GI System

c. Metoclopramide (Reglan)

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)

B) Adhesions

An 80-year-old woman has been admitted to the medical unit of the hospital with a diagnosis of small bowel obstruction. The nurse is justified in questioning whether the patient has a history of: A) Anorexia nervosa B) Adhesions C) Hemorrhoids D) Pancreatitis

C. Confusion

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent CNS side effect of this medication? A. Tremors B. Dizziness C. Confusion D. Hallucinations

B) Aspirate and measure the stomach contents on a regular basis.

An older woman has been receiving enteral feeds by nasogastric (NG) tube for the past several days due to a decrease in her level of consciousness. How can the nurse best assess the patient's tolerance of the current formula and rate of delivery? A) Carefully document the number and consistency of bowel movements. B) Aspirate and measure the stomach contents on a regular basis. C) Monitor the patient's skin turgor and the color of her sclerae. D) Perform regular chest auscultation and monitor her oxygen saturation levels.

a. 2

A 34-year-old female patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups. a. 2 b. 3 c. 4 d. 5

b. periodically aspirates and tests gastric pH

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.

B) Barium enema

A patient has come into the radiology department to undergo testing for possible polyps. What diagnostic test may be done to diagnose this type of lesion? A) Gastric analysis B) Barium enema C) Barium swallow D) Gastroscopy

b. Ask the patient about the concerns with stoma management.

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all these changes. I don't want to look at the stoma." What is the best action by the nurse? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Develop a detailed written list of ostomy care tasks for the patient. d. Postpone any teaching until the patient adjusts to the ileostomy.

A) "How much alcohol do you typically drink?"

As part of a newly admitted patient's admission assessment, the nurse is questioning the patient about risk factors for liver disease. Which of the following questions most directly addresses these risk factors? A) "How much alcohol do you typically drink?" B) "Do you know if your immunizations are up to date?" C) "What do you do for a living?" D) "Do you have any chronic illnesses that your care team is not aware of?"

c. lie down for about 30 minutes after eating

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.

c. Assist the patient with oral care.

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.

D) The patient will not have to wear an external collection bag.

A man with severe ulcerative colitis has been informed by his health care provider that he will require a colectomy and an ileostomy. The patient has been told by his health care provider that he is candidate for a continent ileal reservoir (Kock pouch). The patient's nurse recognizes which of the following advantages to the use of a Kock pouch as an alternative to the creation of an ileal stoma? A) The patient's abdominal wall will remain intact. B) The patient will soon be able to resume normal bowel function. C) The patient will have to make minimal dietary modifications. D) The patient will not have to wear an external collection bag.

C. Bowel perforation

A patient returns to his room following a diagnostic colonoscopy after radiologic evidence of diverticulosis. He reports an increase in abdominal pain, fever, and chills. Which clinical condition is most concerning to the nurse? A. Colon cancer B. Hemorrhoids C. Bowel perforation D. Anal fissure

A) Antibiotics E) Proton pump inhibitors

Diagnostic testing has attributed a middle-aged man's peptic ulcer to Helicobacter pylori, and the man has been prescribed a therapeutic drug regimen. Which of the following drug families will form the basis of the man's drug therapy? Select all that apply. A) Antibiotics B) Prokinetics (GI stimulants) C) Antiemetics D) Antacids E) Proton pump inhibitors

A) "Have you ever been diagnosed with reflux?"

Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors? A) "Have you ever been diagnosed with reflux?" B) "Do you consider yourself to have a healthy diet?" C) "Have you been prone to infections over the past few years?" D) "Do you ever find it difficult to swallow certain foods?"

A) Surrounding and protecting many of the organs in the gastrointestinal tract

Following a CT and biopsy, a female patient has received a diagnosis of mesenteric cancer. What is the physiologic function of a mesentery? A) Surrounding and protecting many of the organs in the gastrointestinal tract B) Secreting exocrine digestive enzymes into the peritoneal space C) Producing the rhythmic muscular contractions of peristalsis D) Resorbing excess bile between meals and while an individual is fasting

c. reposition the tube and check for placement.

Four hours after a bowel resection, a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to a. auscultate for hypotonic bowel sounds. b. notify the patient's health care provider. c. reposition the tube and check for placement. d. remove the tube and replace it with a new one.

a. administer IV fluids.

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to a. administer IV fluids. b. give stool softeners and enemas. c. order a diet high in fiber and fluids. d. prepare the patient for colonoscopy.

A) Indicates acceptance of altered appearance and demonstrates positive self-image

The nurse caring for a patient who is being discharged home after a radical neck dissection has worked 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

b. colonoscopy.

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about a. endoscopy. b. colonoscopy. c. computerized tomography screening. d. carcinoembryonic antigen (CEA) testing.

b. Monitor stools for blood.

Which nursing action will the nurse include in the plan of care for a 35- year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Ambulate four times daily. d. Increase dietary fiber intake.

c. check for circulation and tissue perfusion.

A 19-year-old female is brought to the emergency department with a knife handle protruding from the abdomen. During the initial assessment of the patient, the nurse should a. remove the knife and assess the wound. b. determine the presence of Rovsing sign. c. check for circulation and tissue perfusion. d. insert a urinary catheter and assess for hematuria.

B) Pregnancy

A 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from what for the next 2 years? A) Multivitamin supplements B) Pregnancy C) Antidepressants D) Control-top panty hose

c. Administer loperamide (Imodium) after each stool.

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.

A) "Actually, it's been found that stress doesn't really cause ulcers."

A 58-year-old man who leads a busy lifestyle managing his own business has been diagnosed with a gastric ulcer. The man has told the nurse, "My wife warned me that my job stress would eventually catch up with me!" How should the nurse best respond to the patient's statement? A) "Actually, it's been found that stress doesn't really cause ulcers." B) "Researchers have found that your environment is the most significant cause of ulcers." C) "Ulcers aren't caused by anything specific; some people develop them for no particular reason." D) "Most ulcers are a consequence of the different medications that you take."

b. Prepare the patient for surgery.

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patient's oral temperature. d. Obtain information about the accident.

c. The patient is lethargic and difficult to arouse.

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.

B) Food and bacteria have accumulated in a herniated area of the patient's colon.

A 58-year-old with a longstanding diagnosis of diverticulitis has been admitted to the hospital due to an acute exacerbation in her symptoms. The care team has deemed surgery unnecessary, but is pursuing aggressive medical treatment. What pathophysiological process is contributing to this woman's health problem? A) Proliferation of bacteria in the woman's large bowel has eliminated her normal flora. B) Food and bacteria have accumulated in a herniated area of the patient's colon. C) Uncoordinated peristalsis has resulted in irritation of the colon and stagnation of the bowel's contents. D) Stenosis of the ileocecal valve has created an infected obstruction.

c. "Having this new diagnosis must be very hard for you."

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."

d. abdominal distention.

A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for a. referred back pain. b. metabolic alkalosis. c. projectile vomiting. d. abdominal distention.

D. Vomiting following cancer chemotherapy

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? A. Intestinal obstruction B. Peptic ulcer with melena C. Diverticulitis with perforation D. Vomiting following cancer chemotherapy

C. Nausea D. Cramping in the abdomen

A nurse receives report on a patient experiencing dumping syndrome. The nurse knows that the patient would be displaying which symptom 30 minutes after eating? Select all that apply. A. Difficulty swallowing B. Heartburn C. Nausea D. Cramping in the abdomen

D) Osmotic transport of extracellular fluid into the gastrointestinal tract

A patient asks the home health nurse from what the distressing symptoms of dumping syndrome result. What physiological occurrence should the nurse explain? A) Irritation of the phrenic nerve due to diaphragmatic pressure B) Chronic malabsorption of iron and vitamins A and C C) Reflux of bile into the distal esophagus D) Osmotic transport of extracellular fluid into the gastrointestinal tract

b. discontinue the patient's oral food intake.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery.

