worse when lying down.

Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? 1. Start an IV infusion 2. Administer an enema 3. Cancel the diagnostic test 4. Explain that diarrhea is expected

4. Explain that diarrhea is expected

A nurse is collecting data from a client who has acute pancreatitis. Which of the following findings is the priority to report? 1. History of cholelithiasis 2. Elevated serum amylase levels 3. Decrease in bowel sounds upon auscultation 4. Hand spasms when blood pressure is checked

4. Hand spasms when blood pressure is checked

The nurse identifies which of the following types of jaundice and an adult experiencing a transfusion reaction? 1. Nonobstructive 2. Hepatocellular 3. Obstructive 4. Hemolytic

4. Hemolytic

88. The school nurse is discussing ways to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important intervention that the school nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other. 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Thoroughly wash hands.

4. Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread.

25. Which assessment data support the client's diagnosis of gastric ulcer? 1. Presence of blood in the client's stool for the past month. 2. Complaints of a burning sensation that moves like a wave. 3. Sharp pain in the upper abdomen after eating a heavy meal. 4. Comparison of complaints of pain with ingestion of food and sleep

4. In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night that is often relieved by eating food. Pain occurs 1-3 hours after meals.

While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? 1. Sigmoid colon 2. Appendix 3. Spleen 4. Liver

4. Liver The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney.

3.The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understands the discharge instructions? 1. "I should not eat for twenty-four (24) hours following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid drinking orange juice and eating tomatoes until my esophagus heals."

4. Orange and tomato juices are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal.

To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement? 1. Apply soft wrist restraints 2. Raise all four side rails on the bed 3. Prevent visitors so as to not agitate the patient 4. Pad the side rails on the bed

4. Pad the side rails on the bed to reduce injury if the patient becomes agitated or restless.

Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis? 1. Tetany 2. Shock 3. Multiple organ dysfunction syndrome 4. Pancreatic necrosis

4. Pancreatic necrosis

29. The client diagnosed with peptic ulcer disease is admitted into the hospital. Which nursing diagnosis should the nurse include in the plan of care to observe for physiological complications? 1. Alteration in bowel elimination patterns. 2. Knowledge deficit in the causes of ulcers. 3. Inability to cope with changing family roles. 4. Potential for alteration in gastric emptying.

4. Potential for alteration in gastric emptying is caused by edema or scarring associated with peptic ulcer disease, which may cause a feeling of "fullness," vomiting of undigested food, or abdominal distention.

A nurse is contributing to the plan of care for a client who has hepatitis B with ascites. Which of the following interventions should the nurse recommend? 1. Initiate contact precautions 2. Weigh the client weekly 3. Measure abdominal girth every 48 hours 4. Provide a high calorie high carbohydrate diet

4. Provide a high calorie, high carbohydrate diet to promote healing of the liver tissue Standard precautions are adequate. Weight should be obtained daily.

A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? 1. Quickly insert the tube 2. Notify the physician immediately 3. Remove the tube and reinsert when the respiratory distress subsides 4. Pull back on the tube and wait until the respiratory distress subsides

4. Pull back on the tube and wait until the respiratory distress subsides During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides.

61. The client is four (4) hours postoperative open cholecystectomy. Which data would warrant immediate intervention by the nurse? 1. Absent bowel sounds in all four (4) quadrants. 2. The T-tube with 60 mL of green drainage. 3. Urine output of 100 mL in the past three (3) hours. 4. Refusal to turn, deep breathe, and cough.

4. Refusing to turn, deep breathe, and cough puts the client at risk for pneumonia. This client needs immediate intervention to prevent complications.

95. Which statement by the client diagnosed with hepatitis would warrant immediate intervention by the clinic nurse? 1. "I will not drink any type of beer or mixed drink." 2. "I will get adequate rest so that I don't get exhausted." 3. "I had a big hearty breakfast this morning." 4. "I took some cough syrup for this nasty head cold."

4. The client needs to understand that some types of cough syrup have alcohol and all alcohol must be avoided to prevent further injury to the liver; therefore this statement requires intervention.

50. The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? 1. Discuss the importance of drinking 1000 mL of water daily. 2. Instruct the client to exercise at least three (3) times a week. 3. Teach the client about a eating a low-residue diet. 4. Explain the need to have daily bowel movements.

4. The client should have regular bowel movements, preferably daily. Constipation may cause diverticulitis, which is a potentially life-threatening complication of diverticulosis.

124. The nurse writes a nursing diagnosis of "altered nutrition: less than body requirements related to low self-esteem" for a client diagnosed with anorexia. Which client goal should be included in the plan of care? 1. The nurse will prevent the client from doing excessive exercise. 2. The client eats 50% of the meals provided. 3. Dietary will provide high-protein milk shakes t.i.d. 4. The client will verbalize one positive attribute.

4. The etiology of the diagnosis of anorexia is "low self-esteem." Therefore the goal must address the client's low self-esteem.

5. The nurse is caring for a client diagnosed with gastroesophageal reflux disease (GERD). Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side-lying position and take antacids before meals. 4. Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client.

4. The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux.

49. The client admitted to the medical unit with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temperature of 100.6F. Which action should the nurse implement first? 1. Notify the health-care provider. 2. Document the findings in the chart. 3. Administer an oral antipyretic. 4. Assess the client's abdomen.

4. The nurse should assess the client to determine if the abdomen is soft and nontender. A rigid tender abdomen may indicate peritonitis.

41. The client who has had an abdominal perineal resection is being discharged. Which discharge information should the nurse teach? 1. The stoma should be a white, blue, or purple color. 2. Limit ambulation to prevent the pouch from coming off. 3. Take pain medication when the pain level is at an "8." 4. Empty the pouch when it is one-third to one-half full.

4. The pouch should be emptied when it is one-third to one-half full to prevent the contents from becoming too heavy for the seal to hold and to prevent leakage from occurring.

21. The client diagnosed with IBD is prescribed sulfasalazine (Asulfidine), a sulfonamide antibiotic. Which statement best describes the rationale for administering this medication? 1. It is administered rectally to help decrease colon inflammation. 2. This medication slows gastrointestinal motility and reduces diarrhea. 3. This medication kills the bacteria that cause the exacerbation. 4. It acts topically on the colon mucosa to decreases inflammation.

4. This antibiotic is poorly absorbed from the gastrointestinal tract and acts topically on the colonic mucosa to inhibit the inflammatory process

141. The client is placed on percutaneous gastrostomy (PEG) tube feedings. Which occurrence would warrant immediate intervention by the nurse? 1. The client tolerates the feedings being infused at 50 mL/hour. 2. The client pulls the nasogastric feeding tube out. 3. The client complains of being thirsty. 4. The client has green, watery stool.

4. This client needs to be cleaned immediately; the abdomen must be assessed; and a determination must be made regarding the type of feeding and the additives and medications being administered and skin damage occurring. This client is priority

131. The 36-year-old female client diagnosed with anorexia nervosa tells the nurse "I am so fat. I won't be able to eat today." Which response by the nurse is most appropriate? 1. "Can you tell me why you think you are fat?" 2. "You are skinny. Many women wish they had your problem." 3. "If you don't eat, we will have to restrain you and feed you." 4. "Not eating might cause physical problems."

4. This is a factual statement to the client about the possible results if the client refuses nourishment.

A nurse is reviewing a new prescription for ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include? 1. This medication is used to decrease acute biliary pain 2. This medication requires thyroid function monitoring every six months 3. This medication is not recommended for clients who have diabetes 4. This medication dissolve gallstones gradually over a period of up to two years

4. This medication dissolves gallstones gradually over a period of up to two years

A patient discharged following a laparoscopic cholecystectomy calls the surgeon's office complaining of severe right shoulder pain 24 hours after surgery. Which of the following statements is the correct information for the nurse to provide to this patient? 1. This may be the beginning symptoms of infection. You need to come see the surgeon today for an evaluation 2. This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated 3. This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use 4. This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort.

4. This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort.

68. Which expected outcome would be appropriate for the client scheduled to have a cholecystectomy? 1. Decreased pain management. 2. Ambulate first day postoperative. 3. No break in skin integrity. 4. Knowledge of postoperative care.

4. This would be an expected outcome for the client scheduled for surgery. This indicates that preoperative teaching has been effective.

Which of the following indicates an overdose of lactulose? 1. Fecal impaction 2. Constipation 3. Hypo active bowel sounds 4. Watery diarrhea

4. Watery diarrhea

Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: 1. a sedentary lifestyle and smoking. 2. a history of hemorrhoids and smoking 3. alcohol abuse and a history of acute renal failure 4. alcohol abuse and smoking

4. alcohol abuse and smoking

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: 1. whole blood and albumin 2. platelets and packed red blood cells 3. fresh frozen plasma and whole blood 4. cryoprecipitate and fresh frozen plasma

4. cryoprecipitate and fresh frozen plasma The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors.

Peritonitis can occur as a complication of: 1. septicemia 2. multiple organ failure 3. hypovolemic shock 4. peptic ulcer disease

4. peptic ulcer disease

During initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate: 1. ischemic bowel 2. peritonitis 3. hypovolemic shock 4. perforated bowel

4. perforated bowel

Which phase of hepatitis would the nurse incur strict precautionary measures at? 1. icteric 2. non-icteric 3. post-icteric 4. pre-icteric

4. pre-icteric Pre-icteric is the infective phase and precautionary measures should be strictly enforced. However, most patients are not always diagnosed during this phase.

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? 1. vitamin A 2. vitamin D 3. vitamin E 4. vitamin K

4. vitamin K

56. The nurse is preparing to administer a 250-mL intravenous antibiotic to the client. The medication must infuse in one (1) hour. An intravenous pump is not available and the nurse must administer the medication via gravity with IV tubing 10 gtts/min. At what rate should the nurse infuse the medication?_______

42 gtts per minute

45. The nurse is preparing to hang a new bag of total parental nutrition on a client that has had an abdominal perineal resection. The bag has 1500 mL of 50% dextrose, 10 mL of trace elements, 20 mL of multivitamins, 20 mL of potassium chloride, and 500 mL of lipids. The bag is to infuse over the next 24 hours. At what rate should the nurse set the pump? _______

85 mL/hours. First determine the total amount to be infused over 24 hours. 1500 500 20 20 2040 mL over 24 hours. Then, determine the rate per hour. 2040 ÷ 24 85 mL/hour T

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? A. "medications will kill the bacteria and stop the acid production." B. "I should take these medications only when I have pain from my ulcer." C. "My ulcer will heal because these medications will kill the bacteria." D. "These medications will coat the ulcer and decrease the acid production in my stomach."

A

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? A. Duodenum B.Stomach C. Esophagus D. Pylorus

A

d

A 64-year-old patient with a history of arthritis and hypertension is admitted with progressive epigastric cramping, dyspepsia, nausea, and dark sticky stools for 2 days. Which order should the nurse question? A. Guaiac stool sample 2 B. Stool sample for bacterial testing C. IV fluids, normal saline at 125 ml/hr D. Naproxen (Naprosyn) 500 mg twice daily

d

A client has undergone a subtotal gastrectomy for gastric cancer and is scheduled to begin radiation therapy. What is most important information for the nurse to include in the teaching plan for the client? A. Management of alopecia B. Medication management C. Nutritional intake D. Skin care

Dumping syndrome

A group of manifestations that occur following eating. A shift of fluid to the abdomen is triggered by rapid gastric emptying or high-carbohydrate ingestion. In response to the sudden influx of a hypertonic fluid, the small intestine pulls fluid from the extracellular space to convert the hypertonic fluid to an isotonic fluid. This fluid shift causes a decrease in circulating volume, resulting in vasomotor symptoms (syncope, pallor, palpitations, dizziness, headache). Gastric surgery, especially gastrojejunostomy (Billroth II), poses the greatest risk for dumping syndrome. Following gastric surgery, the reduced stomach has less ability to control the amount and rate of chyme that enters the small intestine after a meal.

Vagotomy

A highly selective vagotomy severs only the nerve fibers that disrupt acid production. Often done laparoscopically to reduce postoperative complications.

b

A patient in the ED has been experiencing upper abdominal pain after meals for the past 2 months. She also notices that when she takes a nap or sleeps at night, she has pain. Eating seems to decrease the pain. She has been taking OTC antacids with some relief. The nurse understands that which assessment factor places the patient at risk for peptic ulcer disease? A. GERD 4 years ago B. Weight loss of 35 pounds C. Use of NSAIDs to control arthritis pain D. Use of prednisone (Deltasone) for inflammation

dumping syndrome

A term that refers to a group of vasomotor symptoms that occur after eating; believed to occur as a result of the rapid emptying of food contents into the small intestine, which shifts fluid into the gut, causing abdominal distention

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. A. Omeprazole (Prilosec) B. Cimetidine (Tagamet) C. Famotidine (Pepcid) D. Ranitidine (Zantac)

A. Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.

Which of the following is considered an early symptom of gastric cancer? A. Pain relieved by antacids B. Weight loss C. Dyspepsia D. Bloating after meals

A. Symptoms of early disease, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms of progressive disease include weight loss, bloating after meals, and dyspepsia.

A patient sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this patient? A. Curling's ulcer B. Meckel's ulcer C. Peptic ulcer D. Esophageal ulcer

A. Ulcer is associated with burns

The nurse is observing a co-worker who is caring for a client with a nasogastric tube following esophageal surgery. Which actions by the co-worker require the nurse to intervene? (Select all that apply.) A. Checking tube placement every 12 hours B. Keeping the bed flat C. Placing the client upright when taking sips of water D. Providing mouth care every 8 hours E. Securing the tube

A. Checking tube placement every 12 hours B. Keeping the bed flat D. Providing mouth care every 8 hours The nasogastric tube should be checked every 4 to 8 hours. The head of the bed should be elevated at least 30 degrees. Oral hygiene should be provided every 2 to 4 hours. The client should be placed upright when taking sips or small amounts of water to prevent choking and to allow observation of the client for dysphagia. The tube should be secured to prevent dislodgment.

A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing hepatitis A? A. Children and young adults B. Older adults C. Women who are pregnant D. Middle-aged men

A. Children and young adults

A nurse is assisting with the care of the client who has a history of cirrhosis and is admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? A. Gamma-glutamyl transferase B. Alkaline phosphatase C. Serum bilirubin D. Alanine aminotransferase (ALT)

A. Gamma-glutamyl transferase The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs.

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure? A. Prothrombin time B. Serum lipase C. Bilirubin D. Calcium

A. Prothrombin time A major complication following a liver biopsy is hemorrgage. Many clients who have liver disease have clotting defects and are at risk for bleeding.

A nurse is caring for a client who is 4 hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? A. Right shoulder pain B. Urine output 20 mL/hr C. Temperature 38.4 degrees Celsius (101.1 degrees Fahrenheit)

A. Right shoulder pain

A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray? A. Wheat toast B. Tapioca pudding C. Hard-boiled eggs D. Mashed potatoes

A. Wheat toast - celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat

DRUG CLASS THAT CAN CAUSE LIVER FAILURE

ACETAMINOPHEN

2. A client wants to lose 1.5 pounds a week. After reviewing a diet history, the nurse determines the client typically eats 2450 calories a day. What should the clients calorie goal be to achieve this weight loss? (Record your answer using a whole number.) __ calories/day

ANS: 1700 calories/day

1. A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number.) ____ mL

ANS: 25 mL

3. A client is receiving continuous tube feeding at 70 mL/hr. When the bag is empty, how much formula does the nurse add? (Record your answer using a whole number.) _____ mL

ANS: 280 mL

1. A client weighs 228 pounds (103.6 kg) and is 53 (160 cm) tall. What is this clients body mass index (BMI)? (Record your answer using a decimal rounded up to the nearest tenth.) _____

ANS: 40.4

1. A nurse prepares to administer 12 mg/kg of 5-fluorouracil chemotherapy intravenously to a client who has colon cancer. The client weights 132 lb. How many milligrams should the nurse administer? (Record your answer using a whole number.) _____ mg

ANS: 720 mg

Vasopressin (Pitressin) 0.2 units/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 100 units/250 mL normal saline. How many mL/hr will the nurse infuse?

ANS: 30 There are 0.4 units/1 mL. An infusion of 30 mL/hr will result in the patient receiving 0.2 units/min as prescribed.

In which order will the nurse take the following actions when caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy? (Put a comma and a space between each answer choice [A, B, C, D].) a. Contact the health care provider. b. Assess blood pressure and heart rate. c. Give the PRN acetaminophen (Tylenol). d. Place the patient on contact precautions.

ANS: D, B, A, C Proton pump inhibitors including omeprazole (Prilosec) may increase the risk of Clostridium difficile-associated colitis. Because the patient's history and symptoms are consistent with C. difficile infection, the initial action should be initiation of infection control measures to protect other patients. Assessment of blood pressure and pulse is needed to determine whether the patient has symptoms of hypovolemia and/or shock. The health care provider should be notified so that actions such as obtaining stool specimens and antibiotic therapy can be started. Tylenol may be administered, but is the lowest priority of the actions.

1. A client is in the family practice clinic. Today the client weighs 186.4 pounds (84.7 kg). Six months ago the client weighed 211.8 pounds (96.2 kg). What action by the nurse is best? a. Ask the client if the weight loss was intentional. b. Determine if there are food allergies or intolerances. c. Perform a comprehensive nutritional assessment. d. Perform a rapid bedside blood glucose test.

ANS: A

1. A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion

ANS: A

10. The nurse is teaching a patient with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge? a. "Nizatidine (Axid) needs to be taken three times a day to be effective." b. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." c. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." d. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

ANS: A

101. The RN who usually works on the pediatric unit is floated to the GI medical-surgical unit. Which client is most appropriate for the charge nurse to assign to the float nurse? a. A 20-year-old with anorexia nervosa receiving total parenteral nutrition through a central venous line b. A 35-year-old who had a laparoscopic gastroplasty yesterday and is now taking sips of clear liquids c. A 60-year-old with gastric cancer receiving elemental feedings through a jejunostomy tube d. A 65-year-old with morbid obesity who requires a preoperative bariatric surgery assessment

ANS: A

11. A nurse cares for a client who states, My husband is repulsed by my colostomy and refuses to be intimate with me. How should the nurse respond? a. Lets talk to the ostomy nurse to help you and your husband work through this. b. You could try to wear longer lingerie that will better hide the ostomy appliance. c. You should empty the pouch first so it will be less noticeable for your husband. d. If you are not careful, you can hurt the stoma if you engage in sexual activity.

ANS: A

12. A nurse assesses a client with Crohns disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Distended abdomen b. Temperature of 100.0 F (37.8 C) c. Loose and bloody stool d. Lower abdominal cramps

ANS: A

13. A nurse reviews the chart of a client who has Crohns disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions? a. Serum potassium of 2.6 mEq/L b. Client ate 20% of breakfast meal c. White blood cell count of 8200/mm3 d. Clients weight decreased by 3 pounds

ANS: A

13. The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal (GI) bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? a. "A fluid solution goes down the tube to help clean out your stomach." b. "The medication goes down the tube to help clean out your stomach." c. "The primary health care provider requested the tube to be placed just in case it was needed." d. "We'll start feeding you through it once your stomach is cleaned out."

ANS: A

14. A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says I didnt know it would be this hard to live like this. What response by the nurse is best? a. Assess the clients coping and support systems. b. Inform the client that things will get easier. c. Re-educate the client on needed dietary changes. d. Tell the client lifestyle changes are always hard.

ANS: A

15. A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate? a. Increase the fiber and water in your diet. b. Reduce fat to less than 30% each day. c. Report dry mouth and decreased sweating. d. Lorcaserin may cause loose stools for a few days.

ANS: A

15. A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the clients foods. d. Make the client NPO.

ANS: A

15. A nurse assesses a client who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider? a. White blood cell (WBC) count of 1500/mm3 b. Fatigue c. Nausea and diarrhea d. Mucositis and oral ulcers

ANS: A

15. A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurse's highest priority intervention? a. Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider b. Asking the primary health care provider for a referral for home health services to assist with dressing changes c. Asking the spouse if any other family members are in the medical profession and could help change the dressing d. Offer literature on dressing changes and schedule follow-up phone calls with the patient and spouse to talk them through dressing changes when at home.

ANS: A

16. A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, The stool in my pouch is still liquid. How should the nurse respond? a. The stool will always be liquid with this type of colostomy. b. Eating additional fiber will bulk up your stool and decrease diarrhea. c. Your stool will become firmer over the next couple of weeks. d. This is abnormal. I will contact your health care provider.

ANS: A

16. An older female patient is diagnosed with gastric cancer. Which statement made by the patient's family demonstrates a correct understanding of the disorder? a. "This may be related to her recurring ulcer disease." b. "This cancer is probably curable with surgery." c. "Gastric cancer has a strong genetic component." d. "Thank goodness she won't have to undergo surgery."

ANS: A

17. A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Sulfasalazine (Azulfidine) d. Ceftriaxone (Rocephin)

ANS: A

2. A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. Have you been experiencing any constipation? b. Are you eating a diet high in fiber and fluids? c. Do you have a history of high blood pressure? d. What vitamins and supplements are you taking?

ANS: A

20. A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Pale and bluish stoma b. Liquid stool c. Ostomy pouch intact d. Blood-smeared output

ANS: A

20. A nurse cares for a client who has a new colostomy. Which action should the nurse take? a. Empty the pouch frequently to remove excess gas collection. b. Change the ostomy pouch and wafer every morning. c. Allow the pouch to completely fill with stool prior to emptying it. d. Use surgical tape to secure the pouch and prevent leakage.

ANS: A

20. The nurse working during the day shift on the medical unit has just received report. Which patient does the nurse plan to assess first? a. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy b. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal c. Middle-aged patient with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast d. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

ANS: A

22. A nurse cares for a client with ulcerative colitis. The client states, I feel like I am tied to the toilet. This disease is controlling my life. How should the nurse respond? a. Lets discuss potential factors that increase your symptoms. b. If you take the prescribed medications, you will no longer have diarrhea. c. To decrease distress, do not eat anything before you go out. d. You must retake control of your life. I will consult a therapist to help.

