GI System

85. decending colostomy 1. Formed stool on relatively regular basis 2. Semiliquid stool at unpredictable times 3. Liquid and unformed stool 4. Extremely watery stool with concentrations of digestive enzymes 5. No effluent

1. Formed stool on relatively regular basis

86. transverse colostomy 1. Formed stool on relatively regular basis 2. Semiliquid stool at unpredictable times 3. Liquid and unformed stool 4. Extremely watery stool with concentrations of digestive enzymes 5. No effluent

2. Semiliquid stool at unpredictable times

87. Ascending colostomy 1. Formed stool on relatively regular basis 2. Semiliquid stool at unpredictable times 3. Liquid and unformed stool 4. Extremely watery stool with concentrations of digestive enzymes 5. No effluent

3. Liquid and unformed stool

88. ileostomy 1. Formed stool on relatively regular basis 2. Semiliquid stool at unpredictable times 3. Liquid and unformed stool 4. Extremely watery stool with concentrations of digestive enzymes 5. No effluent

4. Extremely watery stool with concentrations of digestive enzymes

89. continent ileostomy 1. Formed stool on relatively regular basis 2. Semiliquid stool at unpredictable times 3. Liquid and unformed stool 4. Extremely watery stool with concentrations of digestive enzymes 5. No effluent

5. no effluent

5. The nurse is caring for a patient that complains "I dont see why I cant have a CT scan instead of the expensive MRI." Which response is most appropriate for the nurse to make? a. "The MRI provides better contrast between normal and pathologic tissue." b. "The MRI requires less analysis and is easier to read." c. "The MRI produces a digital image that can be transmitted via email." d. "The MRI exposes the patient to less radiation."

A. "The MRI provides a better contrast between normal and pathologic tissue" Magnetic resonance imaging (MRI) uses radiofrequency signals to determine how hydrogen atoms behave in the magnetic field. In addition, the MRI provides a better contrast than computed tomography (CT) between healthy tissues and pathologic tissues.

8. The nurse is caring for a patient who returns to the floor at lunch time after undergoing an upper GI (UGI series). Which action is most important for the nurse to perform first? a. Administer a laxative. b. Educate the patient about the possibility of white stools. c. Offer the patient a small snack. d. Provide oral care.

A. Administer a laxative The contrast media used in the series features barium that can harden and lead to an impaction. Patients should have a bowel movement quickly after the procedure to eliminate the medium from the body. While fluids and snacks or meal trays should be given as quickly as possible, patients should be educated about the possibility of white stools for several days postprocedure, and oral care should be provided, these interventions are of lesser importance since they do not directly work to quickly prevent a postprocedure complication.

15. The nurse is caring for a patient who is complaining of postoperative gas pain. What intervention should nurse implement? a. Assist the patient with ambulation. b. Apply a cold compress on the abdomen. c. Offer a cup of coffee or tea. d. Offer chilled vegetable juice.

A. Assist the patient with ambulation Ambulation is the most effective method for helping a patient expel gas. Hot or cold beverages and cold compresses will increase gas.

14. The nurse is reviewing the laboratory results of an assigned patient. The serum bilirubin is 2.8 mg/dL. The nurse anticipates that the patient's urine will display which finding? a. Dark color b. Low specific gravity c. Very scant amount d. Foul odor

A. Dark color Normal serum bilirubin is 0.1 to 1.2 mg/dL. Jaundice is present at readings above 2.5 mg/dL. The patient who is jaundiced will have dark, tea-colored urine. Specific gravity refers to the concentration of the urine. The amount and odor of urine will not be directly influenced by the bilirubin level.

20. The nurse explains that the older adult is prone to digestive disorders related to which age-related change(s)? SATP a. Decreased hydrochloric acid b. Increased enzyme levels c. Inadequate chewing d. Diminished intestinal motility e. Gastroesophageal sphincter incompetence

A. Decreased hydrochloric acid C. Inadequate chewing D. Diminished intestinal motility E. Gastroesophageal sphincter incompetence Age-related changes that predispose the older adult to digestive disorders include decreased hydrochloric acid, inadequate chewing, diminished intestinal motility, and gastroesophageal sphincter incompetence. Age does not increase digestive enzyme levels.

10. When assessing a patient's bowel sounds, nurse auscultates loud bowel sounds in each quadrant every 3 seconds. The nurse understands that these findings could indicate that the patient is experiencing which condition? a. Diarrhea b. Paralytic ileus c. Vomiting d. Constipation

A. Diarrhea Loud, rapid bowel sounds are indicative of hypermobility, which could result in diarrhea. Absent bowel sounds are associated with paralytic ileus. Normal bowel sounds present as soft gurgles and clicks every 5 to 15 seconds. Hypoactive bowel sounds indicate decreased motility and could indicate that the patient is constipated.

22. Which action(s) should the nurse recommend to promote a patient's bowel health? (Select all that apply.) a. Exercise regularly. b. Include adequate bulk in the diet. c. Drink adequate water. d. Defecate at approximately the same time every day. e. Take a laxative to maintain a regular defecation pattern.

A. Exercise regularly. B. Include adequate bulk in the diet. C. Drink adequate water. D. Defecate at approximately the same time every day. Daily exercise and intake of adequate bulk and water are contributions to bowel health. Heeding the need to defecate and defecating at the same time daily will help to keep the gastrocolic reflex healthy. Taking daily laxatives is not conducive to good bowel health.

17. The nurse is talking with a patient who has been experiencing nausea and vomiting. The patient indicates an interest in using alternative therapies for the condition. Which product may aid in nausea management? a. Ginger b. Ginseng c. Chamomile d. Soy

A. Ginger Ginger has been used for centuries in Asia to combat nausea and vomiting, motion sickness, and dyspepsia. It is available candied in capsules, fluid extract, and tablets, and tincture or as fresh ginger root that can be grated and used to make tea. Ginger may decrease the action of histamine (H2) receptor antagonists and proton pump inhibitors and may increase absorption of medications taken orally. Ginger may decrease the effect of antidiabetic medications. It should not be used during pregnancy or lactation.

13. During a morning assessment, the nurse observes that a patient displays bulging flanks when supine with the knees flexed. Which action should the nurse take next? a. Measure the patient's abdominal girth. b. Auscultate each quadrant of the abdomen for 5 minutes. c. Document the finding. d. Notify the charge nurse.

