GI Practice questions from saunders / nurse sara

Left colon tumor symptoms

flat ribbon like stools crampy gas pains frequent diarrhea

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively 1.Low fiber 2.Low calorie 3.High protein 4.High carbohydrate

1.Low fiber Rationale:For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1.Lying recumbent following meals 2.Consuming small, frequent, bland meals 3.Taking H2-receptor antagonist medication 4.Raising the head of the bed on 6-inch (15 cm) blocks

1.Lying recumbent following meals Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals; use of H2-receptor antagonists and antacids; and elevation of the thorax following meals and during sleep

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? 1.This is a normal, expected event. 2.The client is experiencing early signs of ischemic bowel. 3.The client should not have the nasogastric tube removed. 4.This indicates inadequate preoperative bowel preparation.

1.This is a normal, Rationale:As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options 2, 3, and 4 are incorrect interpretations

The nurse checks the gastric residual of an unconscious client receiving nasogastric tube feedings continuously at 50 mL/hr. The nurse notes that the residual is 250 mL at 0800 and 300 mL at 0900. The nurse determines that the client is experiencing which complication? 1.Air in the stomach 2.Too slow an infusion rate 3.Delayed gastric emptying 4.Early signs of peptic ulcer

3.Delayed gastric emptying Rationale:If the gastric residual is greater than 200 mL for 2 consecutive hours, the client may be experiencing delayed gastric emptying. If this occurs, the feeding is stopped, and the primary health care provider should be notified. The nurse should assess whether abdominal girth is enlarged and should auscultate bowel sounds to rule out intestinal obstruction. Some clients benefit from administration of metoclopramide to stimulate gastric emptying. Air in the stomach would be accompanied by abdominal distention and increased abdominal girth. The infusion rate cannot be too slow if the client is not tolerating the rate. Early peptic ulcer could be detected by a Hematest-positive gastric aspirate. In addition, agency procedures should be followed regarding gastric residuals.

The nurse is performing an admission assessment on a client who has been admitted to the hospital with a diagnosis of suspected gastric ulcer. The nurse is asking the client questions about pain. Which client statement supports the diagnosis of gastric ulcer? 1."The pain doesn't usually come right after I eat." 2."The pain gets so bad that it wakes me up at night." 3."The pain that I get is located on the right side of my chest." 4."My pain comes shortly after I eat, maybe a half hour or so later."

4."My pain comes shortly after I eat, maybe a half hour or so later." Rationale:Gastric ulcer pain often occurs in the upper epigastrium, with localization to the left of the midline, and may be exacerbated by intake of food. The pain occurs 30 to 60 minutes after a meal and rarely occurs at night. Duodenal ulcer pain is usually located to the right of the epigastrium. The pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often awakens the client at night.

The nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present? 1.A sunken and hidden stoma 2.A narrow and flattened stoma 3.A stoma that is dusky or bluish 4.A stoma that is elongated with a swollen appearance

4.A stoma that is elongated with a swollen appearance A prolapsed stoma is one in which the bowel protrudes, causing an elongated and swollen appearance of the stoma. A retracted stoma is characterized by a sinking of the stoma. A stoma with a narrow opening is described as being stenosed. Ischemia of the stoma would be associated with a dusky or bluish color.

The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed that the nasogastric tube be removed. What is the priority nursing assessment prior to removing the tube? 1.Checking for normal serum electrolyte levels 2.Checking for normal pH of the gastric aspirate 3.Checking for proper nasogastric tube placement 4.Checking for the presence of bowel sounds in all 4 quadrants

4.Checking for the presence of bowel sounds in all 4 quadrants Distention, vomiting, and abdominal pain are a few of the symptoms associated with intestinal obstruction. Nasogastric tubes may be used to remove gas and fluid from the stomach, relieving distention and vomiting. Bowel sounds return to normal as the obstruction is resolved and normal bowel function is restored. Discontinuing the nasogastric tube before normal bowel function may result in a return of the symptoms, necessitating reinsertion of the nasogastric tube. Serum electrolyte levels, pH of the gastric aspirate, and tube placement are important assessments for the client with a nasogastric tube in place but would not assist in determining the readiness for removing the nasogastric tube

The nurse should instruct a client with an ileostomy to include which action as part of essential care of the stoma? 1.Massage the area below the stoma. 2.Take in high-fiber foods such as nuts. 3.Limit fluid intake to prevent diarrhea. 4.Cleanse the peristomal skin meticulously.

4.Cleanse the peristomal skin meticulously.

The nurse is caring for a client who has just returned from the operating room after the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment? 1.Apply ice to the stoma site. 2.Apply pressure to the stoma site. 3.Notify the primary health care provider (PHCP). 4.Document the amount and characteristics of the drainage.