A) Infection with Helicobacter pylori

A patient presents to the walk-in clinic complaining of vomiting and burning in his mid-epigastria. The nurse knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? A) Infection with Helicobacter pylori B) Excessive stomach acid secretion C) Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) D) Inadequate production of pancreatic enzymes

c. The patient has absent breath sounds in the left anterior chest.

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.

B) Aspiration pneumonia

A patient with a recent diagnosis of esophageal cancer has undergone an esophagectomy and is currently receiving care in a step-down unit. The nurse in the step-down unit is aware of the specific complications associated with this surgical procedure and is consequently monitoring the patient closely for signs and symptoms of: A) Increased intracranial pressure (ICP) B) Aspiration pneumonia C) Abdominal aortic aneurysm (AAA) D) Dyspepsia

D) Intermittent low suction

A patient with a small bowel obstruction has had a Levin tube inserted and is admitted to a medical unit. The nurse who is caring for this patient is now checking that the wall suction settings are correct and should anticipate which of the following settings? A) Continuous high suction B) Intermittent high suction C) Continuous low suction D) Intermittent low suction

b. 30-year-old female with a femoral hernia who has abdominal pain and vomiting

After change-of-shift report, which patient should the nurse assess first? a. 40-year-old male with celiac disease who has frequent frothy diarrhea b. 30-year-old female with a femoral hernia who has abdominal pain and vomiting c. 30-year-old male with ulcerative colitis who has severe perianal skin breakdown d. 40-year-old female with a colostomy bag that is pulling away from the adhesive wafer

B) "Medications may be of some use, but they don't tend to resolve obesity on their own."

An obese male patient has sought advice from the nurse about the possible efficacy of medications in his efforts to lose weight. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity? A) "Medications are usually reserved for people who have had unsuccessful bariatric surgery." B) "Medications may be of some use, but they don't tend to resolve obesity on their own." C) "Medications are an excellent option for individuals who prefer not to exercise or reduce their food intake." D) "Medications have the potential to reduce hunger but they rarely result in weight loss."

A) Iron and vitamin B12

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) Iron and vitamin B12 B) Prealbumin and bilirubin C) Ionized calcium and C-reactive protein D) Creatinine and blood urea nitrogen (BUN)

A) Potassium levels

Clostridium difficile infection has been moving through an extended-care facility, and several of the elderly residents have been experiencing severe diarrhea. One particularly sick resident has told the nurse that he is now experiencing extreme fatigue and muscle cramps and that his heart feels like it occasionally "skips a beat." The nurse should facilitate a stat assessment of this resident's: A) Potassium levels B) Calcium levels C) Cardiac biomarkers D) Hemoglobin and hematocrit

A) Insertion of a nasogastric (NG) tube to suction to decompress the stomach

Computed tomography of a patient with a sudden onset of severe nausea and vomiting has revealed the presence of a pyloric obstruction. Which of the following interventions is the nurse's priority in the immediate care of this patient? A) Insertion of a nasogastric (NG) tube to suction to decompress the stomach B) Insertion of a central line for parenteral nutrition C) Administration of a saline enema to purge the lower bowel D) Gastric lavage

D. Monitor vital signs and observe for signs of hypovolemia.

The client with peptic ulcer is admitted to the hospital's intensive care unit with obvious gastric bleeding. What is the priority intervention for the nurse? A. Keep an accurate record of intake and output B. Provide for quiet environment, restrict visitors C. Prepare the client for an endoscopy D. Monitor vital signs and observe for signs of hypovolemia.

d. antacids after meals and sucralfate 30 minutes before meals.

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.

d. treats gastroesophageal reflux disease by decreasing stomach acid production.

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.

b. The patient's lungs have crackles audible to the midchest.

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.

b. "Have you noticed a recent weight loss?"

The nurse is admitting a 67-year-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you usually drink?" b. "Have you noticed a recent weight loss?" c. "What time of day do your bowels move?" d. "Do you eat meat or other animal products?"

a. Cullen sign.

The nurse is assessing a 31-year-old female patient with abdominal pain. Th nurse,who notes that there is ecchymosis around the area of umbilicus, will document this finding as a. Cullen sign. b. Rovsing sign. c. McBurney sign. d. Grey-Turner's signt.

c. Temperature 102.1° F (38.9° C)

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

A) Intestinal malabsorption

The nurse is aware that many of the diseases of the lower gastrointestinal tract can be identified by the characteristics of the patient's stool. What would voluminous, greasy stools suggest? A) Intestinal malabsorption B) Inflammatory colitis C) Colon cancer D) Small bowel obstruction

A) Increased bilirubin level in the blood

The nurse is caring for a patient who has a gallstone blocking his bile duct. When the nurse assesses the patient's laboratory studies, what would be an expected finding? A) Increased bilirubin level in the blood B) Decreased cholesterol level C) Increased blood urea nitrogen (BUN) level D) Decreased serum alkaline phosphatase level

C) Nausea and esophageal distention can result from eating too fast.

The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice? A) Eating too quickly can cause gastric ulceration. B) The cardiac sphincter is unable to dilate quickly after bariatric surgery. C) Nausea and esophageal distention can result from eating too fast. D) Eating quickly is associated with weight gain.

d. proton pump inhibitors.

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.

c. Drain and measure the output from the ostomy.

Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown.

c. Applying petroleum jelly to the lips

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? a. Auscultation for bowel sounds b. Nasogastric (NG) tube irrigation c. Applying petroleum jelly to the lips d. Assessment of the nares for irritation

b. The patient has noticed blood in the stools.

Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the health care provider? a. The patient has a history of constipation. b. The patient has noticed blood in the stools. c. The patient had an appendectomy at age 27. d. The patient smokes a pack/day of cigarettes.

C) Peripherally inserted central catheter (PICC)

A 26-year-old man experienced severe burns in an industrial accident and has been admitted to the burn unit of a tertiary care hospital. In the days since the accident, the care team has been pleased with the trajectory of the man's recovery, and they estimate that he will require parenteral nutrition for 2 to 3 months. Which of the following access devices is most likely appropriate for this patient's nutritional needs? A) Implanted port B) Tunneled central catheter C) Peripherally inserted central catheter (PICC) D) Nontunneled central catheter

C) Abdominal ultrasonography

A 50-year-old male patient with a history of cholelithiasis (gallstones) has presented to the emergency department (ED) with severe upper right quadrant pain. The ED nurse should anticipate the need to facilitate which of the following diagnostic tests? A) Computed tomography (CT) of the abdomen B) Barium swallow C) Abdominal ultrasonography D) Endoscopic retrograde cholangiopancreatography (ERCP)

B) Positioning the patient in a high Fowler's position to protect the airway

A 54 year-old man is postoperative day 1 following neck dissection surgery. Which of the following nursing actions should the nurse prioritize in the care of this patient? A) Teaching the patient about the signs and symptoms of major postoperative complications B) Positioning the patient in a high Fowler's position to protect the airway C) Ensuring that naloxone (Narcan) is available at the patient's bedside D) Maintaining protective isolation for 24 to 36 hours after surgery

B) Carcinoembryonic antigen (CEA)

A 56-year-old presented to her nurse practitioner because she had been experiencing unprecedented constipation and the passage of pencil-like stools despite her high fluid and fiber intake. The nurse recognized the need to assess the patient for colorectal cancer and ordered diagnostic evaluations. What component of the patient's blood work would be most indicative of the presence of cancer? A) C-reactive protein (CRP) B) Carcinoembryonic antigen (CEA) C) Ceruloplasmin D) Coproporphyrin

B) Remaining upright for at least 1 hour following each meal

A 59-year-old woman with a recent history of heartburn, regurgitation, and occasional dysphagia has been diagnosed with a sliding hiatal hernia following an upper GI series. The nurse is providing patient education about the management of this health problem. What should the nurse suggest as a management strategy to this patient? A) Minimizing her intake of highly spiced foods and dairy products B) Remaining upright for at least 1 hour following each meal C) Abstaining from alcohol D) Drinking one to two glasses of water before and after each meal