A. Measure the patient's abdominal girth. The nurse's initial assessment indicates fluid accumulation. The nurse needs to obtain more information, first measuring abdominal girth. The nurse can then percuss from the umbilicus to the flanks to detect fluid shifts, and document all findings. The nurse will only auscultate bowel sounds for 5 minutes in each quadrant if bowel sounds are not heard before then. It is unnecessary to notify the charge nurse at this time.

21. Which factor(s) increase the risk for developing pancreatic cancer? (Select all that apply.) a. Obesity b. Jewish ethnicity c. Diabetes mellitus (DM) d. Hepatitis A e. Smoking

A. Obesity C. Diabetes E. Smoking Pancreatic cancer incidence rises steadily with age. Although the cause of pancreatic cancer is not known, the incidence is higher in cigarette smokers. Obesity, chronic pancreatitis, and DM are also risk factors for this cancer. Jewish ethnicity and hepatitis are not contributory to the disease.

24. The nurse is caring for a patient immediately following a liver biopsy. Which actions are appropriate for the nurse to take? (Select all that apply.) a. Position the patient on the right side. b. Assess the patient's pain. c. Monitor vital signs every 15 minutes for the first hour. d. Instruct patient to cough and deep-breathe. e. Assess for hematoma at puncture site.

A. Position the patient on the right side. B. Assess the patient's pain C. Monitor vital signs every 15 minutes for the first hour. E. Assess for hematoma at puncture site. The liver biopsy is performed under local or general anesthesia. Postprocedural care will include positioning on the right side for the first 2 h, and assessing pain, vital signs and the puncture site. The patient should not cough as it increases intra-abdominal pressure and may stimulate bleeding.

12. The nurse is percussing a patient's abdomen and hears a dull thud in the right upper quadrant. This sound indicates that nurse is percussing over which location? a. The liver b. The small intestine c. The stomach d. The lungs

A. The liver Percussion is performed by placing the middle finger of one hand on the abdomen and striking the finger lightly below the knuckle and listening for the pitch of sound produced. A dull thud would be heard over the liver. Tympany would be heard over the stomach and intestines, and resonance would be heard over lung tissue.

23. The nurse is caring for a patient scheduled to have an MRI study. Which instruction(s) should the nurse include in the teaching? (Select all that apply.) a. Radiation exposure is extremely minimal. b. All metal objects, including dental bridges, jewelry, and body piercings, must be removed. c. Do not eat or drink for 4 h before the procedure. d. A radiopaque medium may be injected during the procedure. e. There may be a tingling sensation in metal alloy filling of the teeth.

B. All metal objects, including dental bridges, jewelry, and body piercings, must be removed D. A radiopaque medium may be injected during the procedure E. There may be a tingling sensation in metal alloy filling of the teeth The MRI places the patient in a magnetic field and uses radiofrequency signals to determine how hydrogen atoms behave in the field. All metal must be removed, contrast medium may be injected, and the patient may have a tingling sensation in the teeth with metal alloy fillings. There is no restriction on food or fluid intake in relation to the test. The test does not expose the patient to radiation.

25. The nurse is caring for a patient with anorexia nervosa. Which intervention(s) might the nurse use to stimulate appetite? (Select all that apply.) a. Offer oral care after meals. b. Arrange for preferred foods to be served. c. Encourage family members to bring food from home. d. Suggest that family members or friends come and socialize during the meal. e. Allow ample time to eat and enjoy the meal.

B. Arrange for preferred foods to be served C. Encourage family members to bring food from home. D. Suggest that family members or friends come and socialize during the meal E. Allow ample time to eat and enjoy the meal. Appetite depends on complex mental processes having to do with memory and mental associations that can be pleasant or extremely unpleasant. Appetite is stimulated by the sight, smell, and thought of food. The physical and social environment in which a person is eating stimulates appetite. The enjoyment of eating can be inhibited by unattractive or unfamiliar food, by unpleasant surroundings, and by emotional states such as anxiety, anger, and fear. By serving food based on patient's preferences, encouraging positive interaction, and allowing ample times for meals, the nurse can stimulate appetite. Oral care should be offered before meals to aid in stimulating the appetite.

9. The nurse is assessing a patient's bowel sounds. After auscultating each quadrant for 30 seconds, the nurse fails to hear any sounds. How should the nurse document this finding?

B. Hypoactive bowel sounds Hypoactive bowel sounds can be noted in the medical record when no sounds are heard after listening in each of the four quadrants for 30 seconds. For bowel sounds to be considered absent, it is necessary to verify that no sounds are heard after listening in each of the four quadrants for 5 minutes. If hyperactive, high-pitched sounds are heard in one quadrant, and decreased sounds are heard in another quadrant, assess for nausea and vomiting, as the patient may have an intestinal obstruction.

16. The nurse is planning care for a patient who has experienced moderate diarrhea for 3 days. Which collaborative intervention is most important to include in the plan of care? a. Place the patient on NPO status. b. Limit the patient's diet to clear liquids. c. Administer parenteral nutrition. d. Restrict the patient's diet to soft foods only.

B. Limit the patient's diet to clear liquids If diarrhea is moderate, only clear liquids are permitted by mouth. If the diarrhea is severe, nothing is given by mouth until it subsides. Severe, long-term diarrhea may require the use of total parenteral nutrition. When diarrhea is caused by infection, stool cultures and antibiotics may be necessary. As the condition improves, the diet is advanced.

7. The nurse caring for an 80-year-old woman who is undergoing the extensive bowel preparation for a colonoscopy. The nurse should most closely monitor the patient for which potential complication? a. Diarrhea b. Metabolic acidosis c. Fatigue d. Dyspnea

B. Metabolic acidosis The older patient is especially at risk for problems of electrolyte imbalance, fluid overload, or dehydration when undergoing preparation for diagnostic tests that require a fasting state and/or bowel cleansing. Metabolic acidosis can occur when there is a large volume loss of bowel content. Bowel preparation causes diarrhea and may cause fatigue; bowel preparation should not cause dyspnea.