4.Document the amount and characteristics of the drainage. Rationale:During the first 24 to 72 hours following surgery, mucus and serosanguineous drainage are expected from the stoma. Applying ice or pressure to the stoma site are inappropriate actions. Notifying the PHCP is unnecessary because this is an expected finding

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1.Folate deficiency 2.Malabsorption of fat 3.Intestinal obstruction 4.Fluid and electrolyte imbalance

4.Fluid and electrolyte imbalance A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

A client with a gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse should take which most appropriate action in the care of this client? 1.Obtain a court order for the surgery. 2.Have the charge nurse sign the informed consent immediately. 3.Send the client to surgery without the consent form being signed. 4.Obtain a telephone consent from a family member, following agency policy

4.Obtain a telephone consent from a family member, following agency policy

The nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. Which risk factor for colorectal cancer should the nurse include? 1.High-fiber, low-fat diet 2.Age older than 30 years 3.Distant relative with colorectal cancer 4.Personal history of ulcerative colitis or gastrointestinal polyp

4.Personal history of ulcerative colitis or gastrointestinal polyp

A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse notifies the primary health care provider (PHCP), and the PHCP initially prescribes that the solution and tubing be changed. What should the nurse do with the discontinued materials? 1.Discard them in the unit trash. 2.Return them to the hospital pharmacy. 3.Save them for return to the manufacturer. 4.Prepare to send them to the laboratory for culture.

4.Prepare to send them to the laboratory for culture.

The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients 1.Colectomy 2.Appendectomy 3.Ascending colostomy 4.Small bowel resection

4.Small bowel resection Rationale:The small intestine is responsible for the absorption of most nutrients. The client who has undergone removal of a segment of the small bowel is the one who has a decreased area with which to absorb nutrients. Decreased absorption is not a likely complication with the surgical procedures identified in the remaining option

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD? 1.Recently retired from a job 2.Significant other has a gastric ulcer 3.Occasionally drinks 1 cup of coffee in the morning 4.Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

4.Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis Risk factors for PUD include Helicobacter pylori infection, smoking (nicotine), chewing tobacco, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress. When an NSAID is taken as often as is typical for osteoarthritis, it will cause problems with the stomach. Certain medical conditions such as Crohn's disease, Zollinger-Ellison syndrome, and hepatic and biliary disease also can increase the risk for PUD by changing the amount of gastric and biliary acids produced. Recent retirement should decrease stress levels rather than increase them. Ulcer disease in a first-degree relative also is associated with increased risk for an ulcer. A significant other is not a first-degree relative; therefore, no genetic connection is noted in this relationship. Although caffeinated drinks are a known risk factor for PUD, the option states that the client drinks 1 cup of coffee occasionally.

5. After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?* A. "It is best to try to consume small meals throughout the day than eat 3 large ones." B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love eating those types of hard candies." C. "It is important I avoid eating right before bedtime." D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter."

The answer is D. This statement is incorrect. The patient should have said I will AVOID lying down after eating a meal to help decrease pressure on the lower esophageal sphincter. It is important a patient does not immediately lie down after eating but wait for about 1 hour

4. During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY:* A. Hot and Spicy Pork Rinds B. Peppermint Patties C. Green Beans D. Tomato Soup E. Chocolate Fondue F. Almonds G. Oranges

The answers are A, B, D, E, G. Patients with GERD should avoid foods that relax the lower esophageal sphincter such as greasy/fatty foods (Hot and Spicy Pork Rinds), peppermint (peppermint patties), acidic or citrus foods/juice (tomato soup and oranges), chocolate (chocolate fondue), along with coffee and soft drinks.

The nurse is creating a plan of care for a client who is receiving total parenteral nutrition (TPN). Which assessment should be included in the plan of care? 1.Apical rate every hour 2.Continuous pulse oximetry 3.Blood glucose levels every 6 hours 4.Hemoglobin and hematocrit every 8 hours

blood glucose every 6 hrs Complications associated with TPN therapy include hypoglycemia or hyperglycemia, infection, fluid overload, air embolism, and electrolyte imbalance. It is standard care to monitor blood glucose levels at 6-hour intervals to assess for hyperglycemia. The remaining options contain assessments that are not routine for a client receiving TPN.

The nurse is aware that the most common cause of small bowel obstruction is which of the following? Volvulus Neoplasms Adhesions Hernias

Adhesions

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1."My ulcer will heal because these medications will kill the bacteria." 2."These medications are only taken when I have pain from my ulcer." 3."The medications will kill the bacteria and stop the acid production." 4."These medications will coat the ulcer and decrease the acid production in my stomach."

"The medications will kill the bacteria and stop the acid production.

Dumping syndrome S+S

- Dehydration - Hypotension - Lightheadedness - N/D - Occur 30 minutes after eating a meal or 1-3 hrs after eating o Late hypoglycemia shakiness, HA, irritability, weakness, anxiousness can result in coma, death, lethargy

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective? 1."Baked foods such as chicken or fish are all right to eat." 2."Citrus fruits and raw vegetables need to be included in my daily diet." 3."I can drink beer as long as I consume only a moderate amount each day." 4."I can drink coffee or tea as long as I limit the amount to 2 cups daily."

1."Baked foods such as chicken or fish are all right to eat. Rationale:Dietary modifications for the client with peptic ulcer disease include eliminating foods that can cause irritation to the gastrointestinal (GI) tract. Items that should be eliminated or avoided include highly spiced foods, alcohol, caffeine, chocolate, and citrus fruits. Other foods may be taken according to the client's level of tolerance for that food.