ANS: A

23. A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? a. Certified Wound, Ostomy, and Continence Nurse (CWOCN) b. Home health nursing agency c. Hospice d. Hospital chaplain

ANS: A

3. A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this clients teaching? a. Drink plenty of fluids to prevent dehydration. b. You should only drink 1 liter of fluids daily. c. Increase your protein intake by drinking more milk. d. Sips of cola or tea may help to relieve your nausea.

ANS: A

3. A patient has been discharged home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? a. Schedule of the patient's follow-up examinations and diagnostic testing b. Information on family members' progress in learning how to perform dressing changes c. Copy of the diet plan prepared for the patient by the hospital dietitian d. Detailed account of what occurred during the patient's surgical procedure

ANS: A

3. After teaching a client who has a femoral hernia, the nurse assesses the clients understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss? a. I will put on the truss before I go to bed each night. b. Ill put some powder under the truss to avoid skin irritation. c. The truss will help my hernia because I cant have surgery. d. If I have abdominal pain, Ill let my health care provider know right away.

ANS: A

33. A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? a. Encourage the patient to look at and touch the colostomy stoma b. Instruct the patient about complete care of the colostomy c. Schedule a visit from a patient who has a colostomy and is successfully caring for it d. Suggest that the patient involve family members in the care of the colostomy

ANS: A

34. The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? a. "I can drive my car in about 2 weeks." b. "I need to avoid drinking carbonated sodas." c. "It may take 6 weeks to see the effects of some foods on my bowel patterns." d. "Stool softeners will help me avoid straining."

ANS: A

45. Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? a. Analgesics and antiemetics b. Analgesics and benzodiazepines c. Steroids and analgesics d. Steroids and anti-inflammatory medications

ANS: A

46. What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? a. Bulk-forming laxatives b. Saline laxatives c. Stimulant laxatives d. Stool-softening agents

ANS: A

51. A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? a. Ability of the patient and spouse to perform incision care and dressing changes b. Effective coping mechanisms for the patient and spouse after the surgical experience c. Knowledge about the patient's requested pain medications d. Understanding of the importance of keeping scheduled follow-up appointments

ANS: A

52. A patient with a history of osteoarthritis has a 10-inch (25.5 cm) incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the primary health care provider before the patient's discharge? a. Having a home health consultation for wound care b. Requesting an antianxiety medication c. Requesting pain medication for the patient's osteoarthritis d. Placing the patient in a skilled nursing facility for rehabilitation

ANS: A

54. A patient with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply? a. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." b. "It provides key nutrients and extra calories to promote healing." c. "It is bland and reduces the secretion of gastric acids." d. "It does not contain caffeine or other GI tract stimulants."

ANS: A

56. A male patient with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? a. "A change in position may be what is needed for you to have intercourse with your wife." b. "Have you considered going to see a marriage counselor with your wife?" c. "What has your wife said about your pouch system?" d. "You must get clearance from your primary health care provider before you attempt to have intercourse."

ANS: A

6. A nurse is caring for a client receiving enteral feedings through a Dobhoff tube. What action by the nurse is best to prevent hyperosmolarity? a. Administer free-water boluses. b. Change the clients formula. c. Dilute the clients formula. d. Slow the rate of infusion.

ANS: A

60. A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient? a. "Avoid large crowds and anyone who is sick." b. "Do not take the medication if you are allergic to foods with fatty acids." c. "Expect difficulty with wound healing while you are taking this drug." d. "Monitor your blood pressure and report any significant decrease in it."

ANS: A

66. A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? a. "It is usually ready to be closed in about 1 to 2 months." b. "You need to talk to your primary health care provider about how long you will have this temporary ileostomy." c. "The period of time is indefinite—I am sorry that I cannot say." d. "You will probably have it for 6 months or longer, until things heal."

ANS: A

67. The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include? a. A slice of 5-grain bread b. Chuck steak patty (6 ounces [170 grams]) c. Strawberries (1 cup [160 grams]) d. Tomato (1 medium)

ANS: A

76. A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? a. "Be aware of the signs/symptoms of toxic megacolon that we discussed." b. "If diarrhea increases, you must let your primary health care provider know." c. "You must avoid pregnancy." d. "You will need to decrease your dose of sulfasalazine (Azulfidine)."

ANS: A

8. A nurse and a registered dietitian are assessing clients for partial parenteral nutrition (PPN). For which client would the nurse suggest another route of providing nutrition? a. Client with congestive heart failure b. Older client with dementia c. Client who has multiorgan failure d. Client who is post gastric resection

ANS: A

8. The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patient's ulceration is duodenal in origin and not gastric? a. Pain occurs 1½ to 3 hours after a meal, usually at night. b. Pain is worsened by the ingestion of food. c. The patient has a malnourished appearance. d. The patient is a man older than 50 years.

ANS: A

84. How does the nurse accurately calculate a client's body mass index (BMI)? a. BMI = weight (kg)/height (in meters)2 b. BMI = weight (lb)/height (in inches)2 c. BMI = weight (kg)/height (in meters) d. BMI = weight (lb)/height (in meters)

ANS: A

9. A client is receiving total parenteral nutrition (TPN). On assessment, the nurse notes the clients pulse is 128 beats/min, blood pressure is 98/56 mm Hg, and skin turgor is dry. What action should the nurse perform next? a. Assess the 24-hour fluid balance. b. Assess the clients oral cavity. c. Prepare to hang a normal saline bolus. d. Turn up the infusion rate of the TPN.

ANS: A

9. A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? a. Starting a large-bore IV b. Administering IV pain medication c. Preparing equipment for intubation d. Monitoring the patient's anxiety level

ANS: A

96. Which morbidly obese client is the least likely candidate for bariatric surgery? a. A 34-year-old woman experiencing mental confusion b. A 44-year-old man with a history of hypertension c. A 50-year-old woman with a history of sleep apnea d. A 52-year-old man with a history of type 1 diabetes mellitus

ANS: A

99. The nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems? a. Discontinues the IVFE infusion and notifies the health care provider (HCP) b. Documents the findings and continues to monitor c. Slows the rate of flow of the IVFE infusion d. Switches to total parenteral nutrition (TPN)

ANS: A

3.A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? a. "After the operation I can eat anything I want." b. "I will have to eat smaller, more frequent meals." c. "I will take stool softeners for several weeks." d. "This surgery may not totally control my symptoms."

ANS: A Nutritional and lifestyle changes need to continue after surgery as the procedure does not offer a lifetime cure. The other statements show good understanding. DIF:Evaluating/SynthesisREF:1117 KEY:Gastrointestinal disorders| patient education MSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

8.A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the client's neck. What action by the nurse takes priority? a. Assess the client's oxygenation. b. Facilitate a STAT chest x-ray. c. Prepare for immediate surgery. d. Start two large-bore IVs.

ANS: A The priorities of care are airway, breathing, and circulation. The priority option is to assess oxygenation. This occurs before diagnostic or therapeutic procedures. The client needs two large-bore IVs as a trauma client, but oxygenation comes first. DIF:Applying/ApplicationREF:1123 KEY:Gastrointestinal disorders| trauma nursing| nursing assessment MSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

7. To promote comfort after a colonoscopy, in what position does the nurse place the client? a. Left lateral b. Prone c. Right lateral d. Supine

ANS: A After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position. DIF: Remembering/Knowledge REF: 1096 KEY: Gastrointestinal system| positioning| nonpharmacologic comfort measures MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

2. A client has a large oral tumor. What assessment by the nurse takes priority? a. Airway b. Breathing c. Circulation d. Nutrition

ANS: A Airway always takes priority. Airway must be assessed first and any problems resolved if present. DIF: Applying/Application REF: 1104 KEY: Oral disorders| cancer| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

6. A client is having a temporary tracheostomy placed during surgery for oral cancer. What action by the nurse is best to relieve anxiety? a. Agree on a postoperative communication method. b. Explain that staff will answer the call light promptly. c. Give the client a Magic Slate to write on postoperatively. d. Reassure the client that you will take care of all of his or her needs.

ANS: A Before surgery that interrupts the client's ability to communicate, the nurse, client, and family (if possible) agree upon a method of communication in the postoperative period. The client may or may not prefer a slate and may not be able to communicate in writing. Reassuring the client and telling him or her you will take care of all of his or her needs does not help the client be an active participant in care. Ensuring that the staff will answer the call light promptly will not guarantee this will occur. DIF: Applying/Application REF: 1105 KEY: Oral disorders| communication MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity

8. A client is prescribed cetuximab (Erbitux) for oral cancer and asks the nurse how it works. What response by the nurse is best? a. "It blocks epidermal growth factor." b. "It cuts off the tumor's blood supply." c. "It prevents tumor extension." d. "It targets rapidly dividing cells."

ANS: A Cetuximab (Erbitux) targets and blocks the epidermal growth factor, which contributes to the growth of oral cancers. The other explanations are not correct. DIF: Understanding/Comprehension REF: 1105 KEY: Oral disorders| cancer| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

26. Which patient statement indicates that the nurse's teaching following a gastroduodenostomy has been effective? a. "Vitamin supplements may prevent anemia." b. "Persistent heartburn is common after surgery." c. "I will try to drink more liquids with my meals." d. "I will need to choose high carbohydrate foods."

ANS: A Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome.

6. An older client has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best? a. "Changes in your liver cause drugs to be metabolized differently." b. "Perhaps you don't need as high a dose of the drug as before." c. "Stomach muscles atrophy with age and you digest more slowly." d. "Your body probably can't tolerate as much medication anymore."

ANS: A Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels. The other options do not accurately explain this age-related change. DIF: Understanding/Comprehension REF: 1088 KEY: Gastrointestinal system| older adult| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

19. The nurse will anticipate preparing a 71-year-old female patient who is vomiting "coffee-ground" emesis for a. endoscopy. b. angiography. c. barium studies. d. gastric analysis.

ANS: A Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.

14. A 58-year-old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? a. Offering the patient a drink of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with cold water

ANS: A Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the UAP are appropriate.

25. A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The highest priority action by the nurse is to a. contact the surgeon. b. irrigate the NG tube. c. monitor the NG drainage. d. administer the prescribed morphine.

ANS: A Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion and/or return to surgery are needed. Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is not an adequate response. The patient may need morphine, but this is not the highest priority action.

5. The nurse reads a client's chart and sees that the health care provider assessed mucosal erythroplasia. What should the nurse understand that this means for the client? a. Early sign of oral cancer b. Fungal mouth infection c. Inflammation of the gums d. Obvious oral tumor

ANS: A Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor. DIF: Remembering/Knowledge REF: 1102 KEY: Oral disorders| cancer| pathophysiology MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best? a. Ask the client about shellfish allergies. b. Document this information on the chart. c. Ensure that the client has a ride home. d. Instruct the client on bowel preparation.

ANS: A PTC uses iodinated dye, so the client should be asked about seafood allergies, specifically to shellfish. Documentation should occur, but this is not the priority. The client will need a ride home afterward if the procedure is done on an outpatient basis. There is no bowel preparation for PTC. DIF: Applying/Application REF: 1093 KEY: Gastrointestinal system| gastrointestinal assessment| allergies| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

18. Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea? a. Obtain a stool specimen for culture. b. Administer antidiarrheal medication. c. Provide teaching about antibiotic therapy. d. Teach about adverse effects of acetaminophen (Tylenol).

ANS: A Patients with bloody diarrhea should have a stool culture for E. coli O157:H7. Antidiarrheal medications are usually avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications. Acetaminophen does not cause bloody diarrhea.

4. A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? a. "It's a good thing I love orange and cherry gelatin." b. "My spouse will be here to drive me home." c. "I should refrigerate the GoLYTELY before use." d. "I will buy a case of Gatorade before the prep."

ANS: A The client should be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show a good understanding of the preparation for the procedure. DIF: Evaluating/Synthesis REF: 1095 KEY: Gastrointestinal system| gastrointestinal assessment| patient education MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

7. To palpate the liver during a head-to-toe physical assessment, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.

ANS: A The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.

15. A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.

ANS: A The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.

5. Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa? a. Avoid use of cigarettes and smokeless tobacco. b. Use sunscreen when outside even on cloudy days. c. Complete antibiotic courses used to treat throat infections. d. Use antivirals to treat herpes simplex virus (HSV) infections.

ANS: A Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer.

4.The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a. "I just joined a gym, so I hope that helps me lose weight." b. "I sure hate to give up my coffee, but I guess I have to." c. "I will eat three small meals and three small snacks a day." d. "Sitting upright and not lying down after meals will help." e. "Smoking a pipe is not a problem and I don't have to stop."

ANS: A, B, C, D Lifestyle modifications can help control GERD and include losing weight if needed; avoiding chocolate, caffeine, and carbonated beverages; eating frequent small meals or snacks; and remaining upright after meals. Tobacco is a risk factor for GERD and should be avoided in all forms. DIF:Understanding/ComprehensionREF:1113 KEY: Gastrointestinal disorders| lifestyle modifications| patient education MSC:Integrated Process: Nursing Process: Evaluation NOT:Client Needs Category: Health Promotion and Maintenance

3.A client has been discharged to an inpatient rehabilitation center after an esophagogastrectomy. What menu selections by the client at the rehabilitation center indicate a good understanding of dietary instructions? (Select all that apply.) a. Boost™ supplement b. Greek yogurt c. Scrambled eggs d. Whole milk shake e. Whole wheat toast

ANS: A, B, C, D Malnutrition is a serious problem after this procedure. The client needs high-protein, high-calorie foods that are easy to chew and swallow. The Boost supplement, Greek yogurt, scrambled eggs, and whole milk shake are all good choices. The whole wheat bread, while heart healthy, is not a good choice as it is dry and not easy to chew and swallow. DIF:Evaluating/SynthesisREF:1122 KEY:Gastrointestinal disorders| nutrition| patient education MSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE 1.The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections

ANS: A, B, C, D Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is. DIF:Remembering/KnowledgeREF:1111 KEY: Gastrointestinal disorders MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

4. The nurse working in the gastrointestinal clinic sees clients who are anemic. What are common causes for which the nurse assesses in these clients? (Select all that apply.) a. Colon cancer b. Diverticulitis c. Inflammatory bowel disease d. Peptic ulcer disease e. Pernicious anemia

ANS: A, B, C, D In adults, the most common cause of anemia is GI bleeding. This is commonly associated with colon cancer, diverticulitis, inflammatory bowel disease, and peptic ulcer disease. Pernicious anemia is not associated with GI bleeding. DIF: Remembering/Knowledge REF: 1091 KEY: Gastrointestinal system| laboratory values| gastrointestinal assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. Helicobacter pylori infection d. Iron deficiency anemia e. Pernicious anemia

ANS: A, B, C, E

3. The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A, B, C, E

5. When working with older adults to promote good nutrition, what actions by the nurse are most appropriate? (Select all that apply.) a. Allow uninterrupted time for eating. b. Assess dentures for appropriate fit. c. Ensure the client has glasses on when eating. d. Provide salty foods that the client can taste. e. Serve high-calorie, high-protein snacks.

ANS: A, B, C, E

2. A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse instructs the client and family about the signs of potential complications, which include what problems? (Select all that apply.) a. Cholangitis b. Pancreatitis c. Perforation d. Renal lithiasis e. Sepsis

ANS: A, B, C, E Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP. DIF: Understanding/Comprehension REF: 1095 KEY: Gastrointestinal system| diagnostic testing| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.) a. Decreased hydrochloric acid production b. Diminished sensation that can lead to constipation c. Fat not digested as well in older adults d. Increased peristalsis in the large intestine e. Pancreatic vessels become calcified

ANS: A, B, C, E Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels. DIF: Remembering/Knowledge REF: 1088 KEY: Gastrointestinal system| older adult MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

4. A nurse plans care for a client who is recovering from an inguinal hernia repair. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Encouraging ambulation three times a day b. Encouraging normal urination c. Encouraging deep breathing and coughing d. Providing ice bags and scrotal support e. Forcibly reducing the hernia

ANS: A, B, D

7. A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) a. Lower gastrointestinal bleeding Erosion of the bowel wall b. Abscess formation Localized pockets of infection develop in the ulcerated bowel lining c. Toxic megacolon Transmural inflammation resulting in pyuria and fecaluria d. Nonmechanical bowel obstruction Paralysis of colon resulting from colorectal cancer e. Fistula Dilation and colonic ileus caused by paralysis of the colon

ANS: A, B, D

7. A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this clients plan of care? (Select all that apply.) a. Using premoistened disposable wipes for perineal care b. Turning the client from right to left every 2 hours c. Using an antibacterial soap to clean after each stool d. Applying a barrier cream to the skin after cleaning e. Keeping broken skin areas open to air to promote healing

ANS: A, B, D

2.The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assisting with position changes and getting out of bed b. Keeping the head of the bed elevated to at least 30 degrees c. Reminding the client to use the spirometer every 4 hours d. Taking and recording vital signs per hospital protocol e. Titrating oxygen based on the client's oxygen saturations

ANS: A, B, D The UAP can assist with mobility, keep the head of the bed elevated, and take and record vital signs. The client needs to use the spirometer every 1 to 2 hours. The nurse titrates oxygen. DIF:Applying/ApplicationREF:1122 KEY: Gastrointestinal disorders| postoperative nursing| delegation| unlicensed assistive personnel (UAP) MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

1. A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood? (Select all that apply.) a. Ask a second nurse to double-check the blood. b. Prime the IV tubing with normal saline. c. Prime the IV tubing with dextrose in water. d. Take and record a set of vital signs. e. Teach the client about reaction manifestations.

ANS: A, B, D, E

3. A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this clients assessment? (Select all that apply.) a. Which food types cause an exacerbation of symptoms? b. Where is your pain and what does it feel like? c. Have you lost a significant amount of weight lately? d. Are your stools soft, watery, and black in color? e. Do you experience nausea associated with defecation?

ANS: A, B, E

6. A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition? (Select all that apply.) a. Administer vitamin B12 injections. b. Ask the provider about folic acid replacement. c. Educate the client on enteral feedings. d. Obtain consent for total parenteral nutrition. e. Provide iron supplements for the client.

ANS: A, B, E

6. A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Distended abdomen b. Inability to pass flatus c. Bradycardia d. Hyperactive bowel sounds e. Decreased urine output

ANS: A, B, E

7. A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown bag. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.

ANS: A, B, E

MULTIPLE RESPONSE 1. The nurse is caring for a client with sialadenitis. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Applying warm compresses b. Massaging salivary glands c. Offering fluids every hour d. Providing lemon-glycerin swabs e. Reminding the client to avoid speaking

ANS: A, C The UAP can apply warm compresses and offer fluids. Massaging salivary glands can be done, but not by the UAP. Lemon-glycerin swabs are drying and should not be used. Speaking has no effect on this condition. DIF: Applying/Application REF: 1108 KEY: Delegation| oral disorders| comfort measures| unlicensed assistive personnel (UAP) MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE 1. The nurse is aware of the 2014 American Cancer Society Screening Guidelines for colon cancer, which include which testing modalities for people over the age of 50? (Select all that apply.) a. Colonoscopy every 10 years b. Colonoscopy every 5 years c. Computed tomography (CT) colonography every 5 years d. Double-contrast barium enema every 10 years e. Flexible sigmoidoscopy every 10 years

ANS: A, C The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years. DIF: Remembering/Knowledge REF: 1093 KEY: Gastrointestinal system| gastrointestinal assessment| cancer| health promotion MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Health Promotion and Maintenance

5. After teaching a client with an anal fissure, a nurse assesses the clients understanding. Which client actions indicate that the client correctly understands the teaching? (Select all that apply.) a. Taking a warm sitz bath several times each day b. Utilizing a daily enema to prevent constipation c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories e. Taking a laxative each morning

ANS: A, C, D

1. The nurse understands that malnutrition can occur in hospitalized clients for several reasons. Which are possible reasons for this to occur? (Select all that apply.) a. Cultural food preferences b. Family bringing snacks c. Increased need for nutrition d. Need for NPO status e. Staff shortages

ANS: A, C, D, E

2. A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Wash leafy vegetables carefully before eating or cooking them. b. Do not ingest water from the garden hose or the pool. c. Wash your hands before and after using the bathroom. d. Be sure meat is cooked to the proper temperature. e. Avoid eating eggs that are sunny side up or undercooked.

ANS: A, C, D, E

47. The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) a. Acupuncture b. Decreasing physical activities c. Meditation d. Peppermint oil capsules e. Yoga

ANS: A, C, D, E

48. The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) a. Broccoli b. Buttermilk c. Mushrooms d. Onions e. Peas f. Yogurt

ANS: A, C, D, E

6.A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce

ANS: A, C, D, E Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided. DIF:Understanding/ComprehensionREF:1111 KEY:Gastrointestinal disorders| patient education MSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A nurse studying cancer knows that job-related risks for developing oral cancer include which occupations? (Select all that apply.) a. Coal miner b. Electrician c. Metal worker d. Plumber e. Textile worker

ANS: A, C, D, E The occupations of coal mining, metal working, plumbing, and textile work produce exposure to polycyclic aromatic hydrocarbons (PAHs), which are known carcinogens. Electricians do not have this risk. 1.A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective? a. "I can only take this medicine at night." b. "I should take this on a full stomach." c. "This drug decreases stomach acid." d. "This should be taken 1 hour before meals."***ANS: B Gaviscon should be taken with food in the stomach. It can be taken with meals at any time. Its mechanism of action is not to decrease stomach acid. DIF:Evaluating/SynthesisREF:1113 KEY:Gastrointestinal disorders| antacids| patient education MSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

1. A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly? (Select all that apply.) a. Performs hand hygiene and positions the client in high-Fowlers position, with pillows behind the head and shoulders b. Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx c. Checks for correct placement by checking the pH of the fluid aspirated from the tube d. Secures the NG tube by taping it to the clients nose and pinning the end to the pillowcase e. Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

ANS: A, C, E

4. A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this groups teaching? (Select all that apply.) a. Rotavirus is more common among infants and younger children. b. Escherichia coli diarrhea is transmitted by contact with infected animals. c. To prevent E. coli infection, dont drink water when swimming. d. Clients who have botulism should be quarantined within their home. e. Parasitic diseases may not show up for 1 to 2 weeks after infection.