26. Before a nurse can document the presence of diarrhea, which criteria must be met? (Select all that apply.) a. One loose stool in a 24-h period b. Multiple liquid or semiliquid stools in a 24-h period c. Hyperactive bowel sounds d. Cramping e. Fever

B. Multiple liquid or semiliquid stools in a 24-h period C. Hyperactive bowel sounds D. Cramping Multiple liquid or semiliquid stools in a 24-h period with hyperactive bowel sounds with cramping are the criteria for diarrhea. Fever is not a diagnostic criteria for diarrhea, and a single loose stool is merely documented as such.

#3 The home health nurse is caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH). The nurse should carefully monitor the patient for which potential side effect? a. Gallstones b. Liver disorders c. Bleeding ulcers d. Esophagitis

B. liver disorders; both rifampin & isoniazid are hepatotoxic

27. Rhythmic squeezing action of intestinal tract a. Absorption b. Peristalsis c. Metabolism d. Anabolism e. Catabolism

B. peristalsis

18. The nurse is caring for a patient who has been experiencing severe diarrhea and can now resume solid foods. The nurse educates the patient about appropriate food choices. Which food choice indicates that the nurse's teaching has been successful? a. Whole-grain rice b. Wheat toast c. Applesauce d. Grapes

C. Applesauce When a patient has severe diarrhea and is allowed to resume solid foods, the foods should be slowly introduced in order to help thicken the stool. Foods such as applesauce, pretzels, bananas, white rice, white toast, and yogurt are beneficial.

#1 The nurse cautions that constant stress can cause which alteration to the gastrointestinal system? a. Slowed GI mobility resulting in constipation b. Reversed peristalsis resulting in projectile vomiting c. Increased digestive juices resulting in a gastric ulcer d. Decreased digestive juices resulting in ineffective metabolism

C. increased digestive juices resulting in gastric ulcer; stress increases the gastric secretions, which irritate & finally ulcerate the gastric mucosal lining.

28. Chemical process to make substances needed by the body a. Absorption b. Peristalsis c. Metabolism d. Anabolism e. Catabolism

C. metabolism

#4 The nurse is obtaining a history of a patient with hepatitis A. Which question is most appropriate for the nurse to ask? The nurse is obtaining a history of a patient with hepatitis A. Which question is most appropriate for the nurse to ask? a. "If using drugs, do you share needles?" b. "Do you always practice safe sex?" c. "Have you traveled to Canada in the last month?" d. "Do you eat shellfish or oysters often?"

D. "Do you eat shellfish or oysters often?"; shellfish and mollusks can be contaminated by living in feces-contaminated water.

19. The nurse is performing preprocedure teaching for a patient scheduled to undergo a liver biopsy. After listening to the information, the patient states, "I am so scared. I just don't know if I can do this procedure." Which response is best? a. "The procedure will only last about 15 minutes." b. "Most patients say it feels similar to a punch in the shoulder." c. "You do not have to have the procedure." d. "I understand that you are afraid. Tell me more about your concerns."

D. "I understand that you are afraid. Tell me more about your concerns." The nurse should acknowledge the patient's feelings and promote therapeutic communication. While all of the other statements are true, none of them investigate the underlying cause of the patient's fear. Reassurance about the length of the procedure or the sensation that the patient might experience may be indicated after the patient explains more about specific concerns. While the patient can refuse to have the procedure, dismissing the patient is not an appropriate or therapeutic statement.

11. The nurse is reviewing a student nurse's charting and notes that the student has documented absent bowel sounds. The nurse reminds the student that in order to document absent bowel sounds, one must auscultate each quadrant at what period of time? a. 30 seconds b. 1 minute c. 2 minutes d. 5 minutes

D. 5 minutes The criterion for the documentation of absent bowel sounds is that each quadrant is auscultated for 5 minutes.

#2 The nurse is caring for multiple patients. The nurse determines that which patient has the highest risk of developing gallstones? a. A 37-year-old white man of normal weight on long-term corticosteroids for asthma. b. A 42-year-old African American man of normal weight who has smoked for 25 years. c. A 46-year-old Indonesian woman who is under normal weight and has recently had radiation treatments. d. A 50-year-old obese Mexican American woman who has type 1 diabetes.

D. 50 year old obese mexican american with type 1 diabetes; obesity, diabetes, weight loss, & chron's disease increase the risk for the development of gallstones. Native americans and mexican americans have an ethnic predisposition to gallstones.

6. The nurse is preparing to administer liquid laxative to patient in preparation for a colonoscopy. Which action should the nurse take A. Offer a small snack. B. Take the patient's temperature. C. Mix the laxative with orange juice. D. Chill the laxative and pour it over ice.

D. Chill the laxative and pour it over ice. Chilling the laxative or pouring it over ice makes the drink more palatable and easier to swallow. The nurse should not offer any food, as the accuracy of the test depends on adequate bowel prep. The laxative does not affect the patient's temperature. Mixing the laxative with another substance can make it difficult to judge how much the patient actually consumed if any liquid is remaining.

113. A patient with advanced cirrhosis develops esophageal varices. The nurse anticipates that this complication will be addressed by which type of medication(s)? (Select all that apply.) a. Vasodilators b. Intravenous (IV) vasopressin (Pitressin) c. IV iron d. Beta blockers e. Vitamin K

Ib. ntravenous (IV) vasopressin (Pitressin) d. Beta blockers e. Vitamin K Treatment options include administration of parenteral vasopressors such as vasopressin (Pitressin) to lower portal pressure, a beta blocker to lower blood pressure, and vitamin K to help rectify clotting factor deficiencies. Vasoconstrictors (not vasodilators) such as somatostatin (Zecnil) and octreotide (Sandostatin) are used to reduce portal blood flow, and iron may exacerbate liver failure.

41. The nurse is educating a patient with a hiatal hernia. Which statement indicates that the patient understands the nurse's teaching? a. "I should avoid tea and chocolate." b. "I should wear an abdominal binder for added support. c. "I should sleep flat on a single pillow." d. "I should not eat within an hour of going to bed."

a. "I should avoid tea and chocolate." Hiatal hernia is diagnosed by an upper gastrointestinal (GI) series. Nutritional modification indicated in patients with hiatal hernias includes limiting intake of alcohol, chocolate, caffeine, and fatty food. Other treatment includes weight reduction, avoidance of tight-fitting clothes around the abdomen, administration of antacids, histamine (H2)-receptor antagonists, or proton pump inhibitors, and elevation of the head of the bed on 6- to 8-inch blocks. The patient is instructed not to eat within 3 h of going to bed.