A client's nasogastric feeding tube has become clogged. The nurse should take which action first? 1.Replace the tube. 2.Aspirate the tube. 3.Flush with carbonated liquids. 4.Flush the tube with warm water.

2.Aspirate the tube The first step in attempting to unclog a feeding tube is gently aspirating the tube. If this is not successful, flushing the tube with warm water can be tried.

A client is being weaned from parenteral nutrition (PN) and is expected to begin taking solid food today. The ongoing solution rate has been 100 mL/hour. The nurse anticipates that which prescription regarding the PN solution will accompany the diet prescription? 1.Discontinue the PN. 2.Decrease PN rate to 50 mL/hour. 3.Start 0.9% normal saline at 25 mL/hour. 4.Continue current infusion rate prescriptions for PN

1.Discontinue the PN When a client begins eating a regular diet after a period of receiving PN, the PN is decreased gradually. PN that is discontinued abruptly can cause hypoglycemia. Clients often have anorexia after being without food for some time, and the digestive tract also is not used to producing the digestive enzymes that will be needed. Gradually decreasing the infusion rate allows the client to remain adequately nourished during the transition to a normal diet and prevents the occurrence of hypoglycemia. Even before clients are started on a solid diet, they are given clear liquids followed by full liquids to further ease the transition. A solution of normal saline does not provide the glucose needed during the transition of discontinuing the PN and could cause the client to experience hypoglycemia.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings 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

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective? 1."I should be sure to eat at least 1 cucumber every day." 2."Beet greens, parsley, or yogurt will help to control the colostomy odor." 3."I will need to increase my egg intake and try to eat ½ to 1 egg per day." 4."Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day.

2."Beet greens, parsley, or yogurt will help to control the colostomy odor."

The nurse is caring for a client who is receiving total parenteral nutrition (TPN) via a central line. Which nursing intervention would specifically provide assessment data related to the most common complication associated with TPN? 1.Weighing the client daily 2.Monitoring the temperature 3.Monitoring intake and output (I&O) 4.Monitoring the blood urea nitrogen (BUN) leve

2.Monitoring the temperature most common complication of TPN is sepsis which could manifest into sepsis.

A client with a history of gastric ulcers complains of a sudden, sharp, and severe pain in the midepigastric area, which then spreads over the entire abdomen. The client's abdomen is rigid and board-like on palpation, and the client obtains most comfort from lying in the knee-chest position. The nurse suspects which condition and should perform which action? 1.Obstruction; call the operating room. 2.Perforation; notify the primary health care provider. 3.Intractability; administer cleansing enema. 4.Hemorrhage; increase intravenous fluid rate.

2.Perforation; notify the primary health care provider. the signs and symptoms described in the question are consistent with perforation of the ulcer, which may progress to peritonitis if the perforation is large enough. A client with intestinal obstruction would most likely complain of abdominal pain and distention and nausea and vomiting. Intractability is a term that refers to continued manifestations of a disease process despite ongoing medical treatment. A client with hemorrhage would vomit blood or coffee-ground material or would expel black, tarry, or bloody stools.

The nurse notes that the client's intravenous (IV) site is cool, pale, and swollen and that the solution is not infusing. What is the nurse's priority action? 1.Elevate the extremity. 2.Remove the IV catheter. 3.Assess for signs of infection. 4.Decrease the rate of infusion.

2.Remove the IV catheter. infiltrated

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1.Constipation 2.Abdominal pain 3.An episode of diarrhea 4.Hematest-positive nasogastric tube drainage

3.An episode of diarrhea

A client with a history of gastroesophageal reflux disease (GERD) is diagnosed with peptic ulcer disease (PUD). The primary health care provider prescribes sucralfate in addition to the client's other medications. What teaching should the nurse include in this client's instructions? 1.Take the sucralfate once a day at bedtime with food. 2.Take the sucralfate daily with the proton pump inhibitor. 3.Take the sucralfate before meals and at bedtime on an empty stomach. 4.Take the sucralfate immediately after eating and within 30 minutes of an antacid.

3.Take the sucralfate before meals and at bedtime on an empty stomach.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding 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

The nurse is preparing to insert a nasogastric tube (NG) into a client. What nursing measure will best facilitate insertion of the tube? 1.Placing the NG tube in warm water 2.Hyperextending the head to insert the tube 3.Removing the tube if any resistance to insertion is met 4.Asking the client to swallow as the tube is being advanced

4.Asking the client to swallow as the tube is being advanced

A client has an as-needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1.Paralytic ileus 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting

4.Nausea and vomiting

The nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to cough and has difficulty breathing. What is the most appropriate action 1.Insert the tube quickly. 2.Notify the primary health care provider immediately. 3.Remove the tube and reinsert it 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. It is not necessary to notify the primary health care provider immediately or remove the tube completely. Quickly inserting the tube is not an appropriate action because, in this situation, it is likely that the tube has entered the bronchus.