D) Enteric-coated ASA

A 77-year-old female patient experienced an ischemic stroke 6 days ago and has a nasogastric (NG) tube in place to facilitate tube feeding. The care team has arranged for many of the patient's medications to be made available in liquid form but not all of her medications are available in liquid form. As a result, the nurses have been crushing some of the patient's pills and administering them with warm tap water. Which of the following medications should not be administered in this manner? A) Tylenol with codeine B) Levothyroxine (Synthroid) C) Metoprolol (Lopressor) D) Enteric-coated ASA

A. This is a normal, expected event

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? A. This is a normal, expected event B. The client is experiencing early signs of ischemic bowel C. The client should not have the NG tube removed D. This indicates adequate preoperative bowel preparation

C. An episode of diarrhea

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

B. Heartburn

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? A. Diarrhea B. Heartburn C. Flatulence D. Constipation

C. Reduction of steatorrhea

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? A. Weight loss B. Relief of heartburn C. Reduction of steatorrhea D. Absence of abdominal pain

A. Administer stool softeners as prescribed C. Encourage a high-fiber diet to promote bowel movements without straining. D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. A. Administer stool softeners as prescribed B. Instruct the client to limit fluid intake to avoid urinary retention C. Encourage a high-fiber diet to promote bowel movements without straining. D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed. E. Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

D. Fluid and electrolyte imbalance

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate post operative period for which most frequent complication of this type of surgery? A. Folate deficiency B. Malabsorption of fat C. Intestinal obstruction D. Fluid and electrolyte imbalance

D. Assessing the return of the gag reflex

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan? A. Monitoring the temperature B. Monitoring complaints of heartburn C. Giving warm gargles for a sore throat D. Assessing the return of the gag reflex

B. Relief and epigastric pain

A client who uses non steroidal anti-inflammatory drugs has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? A. Resolved diarrhea B. Relief and epigastric pain C. Decreased platelet count D. Decreased white blood cell count

B. Checking the frequency and consistency of bowel movements

A client with Crohn's Disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment? A. Monitoring the leukocyte count for 2 days after the infusion B. Checking the frequency and consistency of bowel movements C. Checking serum liver enzyme levels before and after the infusion D. Carrying out a Hematest on gastric fluids after the infusion is completed.

D. One hour before meals and at bedtime

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? A. With meals and at bedtime B. Every 6 hours around the clock C. One hour after meals and at bedtime D. One hour before meals and at bedtime

A. Lying recumbent following meals

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? A. Lying recumbent following meals B. Consuming small, frequent, bland meals C. Taking H2 receptor antagonist medications D. Raising the head of the bed on 6 inch (15 cm) blocks

C. "The medication will kill the bacteria and stop the acid production"

A client with 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? A. "My ulcer will heal because these medications will kill the bacteria" B. "These medications are only taken when I have pain from my ulcer" C. "The medication will kill the bacteria and stop the acid production" D. "These medications will coat the ulcer and decrease the acid production in my stomach"

C) Wiping the teeth and gums with a gauze pad

A comatose patient is receiving oral care. What oral care regimen would be most effective in decreasing the patient's 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 with a gauze pad D) Gently stroking the teeth and gums with a lemon and glycerine swab

C. Abdominal distention

A confused patient prematurely removes her NG tube. The nurse knows to observe for which complication? A. Constipation B. Flatulence C. Abdominal distention D. Gastric bleeding

C) "We'll be arranging for you to have small meals several times a day for the next little while."

A male patient is postoperative day 7 following an esophagectomy that was performed for the treatment of esophageal cancer. The patient's nasogastric tube (NG) has just been removed, and the patient has passed a swallowing assessment and appears to have an intact anastomosis. What should the nurse teach the patient about his progression in oral food and fluid intake? A) "For the next few days, you'll likely drink supplements like Boost or Ensure." B) "You'll receive total parenteral nutrition for 3 to 5 days while your esophagus heals." C) "We'll be arranging for you to have small meals several times a day for the next little while." D) "We'll encourage you to now begin eating the same way that you normally do."

C) "Make sure that you don't eat anything after midnight the day before your test."

A male patient's present signs and symptoms are suggestive of an incompetent cardiac sphincter, and he has been scheduled for an upper GI series (barium swallow). What preprocedure teaching should the nurse provide to this patient? A) "Make sure to tell your doctor about any allergies to shellfish." B) "It's important that you take your laxatives as ordered on the day prior to your barium swallow." C) "Make sure that you don't eat anything after midnight the day before your test." D) "You'll need to restrict your fluid intake for 24 hours after the test."

A) Administering feedings at a low, continuous rate rather than by bolus

A nurse is aware that even though tube feedings are generally well-tolerated by most patients, there is a still a risk of dumping syndrome. Which of the following actions has the greatest potential to reduce a patient's risk of experiencing dumping syndrome? A) Administering feedings at a low, continuous rate rather than by bolus B) Administering diuretics prior to initiating a feeding C) Diluting feedings at a 1:2 ratio of feedings to water D) Administering feedings with the patient in a supine position to slow motility

B) The upper GI tract

A nurse is caring for a newly admitted patient with a suspected gastrointestinal (GI) bleed. The nurse assesses the patient's stool after a bowel movement and notes it to be a tarry-black color. The nurse recognizes that the bleeding is likely occurring where? A) The lower GI tract B) The upper GI tract C) The esophagus D) The anal area

B) Eat six small meals daily spaced at equal intervals.

A nurse is caring for a patient who has had bariatric surgery and is developing a teaching plan for the patient. Which information is essential for the nurse to include in this teaching? A) Drink a minimum of 90 mL (3 oz) of fluid with each meal. B) Eat six small meals daily spaced at equal intervals. C) Choose foods high in simple carbohydrates. D) Limit calories to no more than 3,000 daily.

A. PICC line B. Triple lumen catheter D. Implantable venous assess device (Port A Cath)

A nurse is caring for a patient who is on strict bowel rest and will need IV nutrition. The nurse knows the following devices are appropriate for TPN. Select all that apply. A. PICC line B. Triple lumen catheter C. Large Bore IV line D. Implantable venous assess device (Port A Cath) E. Arterial Line

A) Reinsert the NG tube and arrange for x-ray confirmation of placement.

A nurse is conducting morning assessments of several medical patients and has entered the room of a patient who has a nasogastric (NG) tube in situ. Immediately, the nurse observes that the tube has become unsecured from the patient's nose and the mark at the desired point of entry is now approximately 8 inches from the patient's nose. How should the nurse best respond to this assessment finding? A) Reinsert the NG tube and arrange for x-ray confirmation of placement. B) Remove the NG tube and obtain an order for reinsertion. C) Reinsert the NG tube and monitor the patient closely for signs of aspiration. D) Reinsert the NG tube and aspirate stomach contents to confirm correct placement.

A) Initiate NPO status after midnight.

A nurse is explaining to a patient about an ultrasound of the gallbladder the patient is going to have the following morning. What will the nurse do in preparation for this diagnostic study? A) Initiate NPO status after midnight. B) Administer the contrast agent orally 10 to 12 hours before the study. C) Administer the radioactive agent intravenously the evening before the study. D) Encourage the intake of 64 ounces of water 8 hours before the study.

C) The patient maintains or gains weight.

A nurse is preparing to discharge a patient who had gastric surgery. What is an appropriate discharge outcome for this patient? A) The patient's bowel movements are loose. B) The patient eats three meals a day. C) The patient maintains or gains weight. D) The patient consumes a diet high in calcium.