34. The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as which type of bariatric surgery? a. Restrictive b. Malabsorptive c. Restrictive/malabsorptive d. Obstructive

a. Restrictive The three types of bariatric surgery are restrictive, malabsorptive, and restrictive/malabsorptive. Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach and is considered restrictive. This procedure may be performed laparoscopically. The band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight.

68. The nurse is educating a patient with inflammatory bowel disease (IBD) about recommended nutritional choices. Which statement indicates that the nurse's teaching has been successful? a. "I should try to eat foods like white rice and lean poultry." b. "I should avoid red meats and eat large amounts of whole grains." c. "I should eat food that is mushy in consistency." d. "I should increase my intake of green leafy vegetables."

a. "I should try to eat foods like white rice and lean poultry." A low-fat, low-fiber, high-protein, high-calorie diet is recommended for the patient with IBD to make up for the loss of fluid and nutrients in the frequent stools. Low-fat, low-fiber, high-protein, high-calorie foods include foods like white grains or starches and lean, tender meats. Whole grains are extremely high in fiber and should be avoided. A soft diet is not indicated. Green leafy vegetables are a rich source not only of vitamin K, but also of fiber.

33. The nurse calculates the body mass index (BMI) of a man who is 6 feet tall and weighs 150 pounds. Which value is correct? a. 21.0 b. 25.0 c. 43.1 d. 66.3

a. 21.0 The formula to calculate BMI is: weight in kilograms divided by height in meters squared (68.1 kilograms ÷ 3.24 meters = 21.0).

45. For which patient should the nurse question an order for esomeprazole (Nexium)? a. A 55-year-old female who takes digoxin. b. A 52-year-old male who is noncompliant. c. A 38-year-old female who has asthma. d. A 56-year-old male who has epistaxsis.

a. A 55-year-old female who takes digoxin. Esomeprazole (Nexium) interferes with the absorption of digoxin, rabeprazole, and iron salts. In addition, the Food and Drug Administration (FDA) has issued a warning that long-term use of the proton pump inhibitors esomeprazole (Nexium) or omeprazole (Prilosec) may increase the risk of heart problems.

65. The nurse is teaching a group of patients about the process of a mechanical bowel obstruction. Which example should the nurse include in the teaching? a. A tumor obstructs the lumen of the bowel. b. A paralytic ileus causes cessation of peristalsis. c. The bowel is inflamed by diverticulitis. d. The bowel motility is slowed by antidiarrheal drugs.

a. A tumor obstructs the lumen of the bowel. Mechanical obstruction results in blockage of the lumen of the bowel. Examples include tumors, adhesions, strangulated hernia, twisting of the bowel (volvulus), telescoping of one part of the bowel into itself (intussusception), gallstones, barium impaction, and intestinal parasites.

80. The presence of which diagnostic criteria are used to confirm the diagnosis of irritable bowel syndrome (IBS)? (Select all that apply.) a. Abdominal pain that increases with defecation b. Abdominal pain with a change in stool consistency c. Mucorrhea d. Clay-colored stools that float e. Bloating

a. Abdominal pain with a change in stool consistency c. Mucorrhea e. Bloating Diagnosis of IBS is based on clinical manifestations and ruling out the presence of organic bowel disease. Diagnostic criteria include abdominal pain with a change in stool consistency, mucus in the stool (mucorrhea), and abdominal bloating. IBS pain is relieved with defecation; clay-colored stools are associated with problems with the gallbladder.

94. A nurse is caring for a patient who is 4 h postoperative after a laparoscopic cholecystectomy. The patient reports abdominal fullness and mild discomfort. After verifying that the patient's vital signs are stable, what action is most important for the nurse to take next? a. Ambulate the patient. b. Notify the charge nurse. c. Position the patient in high Fowler. d. Administer the ordered PRN analgesic.

a. Ambulate the patient. Retained carbon dioxide (CO2) used during a laparoscopic procedure causes "free air" pain, which may manifest as abdominal fullness and mild discomfort. Early and frequent ambulation helps the CO2 gas dissipate. The charge nurse does not require notification at this time. The nurse should position the patient upright after ambulation. If ambulation does not ease the patient's discomfort, the nurse should then administer the PRN analgesic as ordered.

83. The nursing is planning care for a patient with an acute exacerbation of inflammatory bowel disease (IBD). Which action(s) is/are most important for the nurse to include in the care plan? (Select all that apply.)44 a. Assess number and character of stools. b. Auscultate bowel sounds. c. Obtain weights each shift. d. Encouraging periods of rest. e. Assess for internal bleeding.

a. Assess number and character of stools. b. Auscultate bowel sounds. d. Encouraging periods of rest. e. Assess for internal bleeding. For an acute attack of IBD, care includes monitoring the number and character of stools, periodic auscultation of bowel sounds, and checking for signs of internal bleeding, electrolyte imbalances, or anemia. The nurse should carefully monitor intake and output, but daily weights are sufficient.

The nurse caring for a patient recently admitted with acute pancreatitis. Which action(s) should the nurse include in the daily assessments? (Select all that apply.) a. Auscultate bowel sounds. b. Carefully evaluate amount of food eaten each meal. c. Measure abdominal girth. d. Monitor for effectiveness of pain control. e. Monitor urine output.

a. Auscultate bowel sounds. c. Measure abdominal girth. d. Monitor for effectiveness of pain control. e. Monitor urine output. The nurse should auscultate bowel sounds, measure abdominal girth to monitor for ascites, monitor for pain and evaluate effectiveness of pain control, and monitor urine output. In early acute pancreatitis, the patient should be kept NPO; measuring food is unnecessary

42. The nurse is educating a patient who has gastroesophageal reflux disease (GERD) about dietary modification. Which information is most important for the nurse to include in the teaching plan? a. Avoid highly seasoned or spiced foods. b. Drink ginger ale or lemon lime soda rather than cola. c. Use a straw to drink all fluids. d. Eating three meals spaced evenly apart.

a. Avoid highly seasoned or spiced foods. Avoiding highly seasoned or spicy food should be incorporated into diet changes for the patient with GERD. The avoidance of carbonated beverages with meals and the use of a straw do not reduce the impact of GERD. The frequency of dietary intake does not influence GERD.