A client is receiving total parenteral nutrition (TPN). The nurse monitors the client for complications of the therapy and should assess the client for which manifestations of hyperglycemia 1.Fever, weak pulse, and thirst 2.Nausea, vomiting, and oliguria 3.Sweating, chills, and abdominal pain 4.Weakness, thirst, and increased urine output

4.Weakness, thirst, and increased urine output

1. A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:* A. Bitter taste in mouth B. Dry cough C. Melena D. Difficulty swallowing E. Smooth, red tongue F. Murphy's Sign

A, B, D The answers are A, B, D. These are signs and symptoms seen with GERD. Melena is seen with gastrointestinal bleeding as in peptic ulcer disease. Smooth, red tongue is seen with vitamin B12 deficiency, and Murphy's Signs is seen with cholecystitis.

13. Select all the medications a physician may order to treat a H. Pylori infection that is causing a peptic ulcer? · A. Proton-Pump Inhibitors · B. Antacids · C. Anticholinergics · D. 5-Aminosalicylates · E. Antibiotics · F. H2 Blockers G. Bismuth Subsalicylates

A, E, F, G

2. A patient has developed a duodenal ulcer. As the nurse, you know that which of the following plays a role in peptic ulcer formation. Select ALL that apply:* A. Spicy foods B. Helicobacter pylori C. NSAIDs D. Milk E. Zollinger-Ellison Syndrome

B C E

The initial symptom of abdominal pain described by the client in which of the following ways would lead the nurse to suspect a small bowel obstruction? Sharp, knife-like Rebound, squeezing Dull, aching Colicky, crampy

Colicky, crampy

The nurse is preparing to administer an intermittent enteral feeding through a nasogastric (NG) tube. Which priority assessment should the nurse perform? 1.Observe for digestion of formula. 2.Assess fluid and electrolyte status. 3.Evaluate absorption of the last feeding. 4.Evaluate percussion tone of the stomach

Evaluate absorption of the last feeding. All stomach contents are aspirated and measured before a tube feeding is administered. This procedure measures the gastric residual. The gastric residual is assessed to confirm whether undigested formula from a previous feeding remains, thereby evaluating absorption of the last feeding. It is important to assess gastric residual because administration of an enteral feeding to a full stomach could result in overdistention, predisposing the client to regurgitation and possible aspiration. The remaining options do not relate to the purpose of assessing residual

The nurse is providing discharge instructions to a client following gastrectomy and should instruct 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 fluids taken with meals. 4.Sit in a high-Fowler's position during meals.

Limit the fluids taken with meals.

The nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse should place the client in which position? 1.Modified left lateral recumbent position 2.Modified right lateral recumbent position 3.On the left side of the body, with the head of the bed elevated 45 degrees 4.On the right side of the body, with the head of the bed elevated 45 degrees

Modified left lateral recumbent position

6. You're collecting a patient's medication history that has GERD. Which medication below is NOT typically used to treat GERD?* A. Colesevelam "Welchol" B. Omeprazole "Prilosec" C. Metoclopramide "Reglan" D. Ranitidine HCL "Zantac"

The answer is A. Options B is a proton-pump Inhibitors (PPIs) and it decreases stomach acid and helps the esophagus heal. Option C is a type of prokinetic drug and prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and it improves peristalsis of the GI tract. Option D is a histamine receptor blocker and it blocks histamine. When histamine is released it causes the parietal cells to release HCL but this response will be blocked so gastric acid secretion will be decreased. Option A is a drug used in gallbladder disease.

2. Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus' ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm having later today?" You tell the patient the name of the test is:* A. Lower Esophageal Gastrointestinal Series B. Transesophageal echocardiogram C. Esophageal manometry D. Esophageal pH monitoring

The answer is C. An esophageal manometry assesses the function of the esophagus' ability to squeeze the food down and how the lower esophageal sphincter closes.

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information should the nurse include in the teaching plan? 1.Use 500 to 1000 mL of warm tap water. 2.Suspend the irrigant 36 inches above the stoma. 3.Insert the irrigation cone ½ inch into the stoma. 4.If cramping occurs, open the irrigation clamp farther.

Use 500 to 1000 mL of warm tap water. Rationale:The usual procedure for colostomy irrigation includes using 500 to 1000 mL of warm tap water. The solution is suspended 18 inches above the stoma. The cone is inserted 2 to 4 inches into the stoma but should never be forced. If cramping occurs, the client should decrease the flow rate of the irrigant as needed by closing the irrigation clamp. This practice is not common because of odor-proof pouches.

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1.Tremors 2.Dizziness 3.Confusion 4.Hallucinations

confusion Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an assigned client is empty. Which solution should the nurse hang until another PN solution is mixed and delivered to the nursing unit?

10% dextrose in water

A client with total parenteral nutrition (TPN) infusing has disconnected the tubing from the central line catheter. The nurse assesses the client and suspects an air embolism. The nurse should immediately place the client in which position? 1.On the left side, with the head lower than the feet 2.On the left side, with the head higher than the feet 3.On the right side, with the head lower than the feet 4.On the right side, with the head higher than the feet

1.On the left side, with the head lower than the feet

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function? 1.The passage of flatus 2.Absent bowel sounds 3.The client's ability to tolerate food 4.Bloody drainage from the colostomy

1.The passage of flatus

Priority Nursing diagnoses for pt with numerous episodes of diarrhea from duping syndrome in the past 24 hours?