B) Serum aminotransferases

A nurse is reviewing the liver function panel of a patient's most recent blood work. What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis? A) Clotting factors B) Serum aminotransferases C) GGT D) Alkaline phosphatase

A) Eating

A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? A) Eating B) Drinking milk C) Suppressing emesis D) Having a bowel movement

C. Intestinal perforation

A patient complains of abdominal pain and distention, fever, tachycardia, and diaphoresis. An abdominal x-ray shows free air under the diaphragm. The ED nurse should suspect which condition? A. Intestinal obstruction B. Malabsorption C. Intestinal perforation D. Acute cholelithiasis

B. Regional enteritis

A patient complains of abdominal pain unrelieved by defecation, that typically occurs after meals along with diarrhea. What does the nurse recognize as the most likely diagnosis? A. Ulcerative colitis B. Regional enteritis C. Cholecystitis D. Diverticulosis

C) Avoid carbonated drinks.

A patient diagnosed with esophageal reflux disorder has been admitted to the floor. When planning teaching for this patient what should the nurse advise the patient to do? A) Keep the head of the bed lowered. B) Drink a cup of hot tea before bedtime. C) Avoid carbonated drinks. D) Drink a carbonated drink after meals.

C. Sepsis

A patient has a bowel perforation from a recent surgery and now has been diagnosed with peritonitis. The patient has hypoactive bowel sounds, a temperature of 100.5°F and an elevated WBC count. What is the most serious potential complication of peritonitis for which the nurse should monitor? A. Nausea B. Diarrhea C. Sepsis D. Abdominal tenderness

B. Appendicitis

A patient is complaining of right lower quadrant pain, fever, and decreased appetitive. What does the nurse suspect is the most likely cause? A. Diverticulitis B. Appendicitis C. Small bowel obstruction D. Sigmoid colon cancer

a) Non-steroidal anti-inflammatory drugs

A patient is scheduled to have a fecal occult blood test. Before the test, the nurse should instruct the patient to avoid: a) Non-steroidal anti-inflammatory drugs b) Acetaminophen c) Fish d) Carrots

D) Ensuring that wire cutters or scissors are available at the patient's bedside

A patient who has a mandibular structural abnormality has just been admitted to the postsurgical unit from the PACU following surgical remodeling. To ensure this patient's safety, what action should the nurse prioritize? A) Ensuring that suction tubing and a deep suction catheter are available at the bedside B) Maintaining all four of the patient's bed rails in a raised position C) Encouraging the patient to temporarily use a bedpan rather than a commode or toilet D) Ensuring that wire cutters or scissors are available at the patient's bedside

A) "A barium enema can be uncomfortable but we'll do it very carefully to minimize this."

A patient with a history of chronic constipation has been scheduled for a lower gastrointestinal tract study (barium enema). The patient has presented to the outpatient clinic at the scheduled time and has expressed anxiety about the potential pain and unpleasantness of the barium enema to the nurse. How should the nurse who will assist with the procedure respond to this patient's concerns? A) "A barium enema can be uncomfortable but we'll do it very carefully to minimize this." B) "A barium enema can be painful, but it does not last long, and we'll give you painkillers ahead of time." C) "Actually, most patients report that they hardly even feel the procedure." D) "The sedatives that we'll give you will make sure that you don't remember the procedure."

D) Decreased levels of albumin

A patient with a history of liver cirrhosis has experienced a recent exacerbation in the signs and symptoms of his disease and has consequently been admitted to the hospital. The patient exhibits a firm, distended abdomen, and an abdominal ultrasound confirms a diagnosis of ascites. When reviewing this patient's blood work, what value is most congruent with the presence of ascites? A) Increased D-dimer levels B) Decreased levels of amylase C) Increased levels of B-type natriuretic peptide (BNP) D) Decreased levels of albumin

A) He will need to undergo an upper endoscopy every 6 months to detect malignant changes.

A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus and has been admitted to a medical unit. The nurse is writing a care plan for this patient. What information is essential to include? A) He will need to undergo 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 his stools and should not cause concern. D) Antacids may be discontinued when symptoms of heartburn subside

A) A man who describes himself as always having been a "heavy smoker and a heavy drinker."

A public health nurse is participating in a community health fair that is focused on health promotion and illness prevention. Which of the following older adults most likely faces the highest risk of developing oral cancer? A) A man who describes himself as always having been a "heavy smoker and a heavy drinker." B) A woman who is morbidly obese and has a longstanding diagnosis of systemic lupus erythematosus (SLE). C) A woman who describes herself as a "proud breast cancer survivor for over 10 years." D) A man who states that he enjoys good health, with the exception of "heartburn after nearly every meal."

B) A proton pump inhibitor (PPI)

After relocating to new community, a 60-year-old man has presented for care to a nurse practitioner. During the nurse's initial health assessment, the man states that he has had a diagnosis of gastroesophageal reflux disease (GERD) for several years. The nurse should anticipate that a medication reconciliation is likely to reveal that the man has been prescribed: A) A calcium channel blocker B) A proton pump inhibitor (PPI) C) A bisphosphonate D) A nitrate

C) Fluids must be increased to facilitate the evacuation of the stool.

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test? A) Stool will be yellow for the first 24 hours postprocedure. B) The barium may cause diarrhea. C) Fluids must be increased to facilitate the evacuation of the stool. D) This series includes analysis of gastric secretions.

A) Palpate the patient's parotid glands to detect swelling and tenderness.

An elderly patient comes into the emergency department complaining of an earache. The patient has an oral temperature of 100.2° F. 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 patient's parotid glands to detect swelling and tenderness. B) Assess the temporomandibular joint for evidence of a malocclusion. C) Test the integrity of the 12th cranial nerve by asking the patient to protrude his tongue. D) Inspect the patient's gums for bleeding and hyperpigmentation.

C) An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs.

An elderly patient has developed Clostridium difficile-related diarrhea, a problem that has led to dehydration and hypokalemia. The increased peristalsis that characterizes diarrhea has the potential to cause fluid volume deficit and electrolyte deficits because: A) Increased peristalsis diverts energy away from the absorptive activities of the small intestine. B) Increased peristalsis creates increased metabolic demand, which in turn depletes fluid and electrolyte reserves. C) An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs. D) An increase in peristalsis reduces the normal surface area of the villi and microvilli in the colon.

B) The lox

An individual has had a snack consisting of half a bagel with cream cheese, lox (smoked salmon), red onions, and capers. Stimulation of the person's gastrointestinal tract has resulted in the secretion of numerous digestive enzymes into the small intestine, including trypsin. What component of this person's snack will be primarily digested by the action of trypsin? A) The bagel B) The lox C) The cream cheese D) The red onions and capers

C) Sympathetic stimulation exerts an inhibitory effect, decreasing gastric secretion and motility.

The complex and diverse functions of the gastrointestinal (GI) tract require precise innervation. Which of the following statements most accurately conveys an aspect of the neurology of the GI tract? A) Digestion and secretion are primarily results of the sympathetic nervous system (SNS), which is activated by food intake. B) The majority of the lower GI tract is directly innervated by the central nervous system (CNS). C) Sympathetic stimulation exerts an inhibitory effect, decreasing gastric secretion and motility. D) Parasympathetic activity slows most of the secretory functions within the GI tract.

A. "I will take the cimetidine with my meals" B. "I'll know the medication is working if my diarrhea stops" D. "Taking the cimetidine with an antacid will increase its effectiveness"

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply A. "I will take the cimetidine with my meals" B. "I'll know the medication is working if my diarrhea stops" C. "My episodes of heartburn will decrease if the medication is effective" D. "Taking the cimetidine with an antacid will increase its effectiveness" E. "I will notify my health care provider if I become depressed or anxious" F. "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation"

C. "This medication should only be taken with water"

The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? A. "I will continue taking vitamin supplements" B. "This medication will help to lower my cholesterol" C. "This medication should only be taken with water" D. "A high fiber diet is important while taking this medication"

A) Liver disease

The nurse has noted that a patient's plasma ammonia levels are trending upward and are currently high-normal (45 μg/dL; 32 μmol/L). The nurse should most likely associate this laboratory finding with: A) Liver disease B) Cholecystitis C) Cancer of the gastrointestinal tract D) Esophageal or gastric ulcers

D. Speech pathologist

The nurse is administering liquids to a patient who has recently has been changed from NPO to a clear liquid diet. The patient coughs and occasionally gags with sips of water. Which health care team member would the nurse consult? A. Physical therapist B. Respiratory therapist C. Dietician D. Speech pathologist

C. Irrigating the nasogastric tube

The nurse is caring for a client following a gastrojejunostomy. Which post operative prescription should the nurse question and verify? A. Leg exercises B. Early ambulation C. Irrigating the nasogastric tube D. Coughing and deep breathing exercises

D) Spray or gargle the back of the throat with local anesthetic.