110. The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found which type(s) of body fluid(s) or secretions? (Select all that apply.) a. Semen b. Vaginal secretions c. Sweat d. Breast milk e. Human feces

a. Semen b. Vaginal secretions d. Breast milk e. Human feces HBV, hepatitis C virus (HCV), and hepatitis D virus (HDV) may cause chronic inflammation and necrosis of the tissue. HBV and HCV are transmitted by parenteral routes and sexually as they are present in semen, vaginal secretions, and saliva of carriers, as well as breast milk and human feces. HBV is not transmitted through sweat. Sexual partners of patients who are carriers of HBV and HCV are at high risk for contracting the virus.

82. The nurse preparing a teaching plan for a 20-year-old woman who is taking sulfasalazine (Azulfidine) for Crohn disease. Which information should the nurse include in the teaching plan? (Select all that apply.) a. Avoid tanning beds or going outside during peak hours of sun while taking sulfasalazine (Azulfidine). b. If taking sulfasalazine (Azulfidine) while on oral contraceptives, use a backup method of birth control. c. Sulfasalazine (Azulfidine) decreases the effect of hypoglycemic agents. d. Be aware that sulfasalazine (Azulfidine) may turn the urine orange. e. Be aware that sulfasalazine (Azulfidine) may cause gastrointestinal (GI) upset.

a. Avoid tanning beds or going outside during peak hours of sun while taking sulfasalazine (Azulfidine). b. If taking sulfasalazine (Azulfidine) while on oral contraceptives, use a backup method of birth control. d. Be aware that sulfasalazine (Azulfidine) may turn the urine orange. e. Be aware that sulfasalazine (Azulfidine) may cause gastrointestinal (GI) upset. Sulfasalazine (Azulfidine) causes increased photosensitivity, may interfere with effectiveness of oral contraceptives, can tint the urine orange, and may cause GI upset. Sulfasalazine (Azulfidine) increases the effect of hypoglycemic agents.

104. The nurse is caring for a patient with esophageal varices with a new order for vasopressin (Pitressin). The nurse reviews the patient's history and notes that the patient's comorbidities include coronary artery disease (CAD), type 2 diabetes, gastroesophageal reflux disease (GERD), and fibromyalgia. The nurse should immediately notify the physician about which component of the patient's history? a. CAD b. Diabetes mellitus (DM) type 2 c. GERD d. Fibromyalgia

a. CAD Vasopressin (Pitressin) is a potent medication that causes vasoconstriction and stops bleeding of esophageal varices. With the use of potent vasoconstrictors such as vasopressin (Pitressin), which constricts all vessels, the possibility of it causing a myocardial infarction (MI) is a very real concern and should be used most cautiously with the patient with CAD.

91. The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem? a. Cholecystitis b. Hepatitis c. Pancreatitis d. Gastroenteritis

a. Cholecystitis Nausea and vomiting, fever, and leukocytosis occur with cholecystitis. Pain may be referred to the right clavicle, scapula, or shoulder. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea

53. The nurse correctly recognizes that esophageal cancer is associated with which risk factor(s)? (Select all that apply.) a. Cigarette smoking b. Diabetes c. Hypertension d. Heavy alcohol use e. Smokeless tobacco

a. Cigarette smoking d. Heavy alcohol use e. Smokeless tobacco Cigarette smoking is a major cause of esophageal cancer in the United States. When combined with heavy alcohol consumption, the risk for esophageal cancer greatly increases. Both substances are irritants to the mucosa of the esophagus. Smokeless tobacco is also associated with esophageal cancer. Diabetes and hypertension do not increase the risk of developing esophageal cancer.

79. Which foods or beverages may trigger an attack of irritable bowel syndromes (IBS)? (Select all that apply.) a. Coffee b. Yogurt c. Whole-wheat bread d. White rice e. Orange juice

a. Coffee b. Yogurt c. Whole-wheat bread Stress, caffeine, and sensitivity to certain foods such as dairy and wheat products seem to trigger IBS in some people. White rice and orange juice are not considered to be triggers for IBS.

67. The nurse is aware that the person with ulcerative colitis is a risk factor for developing which disorder? a. Colon cancer b. Chronic urinary infections c. Intussusception d. Volvulus

a. Colon cancer Ulcerative colitis is an inflammation, with the formation of ulcers, of the mucosa of the colon. It is often a chronic disease, and the patient is usually free from symptoms between acute flare-ups. The person with ulcerative colitis is 10 to 15 times more likely to develop colon cancer than those who do not have the disease.

60. The nurse is caring for patient with a history of a chronic incarcerated hernia. The patient suddenly complains of abdominal pain and vomits dark material with a fecal odor. The nurse recognizes these signs as indications of which complication? a. Complete intestinal obstruction b. Rupture c. Gastroenteritis d. Duodenal ulcer

a. Complete intestinal obstruction The symptoms of intestinal obstruction vary according to the location of the obstruction. Fecal odor or material in the emesis suggests a complete intestinal obstruction. In this case, the incarcerated hernia has blocked the flow of bowel content. If there is a defect in the muscular wall of the abdomen, the intestine may break through the defect; his protrusion is called a hernia or a rupture. Gastroenteritis is inflammation of the stomach and intestines. A duodenal ulcer occurs in the small intestine (the duodenum).

54. The nurse instructs the patient on the weight reduction drug Orlistat (Xenical, Alli) that he may experience which side effect(s)? (Select all that apply.) a. Diarrhea b. Hypoglycemia c. Abdominal cramping d. Constipation e. Nausea

a. Diarrhea c. Abdominal cramping e. Nausea Medications that suppress appetite or block fat absorption may be used on a short-term basis. Orlistat (Xenical, Alli) inhibits lipase, causing fats to remain partially undigested and unabsorbed. Gastrointestinal side effects of orlistat include diarrhea (sometimes uncontrolled), abdominal cramping, and nausea

57. To best assist a patient with dysphagia, the nurse should implement which action(s)? (Select all that apply.) a. Encourage "practice swallowing" before the meal. b. Coach the patient to chew thoroughly. c. Assist the patient to sit upright with the head forward and chin tucked. d. Offer fluid during the meal. e. Give the patient thin liquids, such as water.

a. Encourage "practice swallowing" before the meal. b. Coach the patient to chew thoroughly. c. Assist the patient to sit upright with the head forward and chin tucked. d. Offer fluid during the meal. To assist a patient with dysphagia (trouble swallowing), the nurse should encourage practice swallows and visualize the larynx rising. Coaching the patient to chew thoroughly while sitting upright, and offering appropriate liquids are actions that decrease likelihood of aspiration. The nurse should administer thickened liquids.