- Fluid volume deficit

What is the biggest cause of ulcers in the stomach and duodenum?

- H. Pylori

Nurse is assessing a pt just admitted with SBO which bowel sound would be auscultated on this pt?

- Hyperactive above and hypoactive below the obstruction

The nurse is caring for a client with a peptic ulcer who has just had an esophagogastroduodenoscopy (EGD). Which client problem should be the priority? 1.Risk for dehydration caused by bleeding in the gastrointestinal tract 2.Risk for choking and aspiration related to a poor gag reflex postprocedure 3.Lack of knowledge of postprocedure care related to not having had an EGD before 4.Sore throat related to passage of the endoscope through the pharyngeal region during EGD

2.Risk for choking and aspiration related to a poor gag reflex postprocedure

The nurse is preparing to insert a nasogastric tube into a client. The nurse should place the client in which position for insertion? 1.Right side 2.Low-Fowler's 3.High-Fowler's 4.Supine with the head flat

3.High-Fowler's

A client receiving total parenteral nutrition (TPN) experiences sudden development of chest pain, dyspnea, tachycardia, cyanosis, and a decreased level of consciousness. What should the nurse suspect as a complication of the TPN? 1.Air embolism 2.Hyperglycemia 3.Catheter-related sepsis 4.Allergic reaction to the catheter

Air embolism Signs and symptoms of air embolism include decreased level of consciousness, tachycardia, dyspnea, anxiety, feelings of impending doom, chest pain, cyanosis, and hypotension. The signs and symptoms in the question do not indicate hyperglycemia, an infection (catheter-related sepsis), or an allergic reaction.

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1.A decreased pH and an increased Paco2 2.An increased pH and a decreased Paco2 3.A decreased pH and a decreased HCO3- 4.An increased pH and an increased HCO3-

An increased pH and an increased HCO3- Rationale:Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include a decrease in the respiratory rate and depth, and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition.

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the primary health care provider (PHCP)? 1.Dark red drainage 2.Dark brown drainage 3.Green-tinged drainage 4.Light yellowish-brown drainage

Dark red drainage Rationale:For the first 12 hours after gastric surgery, the nasogastric tube drainage may be dark brown to dark red. Later, the drainage should change to a light yellowish-brown color. The presence of bile may cause a green tinge. The PHCP should be notified if dark red drainage, a sign of hemorrhage, is noted 24 hours postoperatively.

· 3. You're educating a group of patients at an outpatient clinic about peptic ulcer formation. Which statement is correct about how peptic ulcers form?* o A. "An increase in gastric acid is the sole cause of peptic ulcer formation." o B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." o C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be released which signals to the parietal cells to release more pepsinogen which erodes the stomach lining further." o D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form."

o B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further."

· 15. A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing?* o A. Obstruction of pylorus o B. Upper gastrointestinal bleeding o C. Perforation o D. Peritonitis

o B. Upper gastrointestinal bleeding

· 5. Helicobacter pylori can live in the stomach's acidic conditions because it secretes ___________ which neutralizes the acid.* o A. ammonia o B. urease o C. carbon dioxide o D. bicarbonate

o B. urease

· 6. The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present?* o A. Ammonia o B. Urea o C. Hydrochloric acid o D. Carbon dioxide

o D. Carbon dioxide

· 1. In the stomach lining, the parietal cells release _________ and the chief cells release __________ which both play a role in peptic ulcer disease.* o A. pepsin, hydrochloric acid o B. pepsinogen, pepsin o C. pepsinogen, gastric acid o D. hydrochloric acid, and pepsinogen

o D. hydrochloric acid, and pepsinogen

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client1.Assessment of vital signs 2.Completion of abdominal examination 3.Insertion of the prescribed nasogastric tube 4.Thorough investigation of precipitating events

1.Assessment of vital signs

The nurse is preparing to discontinue a client's nasogastric tube. The client is positioned properly, and the tube has been flushed with 15 mL of air to clear secretions. Before removing the tube, the nurse should make which statement to the client? 1."Take a deep breath when I tell you, and hold it while I remove the tube." 2."Take a deep breath when I tell you, and bear down while I remove the tube." 3."Take a deep breath when I tell you, and slowly exhale while I remove the tube." 4."Take a deep breath when I tell you, and breathe normally while I remove the tube."

1."Take a deep breath when I tell you, and hold it while I remove the tube." rationale: The client should take a deep breath, because the client's airway will be temporarily obstructed during tube removal. The client is then told to hold the breath and the tube is withdrawn slowly and evenly over the course of 3 to 6 seconds (coil the tube around the hand while removing it) while the breath is held. Bearing down could inhibit the removal of the tube. Exhaling is not possible during removal because the airway is temporarily obstructed during removal. Breathing normally could result in aspiration of gastric secretions during inhalation.