ANS: A, C, E

5. A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L b. Loss of 15 pounds without dieting c. Abdominal pain in upper quadrants d. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L

ANS: A, C, E

3. A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this groups teaching? (Select all that apply.) a. Wash your hands after any contact with animals. b. It is not necessary to buy a meat thermometer. c. Stay away from people who are ill with diarrhea. d. Use separate cutting boards for meat and vegetables. e. Avoid swimming in backyard pools and using hot tubs.

ANS: A, D

4. A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

ANS: A, D

8. A nurse cares for a client who has a nasogastric (NG) tube. Which actions should the nurse take? (Select all that apply.) a. Assess for proper placement of the tube every 4 hours. b. Flush the tube with water every hour to ensure patency. c. Secure the NG tube to the clients upper lip. d. Disconnect suction when auscultating bowel peristalsis. e. Monitor the clients skin around the tube site for irritation.

ANS: A, D, E

80. The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider? (Select all that apply.) a. Anorexia b. Depression c. Drowsiness d. Frequent urination e. Headache f. Vomiting

ANS: A, E, F

1. After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the clients understanding. Which menu selection indicates that the client correctly understands the dietary teaching? a. Ham sandwich on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice c. Grilled cheese sandwich, small banana, cup of hot tea with lemon d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

ANS: B

1. The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.

ANS: B

10. An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the clients lower abdomen. Which action should the nurse take first? a. Measure the clients abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the clients hemoglobin and hematocrit. d. Obtain the clients complete health history.

ANS: B

103. A client has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The client is receiving continuous enteral feedings through a nasogastric (NG) tube. What does the RN ask the LPN/LVN to do for this client? a. Assess nutritional parameters on the client every 3 days. b. Check the residual volume of the NG tube every 4 hours. c. Monitor the client for signs and symptoms of pneumonia. d. Teach the client about the purpose of enteral feedings.

ANS: B

11. A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a. Do you have family or friends for support? b. Id like to know what you are feeling now. c. Well, we knew this would probably happen. d. Would you like me to refer you to hospice?

ANS: B

12. A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best? a. Slippery elm has no benefit for this problem. b. Slippery elm is often used for this disorder. c. There is no evidence that this will work. d. You should not take any herbal remedies.

ANS: B

12. A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, I need to have a bowel movement. Which action should the nurse take? a. Obtain a bedside commode for the client to use. b. Stay with the client while providing privacy. c. Make sure the call light is in reach to signal completion. d. Gather supplies to collect a stool sample for the laboratory.

ANS: B

13. A morbidly obese client is admitted to a community hospital that does not typically care for bariatric-sized clients. What action by the nurse is most appropriate? a. Assess the clients readiness to make lifestyle changes. b. Ensure adequate staff when moving the client. c. Leave siderails down to prevent pressure ulcers. d. Reinforce the need to be sensitive to the client.

ANS: B

14. After teaching a client who has a new colostomy, the nurse provides feedback based on the clients ability to complete self-care activities. Which statement should the nurse include in this feedback? a. I realize that you had a tough time today, but it will get easier with practice. b. You cleaned the stoma well. Now you need to practice putting on the appliance. c. You seem to understand what I taught you today. What else can I help you with? d. You seem uncomfortable. Do you want your daughter to care for your ostomy?

ANS: B

14. The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching? a. "I will need to avoid sweetened fruit juice beverages." b. "I can eat ice cream in moderation." c. "I cannot drink alcohol at all." d. "It is okay to have a serving of sugar-free pudding."

ANS: B

15. A nurse assesses a client who is hospitalized for botulism. The clients vital signs are temperature: 99.8 F (37.6 C), heart rate: 100 beats/min, respiratory rate: 10 breaths/min, and blood pressure: 100/62 mm Hg. Which action should the nurse take? a. Decrease stimulation and allow the client to rest. b. Stay with the client while another nurse calls the provider. c. Increase the clients intravenous fluid replacement rate. d. Check the clients blood glucose and administer orange juice.

ANS: B

16. An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the familys wishes. d. Tell the family that such secrets cannot be kept.

ANS: B

16. Several nurses have just helped a morbidly obese client get out of bed. One nurse accesses the clients record because I just have to know how much she weighs! What action by the clients nurse is most appropriate? a. Make an anonymous report to the charge nurse. b. State That is a violation of client confidentiality. c. Tell the nurse Dont look; Ill tell you her weight. d. Walk away and ignore the other nurses behavior.

ANS: B

17. A nurse cares for a middle-aged male client who has irritable bowel syndrome (IBS). The client states, I have changed my diet and take bulk-forming laxatives, but my symptoms have not gotten better. I heard about a drug called Amitiza. Do you think it might help? How should the nurse respond? a. This drug is still in the research phase and is not available for public use yet. b. Unfortunately, lubiprostone is approved only for use in women. c. Lubiprostone works well. I will recommend this prescription to your provider. d. This drug should not be used with bulk-forming laxatives.

ANS: B

17. Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? a. Retape the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy. b. Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. c. Document instructions for a patient with chronic gastritis about how to use "triple therapy." d. Assess the gag reflex for a patient who has arrived from the post anesthesia care unit after a laparoscopic gastrectomy.

ANS: B

18. A nurse is caring for a morbidly obese client. What comfort measure is most important for the nurse to delegate to the unlicensed assistive personnel (UAP)? a. Designating quiet time so the client can rest b. Ensuring siderails are not causing excess pressure c. Providing oral care before and after meals and snacks d. Relaying any reports of pain to the registered nurse

ANS: B

18. The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? a. Type and crossmatch for 4 units of packed red blood cells. b. Infuse 0.9% normal saline solution at 200 mL/hr. c. Give pantoprazole (Protonix) 40 mg IV now and then daily. d. Insert a nasogastric tube and connect to low intermittent suction.

ANS: B

19. A client is awaiting bariatric surgery in the morning. What action by the nurse is most important? a. Answering questions the client has about surgery b. Beginning venous thromboembolism prophylaxis c. Informing the client that he or she will be out of bed tomorrow d. Teaching the client about needed dietary changes

ANS: B

19. A nurse plans care for a client with Crohns disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this clients plan of care? a. Low-fiber diet b. Skin protection c. Antibiotic administration d. Intravenous glucocorticoids

ANS: B

19. The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? a. Apply antiembolism stockings. b. Place a nasogastric (NG) tube, and connect to suction. c. Insert an indwelling catheter, and check output hourly. d. Give famotidine (Pepcid) 20 mg IV every 12 hours.

ANS: B

2. A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? a. Document the findings in the chart. b. Request an electrocardiogram (ECG). c. Facilitate a serum potassium test. d. Place the client on bedrest.

ANS: B

2. A nurse cares for an older adult client who has Salmonella food poisoning. The clients vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first? a. Apply oxygen via nasal cannula. b. Administer intravenous fluids. c. Provide perineal care with a premedicated wipe. d. Teach proper food preparation to prevent contamination.

ANS: B

21. A nurse cares for a client with a new ileostomy. The client states, I dont think my friends will accept me with this ostomy. How should the nurse respond? a. Your friends will be happy that you are alive. b. Tell me more about your concerns. c. A therapist can help you resolve your concerns. d. With time you will accept your new body.

ANS: B

25. A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? a. "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." b. "I need to go for a walk every evening." c. "Maintaining a low-fiber diet will manage my constipation." d. "Limiting the amount of fluid that I drink with meals is very important."

ANS: B

3. A nurse is reviewing laboratory values for several clients. Which value causes the nurse to conduct nutritional assessments as a priority? a. Albumin: 3.5 g/dL b. Cholesterol: 142 mg/dL c. Hemoglobin: 9.8 mg/dL d. Prealbumin: 28 mg/dL

ANS: B

30. A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? a. Femoral b. Reducible c. Strangulated d. Incarcerated

ANS: B

31. A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? a. "I may have trouble urinating immediately after the surgery." b. "I will need to stay in the hospital overnight." c. "I will not eat after midnight the day of the surgery." d. "My chances of having complications after this procedure are slim."

ANS: B

32. A patient with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? a. Decrease in liver function test results b. Elevated carcinoembryonic antigen c. Elevated hemoglobin levels d. Negative test for occult blood

ANS: B

38. The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? a. "I would take Ex-Lax after the surgery to 'keep things moving'." b. "I will need to eat a diet high in fiber." c. "Limiting my fluids will help me with constipation." d. "To help with the pain, I'll apply ice to the surgical area."

ANS: B

4. A client is receiving bolus feedings through a Dobhoff tube. What action by the nurse is most important? a. Auscultate lung sounds after each feeding. b. Check tube placement before each feeding. c. Check tube placement every 8 hours. d. Weigh the client daily on the same scale.

ANS: B

4. A nurse assesses a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which action should the nurse take? a. Assess the clients heart rate and blood pressure. b. Determine when the client last voided. c. Ask if the client is experiencing flatus. d. Auscultate all quadrants of the clients abdomen.

ANS: B

4. A patient has a long-term history of Crohn's disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? a. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." b. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." c. "What has your doctor told you about how your gastritis developed?" d. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

ANS: B

4. After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will let my husband do all of the cooking for my family. b. Ill take the ciprofloxacin until the diarrhea has resolved. c. I should wash my hands with antibacterial soap before each meal. d. I must place my dishes into the dishwasher after each meal.

ANS: B

40. A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? a. "During the test, you will drink small amounts of an antacid as directed by the technician." b. "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." c. "The test will take between 30 and 45 minutes to complete." d. "You must have nothing to drink (except water) for 24 hours before the test."

ANS: B

41. A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient's incision for signs of infection b. Assisting the patient to stand to void c. Instructing the patient in how to deep-breathe d. Monitoring the patient's pain level

ANS: B

42. The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? a. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. b. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern c. A 40-year-old with a reducible inguinal hernia asking questions about surgery. d. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

ANS: B

5. A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's bestresponse? a. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." b. "These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." c. "Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them." d. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

ANS: B

53. A patient with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? a. Asks the patient whether family members could be trained in stoma care b. Has another patient with a stoma who performs self-care talk with the patient c. Requests that the primary health care provider request antidepressants and a psychiatric consult d. Suggests that the primary health care provider request a home health consultation so stoma care can be performed by a home health nurse

ANS: B

55. A Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include? a. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." b. "Call your primary health care provider if your stoma has a bluish or pale look." c. "Notify the primary health care provider if output from your stoma has a sweetish odor." d. "Remember that you must wear a pouch system at all times."

ANS: B

57. A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)? a. Abdominal pain relieved by bending the knees, constipation b. Chronic diarrhea, abdominal colicky pain, and fever c. Epigastric cramping & persistent rectal bleeding d. Hypotension with vomiting and headache

ANS: B

58. A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? a. Bacteria on the patient's hands b. Ingestion of parasites in the water c. Insufficient vaccinations d. Overcooked food

ANS: B

59. Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? a. Patients with CD experience about 20 loose, bloody stools daily. b. Patients with UC may experience hemorrhage. c. The peak incidence of UC is between 15 and 40 years of age. d. Very few complications are associated with CD.

ANS: B

6. An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.

ANS: B

61. A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient? a. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." c. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." d. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

ANS: B

63. A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime? a. "Avoid all solid foods to allow complete bowel rest." b. "Consume extra fluids to replace fluid losses." c. "Take an over-the-counter antidiarrheal medication." d. "Contact your primary health care provider for an antibiotic medication."

ANS: B

70. Which patient does the charge nurse assign to an experienced LPN/LVN? a. A 28-year-old who requires teaching about how to catheterize a Kock ileostomy b. A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy c. A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 (23 × 109/L) d. A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

ANS: B

71. The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first? a. A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift b. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C) c. A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it d. A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

ANS: B

77. A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? a. "You may have contracted it from an infected infant." b. "You may have consumed contaminated food or water." c. "You may have come into contact with an infected animal." d. "You may have had contact with the blood of an infected person."

ANS: B

78. A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe? a. Balsalazide (Colazal) b. Loperamide (Imodium) c. Mesalamine (Asacol) d. Milk of Magnesia (MOM)

ANS: B

8. A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? a. Contact the provider and recommend a psychiatric consult for the client. b. Encourage the client to verbalize feelings about the diagnosis. c. Provide education about new treatment options with successful outcomes. d. Ask family and friends to visit the client and provide emotional support.

ANS: B

8. After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. Ill rinse my rectal area with warm water after each stool and apply zinc oxide ointment. b. I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel. c. I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry. d. I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment.

ANS: B

81. An older client is at risk for malnutrition. Which nursing intervention is most appropriate to ensure optimum nutritional intake? a. Administering antiemetics and analgesics after meals b. Assisting the client with toileting and oral care prior to meals c. Turning on the television during meals to provide distraction d. Reminding UAPs to allow the client to remain in bed during meals

ANS: B

89. An older adult with severe rheumatoid arthritis in the upper extremities is malnourished. What does the nurse suspect as the cause of this client's malnutrition? a. A decrease in the client's appetite b. Decreasing ability to manipulate eating utensils c. Inadequate income to purchase sufficient food d. Metabolic requirements that are increased owing to immobility

ANS: B

9. A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)? a. Lavaging the tube with ice water b. Performing frequent oral care c. Re-positioning the tube every 4 hours d. Taking and recording vital signs

ANS: B

9. After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will avoid large crowds and people who are sick. b. I will take this medication with my breakfast each morning. c. Nausea and vomiting are common side effects of this drug. d. I must wash my hands after I play with my dog.

ANS: B

90. Which serum albumin level does the nurse expect to see in a healthy, ambulatory adult client? a. 2.3 g/dL (23 g/L) b. 3.7 g/dL (37 g/L) c. 5.1 g/dL (51 g/L) d. 5.8 g/dL (58 g/L)

ANS: B

91. An underweight client is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the client? a. Keeps an accurate and precise food and fluid intake record daily b. Makes certain the client is weighed daily at the same time c. Monitors vital signs every 4 hours and as needed d. Assesses the client's skin for evidence of breakdown weekly

ANS: B

98. The nurse is teaching a group of adults in the community about the 2015-2020 Dietary Guidelines for Americans. What does the nurse emphasize as a dietary strategy suggested in these guidelines? a. Half of each meal should consist of dairy, fruits, and proteins. b. Adults should focus on variety and nutrient density and not calories. c. Older adults should consider lacto-ovarian diets for improved health. d. Adults should include a multivitamin with iron and vitamin B12 in their diet.

ANS: B

4.A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met? a. Choosing foods that are easy to swallow b. Lungs clear after meals and snacks c. Properly performing swallowing exercises d. Weight unchanged after 2 weeks

ANS: B All these assessment findings are positive for this client. However, this client is at high risk for aspiration. Clear lungs after eating indicates no aspiration has occurred. Choosing easy-to-swallow foods, performing swallowing checks, and having an unchanged weight do not assess aspiration, and therefore do not indicate that the priority goal has been met. DIF:Evaluating/SynthesisREF:118 KEY:Gastrointestinal disorders| respiratory assessment| patient safety MSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

6.A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best? a. Arrange an intensive care unit tour. b. Assess the client's psychosocial status. c. Document the teaching and response. d. Have the client begin nutritional supplements.

ANS: B Clients facing this long, difficult procedure are often anxious and fearful. The nurse should now assess the client's psychosocial status and provide the care and teaching required based on this assessment. An intensive care unit tour may help decrease stress but is too limited in scope to be the best response. Documentation should be thorough, but the nurse needs to do more than document. The client should begin nutritional supplements prior to the operation, but again this response is too limited in scope. DIF:Applying/ApplicationREF:1120 KEY: Gastrointestinal disorders| psychosocial response| nursing assessment| coping MSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Psychosocial Integrity

5.A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client? a. Enteral tube feeding b. Esophageal dilation c. Nissen fundoplication d. Photodynamic therapy

ANS: B Esophageal dilation can provide immediate relief of esophageal strictures that impair swallowing. Enteral tube feeding is a method of providing nutrition when dysphagia is severe, but esophageal dilation would be attempted before this measure is taken. Nissen fundoplication is performed for severe gastroesophageal reflux disease. Photodynamic therapy is performed for esophageal cancer. DIF:Understanding/ComprehensionREF:1120 KEY:Gastrointestinal disorders| patient education MSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

10.A client has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first? a. Notify the surgeon. b. Put on a pair of gloves. c. Reinsert the NG tube. d. Take a set of vital signs.

ANS: B To avoid exposure to blood and body fluids, the nurse first puts on a pair of gloves. Taking vital signs and notifying the surgeon are also appropriate, but the nurse must protect himself or herself first. The surgeon will reinsert the NG tube either at the bedside or in surgery if the client needs to go back to the operating room. DIF:Applying/ApplicationREF:1114 KEY:Gastrointestinal disorders| Standard Precautions MSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

4. The nurse will plan to monitor a patient with an obstructed common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels.

ANS: B A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.

36. A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which order from the health care provider will the nurse implement first? a. Insert a nasogastric (NG) tube. b. Infuse normal saline at 250 mL/hr. c. Administer IV ondansetron (Zofran). d. Provide oral care with moistened swabs.

ANS: B Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.

1. The student nurse studying the gastrointestinal system understands that chyme refers to what? a. Hormones that reduce gastric acidity b. Liquefied food ready for digestion c. Nutrients after being absorbed d. Secretions that help digest food

ANS: B Before being digested, food must be broken down into a liquid form. This liquid is called chyme. Secretin is the hormone that inhibits acid production and decreases gastric motility. Absorption is carried out as the nutrients produced by digestion move from the lumen of the GI tract into the body's circulatory system for uptake by individual cells. The secretions that help digest food include hydrochloric acid, bile, and digestive enzymes. DIF: Remembering/Knowledge REF: 1085 KEY: Gastrointestinal system MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting? a. Glass of orange juice b. Dish of lemon gelatin c. Cup of coffee with cream d. Bowl of hot chicken broth

ANS: B Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.

11. A client who has been taking antibiotics reports severe, watery diarrhea. About which test does the nurse teach the client? a. Colonoscopy b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B c. Ova and parasites d. Stool culture

ANS: B Clients taking antibiotics are at risk for Clostridium difficile infection. The most common test for this disorder is a stool sample for ELISA toxin A+B. Colonoscopy, ova and parasites, and stool culture are not warranted at this time. DIF: Understanding/Comprehension REF: 1093 KEY: Gastrointestinal system| gastrointestinal assessment| diagnostic testing| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

16. The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following? a. "The cobalamin injections will prevent gastric inflammation." b. "The cobalamin injections will prevent me from becoming anemic." c. "These injections will increase the hydrochloric acid in my stomach." d. "These injections will decrease my risk for developing stomach cancer."

ANS: B Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer.

12. Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a. "Peppermint tea may reduce your symptoms." b. "Keep the head of your bed elevated on blocks." c. "You should avoid eating between meals to reduce acid secretion." d. "Vigorous physical activities may increase the incidence of reflux."

ANS: B Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

13. Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? a. Notify the doctor about bloody nasogastric (NG) drainage. b. Elevate the head of the bed to at least 30 degrees. c. Reposition the NG tube if drainage stops. d. Start oral fluids when the patient has active bowel sounds.

ANS: B Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.

22. A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will a. decrease nausea and vomiting. b. inhibit development of stress ulcers. c. lower the risk for H. pylori infection. d. prevent aspiration of gastric contents.

ANS: B Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.

13. A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area

ANS: B Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.

21. Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)? a. "Ranitidine absorbs the gastric acid." b. "Ranitidine decreases gastric acid secretion." c. "Ranitidine constricts the blood vessels near the ulcer." d. "Ranitidine covers the ulcer with a protective material."

ANS: B Ranitidine is a histamine-2 (H2) receptor blocker, which decreases the secretion of gastric acid. The response beginning, "Ranitidine constricts the blood vessels" describes the effect of vasopressin. The response "Ranitidine absorbs the gastric acid" describes the effect of antacids. The response beginning "Ranitidine covers the ulcer" describes the action of sucralfate (Carafate).

12. The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ? a. Kidneys b. Liver c. Spleen d. Stomach

ANS: B Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue. DIF: Remembering/Knowledge REF: 1091 KEY: Gastrointestinal system| laboratory values| pathophysiology MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

32. A 26-year-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid a. emotionally stressful situations. b. smoked foods such as ham and bacon. c. foods that cause distention or bloating. d. chronic use of H2 blocking medications.

ANS: B Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.

4. A nurse has conducted a community screening event for oral cancer. What client is the highest priority for referral to a dentist? a. Client who has poor oral hygiene practices b. Client who smokes and drinks daily c. Client who tans for an upcoming vacation d. Client who occasionally uses illicit drugs

ANS: B Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not related to the etiology of cancer but may cause a tumor to go unnoticed. Tanning is a risk factor, but short-term exposure does not have the same risk as daily exposure to tobacco and alcohol. Illicit drugs are not related to oral cancers. DIF: Understanding/Comprehension REF: 1103 KEY: Oral disorders| health screening| primary prevention| nursing assessment MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Health Promotion and Maintenance

30. Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? a. "You will need to remain on a bland diet." b. "Avoid foods that cause pain after you eat them." c. "High-protein foods are least likely to cause you pain." d. "You should avoid eating any raw fruits and vegetables."

ANS: B The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa, but chewing well seems to decrease this problem and some patients may tolerate these foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.