38. Which causative agent is the primary cause of Barrett esophagus? a. Gastroesophageal reflux disease (GERD) b. Eating hot, spicy foods c. Anorexia nervosa d. Esophageal polyps

a. GERD A major cause of Barrett esophagus is esophageal reflux.

55. The nurse explains to an obese patient that initial medically supervised weight reduction includes which components(s)? (Select all that apply.) a. General health assessment b. Specialized exercise program c. Participation in a support group d. Stress reduction e. Surgery

a. General health assessment b. Specialized exercise program c. Participation in a support group d. Stress reduction Dietary control and exercise are the main treatments for obesity. A general health assessment should be conducted before a patient is placed on a weight reduction diet. A provider will usually prescribe a lower calorie diet and exercise. The patient is taught ways to change thinking about food and weight. Those with a BMI over 40 may have surgery to achieve weight reduction if they meet established criteria. Participation in a support group and behavior modification with some sort of reward for weight loss are part of the total treatment plan. Teaching stress reduction and alternate ways of coping are essential to success. Medications that suppress appetite or block fat absorption may be used on a short-term basis. Surgery would be a last resort.

84. The nurse is teaching a patient about peristomal skin care. Which information is most important for the nurse to include? (Select all that apply.) a. Gently remove the faceplate of the appliance to avoid skin irritation. b. Washing the peristomal area with a scrubbing motion to rid the skin of fecal waste. c. Thoroughly rinse the skin. d. Apply a skin barrier to the peristomal area. e. Cut the faceplate to allow a -inch opening around the stoma.

a. Gently remove the faceplate of the appliance to avoid skin irritation. c. Thoroughly rinse the skin. d. Apply a skin barrier to the peristomal area. The faceplate should be removed gently to avoid skin damage; rinsing and drying, and application of a skin barrier, is essential. Washing should be gentle; the patient should avoid scrubbing that could irritate the skin. The faceplate should allow a 1/8-inch opening around the stoma.

Fecal-oral transmission, acute onset a. HAV b. HBV c. HCV d. HDV e. HEV

a. HAV

78. Which contributing factor(s) may lead to hernia development? (Select all that apply.) a. Heavy lifting b. Chronic cough c. Straining with defecation d. Ascites e. Strenuous sexual activity

a. Heavy lifting b. Chronic cough c. Straining with defecation d. Ascites The most common contributing factors in the development of a hernia are straining to lift heavy objects, chronic cough, straining to void or pass stool, and ascites. Sexual activity is not usually a cause for herniation.

106. The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient? a. Instruct the patient to sit and lean forward. b. Monitor intake and output. c. Monitor laboratory values and note changes. d. Check blood glucose values frequently.

a. Instruct the patient to sit and lean forward. Pancreatitis causes abdominal pain that is usually acute, steady, and localized to the epigastrium or left upper quadrant. As it progresses, it spreads and radiates to the back and flank. Sitting and leaning forward may ease the pain. The severity of the pain may slowly decrease after 24 h. Eating makes the pain worse. While monitoring intake and output and laboratory values are important actions, none of these actions actively address the patient's pain.

100. The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test? a. Liver biopsy b. Elevated aspartate aminotransferase (AST) c. Elevated alanine aminotransferase (ALT) d. Elevated lactate dehydrogenase (LDH)

a. Liver biopsy Liver biopsy is the definitive test. AST, ALT, and LDH tests will be elevated, but they are not specific for cirrhosis.

109. The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (Select all that apply.) a. Obesity b. Daily exercise regimen c. Diabetes mellitus (DM) d. Taking cholesterol-lowering drugs e. Mexican American ethnicity

a. Obesity c. Diabetes mellitus (DM) d. Taking cholesterol-lowering drugs e. Mexican American ethnicity Cholelithiasis is the presence of gallstones within the gallbladder or in the biliary tract. Obesity, DM, intake of cholesterol-lowering drugs, and Mexican American ethnicity are risk factors for the development of gallstones. A sedentary lifestyle is a risk factor for cholelithiasis.

111. The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis, blocks the blood flow through the liver, it can lead to which complication(s)? (Select all that apply.) a. Portal hypertension b. Decrease in metabolic processes of the liver c. Decrease in clotting factors d. Increase in ascites e. Decrease in aldosterone

a. Portal hypertension b. Decrease in metabolic processes of the liver c. Decrease in clotting factors d. Increase in ascites Cirrhosis is a progressive, chronic disease of the liver. The destruction of normal hepatic structures and their replacement with necrotic tissue occur. Fibrous bands of connective tissue develop in the organ. The bands eventually constrict and partition the liver tissue into irregular nodules. If this process is halted before too much liver tissue is damaged, the liver tissue will regenerate. Late cirrhosis is considered irreversible. The outcomes of cirrhosis of the liver are failure of its cells to perform their functions and the development of portal hypertension. Aldosterone levels are increased rather than decreased.

58. The nurse is caring for a 70-year-old patient who was diagnosed with gastroenteritis after returning from a camping trip to Mexico. Which manifestation(s) is/are consistent with this diagnosis? (Select all that apply.) a. Positive stool culture for Giardia or Shigella b. Abdominal cramping c. Fat in the stool d. Mucus in stool e. Blood in stool

a. Positive stool culture for Giardia or Shigella b. Abdominal cramping d. Mucus in stool e. Blood in stool Manifestations associated with gastroenteritis include a positive stool culture for Giardia or Shigella, abdominal cramping, and presence of mucus or blood in the stool. Fat in the stool is not symptomatic of gastroenteritis.

52. The nurse is caring for a patient who is suspected of having oral cancer. When reviewing the patient's health history, which finding provides supportive data for the diagnosis? a. Presence of leukoplakia b. History of oral herpes simplex c. History of an oral yeast infection d. Reports of a dry oral cavity

a. Presence of leukoplakia Leukoplakia, a precancerous lesion, may occur on the tongue or mucosa.

99. In caring for a patient with hepatitis B, a nurse would employ which precautions? a. Standard Precautions b. Strict isolation c. Contact Precautions d. Surgical asepsis

a. Standard Precautions Standard Precautions are needed to care for a patient with hepatitis B. Isolation and contact precautions are not indicated for this diagnosis unless this patient is experiencing active bleeding. Surgical asepsis is not required.