The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? 1.A client with an ileostomy 2.A client with heart failure 3.A client on long-term corticosteroid therapy 4.A client receiving frequent wound irrigations

1.A client with an ileostomy Rationale:A fluid volume deficit occurs when the fluid intake is not sufficient to meet the fluid needs of the body. Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy or a client receiving frequent wound irrigations is most at risk for fluid volume excess.

The nurse, caring for a group of adult clients on an acute care medical-surgical nursing unit, determines that which clients would be the most likely candidates for parenteral nutrition (PN)? Select all that apply. 1.A client with extensive burns 2.A client with cancer who is septic 3.A client who has had an open cholecystectomy 4.A client with severe exacerbation of Crohn's disease 5.A client with persistent nausea and vomiting from chemotherapy

1.A client with extensive burns 2.A client with cancer who is septic 4A client with severe exacerbation of Crohn's disease 5.A client with persistent nausea and vomiting from chemotherapy

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? 1.Age younger than 50 years 2.History of colorectal polyps 3.Family history of colorectal cancer 4.Chronic inflammatory bowel disease

1.Age younger than 50 years

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply 1.Coffee 2.Chocolate 3.Peppermint 4.Nonfat milk 5.Fried chicken 6.Scrambled egg

1.Coffee 2.Chocolate 3.Peppermint5.Fried chicken Rationale:Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect.

The nurse is caring for a client experiencing acute lower gastrointestinal bleeding. In developing the plan of care, which priority problem should the nurse assign to this client? 1.Deficient fluid volume related to acute blood loss 2.Risk for aspiration related to acute bleeding in the GI tract 3.Risk for infection related to acute disease process and medications 4.Imbalanced nutrition, less than body requirements, related to lack of nutrients and increased metabolism

1.Deficient fluid volume related to acute blood loss

A client receiving total parenteral nutrition (TPN) through a single-lumen central intravenous (IV) line is scheduled to receive an antibiotic by the IV route. Which action by the nurse is appropriate before hanging the antibiotic solution? 1.Ensure a separate IV access for the antibiotic. 2.Turn off the solution for 30 minutes before administering the antibiotic. 3.Flush the central IV line with 60 mL of normal saline before giving the antibiotic. 4.Check with the pharmacy to be sure the antibiotic can be given through the TPN solution line.

1.Ensure a separate IV access for the antibiotic Rationale:The TPN solution line is used only for the administration of the solution. Any other IV medication must be run though a separate IV access site; therefore, the remaining options are incorrect.

The nurse is teaching an older client about measures to prevent constipation. Which statement by the client indicates a need for further teaching? 1."I walk 1 to 2 miles every day." 2."I need to decrease fiber in my diet." 3."I have a bowel movement every other day." 4."I drink 6 to 8 glasses of water every day

2."I need to decrease fiber in my diet. Rationale:An older client has an increased tendency to experience constipation because of decreased stomach-emptying time and a lowered basal metabolic rate. Adequate dietary fiber is an important factor in aiding bowel function. Dietary fiber increases fecal weight and water content and accelerates the transit of fecal mass through the gastrointestinal tract. The retention of water by the fiber has the ability to soften stools and promote regularity. Fluid intake and exercise also facilitate bowel elimination.

The ambulatory care nurse is providing instructions to a client who is scheduled for a colonoscopy and possible removal of a polyp. Which instructions are appropriate for client preparation for this procedure? 1.Clear liquids may be consumed starting 24 hours after the procedure. 2.A bowel preparation will be needed in preparation for the procedure. 3.Clear liquids only are allowed on the day of the scheduled procedure. 4.If blood-tinged stools are noted after the procedure, the primary health care provider should be notified.

2.A bowel preparation will be needed in preparation for the procedure. Rationale:The client should be instructed that bowel preparation with a laxative is prescribed before the procedure to cleanse the bowel. Oral intake is allowed after the procedure once the client is stable. A clear liquid diet is permitted on the day before the procedure (per primary health care provider preference), and then oral intake is avoided for 8 hours immediately before the procedure. If a polyp has been removed, the client is instructed that the stool may be tinged with blood. However, any signs of tenderness, abdominal pain, or bloody stools should be reported to the primary health care provider

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription 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 The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the primary health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

The nurse is planning to teach a client with malabsorption syndrome about the necessity of following a low-fat diet. The nurse develops a list of high-fat foods to avoid and should include which food items on the list? Select all that apply. 1.Oranges 2.Broccoli 3.Margarine 4.Cream cheese 5.Luncheon meats 6.Broiled haddock

3.Margarine 4.Cream cheese 5.Luncheon meats

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching 1."I plan to eat 4 to 6 small meals a day." 2."I should sleep in the right side-lying position." 3."I plan to have a snack 1 hour before going to bed." 4."I will stop having a glass of wine each evening with dinner."

3."I plan to have a snack 1 hour before going to bed avoiding eating at least 3 hours before going to bed because reflux episodes are most damaging at night.