7. A nurse is caring for four clients. After receiving the hand-off report, which client should the nurse see first? a. Client having a radial neck dissection tomorrow who is asking questions b. Client who had a tracheostomy 4 hours ago and needs frequent suctioning c. Client who is 1 day postoperative for an oral tumor resection who is reporting pain d. Client waiting for discharge instructions after a small tumor resection

ANS: B The client who needs frequent suctioning should be seen first to ensure that his or her airway is patent. The client waiting for pain medication should be seen next. The nurse may need to call the surgeon to see the client who is asking questions. The client waiting for discharge instructions can be seen last. DIF: Applying/Application REF: 1104 KEY: Oral disorders| airway| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

17. Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori? a. Sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol) b. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) c. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix) d. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan)

ANS: B The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

2. A 62- year-old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.

ANS: B The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes.

13. A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is best? a. Allow the client cool liquids only. b. Assess the client's gag reflex. c. Remind the client to remain NPO. d. Tell the client to wait 4 hours.

ANS: B The local anesthetic used during this procedure will depress the client's gag reflex. After the procedure, the nurse should ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the client's readiness for them. DIF: Understanding/Comprehension REF: 1094 KEY: Gastrointestinal assessment| diagnostic testing| patient safety MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

44. The nurse and a licensed practical/vocational nurse (LPN/LVN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/LVN requires that the nurse intervene? a. The LPN/LVN uses soft swabs to provide for oral care. b. The LPN/LVN positions the head of the bed in the flat position. c. The LPN/LVN encourages the patient to use pain medications before coughing. d. The LPN/LVN includes the enteral feeding volume when calculating intake and output.

ANS: B The patient's bed should be in Fowler's position to prevent reflux and aspiration of gastric contents. The other actions by the LPN/LVN are appropriate.

41. The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? a. The bowel sounds are hyperactive in all four quadrants. b. The patient's lungs have crackles audible to the midchest. c. The nasogastric (NG) suction is returning coffee-ground material. d. The patient's blood pressure (BP) has increased to 142/84 mm Hg.

ANS: B The patient's lung sounds indicate that pulmonary edema may be developing as a result of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding.

24. A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? a. Irrigate the NG tube. b. Check the vital signs. c. Give the ordered antacid. d. Elevate the foot of the bed.

ANS: B The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.

23. A 68-year-old patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse a. monitors arterial blood gas values daily. b. periodically aspirates and tests gastric pH. c. checks each stool for the presence of occult blood. d. measures the volume of residual stomach contents.

ANS: B The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal (GI) bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.

17. Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly? a. 1 b. 2 c. 3 d. 4

ANS: B The spleen is usually not palpable, but when palpated, it is located in left upper quadrant of abdomen.

10. A nurse assesses a client's oral cavity and observes the condition depicted in the photo below: What action by the nurse is best? a. Ask about the client's human immunodeficiency virus (HIV) status. b. Assess the client for dysphagia. c. Listen to the client's lung sounds. d. Refer the client to an oncologist.

ANS: B This client has oral candidiasis. If the infection extends down the pharynx, the client could have difficulty swallowing. Therefore, the nurse should assess the client for dysphagia. HIV status may or may not be related but is not the priority. Listening to the lungs is unrelated. Since oral candidiasis is an infectious condition, referral to an oncologist is not needed. DIF: Applying/Application REF: 1100 KEY: Oral disorders| nursing assessment| dysphagia MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

9. A client presents to the emergency department reporting severe abdominal pain. On assessment, the nurse finds a bulging, pulsating mass in the abdomen. What action by the nurse is the priority? a. Auscultate for bowel sounds. b. Notify the provider immediately. c. Order an abdominal flat-plate x-ray. d. Palpate the mass and measure its size.

ANS: B This observation could indicate an abdominal aortic aneurysm, which could be life threatening and should never be palpated. The nurse notifies the provider at once. An x-ray may be indicated. Auscultation is part of assessment, but the nurse's priority action is to notify the provider. DIF: Remembering/Knowledge REF: 1090 KEY: Gastrointestinal system| gastrointestinal assessment| nursing assessment| communication MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

11. The nurse is assessing an alert and independent 78-year-old woman for malnutrition risk. The most appropriate initial question is which of the following? a. "How do you get to the store to buy your food?" b. "Can you tell me the food that you ate yesterday?" c. "Do you have any difficulty in preparing or eating food?" d. "Are you taking any medications that alter your taste for food?"

ANS: B This question is the most open-ended, and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question.

Chapter 53: Care of Patients with Oral Cavity Problems Chapter 53: Care of Patients with Oral Cavity Problems Ignatavicius: Medical-Surgical Nursing, 8th Edition MULTIPLE CHOICE 1. A student nurse is providing care to an older client with stomatitis and dysphagia. What action by the student nurse requires the registered nurse to intervene? a. Assisting the client to perform oral care every 2 hours b. Preparing to administer a viscous lidocaine gargle c. Reminding the client not to swallow nystatin (Mycostatin) d. Teaching the client to use a soft-bristled toothbrush

ANS: B Viscous lidocaine gargles or mouthwashes are sometimes prescribed for clients with stomatitis and pain. However, the numbing effect can lead to choking or mouth burns from hot food. This client already has difficulty swallowing, so this medication is not appropriate. Therefore, the nurse should intervene when the student prepares to administer this preparation. The other options are correct actions. DIF: Applying/Application REF: 1102 KEY: Oral disorders| topical anesthetics| fungal infections MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

1. After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the clients understanding. Which statements made by the client indicate that the client correctly understands the teaching? (Select all that apply.) a. Ill have my housekeeper keep my toilet clean. b. I must take a shower or bathe every day. c. I should have my well water tested. d. I will ask my sexual partner to have a stool test. e. I must only eat raw vegetables from my own garden.

ANS: B, C, D

113. An obese client has been taking orlistat (Xenical) 60 mg orally three times a day for 4 weeks, but has only lost 10 pounds (4.5 kg). The health care provider doubles the dosage and recommends behavioral changes. What behavioral changes does the nurse include in the teaching plan? (Select all that apply.) a. Cognitive restructuring to learn negative coping statements b. Keeping a daily food diary c. Identifying emotional and situational factors that stimulate eating d. Increasing exercise e. Seeking behaviors in others that one can model

ANS: B, C, D

2. After teaching a client who is recovering from a colon resection, the nurse assesses the clients understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) a. I must change the ostomy appliance daily and as needed. b. I will use warm water and a soft washcloth to clean around the stoma. c. I might start bicycling and swimming again once my incision has healed. d. Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown. e. I will check the stoma regularly to make sure that it stays a deep red color. f. I must avoid dairy products to reduce gas and odor in the pouch.

ANS: B, C, D

5.The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations? (Select all that apply.) a. Aphasia b. Dysphagia c. Eructation d. Halitosis e. Weight gain

ANS: B, C, D Common signs of esophageal disorders include dysphagia, eructation, halitosis, and weight loss. Aphasia is difficulty with speech, commonly seen after stroke. DIF:Remembering/KnowledgeREF:1124 KEY:Gastrointestinal disorders| nursing assessment MSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

112. The nurse is instructing a group of overweight clients on the complications of obesity that develop when weight is not controlled through diet and exercise. Which lifestyle changes does the nurse emphasize? (Select all that apply.) a. "Begin a weight-training program for building muscle mass." b. "Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." t c. "Eat a variety of foods, especially grain products, vegetables, and fruits." d. "Engage in moderate physical activity for at least 30 minutes each day." e. "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home." f. "Liquid dietary supplements can be substituted safely for solid food while attempting to lose weight."

ANS: B, C, D, E

4. A clients small-bore feeding tube has become occluded after the nurse administered medications. What actions by the nurse are best? (Select all that apply.) a. Attempt to dissolve the clog by instilling a cola product. b. Determine if any of the medications come in liquid form. c. Flush the tube before and after administering medications. d. Mix all medications in the formula and use a feeding pump. e. Try to flush the tube with 30 mL of water and gentle pressure.

ANS: B, C, E

49. A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? (Select all that apply.) a. Antihistamines b. Caffeinated drinks c. Stress d. Sleeping pills e. Combinations of genetic, immunological, and hormonal factors

ANS: B, C, E

5. The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to what organ dysfunctions? (Select all that apply.) a. Alanine aminotransferase: biliary system b. Ammonia: liver c. Amylase: liver d. Lipase: pancreas e. Urine urobilinogen: stomach

ANS: B, D Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function. 1.Which information about an 80-year-old man at the senior center is of most concern to the nurse? a. Decreased appetite b. Unintended weight loss c. Difficulty chewing food d. Complaints of indigestion***ANS: B Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed but are not of as much concern as the weight loss.

3. A nurse is designing a community education program to meet the Healthy People 2020 objectives for nutrition and weight status. What information about these goals does the nurse use to plan this event? (Select all that apply.) a. Decrease the amount of fruit to 1.1 cups/1000 calories. b. Increase the amount of vegetables to 1.1 cups/1000 calories. c. Increase the number of adults at a healthy weight by 25%. d. Reduce the number of adults who are obese by 10%. e. Reduce the consumption of saturated fat by nearly 10%.

ANS: B, D, E

1. The nurse and the dietitian are planning sample diet menus for a patient who is experiencing dumping syndrome. Which sample meal is best for this patient? a. Chicken salad on whole wheat bread b. Liver and onions c. Chicken and rice d. Cobb salad with buttermilk ranch dressing

ANS: C

10. A client tells the nurse about losing weight and regaining it multiple times. Besides eating and exercising habits, for what additional data should the nurse assess as the priority? a. Economic ability to join a gym b. Food allergies and intolerances c. Psychosocial influences on weight d. Reasons for wanting to lose weight

ANS: C

10. A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, I am having trouble swallowing this pill. Which action should the nurse take? a. Contact the clinical pharmacist and request the medication in suspension form. b. Empty the contents of the capsule into applesauce or pudding for administration. c. Ask the health care provider to prescribe the medication as an enema instead. d. Crush the pill carefully and administer it in applesauce or pudding.

ANS: C

100. The nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them? a. "One to two hours of cardiovascular exercise every day is a good idea." b. "Joining a fitness program or gym will help greatly with your exercise." c. "Walking 30 to 40 minutes provides the same benefit as long periods of exercise." d. "You will benefit most if you get into a group that shares your exercise goals."

ANS: C

102. The nurse manager in a long-term care facility plans nutritional assessments of all residents. Which nutritional assessment activity does the nurse delegate to unlicensed assistive personnel (UAP) at the facility? a. Assessing residents' abilities to swallow b. Determining residents' functional status c. Measuring the daily food and fluid intake of residents d. Screening a portion of the residents with the Mini Nutritional Assessment

ANS: C

108. An 87-year-old resident from an extended care facility has not been eating for several days and is admitted to the hospital with a diagnosis of malnutrition. She has an enteral feeding tube placed in her left nostril. Her medications include digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel). The nurse checks the gastric pH of the feeding tube and obtains a value of 6.0, which may indicate that the feeding tube is in the client's lungs. Is there another possible explanation for the nurse to consider? a. No; the feeding tube must be removed. b. No; the potassium effect will prevent the pH from reaching 6.0. c. Yes; the client is taking Zantac. d. Yes; the pH paper has expired and is giving a false reading.

ANS: C

109. An older malnourished client who is taking digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel) develops a severe case of diarrhea. What does the nurse suspect is a possible cause? a. Digoxin (Lanoxin) b. Gastritis c. Potassium chloride (Kay Ciel) d. Ranitidine (Zantac)

ANS: C

11. A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a. Inspection of oral mucosa b. Recent dietary intake c. Heart rate and rhythm d. Percussion of abdomen

ANS: C

110. An obese client is prescribed orlistat (Xenical). The client asks the nurse how the drug works. How does the nurse respond? a. "It decreases the amount of norepinephrine in your brain. This action will increase your feeling of being satisfied on less food." b. "It increases the amount of serotonin in your brain. This action will greatly increase your metabolic rate, and you will burn calories quicker." c. "It inhibits enzymes and changes the way your body digests fats. Because fats are only partially digested and absorbed, calorie intake is decreased." d. "It will alter the chemistry of your brain. Consequently, you will feel full before you overeat."

ANS: C

12. A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority? a. Assess the clients pain. b. Check the surgical incision. c. Ensure an adequate airway. d. Program the morphine pump.

ANS: C

12. The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? a. Administering a histamine2 (H2) antagonist b. Initiating enteral nutrition c. Administering intravenous (IV) fluids d. Administering antianxiety medication

ANS: C

13. A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate? a. Aspirin must be avoided. b. Do not worry about black stools. c. Report diarrhea to your provider. d. Take 1 hour before meals.

ANS: C

14. For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age

ANS: C

16. After teaching a client who has diverticulitis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. Ill ride my bike or take a long walk at least three times a week. b. I must try to include at least 25 grams of fiber in my diet every day. c. I will take a laxative nightly at bedtime to avoid becoming constipated. d. I should use my legs rather than my back muscles when I lift heavy objects.

ANS: C

17. A nurse attempted to assist a morbidly obese client back to bed and had immediate pain in the lower back. What action by the nurse is most appropriate? a. Ask another nurse to help next time. b. Demand better equipment to use. c. Fill out and file a variance report. d. Refuse to assist the client again.

ANS: C

18. A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this clients plan of care? a. You may experience nausea and vomiting for the first few weeks. b. Carbonated beverages can help decrease acid reflux from anastomosis sites. c. Take a stool softener to promote softer stools for ease of defecation. d. You may return to your normal workout schedule, including weight lifting.

ANS: C

19. A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? a. Eat low-fiber and low-residual foods. b. White rice and bread are easier to digest. c. Add vegetables such as broccoli and cauliflower to your new diet. d. Foods high in animal fat help to protect the intestinal mucosa.

ANS: C

2. A nursing student is studying nutritional problems and learns that kwashiorkor is distinguished from marasmus with which finding? a. Deficit of calories b. Lack of all nutrients c. Specific lack of protein d. Unknown cause of malnutrition

ANS: C

24. The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? a. "A dark or purplish-looking stoma is normal and would not concern me." b. "If the skin around the stoma is red or scratched, it will heal soon." c. "I need to check for leakage underneath my colostomy." d. "I need to strive for a very tight fit when applying the barrier around the stoma."

ANS: C

26. A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? a. Steak with pasta b. Spaghetti with tomato sauce c. Steamed broccoli with turkey d. Tuna salad with wheat crackers

ANS: C

29. A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? a. "Are you afraid of what your spouse will think of the colostomy?" b. "Don't worry. You will get used to the colostomy eventually." c. "Tell me what worries you the most about this procedure." d. "Why are you so afraid of having this procedure done?"

ANS: C

3. A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The clients blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.

ANS: C

36. A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? a. Attaching the tube to low intermittent suction b. Auscultating for bowel sounds and peristalsis while the suction runs c. Connecting the tube to low continuous suction d. Flushing the tube with 30 mL of normal saline every 24 hours

ANS: C

4. A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a. Assess the client for iodine or shellfish allergies. b. Educate the client on the side effects of sedation. c. Inform the client a second scan may be needed. d. Teach the client about bowel preparation for the scan.

ANS: C

43. A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? a. "A combination of chemotherapeutic agents has caused them." b. "GI problems are symptoms of the advanced stage of your disease." c. "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." d. "You have these as a result of the radiation treatment."

ANS: C

5. A client having a tube feeding begins vomiting. What action by the nurse is most appropriate? a. Administer an antiemetic. b. Check the clients gastric residual. c. Hold the feeding until the nausea subsides. d. Reduce the rate of the tube feeding by half.

ANS: C

5. A nurse assesses a client who is hospitalized with an exacerbation of Crohns disease. Which clinical manifestation should the nurse expect to find? a. Positive Murphys sign with rebound tenderness to palpitation b. Dull, hypoactive bowel sounds in the lower abdominal quadrants c. High-pitched, rushing bowel sounds in the right lower quadrant d. Reports of abdominal cramping that is worse at night

ANS: C

6. A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

ANS: C

6. The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? a. "It is okay to continue to drink coffee in the morning when I get to work." b. "I will need to take vitamin B12 shots for the rest of my life." c. "I should avoid alcohol and tobacco." d. "I should eat small meals about six times a day."

ANS: C

64. A patient returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this patient after the patient is situated in bed? a. High Fowler's b. Lateral Sims' (side-lying) c. Semi-Fowler's d. Supine

ANS: C

65. A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? a. "Drinking carbonated beverages will help with your abdominal distress." b. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." c. "Lactose-containing foods should be reduced or eliminated from your diet." d. "Raw vegetables and high-fiber foods may help to diminish your symptoms."

ANS: C

69. A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care? a. Instructing the patient about the use of electrolyte-containing oral rehydration products b. Administering loperamide (Imodium) 4 mg from the patient's medicine cabinet c. Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions d. Teaching the patient how to clean the perineal area after each loose stool

ANS: C

7. A nurse cares for a teenage girl with a new ileostomy. The client states, I cannot go to prom with an ostomy. How should the nurse respond? a. Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance. b. The pouch wont be as noticeable if you avoid broccoli and carbonated drinks prior to the prom. c. Lets talk to the enterostomal therapist about options for ostomy supplies and dress styles. d. You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable.

ANS: C

7. A nurse is caring for four clients receiving enteral tube feedings. Which client should the nurse see first? a. Client with a blood glucose level of 138 mg/dL b. Client with foul-smelling diarrhea c. Client with a potassium level of 2.6 mEq/L d. Client with a sodium level of 138 mEq/L

ANS: C

7. A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, My doctor told me that the fecal occult blood test was negative for colon cancer. I dont think I need the colonoscopy and would like to cancel it. How should the nurse respond? a. Your doctor should not have given you that information prior to the colonoscopy. b. The colonoscopy is required due to the high percentage of false negatives with the blood test. c. A negative fecal occult blood test does not rule out the possibility of colon cancer. d. I will contact your doctor so that you can discuss your concerns about the procedure.

ANS: C

7. The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor

ANS: C

73. An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action? a. Pain when coughing b. States, "I am too tired to walk very much" c. States, "I feel like the incision is splitting open" d. Temperature of 100.8°F (38.2°C).

ANS: C

75. A patient with ulcerative colitis (UC) is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen? a. Corticosteroid therapy will be stopped. b. Sulfasalazine (Azulfidine) will be stopped. c. Corticosteroid therapy will be tapered. d. Sulfasalazine (Azulfidine) will be tapered.

ANS: C

79. A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient? a. Applying hydrocortisone cream b. Cleaning the area with soap and hot water c. Using sitz baths three times daily d. Wearing absorbent cotton underwear

ANS: C

8. A nurse answers a clients call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.

ANS: C

85. The nurse is performing a health assessment on an obese client who states, "I have tried many diets in an effort to lose weight, but have been unsuccessful." How does the nurse assess whether the client's response to stress is related to the client's obesity? a. "Do you have a history of mental problems, especially depression?" b. "Do you usually use alcohol or drugs when you feel stressed?" c. "Tell me what you do to relieve stress in your daily life." d. "What is it about your obesity that causes you to feel uncomfortable?"

ANS: C

86. A young adult man says that he cannot stay on a diet because of trouble finding one that will incorporate his food preferences. How does the nurse mosteffectively plan nutritional care for this client? a. Calculates his body mass index (BMI) b. Records a 24-hour diary of his physical activities c. Obtains a 24-hour recall (diary) of his food intake d. Measures his accurate height and weight measurements

ANS: C

88. The nurse is teaching a middle-aged adult client with a body mass index (BMI) of 27.5 and a height of 5'2" (157.5 cm) about what the BMI number means, and about malnutrition. Which client statement indicates a need for further instruction? a. "If I could get my BMI below 25, my risk for malnutrition would decrease." b. "I realize that this means that I have some increased health risks." c. "My goal should be to get my BMI below 18.5." d. "This means that I have an increased amount of total fat stored in my body."

ANS: C

9. A nurse cares for a client with colon cancer who has a new colostomy. The client states, I think it would be helpful to talk with someone who has had a similar experience. How should the nurse respond? a. I have a good friend with a colostomy who would be willing to talk with you. b. The enterostomal therapist will be able to answer all of your questions. c. I will make a referral to the United Ostomy Associations of America. d. Youll find that most people with colostomies dont want to talk about them.

ANS: C

93. A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing? a. Calcium imbalance b. Fluid volume deficit c. Fluid volume overload d. Potassium imbalance

ANS: C

94. A female client is concerned that her inability to conceive a child is connected to her morbid obesity. How does the nurse respond? a. "Do you feel that your obesity is keeping you from getting pregnant?" b. "Have you considered adoption as an option?" c. "Tell me about any changes in your menstrual cycle each month." d. "What has your health care provider told you about your problems in getting pregnant?"

ANS: C

95. A client is placed on orlistat (Xenical) as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the client to expect from using this drug? a. Dry mouth, constipation, and insomnia b. Insomnia, dry mouth, and blurred vision c. Loose stools, abdominal cramps, and nausea d. Palpitations, constipation, and restlessness

ANS: C

7.A client is 1 day postoperative after having Zenker's diverticula removed. The client has a nasogastric (NG) tube to suction, and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate? a. Document the findings as normal. b. Irrigate the NG tube with sterile saline. c. Notify the surgeon about this finding. d. Remove and reinsert the NG tube.