40. The nurse is caring for a patient who is postoperative after esophageal resection. Shortly after the nurse starts a feeding, the patient suddenly becomes dyspneic and complains of substernal pain. What should the nurse do first? a. Stop the feeding. b. Ambulate the patient. c. Notify the charge nurse. d. Reassure the patient.

a. Stop the feeding After esophageal resection, pain, increased temperature, and dyspnea may indicate leakage of the feeding into the mediastinum. The nurse should immediately discontinue the feeding, then notify the charge nurse and address any patient concerns. Ambulation is not indicated at this time; ambulation is an intervention to address gas pains.

59. Which type of hernia can lead to necrosis? a. Strangulated hernia b. Indirect hernia c. Direct hernia d. Irreducible hernia

a. Strangulated hernia The incarcerated hernia may become strangulated, which cuts off the blood supply and can lead to necrosis of the trapped bowel loop. Hernias are classified as reducible, which means the protruding organ can be returned to its proper place by pressing on the organ, and irreducible, which means that the protruding part of the organ is tightly wedged outside the cavity and cannot be pushed back through the opening. Another name for an irreducible hernia is incarcerated hernia. An indirect hernia protrudes through the inguinal ring. A direct hernia protrudes through the posterior inguinal wall.

77. The nurse is educating a group of patients about high-fiber dietary selections. Which patient menu selection indicates that the nurse's teaching has been successful? a. Turkey sandwich on whole-wheat toast, pears, and tea b. Grilled chicken, corn, and water c. Cheese pizza, salad, and milk d. Bacon, lettuce, and tomato sandwich on sourdough, blackberry compote, and orange juice

a. Turkey sandwich on whole-wheat toast, pears, and tea A high-fiber diet is encouraged for the patient with diverticular disease. Eating whole-grain cereals and breads, as well as fruits such as apples, seedless berries, peaches, and pears adds fiber. High-fiber vegetables—squash, broccoli, cabbage, and spinach—and legumes, including dried beans, peas, and lentils, provide bulk that decreases constipation and speeds the transit time in the intestine. The meal with a turkey sandwich on whole-wheat bread and pears is the only meal choice with multiple high-fiber foods (bread and pears).

30. Transfer of nutrients from intestine to bloodstream a. Absorption b. Peristalsis c. Metabolism d. Anabolism e. Catabolism

a. absportion

35. The nurse is discussing bariatric surgery complications with a patient. Which statement indicates that the patient accurately understands the nurse's teaching about common procedural side effects? a. "I understand that gastric ulcers frequently occur in patients who have bariatric surgery." b. "Gallstones are a common occurrence in patients who have bariatric surgery." c. "I know an umbilical hernia might happen after I have bariatric surgery." d. "Unfortunately, I may experience gastritis after having bariatric surgery."

b. "Gallstones are a common occurrence in patients who have bariatric surgery." Nutritional deficiencies caused by the banding result in the formation of gallstones in a large percentage of bariatric surgery patients. About a third of patients who undergo bariatric surgery develop gallstones.

108. A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate? a. "If you are having unprotected sexual intercourse with your partner, there is a relatively high risk for hepatitis A." b. "Hepatitis A is not transmitted as a result of close contact with an infected individual." c. "Hepatitis A transmission is associated with contact with infected body fluids." d. "Hepatitis A is relatively uncommon in our country and seen more in underdeveloped countries."

b. "Hepatitis A is not transmitted as a result of close contact with an infected individual." Hepatitis A and hepatitis E viruses are transmitted primarily by the fecal-oral route. They are responsible for the epidemic forms of viral hepatitis. Hepatitis A virus can be transmitted by food handlers to customers or by mollusk shellfish from contaminated waters. Hepatitis B is transmitted via infected blood and body fluids. Hepatitis E virus infection is primarily seen in less developed countries.

102. The nurse is caring for a patient with cirrhosis. The nurse is educating the patient about nutritional implications related to his diagnosis. Which statement indicates that the nurse's teaching has been successful? a. "I should eat lots of sweet potatoes and carrots for vitamin A." b. "I should choose proteins like cottage cheese and quinoa instead of chicken." c. "I should eat oysters and shellfish for a good source of copper." d. "I should eat red meat and dark, leafy vegetables to boost my iron stores."

b. "I should choose proteins like cottage cheese and quinoa instead of chicken." Traditionally, limitation of dietary protein intake was prescribed; however, this approach is being challenged and the current recommendation is to manage encephalopathy with medications rather than to restrict protein. Vegetable proteins are preferred because they do not contribute to encephalopathy. Substituting meat proteins for protein sources like quinoa and cottage cheese is a good dietary choice. Patients with liver inflammation or cirrhosis should avoid taking large doses of vitamins and minerals. Vitamin A, iron, and copper can worsen the liver damage, so this patient should not try to increase intake of these vitamins and minerals.

120. The nurse is caring for a patient who has been diagnosed with Crohn disease. When providing education concerning dietary recommendations, which statement indicates that the nurse's teaching has been successful? a. "I should try to eat as much fiber daily as I can." b. "Reducing dietary fat and fiber will be helpful in managing my condition." c. "I should not have lactose-containing products." d. "Eating a larger breakfast and smaller lunch and dinner portions is recommended."

b. "Reducing dietary fat and fiber will be helpful in managing my condition." The recommended diet in Crohn disease consists of low-fat, low-fiber foods that are high in protein and calories. Small frequent feedings are best. Lactose avoidance helps some patients.

62. The nurse is caring for a patient whose home medications include bismuth subsalicylate (Pepto Bismol). The nurse should educate the patient about which side effect of this medication? a. Pink urine b. Sunburn-like rash c. Stained teeth d. Black stools

d. Black stools This medication often turns the stool black. It does not cause a rash, or stain the urine or teeth.

56. The nurse is presenting a program about bulimia nervosa to a group of student nurses. After the program, the participants correctly identify which method(s) of treatment? (Select all that apply.) a. Appetite suppressants b. Antidepressant medications c. Psychotherapy d. Behavior modification e. Increased exercise

b. Antidepressant medications c. Psychotherapy d. Behavior modification Bulimia nervosa is a psychological disorder. The bulimic patient consumes large quantities of food and then induces vomiting to get rid of it so that weight is not gained. Laxatives may be taken to purge the system after an eating binge. Treatment of bulimia includes psychotherapy, antidepressant medication, and behavior modification. Appetite suppressants and exercise are not part of treatment for bulimia nervosa.