The nurse is caring for a postoperative client who has just returned from surgery for creation of a colostomy. The nurse inspects the colostomy stoma and recognizes that which is a normal assessment finding for this client? 1.A pale color 2.A purple color 3.A brick-red color 4.A large amount of red drainage

3.A brick-red color Rationale:Normal characteristics of a stoma include a rose to brick-red color indicating viable mucosa, mild to moderate edema during the initial postoperative period, and a small amount of oozing blood from the stoma mucosa (because of its high vascularity) when it is touched. A pale color may indicate anemia. A stoma that is dark red to purple indicates inadequate blood supply to the stoma or bowel due to adhesions, low blood flow state, or excessive tension on the bowel at the time of construction. A small amount of bleeding is considered normal, but a moderate to large amount of bleeding from the stoma mucosa could indicate coagulation factor deficiency, stomal varices secondary to portal hypertension, or lower gastrointestinal bleeding.

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially? 1.Call the surgeon to report the problem. 2.Reposition the NG tube to the proper location. 3.Check the suction device to make sure it is working. 4.Irrigate the NG tube with saline to remove the obstruction

3.Check the suction device to make sure it is working. Rationale:After gastric surgery, the client will have an NG tube in place until bowel function returns. It is important for the NG tube to drain properly to prevent abdominal distention and vomiting. The nurse must ensure that the NG tube is attached to suction at the level prescribed and that the suction device is working correctly. The tip of the NG tube may be placed near the suture line. Because of this possibility, the nurse should never reposition the NG tube or irrigate it. If the NG tube needs to be repositioned, the nurse should call the surgeon, who would do this repositioning under fluoroscopy.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which manifestation of duodenal ulcer? 1.Weight loss 2.Nausea and vomiting 3.Pain relieved by food intake 4.Pain radiating down the right arm

3.Pain relieved by food intake Rationale:A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.

The registered nurse is preparing to insert a nasogastric tube in an adult client. To determine the accurate measurement of the length of the tube to be inserted, the nurse should take which action? 1.Mark the tube at 10 inches (25.5 cm). 2.Mark the tube at 32 inches (81 cm). 3.Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the xiphoid process. 4.Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the top of the sternum.

3.Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the xiphoid process.

Which clinical findings are consistent with sepsis diagnostic criteria? Select all that apply 1.Urine output 50 mL/hr 2.Hypoactive bowel sounds 3.Temperature of 102° F (38.9° C) 4.Heart rate of 96 beats per minute 5.Mean arterial pressure 65 mm Hg 6.Systolic blood pressure 110 mm Hg

3.Temperature of 102° F (38.9° C) 4.Heart rate of 96 beats per minute 5.Mean arterial pressure 65 mm Hg

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result? 1.The client reports some pain before meals. 2.The client frequently is awakened at 2 a.m. with heartburn. 3.The client has eliminated any irritating foods from the diet. 4.The client's pain is minimal with histamine H2-receptor antagonists.

3.The client has eliminated any irritating foods from the diet. Expected outcomes for the client with PUD who is experiencing pain include elimination of irritating foods from the diet, effectiveness of prescribed medications to eliminate pain, self-reporting of absence of pain with medication, and an ability to sleep through the night without pain. The client who continues to be awakened by pain requires further modification of medication therapy, which may include adjustment of timing of histamine H2-receptor antagonist administration or an additional dose of antacid before the time when pain usually awakens the clien

The nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse asks the client to take which essential action during the tubing change 1.Breathe normally. 2.Turn the head to the right. 3.Exhale slowly and evenly. 4.Take a deep breath, hold it, and bear down.

4.Take a deep breath, hold it, and bear down. The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tubing changes. The nurse asks the client to take a deep breath, hold it, and bear down. If the intravenous line is on the right, the client turns his or her head to the left. This position increases intrathoracic pressure. Breathing normally and exhaling slowly and evenly are inappropriate and could enhance the potential for an air embolism during the tubing change.

The nurse is caring for a client with a diagnosis of severe dehydration. The client has been receiving intravenous (IV) fluids and nasogastric (NG) tube feedings. The nurse monitors fluid balance using which as the best indicator?

DAILY WEIGHTS

The nurse anticipates that the initial treatment for small bowel obstruction will involve which of the following? Insertion of a rectal tube for drainage Surgical intervention Colonoscopy and irrigation Decompression of bowel via nasogastric tube

Decompression of bowel via nasogastric tube

The nurse is performing an admission assessment of a client with a possible right colon tumor. Which sign or symptom should the nurse anticipate the client may report? 1.Frequent diarrhea 2.Crampy gas pains 3.Flat, ribbon-like stools 4.Dull abdominal pain exacerbated by walking

Dull abdominal pain exacerbated by walking, dark red mahogany colored blood mixed in stool

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for?

Metabolic alkalosis Rationale:Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.

The nurse is caring for a client who is receiving bolus feedings via a nasogastric tube. As the nurse is finishing the feeding, the client asks for the bed to be positioned flat for sleep. The nurse understands that which is the appropriate position for this client at this time? 1.Head of bed flat, with the client supine for 60 minutes 2.Head of bed flat, with the client in the supine position for at least 30 minutes 3.Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes 4.Head of bed in a semi-Fowler's position, with the client in the left lateral position for 60 minutes

Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes Aspiration is a possible complication associated with nasogastric tube feeding. The head of the bed is elevated 30 to 45 degrees for 60 minutes after a bolus tube feeding to prevent vomiting and aspiration. The right lateral position uses gravity to facilitate gastric emptying and thus prevent vomiting. The flat supine position is to be avoided for the first 30 minutes after a tube feeding.