The nurse is caring for a patient who is scheduled for a gastroscopy. What preparation is needed for a gastroscopy? A) Insert a nasogastric tube. B) Administer a micro Fleet enema. C) Have the patient lie in a dorsal position. D) Spray or gargle the back of the throat with local anesthetic.

C) The tube is in the stomach.

The nurse is checking placement of a nasogastric (NG) tube that has been in place for 2 days. The tube is draining green aspirate. What does this color of aspirate indicate? A) The tube is in the pleural space. B) The tube is the intestine. C) The tube is in the stomach. D) The tube is in the esophagus.

C) Smokes two packs of cigarettes daily

The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem? A) Consumes one or more protein drinks daily B) Takes over-the-counter antacids frequently C) Smokes two packs of cigarettes daily D) Reports a history of social drinking on a weekly basis

A) "The medication inhibits acid secretions."

The nurse is conducting a patient teaching with a patient who has just been prescribed lansoprazole (Prevacid). What statement would indicate that the patient correctly understands the action of this medication? A) "The medication inhibits acid secretions." B) "The medication is an antibiotic." C) "The medication is an analgesic." D) "The medication will repair my ulcer."

D) The nurse should document normoactive bowel sounds.

The nurse is conducting an abdominal assessment of a patient who is postoperative day 1 following an open cholecystectomy. During auscultation of the patient's abdomen, the nurse has noted that clicks and gurgles are audible approximately every 10 seconds. How should the nurse follow up this assessment finding? A) The nurse should administer a p.r.n. stool softener. B) The nurse should contact the patient's care provider. C) The nurse should assess the patient for paralytic ileus. D) The nurse should document normoactive bowel sounds.

A) Prealbumin

The nurse is conducting an assessment of a patient's nutritional status prior to postpyloric intubation. When assessing the patient's most recent laboratory values the nurse should pay particular attention to the patient's level of: A) Prealbumin B) Potassium C) Blood glucose D) Alkaline phosphatase

C. Pain relieved by food intake

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 sign(s) and symptom(s) of duodenal ulcer? A. Weight loss B. Nausea and vomiting C. Pain relieved by food intake D. Pain radiating down the right arm

A) Esophageal or pyloric obstruction related to scarring

The nurse is doing triage at the emergency department when a middle-aged patient presents with abdominal pain and heartburn. The patient states the symptoms have persisted for several days following a particularly spicy meal. When assessing the patient, the nurse notes the patient has a history of acute gastritis. What complication should the nurse assess for? A) Esophageal or pyloric obstruction related to scarring B) Acute systemic infection related to peritonitis C) Gastric hyperacidity related to excessive gastrin secretion D) Bruising on the patient's flanks

A. Notify the HCP

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. What is the most appropriate nursing intervention? A. Notify the HCP B. Administer the prescribed pain medication C. Call and ask the OR team to perform surgery as soon as possible D. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

A. Sweating and pallor

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? A. Sweating and pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain

D. A rigid, boardlike abdomen

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, boardlike abdomen

B. The client understands and maintains lifestyle modifications

The nurse is planning for the discharge of a client with peptic ulcer disease. Which outcome must be included in the plan of care? A. The client's pain is controlled with NSAIDs B. The client understands and maintains lifestyle modifications C. The client takes antacids around the clock D. The client has no episodes of GI bleeding

A. Coffee B. Chocolate C. Peppermint E. Fried chicken

The nurse is planning to teach a client with GERD about substances to avoid. Which items should the nurse include on the list? Select all that apply. A. Coffee B. Chocolate C. Peppermint D. Nonfat milk E. Fried chicken F. Scrambled eggs

A) IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered.

The nurse is preparing to administer an IV fat emulsion simultaneously with parenteral nutrition (PN). What approach to the administration of a fat emulsion is appropriate? A) IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. B) The nurse should prepare for placement of another IV line, as IV fat emulsions may not be infused simultaneously through the line used for PN. C) IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site after running the emulsion through a filter. D) The IV fat emulsions can be piggy-backed into any existing IV solution that is infusing.

A) Inspection, auscultation, percussion, and palpation

The nurse is preparing to perform an abdominal assessment of a newly admitted patient. When performing an abdominal assessment, what examination sequence should the nurse follow? A) Inspection, auscultation, percussion, and palpation B) Inspection, auscultation, palpation, and percussion C) Inspection, percussion, palpation, and auscultation D) Inspection, palpation, percussion, and auscultation

A) Place distal tip to nose, then ear tip and end of xiphoid process.

The nurse is preparing to place a nasogastric (NG) tube in one of his patients. What is the process for determining the length of an NG tube to be placed in the stomach? A) Place distal tip to nose, then ear tip and end of xiphoid process. B) Instruct the patient to lie prone and measure tip of nose to umbilical area. C) Insert the tube into nose until tube fills with secretions. D) Obtain an order from the health care provider for the number of inches to insert the tube.

B. Purple discoloration of the stoma

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the HCP? A. Stoma is beefy red and shiny B. Purple discoloration of the stoma C. Skin excoriation around the stoma D. Semi-formed stool noted in the stony pouch

C) Secretion D) Absorption E) Movement of nutrients into the blood stream.

The nurse is providing care for a patient whose cancer has metastasized to her small intestine. What does the small intestine do? Select all that apply. A) Creation of human waste products B) Reabsorption of water to maintain blood pressure C) Secretion D) Absorption E) Movement of nutrients into the blood stream.

B) Determine if motion is transmitted from one of the patient's flanks to the other.

The nurse is providing care for a patient with a diagnosis of cirrhosis. Daily assessment of the patient's abdominal girth has revealed a gradual increase, and the nurse now wishes to assess for the presence of ascites using a fluid wave test. When conducting this assessment, the nurse should: A) Ask the patient to slowly move from one side-lying position to the other. B) Determine if motion is transmitted from one of the patient's flanks to the other. C) See if rebound tenderness is symmetrical between the patient's flanks. D) Determine if the patient's abdomen maintains its shape during deep palpation.

A. Nuts C. Liver E. Lentils

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in Vitamin B12 in the diet? Select all that apply. A. Nuts B. Corn C. Liver D. Apples E. Lentils F. Bananas

C. Limit the fluid intake with meals

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? A. Ambulate following a meal B. Eat high-carbohydrate foods C. Limit the fluid intake with meals D. Sit in a high Fowler's position during meals

A. "I should increase the fiber in my diet"

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's Disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? A. "I should increase the fiber in my diet" B. "I will need to avoid caffeinated beverages" C. "I am going to learn some stress reduction techniques" D. "I can have exacerbations and remissions with Crohn's Disease"

D) Jaundice

The nurse is receiving the morning report about a patient who is being treated on the hospital's medical unit. The nurse is informed that the patient's serum bilirubin level has been trending upward over the past 2 days and is now well above the normal reference range. The nurse should anticipate which of the following assessment findings? A) Dependent edema B) Cold intolerance C) Ascites D) Jaundice

A) Avoid applying suction on or near the graft site.

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 graft site. B) Position patient on his nonoperative side with the head of the bed down. C) Assess viability of the graft before beginning suctioning. D) Evaluate the patient's ability to swallow saliva and clear fluids.