ANS: C NG tubes placed during surgery should not be irrigated or moved unless prescribed by the surgeon. The nurse should notify the surgeon about this finding. Documentation is important, but this finding is not normal. DIF:Applying/ApplicationREF:1123 KEY: Gastrointestinal disorders| postoperative nursing| nasogastric tubes| communication MSC:Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

11.A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)

ANS: C Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid. DIF:Remembering/KnowledgeREF:1113 KEY: Gastrointestinal disorders| proton pump inhibitors| patient education MSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

9.A client has a nasogastric (NG) tube. What action by the nursing student requires the registered nurse to intervene? a. Checking tube placement every 4 to 8 hours b. Monitoring and documenting drainage from the NG tube c. Pinning the tube to the gown so the client cannot turn the head d. Providing oral care every 4 to 8 hours

ANS: C The client should be able to turn his or her head to prevent pulling the tube out with movement. The other actions are appropriate. DIF:Applying/ApplicationREF:1123 KEY:Gastrointestinal disorders| nasogastric tube| supervision MSC:Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

13.A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first? a. Client who underwent diverticula removal with a pulse of 106/min b. Client who had esophageal dilation and is attempting first postprocedure oral intake c. Client who had an esophagectomy with a respiratory rate of 32/min d. Client who underwent hernia repair, reporting incisional pain of 7/10

ANS: C The client who had an esophagectomy has a respiratory rate of 32/min, which is an early sign of sepsis; this client needs to be assessed first. The client who underwent diverticula removal has a pulse that is out of the normal range (106/min), but not terribly so. The client reporting pain needs pain medication, but the client with the elevated respiratory rate needs investigation first. The nurse should see the client who had esophageal dilation prior to and during the first attempt at oral feedings, but this can wait until the other clients are cared for. DIF:Analyzing/AnalysisREF:1121 KEY:Gastrointestinal disorders| sepsis| nursing assessment MSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

14.The following data relate to an older client who is 2 hours postoperative after an esophagogastrostomy: Physical Assessment Vital Signs Physician Orders Skin dry Urine output 20 mL/hr NG tube patent with 100 mL brown drainage/hr Restless Pulse: 128 beats/min Blood pressure: 88/50 mm Hg Respiratory rate: 20 on ventilator Cardiac output: 2.1 L/min Oxygen saturation: 99% Normal saline at 75 mL/hr Morphine sulfate 2 mg IV push every 1 hr PRN pain Intake and output every hour Vital signs every hour Vancomycin (Vancocin) 1 g IV every 8 hr What action by the nurse is best? a. Administer the prescribed pain medication. b. Consult the surgeon about a different antibiotic. c. Consult the surgeon about increased IV fluids. d. Have respiratory therapy reduce the respiratory rate.

ANS: C This client's vital signs, cardiac output, dry skin, and urine output indicate hypovolemia or possible hypotension resulting from pressure placed on the posterior heart during surgery. The client needs more fluids, so the nurse should consult with the surgeon about increasing the fluid intake. The client may be restless as a result of the hypotension and may not need pain medication at this time. There is no reason to request a different antibiotic. The respiratory rate does not need to be adjusted. DIF:Analyzing/AnalysisREF:1121 KEY: Gastrointestinal disorders| fluid and electrolyte imbalances| communication MSC:Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

34. A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? a. The patient has been vomiting for 4 days. b. The patient takes antacids 8 to 10 times a day. c. The patient is lethargic and difficult to arouse. d. The patient has undergone a small intestinal resection.

ANS: C A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration.

4. Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer? a. Bleeding during tooth brushing b. Painful blisters at the lip border c. Red, velvety patches on the buccal mucosa d. White, curdlike plaques on the posterior tongue

ANS: C A red, velvety patch suggests erythroplasia, which has a high incidence (greater than 50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes simplex).

12. A 54-year-old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b. The patient reports a sore throat. c. The oral temperature is 101.6° F. d. The apical pulse is 104 beats/minute.

ANS: C A temperature elevation may indicate that a perforation has occurred. The other assessment data are normal immediately after the procedure.

8. Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds

ANS: C Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.

9. After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.

ANS: C After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.

5. A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is best? a. Ask the client to call back if this happens again today. b. Instruct the client to go to the emergency department. c. Remind the client that a small amount of bleeding is possible. d. Tell the client to come in to the clinic this afternoon.

ANS: C After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse should remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness. DIF: Understanding/Comprehension REF: 1096 KEY: Gastrointestinal system| gastrointestinal assessment| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

33. The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider? a. Absent bowel sounds b. Complaints of incisional pain c. Temperature 102.1° F (38.9° C) d. Scant nasogastric (NG) tube drainage

ANS: C An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery.

7. A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's a. apical pulse. b. bowel sounds. c. breath sounds. d. abdominal girth.

ANS: C Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.

40. Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood? a. Give an IV H2 receptor antagonist. b. Draw blood for typing and crossmatching. c. Administer 1000 mL of lactated Ringer's solution. d. Insert a nasogastric (NG) tube and connect to suction.

ANS: C Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.

42 Med Surg Nursing Management: Upper Gastrointestinal Problems 9Th edition 1. A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea? a. Keep the patient NPO for 2 hours before and after dressing changes. b. Avoid performing dressing changes close to the patient's mealtimes. c. Administer the prescribed morphine sulfate before dressing changes. d. Give the ordered prochlorperazine (Compazine) before dressing changes.

ANS: C Because the patient's nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea/vomiting that occur at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.

3. A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for a. hydrogen peroxide rinses. b. the use of antiviral agents. c. administration of nystatin (Mycostatin) tablets. d. referral to a dentist for professional tooth cleaning.

ANS: C Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.

6. Which statement to the nurse from a patient with jaundice indicates a need for teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I use acetaminophen (Tylenol) every 4 hours for back pain." d. "I need to take an antacid for indigestion several times a week"

ANS: C Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education.

38. A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? a. The patient is experiencing intermittent waves of nausea. b. The patient complains of 7/10 (0 to 10 scale) abdominal pain. c. The patient has absent breath sounds in the left anterior chest. d. The patient has hypoactive bowel sounds in all four quadrants.

ANS: C Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The nausea and abdominal pain should also be addressed but they are not as high priority as the patient's respiratory status. The patient's decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

42. After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective? a. Patient orders nonfat milk for each meal. b. Patient uses the prescribed corticosteroid inhaler. c. Patient schedules an appointment for allergy testing. d. Patient takes ibuprofen (Advil) to control throat pain.

ANS: C Eosinophilic esophagitis is frequently associated with environmental allergens, so allergy testing is used to determine possible triggers. Corticosteroid therapy may be prescribed, but the medication will be swallowed, not inhaled. Milk is a frequent trigger for attacks. NSAIDs are not used for eosinophilic esophagitis.

16. While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about a. preventing noninfectious hepatitis. b. treating inflammatory bowel disease. c. risk for developing colorectal cancer. d. using antacids and proton pump inhibitors.

ANS: C Familial adenomatous polyposis is a genetic condition that greatly increases the risk for colorectal cancer. Noninfectious hepatitis, use of medications that treat increased gastric pH, and inflammatory bowel disease are not related to FAP.

3. A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride (Versed). The client's respiratory rate is 8 breaths/min. What action by the nurse is best? a. Administer naloxone (Narcan). b. Call the Rapid Response Team. c. Provide physical stimulation. d. Ventilate with a bag-valve-mask.

ANS: C For an EGD, clients are given mild sedation but should still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse's first action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for Versed. The Rapid Response Team is not needed at this point. The client does not need manual ventilation. DIF: Applying/Application REF: 1094 KEY: Gastrointestinal system| medication side effects| nursing implementation MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed? a. "I take antacids between meals and at bedtime each night." b. "I sleep with the head of the bed elevated on 4-inch blocks." c. "I eat small meals during the day and have a bedtime snack." d. "I quit smoking several years ago, but I still chew a lot of gum."

ANS: C GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

9. Which patient choice for a snack 2 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a. Chocolate pudding b. Glass of low-fat milk c. Cherry gelatin with fruit d. Peanut butter and jelly sandwich

ANS: C Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

43. An 80-year-old who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? a. Sucralfate (Carafate) b. Omeprazole (Prilosec) c. Metoclopramide (Reglan) d. Aluminum hydroxide (Amphojel)

ANS: C Metoclopramide can cause central nervous system (CNS) side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton-pump inhibitors, mucosal protectants, or antacids.

35. A 26-year-old woman has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)? a. Auscultate the bowel sounds. b. Assess for signs of dehydration. c. Assist the patient with oral care. d. Ask the patient about the nausea.

ANS: C Oral care is included in UAP education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice.

27. At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to a. increase the amount of fluid with meals. b. eat foods that are higher in carbohydrates. c. lie down for about 30 minutes after eating. d. drink sugared fluids or eat candy after meals.

ANS: C The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

37. Which patient should the nurse assess first after receiving change-of-shift report? a. A patient with nausea who has a dose of metoclopramide (Reglan) due b. A patient who is crying after receiving a diagnosis of esophageal cancer c. A patient with esophageal varices who has a blood pressure of 92/58 mm Hg d. A patient admitted yesterday with gastrointestinal (GI) bleeding who has melena

ANS: C The patient's history and blood pressure indicate possible hemodynamic instability caused by GI bleeding. The data about the other patients do not indicate acutely life-threatening complications.

11. A 58-year-old woman who recently has been diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate? a. "You may have quite a few years still left to live." b. "Thinking about dying will only make you feel worse." c. "Having this new diagnosis must be very hard for you." d. "It is important that you be realistic about your prognosis."

ANS: C This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have only a low survival rate, so the response "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. The response beginning, "It is important that you be realistic," discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.

9. A client had an oral tumor removed this morning and now has a tracheostomy. What action by the nurse is the priority? a. Delegate oral care every 4 hours. b. Monitor and record the client's intake. c. Place the client in a high-Fowler's position. d. Remove the inner cannula for cleaning.

ANS: C To promote airway clearance, this client should be placed in a semi- or high-Fowler's position. Oral care can be delegated, but that is not the priority. Intake and output should also be recorded but again is not the priority. The inner cannula may or may not need to be cleaned, and the tracheostomy may or may not have a disposable cannula. DIF: Applying/Application REF: 1104 KEY: Oral disorders| airway MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

20. A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question? a. Infuse lactated Ringer's solution at 250 mL/hr. b. Monitor blood urea nitrogen and creatinine daily. c. Administer loperamide (Imodium) after each stool. d. Provide a clear liquid diet and progress diet as tolerated.

ANS: C Use of antidiarrheal agents is avoided with this type of food poisoning. The other orders are appropriate.

5. A nurse working with a client who has possible gastritis assesses the clients gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting

ANS: C, D

2. A nurse has delegated feeding a client to an unlicensed assistive personnel (UAP). What actions does the nurse include in the directions to the UAP? (Select all that apply.) a. Allow 30 minutes for eating so food doesnt get spoiled. b. Assess the clients mouth while providing premeal oral care. c. Ensure warm and cold items stay at appropriate temperatures. d. Remove bedpans, soiled linens, and other unpleasant items. e. Sit with the client, making the atmosphere more relaxed.

ANS: C, D, E

6. A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes? (Select all that apply.) a. Indirect inguinal hernia An enlarged plug of fat eventually pulls the peritoneum and often the bladder into a sac b. Femoral hernia A peritoneum sac pushes downward and may descend into the scrotum c. Direct inguinal hernia A peritoneum sac passes through a weak point in the abdominal wall d. Ventral hernia Results from inadequate healing of an incision e. Incarcerated hernia Contents of the hernia sac cannot be reduced back into the abdominal cavity

ANS: C, D, E

10. A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a. Albumin: 2.1 g/dL b. Hematocrit: 28% c. Hemoglobin: 8.1 mg/dL d. International normalized ratio (INR): 4.2

ANS: D

104. Which client on the medical-surgical unit does the charge nurse assign to the LPN/LVN? a. A 28-year-old with morbid obesity who had bariatric surgery today b. A 30-year-old recently admitted with severe diarrhea and Clostridium difficile infection c. A 36-year-old whose family needs instruction about how to use a gastric feeding tube d. A 39-year-old with a jejunal feeding tube who needs elemental feedings administered

ANS: D

105. An RN receives the change-of-shift report about these four clients. Which client does the nurse assess first? a. A 30-year-old admitted 2 hours ago with malnutrition associated with malabsorption syndrome b. A 45-year-old who had gastric bypass surgery and is reporting severe incisional pain c. A 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL (16.7 mmol/L) d. A 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min

ANS: D

106. The nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately? a. Bowel sounds are not audible in all quadrants. b. Client's skin under the panniculus is excoriated. c. The client reports pain when being repositioned. d. Urine output total is 15 mL for the past 2 hours.

ANS: D

107. Which nursing care activity for a malnourished client does the nurse safely delegate to unlicensed assistive personnel (UAP)? a. Completing the Mini Nutritional Assessment b. Determining body mass index (BMI) c. Estimating body fat using skinfold measurements d. Measuring current height and weight

ANS: D

11. A client asks the nurse about drugs for weight loss. What response by the nurse is best? a. All weight-loss drugs can cause suicidal ideation. b. No drugs are currently available for weight loss. c. Only over-the-counter medications are available. d. There are three drugs currently approved for this.

ANS: D

11. The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is mostindicative of bleeding? a. Respiratory rate from 24 to 20 breaths/min b. Apical pulse from 80 to 72 beats/min c. Temperature from 97.9° F to 98.9° F (36.6°C to 37.2°C) d. Blood pressure from 140/90 to 110/70 mm Hg

ANS: D

111. An obese client with a body mass index of 30 and hypertension has been taking prescription orlistat for 4 weeks and reports loose stools, abdominal cramps, and nausea. What does the nurse recommend for this client? a. Asking the provider to change the medication to phendimetrazine (Bontril). b. Changing to the lower dose, over-the-counter form of orlistat to reduce these effects. c. Increasing the daily activity level to improve overall metabolism. d. Reducing nutritional fat intake to less than 30% of the client's daily food intake.

ANS: D

13. An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first? a. Send a blood sample for a type and crossmatch. b. Insert a large intravenous line for fluid resuscitation. c. Obtain the heart rate and blood pressure. d. Assess and maintain a patent airway.

ANS: D

14. A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the clients bowel sounds.

ANS: D

18. A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection. Which assessment should the nurse complete first? a. Heart rate and rhythm b. Bowel sounds c. Urinary output d. Respiratory rate

ANS: D

2. A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds (2.3 kg) of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? a. Explain to the patient the importance of drinking the enteral supplements prescribed. b. Ask the patient's family to try to persuade the patient to drink the supplements. c. Inform the patient that a nasogastric tube may be necessary if he or she fails to comply. d. Ask the patient if a change in flavor would make the supplement more palatable.

ANS: D

20. A client is receiving total parenteral nutrition (TPN). What action by the nurse is most important? a. Assessing blood glucose as directed b. Changing the IV dressing each day c. Checking the TPN with another nurse d. Performing appropriate hand hygiene

ANS: D

21. A nurse cares for a client who has a family history of colon cancer. The client states, My father and my brother had colon cancer. What is the chance that I will get cancer? How should the nurse respond? a. If you eat a low-fat and low-fiber diet, your chances decrease significantly. b. You are safe. This is an autosomal dominant disorder that skips generations. c. Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer. d. You should have a colonoscopy more frequently to identify abnormal polyps early.

ANS: D

21. A nurse is weighing and measuring a client with severe kyphosis. What is the best method to obtain this clients height? a. Add the trunk and leg measurements. b. Ask the client how tall he or she is. c. Estimate by measuring clothing. d. Use knee-height calipers.

ANS: D

21. The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health care provider will request which medication for this patient? a. Bismuth subsalicylate (Pepto-Bismol) b. Magnesium hydroxide (Maalox) c. Metronidazole (Flagyl) d. Misoprostol (Cytotec)

ANS: D

22. A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? a. Administer pain medication. b. Assess skin temperature and color. c. Check on the amount of urine output. d. Take vital signs.

ANS: D

27. A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? a. "Have you asked your primary health care provider what he or she thinks your chances are?" b. "It is hard to know what can predispose a person to develop a certain disease." c. "No. Just because they both had CRC doesn't mean that you will have it, too." d. "The only way to know whether you are predisposed to CRC is by genetic testing."

ANS: D

28. The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? a. "I will have my spouse change the bag for me." b. "If I have any leakage, I'll put a towel over it." c. "I can put aspirin tablets in the pouch in order to reduce odor" d. "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

ANS: D

35. A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? a. Cramping intermittently, metabolic acidosis, and minimal vomiting b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis c. Metabolic acidosis, upper abdominal distention, and intermittent cramping d. Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

ANS: D

37. A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? a. Administers medication for pain b. Changes the nasogastric suction level from "intermittent" to "constant" c. Positions the patient in high-Fowler's position d. Prepares the patient for emergency surgery

ANS: D

39. A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? a. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." b. "It is inherited, so it could run in your family." c. "It might be caused by a virus, so you could have gotten it almost anywhere." d. "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

ANS: D

44. What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? a. It destroys the cancer's cell wall, which will kill the cell. b. It decreases blood flow to rapidly dividing cancer cells. c. It stimulates the body's immune system and stunts cancer growth. d. It blocks factors that promote cancer cell growth.

ANS: D

5. A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

ANS: D

5. A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily b. A 44-year-old with irritable bowel syndrome (IBS) c. A 60-year-old lawyer who works 65 hours per week d. A 72-year-old who eats fast food frequently

ANS: D

50. A patient who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? a. A list of medical supply facilities where wound care supplies may be purchased b. Proper handwashing techniques to avoid cross-contamination of the patient's wound c. The amount of pain medication that the patient is allowed to take in each dose d. Written and oral instructions regarding signs/symptoms to report to the primary health care provider

ANS: D

6. After teaching a client with diverticular disease, a nurse assesses the clients understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice

ANS: D

62. A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? a. Administering a Fleet's enema when needed b. Applying heat to acute inflammation for pain relief c. Avoiding the use of bulk-forming agents d. Using hydrocortisone cream to relieve pain

ANS: D

68. An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse? a. A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula b. A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas c. A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir d. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

ANS: D

7. Which patient assessment information is correlated with a diagnosis of chronic gastritis? a. Anorexia, nausea, and vomiting b. Frequent use of corticosteroids c. Hematemesis and anorexia d. Radiation therapy, smoking, and excessive alcohol use

ANS: D

72. An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? a. Administer acetaminophen (Tylenol) 650 mg rectally. b. Draw blood for a complete blood count and serum electrolytes. c. Obtain a stool specimen for culture and sensitivity. d. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

ANS: D

74. A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed? a. "It is to stop the diarrhea and bloody stools." b. "This will minimize your GI discomfort." c. "With this medication, your cramping will be relieved." d. "Your intestinal inflammation will be reduced."

ANS: D

82. A client who has undergone a bariatric surgical procedure is recuperating after surgery. Which nursing intervention most effectively prevents injury to the client who is being re-positioned postoperatively? a. Administering pain medication b. Making sure not to move the client's nasogastric (NG) tube c. Monitoring skinfold areas and keeping them clean and dry d. Using a weight-rated extra-wide bed for the client t

ANS: D

83. An older adult client needs additional dietary protein, but refuses to drink the prescribed liquid protein supplements. Which nursing intervention is mosteffective in increasing the client's protein intake? a. Administering the liquid supplement with routine medications b. Giving a glucose polymer modular supplement c. Keeping a food and fluid intake diary for at least 3 days d. Providing protein modular supplements in the form of puddings

ANS: D

87. Based on nutritional screening findings and assessments, which client will be the preferred candidate for surgical treatment for obesity? a. Man with a body mass index (BMI) of 40, weight 75% above ideal body weight b. Man with a BMI of 41, weight 80% above ideal body weight c. Woman with a BMI of 38, weight 50% above ideal body weight d. Woman with a BMI of 42, weight 100% above ideal body weight

ANS: D

92. A client who is receiving total enteral nutrition exhibits acute confusion and shallow breathing and says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's signs and symptoms? a. The enteral tube is dislodged. b. Abdominal distention is present. c. Severe hyperglycemia is present. d. Refeeding syndrome is occurring. e. Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to clients who are starved, severely malnourished or metabolically stressed due to severe illness.

ANS: D

97. A client has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this client? a. Ambulating the client as quickly as possible after surgery b. Applying an abdominal binder daily when the client is out of bed c. Observing for tachycardia, nausea, diarrhea, and abdominal cramping d. Providing six small feedings daily and offering fluids frequently

ANS: D

12.After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best? a. "Bacteria can often cause ulcers." b. "This operation often causes ulcers." c. "The medication keeps your blood pH low." d. "It prevents stress-related ulcers."

ANS: D After surgery, anti-ulcer medications such as pantoprazole are often given to prevent stress-related ulcers. The other responses are incorrect. DIF:Understanding/ComprehensionREF:1113 KEY: Gastrointestinal disorders| proton pump inhibitors| patient education MSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2.A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? a. Document the findings in the chart. b. Notify the surgeon immediately. c. Reassess the drainage in 1 hour. d. Take a full set of vital signs.

ANS: D The drainage in the NG tube should initially be brown with old blood. The presence of bright red blood indicates bleeding. The nurse should take a set of vital signs to assess for shock and then notify the surgeon. Documentation should occur but is not the first thing the nurse should do. The nurse should not wait an additional hour to reassess. DIF:Applying/ApplicationREF:1116 KEY: Gastrointestinal disorders| postoperative nursing| nursing assessment MSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

10. The nurse will anticipate teaching a patient experiencing frequent heartburn about a. a barium swallow. b. radionuclide tests. c. endoscopy procedures. d. proton pump inhibitors.

ANS: D Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

3. A female client hospitalized for an unrelated problem has a large pearly-white lesion on her lip, to which she continues to apply lipstick that she will not remove for inspection. The client refuses to discuss the lesion with the nurse or health care provider. What action by the nurse is best? a. Ask the client why her appearance is so important. b. Ignore the lesion since the client will not discuss it. c. Inform the client that early-stage cancer is curable. d. Work with the client to establish a trusting relationship.