Potassium chloride may be administered in the client with small bowel obstruction and dehydration to correct hypokalemia. The nurse knows that a client experiencing decreased potassium levels would exhibit which of the following signs and symptoms? Increased thirst, polyuria Hypotension, muscle weakness Increased reflexes, tachycardia Hypertension, bradycardia

Hypotension, muscle weakness Rationale:Signs and symptoms of hypokalemia can include hypotension, muscle weakness, fatigue, anorexia, nausea and vomiting, polyuria, decreased bowel motility and decreased BP. pg 243-245

The nurse is aware that untreated small bowel obstruction can progress to which type of shock? Cardiogenic Hypovolemic None of these Distributive

Hypovolemic Rationale:The vomiting that accompanies small bowel obstruction can lead to acute fluid losses, which can lead to hypovolemic shock. Hypovolemia can occur from the fluid shifts related to the edema and congestion occurring in the bowel pg 1303

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1.With meals and at bedtime 2.Every 6 hours around the clock 3.One hour after meals and at bedtime 4.One hour before meals and at bedtime

One hour before meals and at bedtim

A client with a history of upper gastrointestinal bleeding has a platelet count of 300,000 mm3 (300 × 109/L). The nurse should take which action after seeing the laboratory results? 1.Report the abnormally low count. 2.Report the abnormally high count. 3.Place the client on bleeding precautions. 4.Place the normal report in the client's medical record.

Place the normal report in the client's medical record. Rationale:A normal platelet count ranges from 150,000 to 400,000 mm3 (300 × 109/L) is not an elevated count. The count also is not low; therefore, bleeding precautions are not needed.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the primary health care provider? 1.Stoma is beefy red and shiny 2.Purple discoloration of the stoma 3.Skin excoriation around the stoma 4.Semiformed stool noted in the ostomy pouch

Purple discoloration of the stoma Rationale:Ischemia of the stoma would be associated with a dusky or bluish or purple color. A beefy red and shiny stoma is normal and expected. Skin excoriation needs to be addressed and treated but does not require as immediate attention as purple discoloration of the stoma. Semiformed stool is a normal finding

3. After dinner time, during hourly rounding, a patient awakes to report they feel like "food is coming up" in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention will you perform next?* A. Perform deep suctioning B. Assist the patient into the Semi-Fowler's position C. Keep the patient NPO D. Instruct the patient to avoid milk products

The answer is B. The patient is experiencing regurgitation. The clues in this scenario are the patient signs and symptoms along with the time of day (after dinner time...the patient just ate a meal and is sleeping..we can assume they are lying down). If a patient has reflux disease, the lower esophageal sphincter is weak and after a meal when a person lies down to sleep the food can regurgitate into the throat which will cause the patient to feel like "food in coming up" in the back of the throat and bitter taste in the mouth. Placing the patient in semi-fowler's position will help alleviate this.

7. A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of drug?* A. Proton-pump inhibitor B. Histamine receptor blocker C. Prokinetic D. Mucosal Healing Agent

The answer is C. This drug is known as a prokinetic drug. It prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and improves peristalsis of the GI tract.

8. Which of the following does NOT play a role in the development of GERD?* A. Pregnancy B. Hiatal hernia C. Usage of antihistamines or calcium channel blockers D. All the above play a role in GERD

The answer is D. All the options above play a role in the development of GERD. These options can weaken the lower esophageal sphincter and cause it to not close properly

A client is having a diagnostic workup for colorectal cancer. Which factors in the client's history place the client at increased risk for this type of cancer? Select all that apply. 1.A high-fiber diet 2.A diet high in fats 3.Minimal alcohol intake 4.A diet high in carbohydrates 5.A history of inflammatory bowel disease 6.A maternal grandfather who had a history of heart disease

a diet high in fats, a diet high in carbs, a hx of IBD, A high-fiber diet actually lessens the chances of developing colorectal cancer. This type of cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration.

A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy

hypervolemia

the nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a primary health care provider prescription for which type of suction? 1.High and intermittent 2.Low and intermittent 3.High and continuous 4.Low and continuous

low and intermittent

· 7. A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer?* o A. Duodenal o B. Gastric o C. Esophageal o D. Refractory

o A. Duodenal

A client receiving total parenteral nutrition (TPN) is demonstrating signs and symptoms of an air embolism. What is the first action by the nurse? 1.Stop the TPN solution. 2.Place the client in the high-Fowler's position. 3.Notify the primary health care provider (PHCP). 4.Place the client on the left side in the Trendelenburg's position

stop TPN solution

The nurse is assessing a client with a lactose intolerance disorder for a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1.Twitching 2.Hypoactive bowel sounds 3.Negative Trousseau's sign 4.Hypoactive deep tendon reflexes

twitching Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.