A. "I need to limit my intake of dietary fiber"

The nurse provides instructions to a client about measure to treat IBS. Which statement by the client indicates a need for further teaching? A. "I need to limit my intake of dietary fiber" B. "I need to drink plenty, at least 8 to 10 cups daily" C. "I need to eat regular meals and chew my food well" D. "I will take the prescribed medications because they will regulate my bowel patterns"

A. HIV infection C. Tracheostomy tube D. Inability to close the mouth

The nurse recognizes which which of the following as a cause of xerostomia? Select all that apply. A. HIV infection B. Oral hypoglycemic medications C. Tracheostomy tube D. Inability to close the mouth E. Kidney failure

B) Keep the vent lumen above the patient's stomach level.

The patient is concerned about leakage of gastric contents out of the gastric sump tube the nurse has just inserted. What would the nurse do to prevent reflux gastric contents from coming through the blue vent of a gastric sump tube? A) Prime the tubing with 20 mL of normal saline. B) Keep the vent lumen above the patient's stomach level. C) Maintain the patient in a high Fowler's position. D) Have the patient pin the tube to the thigh.

C) The insertion of a central venous access device

Total parenteral nutrition (TPN) has been ordered for a male patient who has been experiencing a severe and protracted exacerbation of Crohn's disease. Before TPN can be initiated, the patient requires: A) A random blood glucose level of ≤160 mg/dL B) Angiography to determine the patency of his vascular system C) The insertion of a central venous access device D) A fluid challenge to assess his renal function

A. E-mycin, an antibiotic

Which medication should the nurse question before administering it to a patient with peptic ulcer disease? A. E-mycin, an antibiotic B. Prilosec, a PPI C. Flagyl, an antimicrobial agent D. Tylenol, a non-narcotic analgesic

B) Take a stool softener, such as docusate sodium (Colace), daily.

The nursing educator is teaching a group of nurses about constipation and the elderly. What recommendation for this population should a nurse can make about treating chronic constipation? A) Take a mild laxative, such as magnesium citrate, when necessary. B) Take a stool softener, such as docusate sodium (Colace), daily. C) Administer a tap water enema weekly. D) Administer a phospho-soda (Fleet) enema when necessary.

D. Nausea and vomiting

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

b. Infuse normal saline at 250 mL/hr.

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.

B. Use of NSAIDs

A 47-year-old man with epigastric pain is being admitted to the hospital. During the admission assessment and interview, what specific information should the nurse obtain from the patient, who is suspected of having peptic ulcer disease? A. Any allergies to food or medications B. Use of NSAIDs C. Medical history for two previous generations D. History of side effects of all medications

a. collect a stool specimen.

A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to a. collect a stool specimen. b. prepare for colonoscopy. c. schedule a barium enema. d. have blood cultures drawn.

b. Ask the patient to describe the character of the stools and any associated symptoms.

A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first? a. Inform the patient that laboratory testing of blood and stools will be necessary. b. Ask the patient to describe the character of the stools and any associated symptoms. c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. d. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.

B) Rebound tenderness, McBurney's sign, low-grade fever

A 16-year-old girl presents at the emergency department complaining of right lower quadrant pain and is diagnosed with appendicitis. When assessing this patient, what signs or symptoms should the nurse expect to find? A) Rigid abdomen, Levine's sign, pain relief leaning forward B) Rebound tenderness, McBurney's sign, low-grade fever C) Right lower quadrant pain, Chvostek's sign, muscle guarding D) Periumbilical pain, Trousseau's sign, pain relief with pressure

A) Nutritional deficits B) Fluid and electrolyte imbalances C) Intestinal obstruction E) Fistula

A 22-year-old college student has been diagnosed with Crohn's disease after a diagnostic workup that was prompted by his complaints of recurring abdominal pain and diarrhea. The nurse who is contributing to this patient's care should recognize the possibility of which complications of his disease? Select all that apply. A) Nutritional deficits B) Fluid and electrolyte imbalances C) Intestinal obstruction D) Viral infection E) Fistula

c. The patient uses witch hazel compresses to decrease irritation.

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient asks for antidiarrheal medication after each stool. c. The patient uses witch hazel compresses to decrease irritation. d. The patient cleans the perianal area with soap after each stool.

b. Fistulas can form between the bowel and bladder.

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? a. Bacteria in the perianal area can enter the urethra. b. Fistulas can form between the bowel and bladder. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

c. breath sounds.

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.

b. smoked foods such as ham and bacon.

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.

c. "Can you tell me more about the pain?"

A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

d. Apply an ice pack to the right lower quadrant.

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? a. Encourage the patient to sip clear liquids. b. Assess the abdomen for rebound tenderness. c. Assist the patient to cough and deep breathe. d. Apply an ice pack to the right lower quadrant.

D) Nutrition altered, less than body requirements

A 30-year-old woman sought care several weeks ago with complaints of diarrhea with fat content and has been subsequently diagnosed with malabsorption syndrome. The nurse is now creating a plan of nursing care that meets this patient's needs. What nursing diagnosis is the most likely priority in this patient's care? A) Functional incontinence B) Impaired tissue integrity C) Altered sexuality patterns D) Nutrition altered, less than body requirements

A) Knowledge deficit related to the implications of bariatric surgery

A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions? A) Knowledge deficit related to the implications of bariatric surgery B) Altered growth and development related to obesity C) Risk for injury related to obesity D) Spiritual distress related to low body image

b. This type of colostomy is usually temporary.

A 33-year-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching? a. Stool will be expelled from both stomas. b. This type of colostomy is usually temporary. c. Soft, formed stool can be expected as drainage. d. Irrigations can regulate drainage from the stomas.

c. administration of nystatin (Mycostatin) tablets.

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.

d. Apply a scrotal support and ice to reduce swelling.

A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? a. Soak in sitz baths several times each day. b. Cough 5 times each hour for the next 48 hours. c. Avoid use of acetaminophen (Tylenol) for pain. d. Apply a scrotal support and ice to reduce swelling.

b. Check the vital signs.

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.

d. Infuse 1 liter of lactated Ringer's solution over 30 minutes.

A 45-year-old patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120, respirations 32, and blood pressure (BP) 82/54. Which prescribed intervention should the nurse implement first? a. Administer IV ketorolac (Toradol) 15 mg. b. Draw blood for a complete blood count (CBC). c. Obtain a computed tomography (CT) scan of the abdomen. d. Infuse 1 liter of lactated Ringer's solution over 30 minutes.

c. "I eat small meals during the day and have a bedtime snack."

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."

d. document stoma assessment findings.

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. place ice packs around the stoma. b. notify the surgeon about the stoma. c. monitor the stoma every 30 minutes. d. document stoma assessment findings.

d. use of nonsteroidal antiinflammatory drugs (NSAIDs).

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).

a. contact the surgeon.

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.

a. medication use.

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions.

a. Fever

A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? a. Fever b. Nausea c. Joint pain d. Headache

c. Administer the prescribed morphine sulfate before dressing changes.

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.

b. Use a fecal management system

A 54-year-old critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence? a. Apply incontinence briefs. b. Use a fecal management system c. Insert a rectal tube with a drainage bag. d. Assist the patient to a commode frequently.

B) Continuous output of liquid effluent

A 60-year-old woman had a right hemicolectomy and the creation of an ileostomy 4 days ago, and she has been admitted to the postsurgical unit for a 7-day recovery. The nurse's assessment at the beginning of the shift has focused on common postsurgical complications and the patient's stoma and output. At this stage in the patient's recovery, what type of output should the nurse expect from the patient's ileostomy? A) Brown, semi-formed stool B) Continuous output of liquid effluent C) Intermittent output of semi-liquid stool D) Output has not likely begun at this point

B) Assess the woman's typical bowel patterns and her expectations for bowel function.