ANS: D Clients with oral cancers often have body image difficulties due to the location of the tumor or the results of surgical treatment. This client appears to be using denial to cope with this problem. The nurse should work to establish a helping-trusting relationship in hopes that the client will be amenable to future discussions about the lesion. Asking "why" questions often puts people on the defensive and should be avoided. Ignoring the lesion is not being an advocate for the client. Education is important, but right now the client is in denial, so this information will not seem relevant to her. DIF: Applying/Application REF: 1103 KEY: Oral disorders| psychosocial response| coping| communication MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity

14. When a 72-year-old patient is diagnosed with achalasia, the nurse will teach the patient that a. lying down after meals is recommended. b. a liquid or blenderized diet will be necessary. c. drinking fluids with meals should be avoided. d. treatment may include endoscopic procedures.

ANS: D Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying. Patients are advised to drink fluid with meals.

10. A 42-year-old woman is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? a. The patient took a laxative the previous evening. b. The patient had a high-fat meal the previous evening. c. The patient has a permanent gastrostomy tube in place. d. The patient ate a low-fat bagel 4 hours ago for breakfast.

ANS: D Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.

8. A nurse is examining a client reporting right upper quadrant (RUQ) abdominal pain. What technique should the nurse use to assess this client's abdomen? a. Auscultate after palpating. b. Avoid any palpation. c. Palpate the RUQ first. d. Palpate the RUQ last.

ANS: D If pain is present in a certain area of the abdomen, that area should be palpated last to keep the client from tensing up, which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation. DIF: Remembering/Knowledge REF: 1089 KEY: Gastrointestinal system| gastrointestinal assessment| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

5. The nurse receives the following information about a 51-year-old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY).

ANS: D If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort.

28. A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about a. substitution of acetaminophen (Tylenol) for the NSAID. b. use of enteric-coated NSAIDs to reduce gastric irritation. c. reasons for using corticosteroids to treat the rheumatoid arthritis. d. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.

ANS: D Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development, and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis.

29. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take a. sucralfate at bedtime and antacids before each meal. b. sucralfate and antacids together 30 minutes before meals. c. antacids 30 minutes before each dose of sucralfate is taken. d. antacids after meals and sucralfate 30 minutes before meals.

ANS: D Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.

39. Which assessment should the nurse perform first for a patient who just vomited bright red blood? a. Measuring the quantity of emesis b. Palpating the abdomen for distention c. Auscultating the chest for breath sounds d. Taking the blood pressure (BP) and pulse

ANS: D The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal (GI) bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.

31. A 73-year-old patient is diagnosed with stomach cancer after an unintended 20-pound weight loss. Which nursing action will be included in the plan of care? a. Refer the patient for hospice services. b. Infuse IV fluids through a central line. c. Teach the patient about antiemetic therapy. d. Offer supplemental feedings between meals.

ANS: D The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.

3. When caring for a patient with a history of a total gastrectomy, the nurse will monitor for a. constipation. b. dehydration. c. elevated total serum cholesterol. d. cobalamin (vitamin B12) deficiency.

ANS: D The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.

8. The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication a. reduces gastroesophageal reflux by increasing the rate of gastric emptying. b. neutralizes stomach acid and provides relief of symptoms in a few minutes. c. coats and protects the lining of the stomach and esophagus from gastric acid. d. treats gastroesophageal reflux disease by decreasing stomach acid production.

ANS: D The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

45. After change-of-shift report, which patient should the nurse assess first? a. 42-year-old who has acute gastritis and ongoing epigastric pain b. 70-year-old with a hiatal hernia who experiences frequent heartburn c. 53-year-old who has dumping syndrome after a recent partial gastrectomy d. 60-year-old with nausea and vomiting who has dry oral mucosa and lethargy

ANS: D This older patient is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.

10. A client presents to the family practice clinic reporting a week of watery, somewhat bloody diarrhea. The nurse assists the client to obtain a stool sample. What action by the nurse is most important? a. Ask the client about recent exposure to illness. b. Assess the client's stool for obvious food particles. c. Include the date and time on the specimen container. d. Put on gloves prior to collecting the sample.

ANS: D To avoid possible exposure to infectious agents, the nurse dons gloves prior to handling any bodily secretions. Recent exposure to illness is not related to collecting a stool sample. The nurse can visually inspect the stool for food particles, but it still needs analysis in the laboratory. The container should be dated and timed, but safety for the staff and other clients comes first. DIF: Applying/Application REF: 1091 KEY: Gastrointestinal system| Standard Precautions| infection control MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

15. A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about a. the amount of saturated fat in the diet. b. any family history of gastric or colon cancer. c. a history of a large recent weight gain or loss. d. use of nonsteroidal antiinflammatory drugs (NSAIDs).

ANS: D Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.

achlorhydria

Absence of secretion of hydrochloric acid

The nurse finds a client vomiting coffee-ground emesis. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

Administering intravenous (IV) fluids Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the client's change in mental status, which is hypovolemia.

A nurses completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition?

Alcohol use

Gastrectomy

All or part of the stomach is removed with laparoscopic or open approach. ☐ Antrectomy - The antrum portion of the stomach is removed. ☐ Gastrojejunostomy (Billroth II procedure) - The lower portion of the stomach is excised, the remaining stomach is anastomosed to the jejunum, and the remaining duodenum is surgically closed.

Antacids-meds, considerations, education

Aluminum hydroxide, magnesium hydroxide, calcium carbonate, and sodium bicarbonate neutralize excess acid and increase LES pressure. NURSING CONSIDERATIONS: Ensure there are no contraindications with other prescribed medications (levothyroxine). Evaluate kidney function in clients taking magnesium hydroxide. CLIENT EDUCATION: Instruct the client to take antacids when acid secretion is the highest (1 to 3 hr after eating and at bedtime), and to separate from other medications by at least 1 hr.

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hr after treatment begins?

Amylase

a

An EGD confirms that the patient has PUD. Three hours later, the patient is admitted to the medical unit for workup and further testing. On admission the patient reports midline epigastric tenderness and indigestion (dyspepsia). The patient is prescribed triple therapy. Which drugs will the nurse expect to be prescribed for the patient at this time? A. Proton pump inhibitor (PPI) and two antibiotics B. Antibiotic and two PPIs C. Histamine antagonist, antacid, and PPI D. Antacid, PPI, and prostaglandin analogue

A nurse is assessing a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect?

Anorexia

A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer? A) A 65-year-old man with alcoholism who smokes B) A 45-year-old woman who has type 1 diabetes and who wears dentures C) A 32-year-old man who is obese and uses smokeless tobacco D) A 57-year-old man with GERD and dental caries

Ans: A) A 65- year-old man with alcoholism who smokes Feedback: Oral cancers are often associated with the use of alcohol and tobacco, which when used together have a synergistic carcinogenic effect. Most cases of oral cancers occur in people over the age of 60 and a disproportionate number of cases occur in men. Diabetes, dentures, dental caries, and GERD are not risk factors for oral cancer.

The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient? A) Avoid applying suction on or near the suture line. B) Position patient on the non operative side with the head of the bed down. C) Assess the patients ability to perform self-suctioning. D) Evaluate the patients ability to swallow saliva and clear fluids.

Ans: A) Avoid applying suction on or near the suture line Feedback: The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Self-sectioning may be unsafe because the patient may damage the suture line. Following a modified radical neck dissection with graft, the patient is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the patients ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the patients need for suctioning.

A nurse is caring for a patient who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the patients appetite? A) Encourage the family to bring in the patients favored foods. B) Limit visitors at mealtimes so that the patient is not distracted. C) Avoid offering food unless the patient initiates. D) Provide thorough oral care immediately after the patient eats.

Ans: A) Encourage the family to bring in the patients favored foods Feedback: Family involvement and home-cooked favorite foods may help the patient to eat. Having visitors at mealtimes may make eating more pleasant and increase the patients appetite. The nurse should not place the complete onus for initiating meals on the patient. Oral care after meals is necessary, but does not influence appetite.

A nurse is caring for a patient who has had surgery for oral cancer. When addressing the patients long-term needs, the nurse should prioritize interventions and referrals with what goal? A) Enhancement of verbal communication B) Enhancement of immune function C) Maintenance of adequate social support D) Maintenance of fluid balance

Ans: A) Enhancement of verbal communication Feedback: Verbal communication may be impaired by radical surgery for oral cancer. Addressing this impairment often requires a long-term commitment. Immune function, social support, and fluid balance are all necessary, but communication is a priority issue for patients recovering from this type of surgery.

A patient has received treatment for oral cancer. The combination of medications and radiotherapy has resulted in leukopenia. Which of the following is an appropriate response to this change in health status? A) Ensure that none of the patients visitors has an infection. B) Arrange for a diet that is high in protein and low in fat. C) Administer colony stimulating factors (CSFs) as ordered. D) Prepare to administer chemotherapeutics as ordered.

Ans: A) Ensure that none of the patients visitors has an infection Feedback: Leukopenia reduces defense mechanisms, increasing the risk of infections. Visitors who might transmit microorganisms are prohibited if the patients immunologic system is depressed. Changes in diet, CSFs, and the use of chemotherapy do not resolve leukopenia.

A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection? A) Indicates acceptance of altered appearance and demonstrates positive self-image B) Freely expresses needs and concerns related to postoperative pain management C) Compensates effectively for alteration in ability to communicate related to dysarthria D) Demonstrates effective stress management techniques to promote muscle relaxation

Ans: A) Indicates acceptance of altered appearance and demonstrates positive self-image Feedback: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the patients appearance is visibly altered. The face generally appears asymmetric, with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Patients who have had head and neck surgery generally report less pain as compared with other postoperative patients; however, the nurse must assess each individual patients level of pain and response to analgesics. Patients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.

A patient with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the patient may be prescribed what drug? A) Metoclopramide (Reglan) B) Omeprazole (Prilosec) C) Lansoprazole (Prevacid) D) Famotidine (Pepcid)

Ans: A) Metoclopramide (Reglan) Feedback: Metoclopramide (Reglan) is useful in promoting gastric motility. Omeprazole and lansoprozole are proton pump inhibitors that reduce gastric acid secretion. Famotidine (Pepcid) is an H2receptor antagonist, which has a similar effect.

The school nurse is planning a health fair for a group of fifth graders and dental health is one topic that the nurse plans to address. What would be most likely to increase the risk of tooth decay? A) Organic fruit juice B) Roasted nuts C) Red meat that is high in fat D) Cheddar cheese

Ans: A) Organic fruit juice Feedback: Dental caries may be prevented by decreasing the amount of sugar and starch in the diet. Patients who snack should be encouraged to choose less cariogenic alternatives, such as fruits, vegetables, nuts, cheeses, or plain yogurt. Fruit juice is high in sugar, regardless of whether it is organic.

An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2F and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next? A) Palpate the patients parotid glands to detect swelling and tenderness. B) Assess the temporomandibular joint for evidence of a malocclusion. C) Test the integrity of cranial nerve XII by asking the patient to protrude the tongue. D) Inspect the patients gums for bleeding and hyperpigmentation.

Ans: A) Palpate the patients parotid glands to detect swelling and tenderness Feedback: Older adults and debilitated patients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness, as well as swelling of the parotid glands. Pain radiates to the ear. Pain associated with malocclusion of the temporomandibular joint may also radiate to the ears; however, a temperature elevation would not be associated with malocclusion. The 12th cranial nerve is not associated with the auditory system. Bleeding and hyperpigmented gums may be caused by pyorrhea or gingivitis. These conditions do not cause earache; fever would not be present unless the teeth were abscessed.

A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease? Select all that apply. A) Perforation into the mediastinum B) Development of an esophageal lesion C) Erosion into the great vessels D) Painful swallowing E) Obstruction of the esophagus

Ans: A) Perforation into the mediastinum C) Erosion into the great vessels E) Obstruction of the esophagus Feedback: In the later stages of esophageal cancer, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Painful swallowing and the emergence of a lesion are early signs of esophageal cancer.

A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patients care? A) Risk for Aspiration Related to Inhalation of Gastric Contents B) Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired Absorption C) Risk for Decreased Cardiac Output Related to Vasovagal Response D) Risk for Impaired Verbal Communication Related to Oral Trauma

Ans: A) Risk for Aspiration Related to Inhalation of Gastric Contents Feedback: Achalasia can result in the aspiration of gastric contents. It is not normally an acute risk to the patients nutritional status and does not affect cardiac output or communication.

A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patients subsequent care? A) The patient will require an upper endoscopy every 6 months to detect malignant changes. B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C) Small amounts of blood are likely to be present in the stools and are not cause for concern. D) Antacids may be discontinued when symptoms of heartburn subside.

Ans: A) The patient will require an upper endoscopy every 6 months to detect malignant changes Feedback: In the patient with Barretts esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.

A patients neck dissection surgery resulted in damage to the patients superior laryngeal nerve. What area of assessment should the nurse consequently prioritize? A) The patients swallowing ability B) The patients ability to speak C) The patients management of secretions D) The patients airway patency

Ans: A) The patients swallowing ability Feedback: If the superior laryngeal nerve is damaged, the patient may have difficulty swallowing liquids and food because of the partial lack of sensation of the glottis. Damage to this particular nerve does not inhibit speech and only affects management of secretions and airway patency indirectly.

A patient returns to the unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the physician immediately for what? A) Presence of small blood clots in the drainage B) 60 mL of milky or cloudy drainage C) Spots of drainage on the dressings surrounding the drain D) 120 mL of serosanguinous drainage

Ans: B) 60 mL of milky or cloudy drainage Feedback: Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours. Milky drainage is indicative of a chyle fistula, which requires prompt treatment.

A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patients priority need at this time? A) Emotional support from visitors and staff B) An effective means of communicating with the nurse C) Referral to a speech therapist D) Dietary teaching focused on consistency of food and frequency of feedings

Ans: B) An effective means of communicating with the nurse Feedback: Verbal communication may be impaired by radical surgery for oral cancer. It is therefore vital to assess the patients ability to communicate in writing before surgery. Emotional support and dietary teaching are critical aspects of the plan of care; however, the patients ability to communicate would be essential for both. Referral to a speech therapist will be required as part of the patients rehabilitation; however, it is not a priority at this particular time. Communication with the nurse is crucial for the delivery of safe and effective care.

A nurse is caring for a patient who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this patient, what would the nurse be sure to include? A) Increasing calcium intake to promote bone healing B) Avoiding chewing food for the specified number of weeks after surgery C) Techniques for managing parenteral nutrition in the home setting D) Techniques for managing a gastrostomy

Ans: B) Avoiding chewing food for the specified number of weeks after surgery Feedback: The patient who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. Increased calcium intake will not have an appreciable effect on healing. Enteral and parenteral nutrition are rarely necessary.

Results of a patient barium swallow suggest that the patient has GERD. The nurse is planning health education to address the patients knowledge of this new diagnosis. Which of the following should the nurse encourage? A) Eating several small meals daily rather than 3 larger meals B) Keeping the head of the bed slightly elevated C) Drinking carbonated mineral water rather than soft drinks D) Avoiding food or fluid intake after 6:00 p.m.

Ans: B) Keeping the head of the bed slightly elevated Feedback: The patient with GERD is encouraged to elevate the head of the bed on 6- to 8-inch (15- to 20-cm) blocks. Frequent meals are not specifically encouraged and the patient should avoid food and fluid within 2 hours of bedtime. All carbonated beverages should be avoided.

A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD? A) Pyloric sphincter B) Lower esophageal sphincter C) Hypopharyngeal sphincter D) Upper esophageal sphincter

Ans: B) Lower esophageal sphincter Feedback: The lower esophageal sphincter, also called the gastroesophageal sphincter or cardiac sphincter, is located at the junction of the esophagus and the stomach. An incompetent lower esophageal sphincter allows reflux (backward flow) of gastric contents. The upper esophageal sphincter and the hypopharyngeal sphincter are synonymous and are not responsible for the manifestations of GERD. The pyloric sphincter exists between the stomach and the duodenum.

The nurses comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages? A) Dull pain radiating to the ears and teeth B) Presence of a painless sore with raised edges C) Areas of tenderness that make chewing difficult D) Diffuse inflammation of the buccal mucosa

Ans: B) Presence of a painless sore with raised edges Feedback: Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the patient, delay in seeking treatment occurs frequently, and negatively affects prognosis. Dull pain radiating to the ears and teeth is characteristic of malocclusion. Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. Pain related to oral cancer is a late symptom.

A nurse is caring for a patient who has undergone neck resection with a radial forearm free flap. The nurses most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurses most appropriate action? A) Document the findings as being consistent with a viable graft. B) Promptly report these indications of venous congestion. C) Closely monitor the patient and reassess in 30 minutes. D) Reposition the patient to promote peripheral circulation.

Ans: B) Promptly report these indications of venous congestion Feedback: A graft that is blue with mottling may indicate venous congestion. This finding constitutes a risk for tissue ischemia and necrosis; prompt referral is necessary.

A patient has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the patient to describe what sign or symptom? A) Burning pain on swallowing B) Regurgitation of undigested food C) Symptoms mimicking a heart attack D) Chronic parotid abscesses

Ans: B) Regurgitation of undigested food Feedback: An esophageal diverticulum is an outpouching of mucosa and submucosa that protrudes through the esophageal musculature. Food becomes trapped in the pouch and is frequently regurgitated when the patient assumes a recumbent position. The patient may experience difficulty swallowing; however, burning pain is not a typical finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid abscesses are not associated with a diagnosis of esophageal diverticulum.

A nurse in an oral surgery practice is working with a patient scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend which of the following actions? A) Rinse the mouth with alcohol before bedtime for the next 7 days. B) Use warm saline to rinse the mouth as needed. C) Brush around the area with a firm toothbrush to prevent infection. D) Use a toothpick to dislodge any debris that gets lodged in the socket.

Ans: B) Use warm saline to rinse the mouth as needed Feedback: The patient should be assessed for bleeding after the tooth is extracted. The mouth can be rinsed with warm saline to keep the area clean. A firm toothbrush or toothpick could injure the tissues around the extracted area. Alcohol would injure tissues that are healing.

A community health nurse serves a diverse population. What individual would likely face the highest risk for parotitis? A) A patient who is receiving intravenous antibiotic therapy in the home setting B) A patient who has a chronic venous ulcer C) An older adult whose medication regimen includes an anticholinergic D) A patient with poorly controlled diabetes who receives weekly wound care

Ans: C) An older adult whose medication regimen includes an anticholinergic Feedback: Elderly, acutely ill, or debilitated people with decreased salivary flow from general dehydration or medications are at high risk for parotitis. Anticholinergic medications inhibit saliva production. Antibiotics, diabetes, and wounds are not risk factors for parotitis.

A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize? A) Assess ability to clear oral secretions. B) Assess for signs of infection. C) Assess for a patent airway. D) Assess for ability to communicate.

Ans: C) Assess for a patent airway Feedback: Postoperatively, the nurse assesses for a patent airway. The patients ability to manage secretions has a direct bearing on airway patency. However, airway patency is the overarching goal. This immediate physiologic need is prioritized over communication, though this is an important consideration. Infection is not normally a threat in the immediate postoperative period.

A nurse is providing health promotion education to a patient diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the patient to implement? A) Keep the head of the bed lowered. B) Drink a cup of hot tea before bedtime. C) Avoid carbonated drinks. D) Eat a low-protein diet.

Ans: C) Avoid carbonated drinks Feedback: For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. Protein limitation is not necessary.

A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer? A) Promotion of a nutrient-dense, low-fat diet B) Annual screening endoscopy for patients over 50 with a family history of esophageal cancer C) Early diagnosis and treatment of gastroesophageal reflux disease D) Adequate fluid intake and avoidance of spicy foods

Ans: C) Early diagnosis and treatment of gastroesophageal reflux disease Feedback: There are numerous risk factors for esophageal cancer but chronic esophageal irritation or GERD is among the most significant. This is a more significant risk factor than dietary habits. Screening endoscopies are not recommended solely on the basis of family history.

A patient has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient? A) Placing the patient in a left lateral position B) Administering opioids as ordered C) Placing the patient in Fowlers position D) Teaching the patient to use the patient-controlled analgesia (PCA) system

Ans: C) Placing the patient in Fowlers position Feedback: After the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in Fowlers position to facilitate breathing and promote comfort. Lateral positioning does not facilitate oxygenation or comfort. Medications do not facilitate spontaneous breathing.

A patient who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. Which of the following should be included in the patients immediate postoperative plan of care? A) Teaching the patient to self-suction B) Performing chest physiotherapy to promote oxygenation C) Positioning the patient to prevent gastric reflux D) Providing a regular diet as tolerated

Ans: C) Positioning the patient to prevent gastric reflux Feedback: After recovering from the effects of anesthesia, the patient is placed in a low Fowlers position, and later in a Fowlers position, to help prevent reflux of gastric secretions. The patient is observed carefully for regurgitation and dyspnea because a common postoperative complication is aspiration pneumonia. In this period of recovery, self-suctioning is also not likely realistic or safe. Chest physiotherapy is contraindicated because of the risk of aspiration. Nutrition is prioritized, but a regular diet is contraindicated in the immediate recovery from esophageal surgery.

A patient who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this patient include? A) Muscle training to relieve dysphagia B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia by decreasing esophageal peristalsis

Ans: C) Promoting maximum shoulder function Feedback: Shoulder drop occurs as a result of radical neck dissection. Shoulder function can be improved by rehabilitation exercises. Rehabilitation would not be initiated until the patients neck incision and graft, if present, were sufficiently healed. Nerve paralysis in the cervical plexus and other variables affecting swallowing would be managed by a speech therapist rather than a physical therapist.

A patient has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this patients discharge education? A) Resumption of activities of daily living B) Pain control C) Promotion of adequate nutrition D) Strategies for promoting communication

Ans: C) Promotion of adequate nutrition Feedback: The patient who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. The nature of this surgery threatens the patients nutritional status; this physiologic need would likely supersede the resumption of ADLs. Pain should be under control prior to discharge and communication is not precluded by this surgery.

A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this patient? A) Presence of acute pain and anxiety B) Tissue integrity and color of the operative site C) Respiratory status and airway clearance D) Self-esteem and body image

Ans: C) Respiratory status and airway clearance Feedback: Postoperatively, the patient is assessed for complications such as altered respiratory status, wound infection, and hemorrhage. The other assessments are part of the plan of care for a patient who has had a radical neck dissection, but are not the nurses chief priority.

A radial graft is planned in the treatment of a patients oropharyngeal cancer. In order to ensure that the surgery will be successful, the care team must perform what assessment prior to surgery? A) Assessing function of cranial nerves V, VI, and IX B) Assessing for a history of GERD C) Assessing for signs or symptoms of atherosclerosis D) Assessing the patency of the ulnar artery

Ans: D) Assessing the patency of the ulnar artery Feedback: If a radial graft is to be performed, an Allen test on the donor arm must be performed to ensure that the ulnar artery is patent and can provide blood flow to the hand after removal of the radial artery. The success of this surgery is not primarily dependent on CN function or the absence of GERD and atherosclerosis.

A nurse is providing oral care to a patient who is comatose. What action best addresses the patients risk of tooth decay and plaque accumulation? A) Irrigating the mouth using a syringe filled with a bacteriocidal mouthwash B) Applying a water-soluble gel to the teeth and gums C) Wiping the teeth and gums clean with a gauze pad D) Brushing the patients teeth with a toothbrush and small amount of toothpaste

Ans: D) Brushing the patients teeth with a toothbrush and a small amount of toothpaste Feedback: Application of mechanical friction is the most effective way to cleanse the patients mouth. If the patient is unable to brush teeth, the nurse may brush them, taking precautions to prevent aspiration; or as a substitute, the nurse can achieve mechanical friction by wiping the teeth with a gauze pad. Bacteriocidal mouthwash does reduce plaque-causing bacteria; however, it is not as effective as application of mechanical friction. Water-soluble gel may be applied to lubricate dry lips, but it is not part of oral care.

An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body? A) Haloperidol B) Prostigmine C) Epinephrine D) Glucagon

Ans: D) Glucagon Feedback: Glucagon is administered prior to removal of a foreign body because it relaxes the smooth muscle of the esophagus, facilitating insertion of the endoscope. Haloperidol is an antipsychotic drug and is not indicated. Prostigmine is prescribed for patients with myastheniagravis. It increases muscular contraction, an effect opposite that which is desired to facilitate removal of the foreign body. Epinephrine is indicated in asthma attack and bronchospasm.

A nurse is performing health education with a patient who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis? A) Ineffective Tissue Perfusion B) Impaired Skin Integrity C) Aspiration D) Imbalanced Nutrition: Less Than Body Requirements

Ans: D) Imbalanced Nutrition: Less Than Body Requirements Feedback: Because digestion normally begins in the mouth, adequate nutrition is related to good dental health and the general condition of the mouth. Any discomfort or adverse condition in the oral cavity can affect a persons nutritional status. Dental caries do not typically affect the patients tissue perfusion or skin integrity. Aspiration is not a likely consequence of dental caries.

A nurse is caring for a patient who is acutely ill and has included vigilant oral care in the patients plan of care. Why are patients who are ill at increased risk for developing dental caries? A) Hormonal changes brought on by the stress response cause an acidic oral environment B) Systemic infections frequently migrate to the teeth C) Hydration that is received intravenously lacks fluoride D) Inadequate nutrition and decreased saliva production can cause cavities

Ans: D) Inadequate nutrition and decreased saliva production can cause cavities Feedback: Many ill patients do not eat adequate amounts of food and therefore produce less saliva, which in turn reduces the natural cleaning of the teeth. Stress response is not a factor, infections generally do not attack the enamel of the teeth, and the fluoride level of the patient is not significant in the development of dental caries in the ill patient.

A nurse is providing care for a patient whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis? A) Risk for Disuse Syndrome B) Unilateral Neglect C) Risk for Trauma D) Ineffective Tissue Perfusion

Ans: D) Ineffective Tissue Perfusion Feedback: Grafted skin is highly vulnerable to inadequate perfusion and subsequent ischemia and necrosis. This is a priority over chronic pain, which is unlikely to be a long-term challenge. Neglect and disuse are not risks related to the graft site.

A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education? A) Drinking beverages after your meal, rather than with your meal, may bring some relief. B) Its best to avoid dry foods, such as rice and chicken, because theyre harder to swallow. C) Many patients obtain relief by taking over-the-counter antacids 30 minutes before eating. D) Instead of eating three meals a day, try eating smaller amounts more often.

Ans: D) Instead of eating three meals a day, try eating smaller amounts more often Feedback: Management for a hiatal hernia includes frequent, small feedings that can pass easily through the esophagus. Avoiding beverages and particular foods or taking OTC antacids are not noted to be beneficial.

A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies? A) Radiation therapy often results in secondary brain tumors. B) Surgical complications are exceedingly common. C) Diagnosis rarely occurs until the cancer is endstage. D) Metastases are common and respond poorly to treatment.

Ans: D) Metastases are common and respond poorly to treatment Feedback: Deaths from malignancies of the head and neck are primarily attributable to local-regional metastasis to the cervical lymph nodes in the neck. This often occurs by way of the lymphatics before the primary lesion has been treated. This local-regional metastasis is not amenable to surgical resection and responds poorly to chemotherapy and radiation therapy. This high mortality rate is not related to surgical complications, late diagnosis, or the development of brain tumors.

A nurse is caring for a patient who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the patient and notes the presence of high-pitched adventitious sounds over the patients trachea on auscultation. The patients oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurses most appropriate action? A) Encourage the patient to perform deep breathing and coughing exercises hourly. B) Reposition the patient into a prone or semi-Fowlers position and apply supplementary oxygen by nasal cannula. C) Activate the emergency response system. D) Report this finding promptly to the physician and remain with the patient.

Ans: D) Report this finding promptly to the physician and remain with the patient Feedback: In the immediate postoperative period, the nurse assesses for stridor (coarse, high-pitched sound on inspiration) by listening frequently over the trachea with a stethoscope. This finding must be reported immediately because it indicates obstruction of the airway. The patients current status does not warrant activation of the emergency response system, and encouraging deep breathing and repositioning the patient are inadequate responses.

Anatacids

Antacids: aluminum carbonate, magnesium hydroxide (Milk of Magnesia) ■ Antacids are given 1 to 3 hr after meals to neutralize gastric acid, which occurs with food ingestion and at bedtime. ■ Nursing Considerations - Give 1 hr apart from other medications to avoid reducing the absorption of other medications. ■ Client Education ☐ Encourage compliance by reinforcing the intended effect of the antacid (relief of pain, healing of ulcer). ☐ Teach clients to take all medications at least 1 hr before or after taking an antacid.

Antibiotics

Antibiotics: metronidazole (Flagyl), amoxicillin (Amoxil), clarithromycin (Biaxin), tetracycline (Achromycin V) ■ Eliminate H. pylori infection. ■ Nursing Considerations - A combination of two to three different antibiotics may be administered. ■ Client Education - Instruct the client to complete a full course of medication.

chronic gastritis

Appears as a patchy, diffuse, inflammation of the mucosal lining of the stomach

a, c, d, e

As the patient prepares for discharge, the nurse provides education about behaviors that reduce symptoms and aggravate peptic ulcers. Which teaching does the nurse provide? (Select all that apply.) A. Sit upright 30 to 60 minutes after meals. B. Spices should be added to food to enhance flavor. C. Extreme vomiting should be reported to your physician. D. H. pylori can be a concern in patients with peptic ulcers. E. The goal of initial intervention is to control symptoms and prevent further complications.

A client in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? A. Teach the client about antacid effects and side effects. B. Ask the client about medications and dietary intake. C. Suggest that the client sleep with the head elevated 6 inches. D. Tell the client to avoid drinking alcohol late in the evening.

Ask the client about medications and dietary intake. The nurse's initial action should be further assessment of the client's risk factors for gastroesophageal reflux disease. Before suggesting interventions or beginning client teaching, the nurse must elicit more information about the client's symptoms. The nurse needs additional data before telling the client to avoid drinking alcohol late in the evening.

A client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? A. Explain to the client the importance of drinking the enteral supplements prescribed. B. Ask the client's family to try to persuade the client to drink the supplements. C. Inform the client that a nasogastric tube may be necessary if he or she fails to comply. D. Ask the client if a change in flavor would make the supplement more palatable.

Ask the client if a change in flavor would make the supplement more palatable. Asking the client if a change in flavor would help shows that the nurse is attempting to determine why the client is not drinking the supplements. Many clients don't like certain supplement flavors. The nurse should not assume that the client does not understand the importance of drinking the supplements or that the client requires persuasion to drink the supplements. The problem may be entirely different. Telling the client that a nasogastric tube may be necessary could be construed as threatening the client.

type A chronic gastritis

Associated with the presence of antibiotics to parietal cells and intrinsic factor

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a client's hiatal hernia. Which change does the nurse recommend to this client? A. Eat only two or three meals daily. B. Sleep flat in a left side-lying position. C. Drink tea instead of coffee. D. Avoid working while bent over the computer.

Avoid working while bent over the computer. The client should avoid working while bent over because this position presses on the diaphragm, causing discomfort. The client with a hiatal hernia should eat four to six meals a day. The head of the client's bed should be elevated approximately 6 inches. Both tea and coffee should be eliminated from this client's diet because of the caffeine content.

A client is admitted to the hospital with an exacerbation of chronic gastritis. When assessing the client's nutritional status, the nurse should expect to find what type of deficiency? A.vitamin C B. vitamin B12 C. vitamin B6 D. vitamin A

B.

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? A. "I will call my physician if I begin to have abdominal pain." B. "I will have to take vitamin B12 shots up to 1 year after surgery." C. "I will weight myself each day and record the weight." D. "I'm going to visit my pastor weekly for a while."

B. After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia

A nurse is reinforcing teaching with a group of community resident about hepatitis B. Which of the following statement should the nurse include in the teaching? A. "A hepatitis B immunization is recommended for those who travel, especially military personnel." B. "A hepatitis B immunization is given to infants and children." C. "Hepatitis B is acquired by eating foods that are contaminated during handling." D. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation."

B. "A hepatitis B immunization is given to infants and children."

A nurse is reinforcing teaching with a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? A. "This procedure is performed to measure the presence of acid in your esophagus." B. "This procedure can determine how well the lower part of your esophagus works." C. "This procedure is performed while you are under general anesthesia." D. "This procedure can determine if you have colon cancer."

B. "This procedure can determine how well the lower part of your esophagus works." An EGD is useful in determining the function of the esophageal lining and the extend of inflammation, potential scarring, and strictures

A nurse is collecting data from a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect? A. Jaundice B. Anorexia C. Dark urine D. Pale feces

B. Anorexia The early manifestations of hepatitis A and is often severe.

The nurse is caring for a client with esophageal cancer who has received photodynamic therapy using porfimer sodium (Photofrin). What instructions does the nurse include in teaching the client about porfimer sodium? (Select all that apply.) A. Avoid sunlight for 2 weeks. B. Cover all exposed body areas. C. Follow a clear liquid diet for 3 to 5 days after the procedure. D. Monitor for hypertension. E. Tissue particles may be found in the sputum.

B. Cover all exposed body areas. C. Follow a clear liquid diet for 3 to 5 days after the procedure. E. Tissue particles may be found in the sputum. Porfimer sodium causes photosensitivity, and sunglasses and protective clothing covering all exposed body areas are essential. A clear liquid diet should be followed for 3 to 5 days after the procedure and then should be advanced to full liquids as tolerated. The client should be warned that tissue particles may be released from the tumor site and may be present in the sputum. Sunlight should be avoided for 1 to 3 months. Side effects are rare and may include nausea, fever, and constipation. Hypertension is not a side effect of porfimer sodium.

The nurse is assessing a client with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? (Select all that apply.) A. Blood-tinged sputum B. Dyspepsia C. Excessive salivation D. Flatulence E. Regurgitation

B. Dyspepsia D. Flatulence E. Regurgitation Dyspepsia, also known as heartburn, is one of the main symptoms of GERD. Flatulence is common after eating, as well as regurgitation (backward flow into the throat) of food and fluids. Blood-tinged sputum and excessive salivation are not symptoms of GERD.

A nurse is caring for client who has a percutaneous endoscopic gastronomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? A. Flush the tube with water B. Place the client in semi-Folwer's position C. Cleanse the skin around the tube site D. Aspirate the tube prior to each feeding

B. Place the client in semi-Folwer's position The nurse should apply the ABC priority-setting framework

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that the purpose of this procedure is which of the following? A. To visualize colon polyps B. To detect an ulceration in the stomach C. To identify an obstruction in the biliary duct D. To determine the presence of free air in the abdomen

B. To detect an ulceration in the stomach

alkaline reflux gastrophathy

Bile reflux gastropathy; a complication of gastric surgery in which the pylorus is bypassed or removed

The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

Blood pressure from 140/90 to 110/70 mm Hg A decrease in blood pressure is the most indicative sign of bleeding. A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding.

A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect?

Boardlike abdomen

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? A. "I need to chew my food slowly and thoroughly." B"I should pick cereals with less than 2 g of fiber per serving." C. "I need to drink 8 ounces of water before eating." D."A total serving should amount to be less than one cup.

C. After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withholding fluids for 15 minutes before eating to 90 minutes after eating.

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? A. Bradycardia B. Bradypnea C. Mental confusion D. Hypertension

C. Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: A. ibuprofen and aspirin. B. alcohol and tobacco. C. gram-negative bacteria. D.stress and anxiety.

C. The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hr after treatment begins? A. Aldolase B. Lipase C. Amylase D. Lactic dehydrogenase

C. Amylase Pancreatitis is the most common diagnosis for marked elevations of serum amylase. Serum amylase begins to increase about 3 to 6 hr following the onset of acute pancreatitis.

A nurse is reinforcing teaching with a client who has diverticulitis about preventing acute attack. Which of the following foods should the nurse recommend? A. Foods high in vitamin C B. Foods low in fat C. Foods high in fiber D. Foods low in calories

C. Foods high in fiber

A nurse is assisting with the admission of the client who has fulminant hepatic failure. Which of the following procedures should the nurse expect for this client? A. Endoscopic sclerotherapy B. Liver lobectomy C. Liver transplant D. Transjugular intrahepatic portal-systemic shunt placement

C. Liver transplant

A nurse is checking who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? A. Elevated blood pressure B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

C. Rigid abdomen Abdominal tenderness and rigidity occur with a bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume and a lowered blood pressure, or hypotension results

A nurse is assisting with the admission of a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A. Famotidine B. Esomeprazole C. Vasopressin D. Omeprazole

C. Vasopressin Vasopressin constricts the splanchnic bed and decreases portal pressure. It also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varices.

the term for wasting syndrome.A general state of ill health involving marked weight loss and muscle loss

Chachexia

The nurse is reviewing the medication history for a client diagnosed with gastroesophageal reflux disease who has been prescribed esomeprazole (Nexium) once daily. The client reports that the drug doesn't completely control the symptoms. The nurse contacts the provider to discuss which intervention? A. Adding a second proton pump inhibitor medication B. Increasing the dose of esomeprazole C. Changing to a twice-daily dosing regimen D. Switching to omeprazole (Prilosec)

Changing to a twice-daily dosing regimen The proton pump inhibitors are usually effective when given once daily, but can be given twice daily if symptoms are not well controlled. Adding a second medication, increasing the dose, or switching to another proton pump inhibitor is not recommended.

The nurse and the dietitian are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is best for this client? A. Chicken salad on whole wheat bread B. Liver and onions C. Chicken and rice D. Cobb salad with buttermilk ranch dressing

Chicken and rice Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products. The client with dumping syndrome should not be allowed to have mayonnaise, onions, or buttermilk ranch dressing; the dressing is made from milk products. The client can have whole wheat bread only in very limited amounts.

A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing hepatitis A?

Children

A nurse is caring for a client who is 2 days postoperative following a gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding?

Clear liquids

The nurse is working with the dietitian to plan a menu for a client who has persistent difficulty swallowing. What is a suitable breakfast selection for this client? A. Scrambled eggs and toast B. Oatmeal and orange juice C. Puréed fruit and English muffin D. Cream of wheat and applesauce

Cream of wheat and applesauce Both cream of wheat and applesauce are foods of semi-solid consistency and are appropriate for this client. The client who is having difficulty swallowing should be given semi-solid foods and thickened liquids. Toast would not be appropriate, and orange juice would have to be thickened before it is given to this client. An English muffin would be inappropriate for this client because it is not a semi-solid food.

A 70-year-old woman with a complex medical history made an appointment with her primary care provider because she has recently been experiencing heartburn, abdominal pain, and nausea. The clinician has identified that the woman's symptoms are characteristic of acute gastritis. Which of the woman's following statements is suggestive of the etiology of her problem? A. "I remember my father often complaining about heartburn and indigestion." B. "My endocrinologist recently increased my dose of metformin that I take for my diabetes." C. "I've been taking glucosamine supplements because I've been told they'll help my arthritis." D. "I've changed from taking Tylenol for my arthritis pain to taking aspirin."

D

A patient asks the home health nurse from what the distressing symptoms of dumping syndrome result. What physiological occurrence should the nurse explain? A. Reflux of bile into the distal esophagus b. B. Irritation of the phrenic nerve due to diaphragmatic pressure C. Chronic malabsorption of iron and vitamins A and C D .Osmotic transport of extracellular fluid into the gastrointestinal tract

D

An older adult patient with a diagnosis of chronic gastritis has achieved acceptable control of his condition with the use of an H2 receptor antagonist. This patient's symptom control is a result of what therapeutic action of this drug? A.Activation of the gastric buffer system and release of alkaline gastric secretions B. The occlusion of parietal cells C. An increase in the pH of gastric secretions D. A decrease in HCl production by parietal cells

D

A client with gastric cancer is having a resection. What is the nursing management priority for this client? A. Preventing deep vein thrombosis (DVT) B. Teaching about radiation treatment C. Discharge planning D. Correcting nutritional deficits

D Clients with gastric cancer commonly have nutritional deficits and may have cachexia . Therefore, correcting nutritional deficits is a top priority. Chachexia= wasting syndrome.A general state of ill health involving marked weight loss and muscle loss

A client with morbid obesity and a history of severe sleep apnea and severe diabetes is being considered for bariatric surgery. When reviewing the client's medical record, the nurse would identify that which body mass index (BMI) would meet the criteria for such surgery? A. 32 kg/m2 B. 30kg/m2 C. 34 kg/m2 D. 36 kg/m2

D.

A client with morbid obesity is being scheduled for malabsorptive bariatric surgery. The nurse would provide teaching about which procedure? A. Roux-en-Y gastric bypass B. sleeve gastrectomy C. biliopancreatic diversion D. gastric banding

D.

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? A. Oral contrast B. Stool specimen C. Pelvic x-ray D. Nasogastric tube insertion

D.

An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of: A. Prealbumin and bilirubin B. Creatinine and blood urea nitrogen (BUN) C. Ionized calcium and C-reactive protein D. Iron and vitamin B12

D. Dietary deficiencies associated with gastrectomy include malabsorption of organic iron, which may require supplementation with oral or parenteral iron, and a low serum level of vitamin B12, which may require supplementation by the intramuscular route.

A nurse is collecting data from a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High-calorie diet B. Prior gastrointestinal illnesses C. Tobacco use D. Alcohol use

D. Alcohol use Alcohol consumption is one of the major causes of chronic pancreatitis in the US

A nurse is collecting data from a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Decreased heart rate B. Yellowing of the skin C. Increased blood pressure D. Board-like abdomen

D. Board-like abdomen The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a board-like abdomen and severe pain in the abdomen or back that radiates to the right shoulder

A nurse is caring for a client who is 2 days postoperative following a gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding? A. Vanilla pudding B. Apple juice C. Diet ginger ale D. Clear liquids

D. Clear liquids

A nurse is assisting with the card of a client who is receiving total parenteral nutrition (TPN) therapy and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis

D. Diaphoresis The nurse should recognize that the client has the potential for the development of hypoglycemia due to the sudden withdrawal of the TPN solution.

A nurse is caring for a client who is dehydrated and is receiving a continuous tube feeding through a pump at 75 mL/hr. When the nurse checks the client at 0800, which of the following findings requires intervention by the nurse? A. A full pitcher of water sitting on the client's bedside table withing the client's reach B. The disposable feeding bag is from the previous day at 1000 and contains 200mL of feeding C. The client is lying on the right side with a visible dependent loop in the feeding tube D. The head of the bed is elevate 20 degrees

D. The head of the bed is elevate 20 degrees The head of the bed should be at least 30 degrees

melena

Dark, sticky feces, as evidence of blood in the stool

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings?

Diaphoresis

GERD-expected findings

EXPECTED FINDINGS *heartburn* ● Classic report of dyspepsia after eating an offending food or fluid, and regurgitation ● Radiating pain (neck, jaw, or back) ● Report of a feeling of having a heart attack. ● Pyrosis (burning sensation in the esophagus) ● Dyspepsia (indigestion) ● Dysphagia or odynophagia (pain on swallowing) ● Pain that worsens with position (bending, straining, laying down) ● Pain that occurs after eating and lasts 20 min to 2 hr ● Throat irritation (chronic cough, laryngitis), hypersalivation, bitter taste in mouth (caused by regurgitation). Chronic GERD can lead to dysphagia. ● Increased flatus and eructation (burping). ● Pain is relieved (30min-1hr) by drinking water, sitting upright, or taking antacids. ● Manifestations occurring four to five times per week on a consistent basis are considered diagnostic. ● Tooth erosion

Early vs Late manifestations of Dumping Syndrome

Early Manifestations Onset : >Within 30 min after eating Cause: › Rapid emptying Symptoms: › Nausea, vomiting, and dizziness › Tachycardia › Palpitations Late Manifestations Onset: > 1.5 to 3 hr after eating Cause: › Excessive insulin release Symptoms: › Hunger, dizziness, and sweating › Tachycardia and palpitations › Shakiness and feelings of anxiety › Confusion

A client has undergone conventional esophageal surgery. The client's diet has been advanced to semi-solid, and feedings are well tolerated. The client reports experiencing diarrhea about 1 hour after each meal. What is the priority nursing intervention to help prevent further diarrhea? A. Ensure that the client takes adequate amounts of fluids with meals. B. Advance the diet to solid food and encourage eating as much as possible at meals. C. Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal. D. Encourage the client to take fluids between meals rather than with meals.