A 61-year-old woman presented to a scheduled appointment with her nurse practitioner, stating, "I'm having a lot of trouble with constipation over the past few months." What action should the nurse first take in response to this patient's health complaint? A) Assess the woman's family history of constipation and bowel obstruction. B) Assess the woman's typical bowel patterns and her expectations for bowel function. C) Advise the woman to increase her fluid intake, activity level, and fiber intake. D) Arrange for a barium enema or colonoscopy to assess the woman's lower bowel.

d. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.

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.

c. Take prescribed pain medications before a bowel movement is expected.

A 62-year-old patient has had a hemorrhoidectomy at an outpatient surgical center. Which instructions will the nurse include in discharge teaching? a. Maintain a low-residue diet until the surgical area is healed. b. Use ice packs on the perianal area to relieve pain and swelling. c. Take prescribed pain medications before a bowel movement is expected. d. Delay having a bowel movement for several days until healing has occurred.

d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? a. Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives. b. Dietary sources of fiber should be eliminated to prevent excessive gas formation. c. Use of this type of laxative to prevent constipation does not cause adverse effects. d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

D) "I've changed from taking Tylenol for my arthritis pain to taking aspirin."

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) "I've been taking glucosamine supplements because I've been told they'll help my arthritis." C) "My endocrinologist recently increased my dose of metformin that I take for my diabetes." D) "I've changed from taking Tylenol for my arthritis pain to taking aspirin."

b. Assess the patient about risk factors for constipation.

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Assess the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

c. Assess the perineal drainage and incision.

A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a. Teach about a low-residue diet. b. Monitor output from the stoma. c. Assess the perineal drainage and incision. d. Encourage acceptance of the colostomy stoma.

c. Crackles are heard halfway up the posterior chest.

A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the last 6 hours.

d. Offer supplemental feedings between meals.

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.

b. monitor the tumor status after surgery.

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to a. identify any metastasis of the cancer. b. monitor the tumor status after surgery. c. confirm the diagnosis of a specific type of cancer. d. determine the need for postoperative chemotherapy.

A) Nausea and vomiting

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction? A) Nausea and vomiting B) Decrease in urine production C) Mucus in the stool D) Mucosal edema

c. Manually remove the impacted stool.

A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? a. Administer bulk-forming laxatives. b. Assist the patient to sit on the toilet. c. Manually remove the impacted stool. d. Increase the patient's oral fluid intake.

D) A high-fiber diet with increased fruit intake

A community health nurse is performing a home visit to a 53-year-old patient who requires twice-weekly wound care on her foot. The patient mentions that she is currently having hemorrhoids, a problem that she has not previously experienced. What treatment measure should the nurse recommend to this patient? A) Daily application of topical antibiotics B) Decreased fluid intake C) Bathing, rather than showering, once per day D) A high-fiber diet with increased fruit intake

A) Regular screening for colorectal cancers

A community health nurse is presenting at a health fair and is addressing the high incidence of colorectal cancer that exists in Western nations. What measure should the nurse emphasize in order to reduce participants' chances of dying of colorectal cancer? A) Regular screening for colorectal cancers B) Increased physical activity C) A low-protein, organic diet D) Regular use of cleansing enemas

B) Hypotension and tachycardia

A critical care nurse is closely monitoring a patient who has recently undergone surgical repair of a bleeding peptic ulcer. The nurse should prioritize assessments of which of the following signs and symptoms of a recurrence of hemorrhage? A) Restlessness and cyanosis B) Hypotension and tachycardia C) Bradypnea and pursed lip breathing D) Peripheral and pulmonary edema

b. inhibit development of stress ulcers.

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.

a. Position patient with the knees flexed.

A female patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

b. Schedule the patient for yearly colonoscopy.

A new 19-year-old male patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care? a. Obtain blood samples for DNA analysis. b. Schedule the patient for yearly colonoscopy. c. Provide preoperative teaching about total colectomy. d. Discuss lifestyle modifications to decrease cancer risk.

B) Stomach cancer

A nurse at a long-term care facility is conducting an intake assessment and health history with a new female resident and the resident's daughter. The daughter states that her mother had a Billroth II gastrectomy performed several years ago, a fact that must be accommodated into her care. The nurse would be justified in questioning the resident about her history of: A) Peptic ulcer disease B) Stomach cancer C) Gastroesophageal reflux disease (GERD) D) Pyloric stenosis

A) Age greater than 50

A nurse is presenting an educational event to a local community group and is speaking about colorectal cancer. What would the nurse identify as a risk factor associated with colorectal cancer? A) Age greater than 50 B) History of bowel obstruction C) Family history of stomach cancer D) Low-fat, low-protein, low-fiber diet

A) Sepsis

A nurse on a medical unit is receiving morning report on a patient who has been admitted to the unit for the treatment of peritonitis. When providing this patient's care, the nurse should prioritize assessments relevant to what problem? A) Sepsis B) Impaired nutrition C) Pain D) Fecal incontinence

B) Emotional stability and understanding of required lifestyle changes.

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that, in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what? A) Knowledge of the causes of obesity and its associated risks B) Emotional stability and understanding of required lifestyle changes. C) Positive body image and high self-esteem D) Insight into why their past weight loss efforts failed

a. Encourage the patient to ambulate.

A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take? a. Encourage the patient to ambulate. b. Instill a mineral oil retention enema. c. Administer the ordered IV morphine sulfate. d. Offer the ordered promethazine (Phenergan) suppository.

b. Infuse metronidazole (Flagyl) 500 mg IV.

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Insert a urinary catheter to drainage. b. Infuse metronidazole (Flagyl) 500 mg IV. c. Send the patient for a computerized tomography scan. d. Place a nasogastric (NG) tube to intermittent low suction.

C) Small amounts of blood-tinged output

A patient is recovering in the PACU following gastric surgery. The nurse who is providing this patient's care is performing frequent assessments of the character and quantity of the patient's nasogastric (NG) drainage. What are the nurse's expected findings during these assessments? A) Copious quantities of straw-colored output B) Scant amounts of greenish-colored output C) Small amounts of blood-tinged output D) Moderate amounts of clear output

B) Apply a skin barrier to the peristomal skin prior to applying the pouch.

A patient with a new ileostomy is preparing to go home. What should the patient be taught about changing his ileostomy? A) Apply moisturizing lotion after cleaning the stoma. B) Apply a skin barrier to the peristomal skin prior to applying the pouch. C) Dispose of the clamp with each bag change. D) Cleanse the area surrounding the stoma with alcohol.

D) Melena stool

A woman was diagnosed with peptic ulcers several months ago and has been vigilant about implementing the nurse's recommended lifestyle modifications. The woman states that she is motivated to control her ulcers because she has a sister who had to be hospitalized for the treatment of a bleeding ulcer. A bleeding ulcer is strongly suggested when a patient exhibits: A) Chronic constipation B) Early morning heartburn C) Nausea that is relieved by eating D) Melena stool

A) A high-calorie, low-residue diet

A young woman has been diagnosed with inflammatory bowel disease and is meeting with the nurse for health education. In an effort to manage the patient's symptoms, the nurse should recommend: A) A high-calorie, low-residue diet B) A high-fiber, low-protein diet C) Small, frequent meals throughout the day D) A minced or pureed diet

d. 60-year-old with nausea and vomiting who has dry oral mucosa and lethargy

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

D) High Fowler's

After presenting to the emergency department with abdominal pain, a 21-year-old man was diagnosed with appendicitis and underwent a laparoscopic appendectomy. The patient has just been brought to the postsurgical unit from the PACU and is being admitted by the nurse. How should the nurse best position this patient? A) Left-side lying B) Supine C) Semi-Fowler's D) High Fowler's

d. Place the patient on contact precautions.

After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? a. Notify the health care provider. b. Obtain a stool specimen for analysis. c. Teach the patient about handwashing. d. Place the patient on contact precautions.

c. Patient schedules an appointment for allergy testing.

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.

D) Impaired skin integrity related to fecal incontinence

An 81-year-old patient of a subacute geriatric medical unit has become incontinent of stool over the past several days. This development has coincided with a decline in the patient's cognition as a result of severe Alzheimer's disease. In light of the patient's fecal incontinence, what nursing diagnosis should the nurse prioritize when planning this patient's care? A) Altered role performance related to fecal incontinence B) Altered nutrition, less than body requirements related to fecal incontinence C) Situational low self-esteem related to fecal incontinence D) Impaired skin integrity related to fecal incontinence

C) A decrease in HCl production by parietal cells

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) The occlusion of parietal cells B) An increase in the pH of gastric secretions C) A decrease in HCl production by parietal cells D) Activation of the gastric buffer system and release of alkaline gastric secretions

C) Bile is produced in the liver but released by the gallbladder when needed for digesting fats.

The liver performs numerous functions that contribute to homeostasis, including the synthesis of bile. How is bile utilized in the processes of digestion and absorption? A) Bile is produced in the liver in response to meals that are high in protein. B) Bile is stored in the gallbladder until it is needed for carbohydrate metabolism. C) Bile is produced in the liver but released by the gallbladder when needed for digesting fats. D) Bile production increases when an individual's fat intake is reduced over several days.

b. The LPN/LVN positions the head of the bed in the flat position.

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.

b. "The cobalamin injections will prevent me from becoming anemic."

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."

D) Dehydration

The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for? A) Pain B) Fluid overload C) Fatigue D) Dehydration

D) Dehydration

The nurse is caring for a 77-year-old patient with diarrhea. What would be especially important to monitor this patient for? A) Pain B) Fluid overload C) Fatigue D) Dehydration

A) Acyclovir (Zovirax)

The nurse is caring for a patient admitted with symptoms of an anorectal infection. Cultures obtained from a rectal swab indicate that the patient has a viral infection. What medication will the nurse anticipate the health care provider to order for this anorectal infection? A) Acyclovir (Zovirax) B) Doxycycline (Vibramycin) C) Penicillin (Penicillin G) D) Metronidazole (Flagyl)

C) Circulation to the stoma is compromised.

The nurse is caring for a patient who is postoperative day 3 following bowel resection and the creation of a colostomy. While changing the dressing, the nurse notes the stoma is dusky in color. How should the nurse interpret this assessment finding? A) This is a normal color postoperatively. B) The patient's oxygen saturation may be low. C) Circulation to the stoma is compromised. D) The stoma is blocked.

A) The patient will tolerate six small meals a day with no nausea, reflux, or stomach distention.

The nurse is creating a nursing care plan for a patient who has just been admitted to the postsurgical unit following gastric surgery. What desired outcome should the nurse identify in an effort to optimize the patient's nutritional status prior to discharge? A) The patient will tolerate six small meals a day with no nausea, reflux, or stomach distention. B) The patient will resume a normal dietary pattern of three meals a day with no unwanted effects. C) The patient will express an understanding of the appropriate use of dietary supplement drinks. D) The patient will demonstrate the ability to plan a nutritionally balanced, calorie-restricted diet.

c. The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively.

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include? a. Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. b. The patient will begin sitting in a chair at the bedside on the first postoperative day. c. The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively. d. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.

a. endoscopy.

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.

b. hangs the irrigating container 18 inches above the stoma.

The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient a. inserts the irrigation tubing 4 to 6 inches into the stoma. b. hangs the irrigating container 18 inches above the stoma. c. stops the irrigation and removes the irrigating cone if cramping occurs. d. fills the irrigating container with 1000 to 2000 mL of lukewarm tap water.

d. cobalamin (B12) spray or injections.

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for a. oral ferrous sulfate tablets. b. regular blood transfusions. c. iron dextran (Imferon) infusions. d. cobalamin (B12) spray or injections.

B) "I'd encourage you to cut out cigarettes and alcohol from your routine."

The results of a barium enema, colonoscopy, and fecal occult blood testing have resulted in a diagnosis of irritable bowel syndrome (IBS) for a male patient who is obese and who acknowledges an unhealthy lifestyle. What patient education should the nurse provide to this man in an effort to control his symptoms of IBS? A) "It would greatly help your IBS if you could lose some weight." B) "I'd encourage you to cut out cigarettes and alcohol from your routine." C) "Try eating five or six small meals each day rather than three larger meals." D) "Using an over-the-counter stool softener each day could help stabilize your bowels."

C. Periods of pain shortly after eating any food

What assessment finding supports a client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month B. Complaints of sharp pain in the abdomen after eating a heavy meal C. Periods of pain shortly after eating any food D. Complaints of epigastric burning that moves like a wave

d. treatment may include endoscopic procedures.

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.

a. Obtain a stool specimen for culture.

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).

c. Place the patient in a private room on contact isolation.

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile? a. Educate the patient about proper food storage. b. Order a diet with no dairy products for the patient. c. Place the patient in a private room on contact isolation. d. Teach the patient about why antibiotics will not be used.

d. Taking the blood pressure (BP) and pulse

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

d. Corn tortilla with scrambled eggs

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? a. Oatmeal with nonfat milk b. Whole wheat toast with butter c. Bagel with low-fat cream cheese d. Corn tortilla with scrambled eggs

c. Oatmeal with cream

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

c. Red, velvety patches on the buccal mucosa

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

b. "Avoid foods that cause pain after you eat them."

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."

b. "Keep the head of your bed elevated on blocks."

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."

b. Use care when eating high-fiber foods to avoid obstruction of the ileum.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

a. Many over-the-counter (OTC) medications can cause constipation. c. Bulk-forming laxatives are an excellent source of fiber. d. Walking or cycling frequently will help bowel motility. e. A good time for a bowel movement may be after breakfast.

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? a. Many over-the-counter (OTC) medications can cause constipation. b. Stimulant and saline laxatives can be used regularly. c. Bulk-forming laxatives are an excellent source of fiber. d. Walking or cycling frequently will help bowel motility. e. A good time for a bowel movement may be after breakfast.

b. "Ranitidine decreases gastric acid secretion."

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."

a. Avoid use of cigarettes and smokeless tobacco.

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.

b. Live-culture yogurt is usually tolerated.

Which information will the nurse teach a 23-year-old patient with lactose intolerance? a. Ice cream is relatively low in lactose. b. Live-culture yogurt is usually tolerated. c. Heating milk will break down the lactose. d. Nonfat milk is a better choice than whole milk.

b. Dish of lemon gelatin

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

b. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

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)

a. Navy bean soup and vegetable salad

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

b. Elevate the head of the bed to at least 30 degrees.

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.

a. Encourage the patient to express concerns and ask questions about IBS.

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Educate the patient about the use of alosetron (Lotronex) to reduce symptoms. d. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).

c. Administer 1000 mL of lactated Ringer's solution.

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.

c. Cherry gelatin with fruit

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

d. 30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

Which patient should the nurse assess first after receiving change-of-shift report? a. 60-year-old patient whose new ileostomy has drained 800 mL over the previous 8 hours b. 50-year-old patient with familial adenomatous polyposis who has occult blood in the stool c. 40-year-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours d. 30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

c. A patient with esophageal varices who has a blood pressure of 92/58 mm Hg

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

b. "I will need to use a sunscreen when I am outdoors."

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "The medication will be tapered if I need surgery." b. "I will need to use a sunscreen when I am outdoors." c. "I will need to avoid contact with people who are sick." d. "The medication will prevent infections that cause the diarrhea."

a. "Vitamin supplements may prevent anemia."

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."

b. Senna (Senokot) 1 tablet every day

Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question? a. Ferrous sulfate (Feosol) 325 mg daily b. Senna (Senokot) 1 tablet every day c. Psyllium (Metamucil) 2.1 grams 3 times daily d. Diphenoxylate with atropine (Lomotil) prn loose stools

d. "How long have you had abdominal pain?"

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?"