Encourage the client to take fluids between meals rather than with meals. Diarrhea is believed to be the result of vagotomy syndrome and can be managed by taking fluids between meals rather than with meals. For this client, fluids with meals can lead to the development of diarrhea immediately after eating. The client may not be physically ready to advance to a solid diet. The client should eat six to eight small meals daily. Magnesium hydroxide is a magnesium-based antacid that can cause diarrhea.

Peptic ulcer

Erosion of the mucosal lining of the stomach or duodenum. The mucous membranes can become eroded to the point that the epithelium is exposed to gastric acid and pepsin, which can precipitate bleeding and perforation. Perforation that extends through all the layers of the stomach or duodenum can cause peritonitis. An individual who has a peptic ulcer has peptic ulcer disease (PUD). There are gastric ulcers, duodenal ulcers, and stress ulcers (which occur after major stress or trauma).

What are some esophageal disorders

Esophageal disorders include gastroesophageal reflux disease (GERD), hiatal hernia, and esophageal varices.

H2-receptor antagonists

Famotidine; typically used to block gastric secretions

A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend?

Foods high in fiber

A nurse is caring for a client who has a history of cirrhosis and is admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use?

Gamma-glutamyl transferase (GGT)

What is GERD?

Gastric content and enzyme backflow into the esophagus. Some back flow of stomach contents into the esophagus is normal. When the reflux is excessive due to any of the following conditions—an incompetent LES, pyloric stenosis, hiatal hernia, excessive intra-abdominal or intragastric pressure, or motility problems—the corrosive fluids irritate the esophageal tissue, causing delay in their clearance. This further exposes esophageal tissue to the acidic fluids, causing more irritation

type B chronic gastritis

Gastritis associated with H. pylori infection

GERD health promotion and disease prevention

HEALTH PROMOTION AND DISEASE PREVENTION ● Maintain a weight below BMI of 30. ● Stop smoking. ● Limit or avoid alcohol and tobacco use. ● Eat a low-fat diet. ● Avoid foods that lower the LES pressure. chocolate, caffeine, peppermint->AVOID ● Avoid eating or drinking 2 hr before bed. ● Avoid tight‑fitting clothes. ● Elevate the head of the bed 6 to 8 inches

dyspepsia

Indigestion

gastritis

Inflammation of gastric mucosa

The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and then daily. D. Insert a nasogastric tube and connect to low intermittent suction.

Infuse lactated Ringer's solution at 200 mL/hr. The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia. A type and crossmatch, administration of pantoprazole, and insertion of a nasogastric tube must all be done, but the nurse's immediate concern is correcting the client's hypovolemia.

The nurse is reviewing orders for a client with possible esophageal trauma after a car crash. Which request does the nurse implement first? A. Give total parenteral nutrition (TPN) through a central venous catheter. B. Administer cefazolin (Kefzol) 1 g intravenously. C. Obtain a computed tomography (CT) scan of the chest and abdomen. D. Keep the client nothing by mouth (NPO) for possible surgery.

Keep the client nothing by mouth (NPO) for possible surgery. Clients with possible esophageal tears should be NPO until diagnostic testing is completed, because leakage of anything taken orally into the sterile mediastinum could occur. In addition, esophageal rest is maintained for about 10 days after esophageal trauma to allow time for mucosal healing. TPN is prescribed to provide calories and protein for wound healing; although this is important, it is not a priority for the nurse to implement first. Antibiotics may be requested to prevent possible infection, but this is not the priority. A CT of the chest and abdomen will be needed, but is not the nurse's initial action.

A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for this client?

Liver transplant

The nurse is caring for a client diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the health care provider will request which medication to manage diarrhea? A. Loperamide (Imodium) B. Mesalamine (Pentasa) C. Minocycline (Minocin) D. Pantoprazole (Protonix)

Loperamide (Imodium) Diarrhea is thought to be the result of vagotomy syndrome, which develops as a result of interruption of vagal fibers to the abdominal viscera during surgery. It can occur 20 minutes to 2 hours after eating and can be symptomatically managed with loperamide. Mesalamine is used to treat clients with mild to moderate ulcerative colitis. Minocycline is an antibiotic used for treatment of infection. Pantoprazole is used to treat gastroesophageal reflux disease.

Prokinetics-meds, considerations, education

Metoclopramide increases the motility of the esophagus and stomach. NURSING CONSIDERATIONS: Monitor the client taking metoclopramide for extrapyramidal side effects. CLIENT EDUCATION: Instruct the client to report abnormal, involuntary movement.

Which of these assigned clients does the nurse assess first after receiving the change-of-shift report? A. Young adult admitted the previous day with abdominal pain who is scheduled for a computed tomography (CT) scan in 30 minutes B. Adult with gastroesophageal reflux disease (GERD) who is describing epigastric pain at a level of 6 (0-to-10 pain scale) C. Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube D. Older adult admitted with an ileus who has absent bowel sounds and a prescription for metoclopramide (Reglan) on an as-needed (PRN) basis

Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube The presence of blood in NG drainage is an unexpected finding 2 days after esophagogastrectomy and requires immediate investigation. The young adult scheduled for a CT scan, the adult with GERD, and the older adult with an ileus are all stable and do not require the nurse's immediate attention.

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

Misoprostol (Cytotec) Misoprostol is a prostaglandin analogue that protects against nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers. Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have PUD. Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions, but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection.

Mucosal Protectant

Mucosal protectant: sucralfate (Carafate) ■ Nursing Considerations ☐ Give 1 hr before meals and at bedtime. ☐ Monitor for adverse effect of constipation.

stress ulcers

Multiple shallow erosions of the stomach and occasionally the proximal duodenum

DRUG CLASS THAT CAUSE GASTRITIS

NSAIDS

GERD-Fundoplication considerations & education

NURSING CONSIDERATIONS: Complications following fundoplication include temporary dysphagia (monitor for aspiration), gas bloat syndrome (difficulty belching to relieve distention), and atelectasis/pneumonia (monitor respiratory function). CLIENT EDUCATION ● Diet ◯ Avoid offending foods. ◯ Avoid large meals. ◯ Remain upright after eating. ◯ Avoid eating before bedtime. ◯ Consume four to six small meals throughout the day. ● Lifestyle ◯ Avoid clothing that is tight‑fitting around the abdomen. ◯ Lose weight, if applicable. ◯ Elevate the head of the bed 15.2 to 20.3 cm (6 to 8 in) with blocks. ◯ Sleep on the right side

Pernicious anemia

Occurs due to a deficiency of the intrinsic factor normally secreted by the gastric mucosa. ◯ Manifestations include pallor, glossitis, fatigue, and paresthesias. ◯ Client Education - Monthly lifelong vitamin B12 injections will be necessary.

proton pump inhibitors

Omeprazole; suppressed gastric acid secretions

GERD-meds

PPIs: reduce gastric acid by inhibiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion. Antacids Histamine 2 receptor agonists Prokinetics

The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1½ to 3 hours after a meal, usually at night. B. Pain is worsened by the ingestion of food. C. The client has a malnourished appearance. D. The client is a man older than 50 years.

Pain occurs 1½ to 3 hours after a meal, usually at night. A key symptom of duodenal ulcers is that pain usually awakens the client between 1:00 a.m. and 2:00 a.m., occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.

PPIs-meds, considerations, education

Pantoprazole, omeprazole, esomeprazole, rabeprazole, and lansoprazole NURSING CONSIDERATIONS ● Monitor for electrolyte imbalances and hypoglycemia in clients who have diabetes mellitus. ● Long-term use has been related to the development of community-acquired pneumonia and Clostridium difficile infections. CLIENT EDUCATION: Long-term use of PPIs places the client at risk for fractures, especially in older adults

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? A. Apply antiembolism stockings. B. Place a nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.

Place a nasogastric (NG) tube, and connect to suction. To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolism stockings will need to be applied, monitoring output is important, and famotidine (Pepcid) will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis.

The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a client diagnosed with esophageal cancer. Which instruction to the client is the highest priority? A. Place food at the back of the mouth as you eat. B. Do not be overly concerned with tongue or lip movements. C. Before swallowing, tilt the head back to straighten the esophagus. D. Do not attempt to reach food particles that are on the lips or around the mouth.

Place food at the back of the mouth as you eat. Placing food at the back of the mouth when eating will help the client avoid aspirating. Both tongue movements and sealing of the lips should be monitored in this client. The client's head should be tilted forward in the chin-tuck position. The client should be able to reach food particles on her or his lips and around the mouth with the tongue.

A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first?

Place the client in semi-Fowler's position

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure?

Prothrombin time

Proton Pump Inhibitors

Proton pump inhibitors: pantoprazole (Protonix), esomeprazole (Nexium) ■ Reduce gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid. ■ Reduce basal and stimulated acid production. ■ Nursing Considerations - Insignificant side/adverse effects with short-term treatment. ■ Client Education ☐ Instruct the client not to crush, chew, or break sustained-release capsules. ☐ Instruct the client to take omeprazole once a day prior to eating in the morning. ☐ Encourage the client to avoid alcohol and irritating medications (NSAIDs).

A client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider B. Asking the provider for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider Providing the client and spouse with both oral and written instructions on symptoms to report to the provider, as well as on how to perform the dressing change, will reinforce important points and boost the spouse's confidence. Obtaining a referral and recruiting other family members prevent the client and spouse from taking responsibility for the client's care. The spouse's concerns have already been clearly expressed.

Histamine2-receptor antagonists

Ranitidine hydrochloride (Zantac), famotidine (Pepcid) ■ Suppress the secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining the stomach. ■ Used in conjunction with antibiotics to treat ulcers caused by H. pylori. ■ Used to prevent stress ulcers in clients who are NPO after major surgery, have large areas of burns, are septic, or have increased intracranial pressure. ■ Nursing Considerations ☐ Ranitidine and famotidine can be administered IV in acute situations. ☐ Ranitidine can be taken with or without food. ☐ Treatment of peptic ulcer disease is usually started as an oral dose twice a day until the ulcer is healed, followed by a maintenance dose usually taken once a day at bedtime. ■ Client Education - Instruct clients to notify the provider of obvious or occult GI bleeding (coffee-ground emesis).

Histamine 2 receptor agonists-meds, considerations, education

Ranitidine, famotidine, and nizatidine reduce the secretion of acid. The onset is longer than antacids, but the effect has a longer duration. NURSING CONSIDERATIONS: Use cautiously in clients who have kidney disease. CLIENT EDUCATION ● Take with meals and at bedtime. ● Separate dosages from antacids (1 hr before or after taking antacid).

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? A. Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. B. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. C. Document instructions for a client with chronic gastritis about how to use "triple therapy." D. Assess the gag reflex for a client who has arrived from the postanesthesia care unit after a laparoscopic gastrectomy.

Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.

A client with an inoperable esophageal tumor is receiving swallowing therapy. Which task does the home health nurse delegate to an experienced home health aide? A. Teaching family members how to determine whether the client is obtaining adequate nutrition B. Assessing lung sounds for possible aspiration when the client is swallowing clear liquids C. Reminding the client to use the chin-tuck technique each time the client attempts to swallow D. Instructing family members about symptoms that may indicate a need to call the provider

Reminding the client to use the chin-tuck technique each time the client attempts to swallow The role of a home health aide when caring for a client with swallowing difficulty includes reinforcement of previously taught swallowing techniques. Client teaching and providing instructions to family members are not within the scope of practice of a home health aide and should be done by the nurse. Likewise, assessment is part of the nursing process and should be done by a nurse.

A client is being discharged after a minimally invasive esophagectomy. Which teaching point does the nurse consider to be of the highest priority during the predischarge teaching session? A. Instruct the client to eat three meals daily. B. Emphasize the importance of lying down after meals. C. Encourage the client to ask his or her health care provider for antidepressant medication. D. Report the presence of fever and a swollen, painful neck incision.

Report the presence of fever and a swollen, painful neck incision. Wound management and prevention of infection are major concerns because the client who has had an esophagectomy typically has multiple drains and incisions. The client should eat six to eight small meals daily, and should sit up after meals to encourage satisfactory swallowing. The client's coping skills should be assessed, as well as his or her level of anxiety and/or depression, before antidepressant medication is prescribed.

A nurse is caring for a client who is 4 hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect?

Right shoulder pain

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred?

Rigid abdomen

A client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? A. Schedule of the client's follow-up examinations and x-ray assessments B. Information on family members' progress in learning how to perform dressing changes C. Copy of the diet plan prepared for the client by the hospital dietitian D. Detailed account of what occurred during the client's surgical procedure

Schedule of the client's follow-up examinations and x-ray assessments Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly. It may take family members a long time to become proficient at tasks such as dressing changes. Although the case manager should be aware of the diet, family members will likely be preparing the client's daily diet, and they should be provided with this information. It is not necessary for the case manager to have details of the client's surgical procedure unless a significant event has occurred during the procedure.

A client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Starting a large-bore IV B. Administering IV pain medication C. Preparing equipment for intubation D. Monitoring the client's anxiety level

Starting a large-bore IV A large-bore IV should be placed as requested, so that blood products can be administered. IV pain medication is not a recommended treatment for gastrointestinal bleeding. Intubation is not a recommended treatment for bleeding related to PUD. The mental status of the client should be monitored, but it is not necessary to monitor the anxiety level of the client.

A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention by the nurse?

The head of the bed is elevated 20 degrees

c, b, a, d

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order does the nurse assess these clients? A. A client planned for an EGD at 1 PM B. A client requesting pain medication 2 days after a partial gastrectomy C. A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain D. A client who is NPO for tests to rule out gastric cancer

Pyloroplasty

The opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying.

What are the roles of sphincters in esophageal disorders?

There are two sphincters: upper esophageal (UES) also referred to as the oropharyngeal sphincter, and the lower esophageal (LES) also referred to as gastroesophageal sphincter. They prevent the reflux of food and fluids into the mouth or esophagus.

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is used to do which of the following?

To detect an ulceration in the stomach

Which client assessment information is correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C. Hematemesis and anorexia D. Treatment with radiation therapy

Treatment with radiation therapy Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Anorexia, nausea, and vomiting are all symptoms of acute gastritis. Corticosteroid use and hematemesis are also more likely to be signs of acute gastritis.

atrophic gastritis

Type of chronic gastritis that is seen most often in adults; can occur after exposure to toxic substances in the workplace

Which type of positioning should be utilized for a patient undergoing a paracentesis? 1. Supine 2. Up right at the edge of the bed with feet supported on a stool 3. Trendelenburg 4. Prone

Up right at the edge of the bed with feet supported on a stool Fowler's position should be used by the patient confined to bed.

The nurse is caring for a client with a hiatal hernia who had an open fundoplication yesterday. Which task does the nurse delegate to unlicensed assistive personnel (UAP)? A. Using a pillow to support the incision when the client coughs B. Adjusting the position of the nasogastric (NG) tube C. Assessing the level of postoperative pain using a 0-to-10 scale D. Giving the client sips of water once bowel sounds are heard

Using a pillow to support the incision when the client coughs Assisting a client to cough is a task within the education and skill level of UAP. NG tube maintenance, pain assessment, and assessment of bowel sounds require more knowledge of the potential complications associated with this surgical procedure, and are actions best performed by licensed nursing staff.

A nurse in the emergency department is caring for a client who has bleeding esophageal varies. The nurse should anticipate a prescription for which of the following medications?

Vasopressin

pernicious anemia

Vitamin B12 depletion

hematemesis

Vomiting blood

c

What is the approximate annual mortality rate associated with peptic ulcer disease (PUD) in the United States? A. 700 deaths B. 1500 deaths C. 3000 deaths D. 4500 deaths

a

What is the nursing priority in the management of a patient with an active upper GI bleed? A. Obtain vital signs. B. Notify the physician. C. Apply oxygen by nasal cannula. D. Type and cross match the patient for blood products.

A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray?

Wheat toast

a, c, e

When taking a history diagnosed with a gastric ulcer, which assessment findings does the nurse expect? SATA. A. Vomiting B. Weight loss C. Epigastric pain at night D. Relief of epigastric pain after eating E. Melena

a, c, d

Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.) A. Low hemoglobin (Hgb) B. Low white blood cell (WBC) level C. Low hematocrit (Hct) D. Positive for H. pylori bacteria E. Low potassium of 3.4 mEq/L

d

Which patient statement would cause the nurse to suspect that she may have Zollinger-Ellison syndrome (ZES)? A. "I can't lie flat for awhile after I've eaten." B. "I feel much better after taking Zantac (ranitidine)." C. "Occasionally I have pain in my left lower quadrant." D. "The stomach pain hurts, but the foul-smelling diarrhea is worse."

The nurse working during the day shift on the medical unit has just received report. Which client does the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy The client with epigastric pain is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or re-positioning. The client who had a subtotal gastrectomy is not in a life-threatening situation and does not require immediate assessment. The client with gastric cancer and the older adult with advanced gastric cancer are in stable condition and do not require immediate assessment.

GERD-complications

aspiration of gastric fluid and esophageal adenocarcinoma

Client Education for Surgical Interventions

■ Educate the client to take vitamin and mineral supplements due to decreased absorption after a gastrectomy, including vitamin B12, vitamin D, calcium, iron, and folate. ■ Consume small, frequent meals while avoiding large quantities of carbohydrates as directed.

Causes of Peptic Ulcers

■ Helicobacter pylori (H. pylori) infection ■ Nonsteroidal anti-inflammatory drug (NSAID) and corticosteroid use ■ Severe stress ■ Hypersecretory states ■ Type O blood ■ Excess alcohol ingestion ■ Chronic pulmonary or kidney disease ■ Zollinger-Ellison syndrome (combination of peptic ulcers, hypersecretion of gastric acid, and gastrin secreting tumors)

◯ Client Education

■ Lying down after a meal slows the movement of food within the intestines. ■ Limit the amount of fluid ingested at one time. ■ Eliminate liquids with meals, for 1 hr prior to, and following a meal. ■ Consume a high-protein, high-fat, low-fiber, and low- to moderate-carbohydrate diet. ■ Avoid milk, sweets, or sugars (fruit juice, sweetened fruit, milk shakes, honey, syrup, jelly). ■ Consume small, frequent meals rather than large meals

Nursing Actions for Dumping Syndrome

■ Monitor for vasomotor manifestations ■ Assist/instruct the client to lie down when vasomotor manifestations occur. ■ Administer medications. ☐ Administration of powdered pectin or octreotide (Sandostatin) subcutaneously may be prescribed if manifestations are severe and not effectively controlled with dietary measures. Pectin slows the absorption of carbohydrates. Octreotide blocks gastric and pancreatic hormones, which can lead to findings of dumping syndrome. ☐ Antispasmodic medications (dicyclomine [Bentyl]). ☐ Acarbose (Prandase) slows the absorption of carbohydrates. ☐ Malnutrition and fluid electrolyte imbalances may occur due to altered absorption. Monitor intake and output, laboratory values, and weight.

Nursing Actions for Surgical Interventions

■ Monitor incision for evidence of infection. ■ Place the client in a semi-Fowler's position to facilitate lung expansion. ■ Monitor nasogastric tube drainage. Scant blood may be seen in first 12 to 24 hr. ■ Notify the provider before repositioning or irrigating the nasogastric tube (disruption of sutures). ■ Monitor bowel sounds. ■ Advance diet as tolerated to avoid undesired effects (abdominal distention, diarrhea). ■ Administer medication as prescribed (analgesics, stool softeners).

GERD contributing factors

● Excessive ingestion of foods that relax the LES include fatty and fried foods, chocolate, caffeinated beverages (coffee), peppermint, spicy foods, tomatoes, citrus fruits, and alcohol ● Prolonged or frequent abdominal distention (from overeating or delayed emptying) ● Increased abdominal pressure from obesity, pregnancy, bending at the waist, ascites, or tight clothing at the waist ● Medications that relax the LES (theophylline, nitrates, calcium channel blockers, anticholinergics, and diazepam) ● Increased gastric acid caused by medications (NSAIDs) or stress (environmental) ● Debilitation resulting in weakened LES tone ● Hiatal hernia (LES displacement into the thorax with delayed esophageal clearance) ● Lying flat

GERD risk factors

● Obesity ● Older age (delayed gastric emptying and weakened LES tone) ● Sleep apnea ● Nasogastric tube

What is the primary treatment for GERD and what happens if it is left untreated?

● diet and lifestyle changes, advancing to medication use (antacids, H2-receptor antagonists, proton pump inhibitors) and surgery. ● Untreated GERD leads to inflammation, breakdown, and long-term complications, such as Barrett's esophagus or adenocarcinoma of the esophagus.

Perforation/Hemorrhage

◯ When peptic ulcers perforate or bleed, it is an emergency situation. ■ Perforation presents as severe epigastric pain spreading across the abdomen. The abdomen is rigid, board-like, hyperactive to diminished bowel sounds, and there is rebound tenderness. Perforation is a surgical emergency. ■ Gastrointestinal bleeding in the form of hematemesis or melena may cause manifestations of shock (hypotension, tachycardia, dizziness, confusion), and decreased hemoglobin. ◯ Nursing Actions ■ Perform frequent assessments of pain and vital signs to detect subtle changes that may indicate perforation or bleeding. ■ Report findings, prepare the client for endoscopic or surgical intervention, replace fluid and blood losses to maintain blood pressure, insert nasogastric tube, and provide saline lavages.