The nurse is planning skin care of the patient with ascites. Which actions should the nurse include? (Select all that apply.) a. Bathe the patient in hot water. b. Apply emollients to decrease itching. c. Closely trim the patient's fingernails. d. Change the patient's position every 1 to 2 h. e. Coach the patient in deep-breathing exercises.

b. Apply emollients to decrease itching. c. Closely trim the patient's fingernails. d. Change the patient's position every 1 to 2 h. Applying emollients, cutting the fingernails short, and changing the patient's position frequently are appropriate interventions. The nurse should bathe the patient in tepid water. Deep breathing, although a good intervention in certain situations, has nothing to do with skin care.

63. Which age-related change predisposes older adult patients to diverticula? a. Loss of bowel tone reduces motility. b. Chronic constipation increases intra-abdominal pressure and allows herniation. c. The diet may be deficient in bulk. d. Multipharmacy has altered bowel mucosa.

b. Chronic constipation increases intra-abdominal pressure and allows herniation. Most diverticula are asymptomatic, uncommon in people under age 50, and almost universal in those over 90. Increases in intra-abdominal pressure from constipation and straining to defecate causes herniation of the mucosa through the bowel wall, causing a small pocket in the colon.

95. The nurse is caring for a patient who underwent a cholecystectomy 3 days ago. Which assessment finding best indicates to the nurse that the bile flow is no longer obstructed from entering the bowel? a. Excessive flatus b. Dark brown stool c. Dark urine d. Increased appetite

b. Dark brown stool Darkening of stools back to the normal color indicates that the bile has reached the duodenum.

115. Transmission by contact with blood and body fluids, perinatal transmission from mother to infant a. HAV b. HBV c. HCV d. HDV e. HEV

b. HBV

81. Conservative treatment of diverticulosis includes which management? (Select all that apply.) a. Eating a low-fiber diet b. Increasing fluid intake c. Taking stool softeners d. Taking nonsteroidal antiinflammatory drugs (NSAIDs) for discomfort e. Taking bulk laxatives

b. Increasing fluid intake c. Taking stool softeners d. Taking nonsteroidal antiinflammatory drugs (NSAIDs) for discomfort e. Taking bulk laxatives A high-fiber diet is indicated for the treatment of diverticulosis. All other options would be part of a conservative, nonsurgical approach to treatment.

36. The nurse is caring for a patient with suspected dysphagia. Which action is most appropriate for the nurse to take? a. Encourage incentive spirometry use. b. Instruct the patient to take practice swallows before the meal. c. Encourage patient attempts to communicate, and pay attention to nonverbal cues. d. Encourage the patient to keep a food diary.

b. Instruct the patient to take practice swallows before the meal. Dysphagia means difficulty in swallowing. The nurse should have the patient take some "practice swallows" before beginning the meal, and watch to see that the larynx rises with each swallow. Incentive spirometry usage is important for patients with dyspnea, or shortness of breath. Encouraging communication and paying attention to nonverbal cues is an effective intervention for aphasia (inability to use or understand words). Keeping a food diary may be useful in cases of polyphagia (extreme hunger), but it does not evaluate whether or not the patient can swallow effectively.

66. The nurse is aware that an unresolved intestinal obstruction can lead to which complications? a. Systemic infection and fever b. Intestinal rupture and shock c. Adhesions and pain d. Bloating and expelling gas

b. Intestinal rupture and shock An unresolved intestinal obstruction can lead to rupture of the intestine, peritonitis, shock, and death.

76. The nurse is caring for an older adult patient diagnosed with diverticulitis. Which medication is the best choice to manage the patient's pain? a. Meperidine (Demerol) b. Morphine c. Nalbuphine hydrochloride (Nubain) d. Naloxone (Narcan)

b. Morphine Morphine is acceptable for pain management and has fewer side effects than meperidine (Demerol). In earlier recommendations, Demerol was the drug of choice based on a theoretical risk not shown in studies. A metabolite of meperidine (Demerol) is toxic, and the older adult has difficulty metabolizing and eliminating it. The buildup of the toxin in the blood can cause seizures and other mental status changes such as acute confusion. Ask for an alternate analgesic for these patients.

71. The nurse caring for the patient who is immediately postoperative with a new ileostomy. Which intervention is most important for the nurse to implement at this time? a. Change the ostomy pouch frequently. b. Provide emotional support. c. Administer a stool softener. d. Offer the patient frequent snacks.

b. Provide emotional support. Helping the patient adjust to the new ostomy is one of the highest priorities in the immediate postoperative period. In the immediate postoperative period, the pouch should not be changed any more than is necessary to avoid trauma to the skin. A stool softener is not indicated since stools are usually softer and more watery when coming from a stoma. Diet advancement is a gradual process that must coordinate with returning bowel function, and the patient may be NPO for a short time while bowl motility returns.

70. The nurse explains to the patient receiving bevacizumab (Avastin) for a tumor in the colon that the drug slows cancer cell growth by which process? a. Changing the pH of the cell environment b. Reducing blood flow to the tumor c. Overhydrating cells of the tumor, causing them to burst d. Interfering with DNA of tumor cells

b. Reducing blood flow to the tumor Bevacizumab (Avastin) is an antiangiogenesis medication that reduces blood flow to the growing tumor cells, depriving them of nutrients needed for replication.

Coexists with HBV a. HAV b. HBV c. HCV d. HDV e. HEV

d. HDV

105. The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. The nurse recognizes that this finding likely results from which underlying problem? a. Increased amylase b. Retroperitoneal hemorrhage c. Inflammatory response to a pseudocyst d. Ascites

b. Retroperitoneal hemorrhage A bluish tinge around the umbilicus or in the flank area indicates a retroperitoneal hemorrhage. Increased amylase levels, inflammatory response to a pseudocyst, and ascites do not result in a bluish tinge around the belly button.

61. The nurse explains that a hernioplasty is a surgery that involves which process? a. Reducing the hernia by manual pressure b. Sewing synthetic mesh over the abdominal wall defect to reduce the hernia c. Applying an individualized truss for the reduction of the hernia d. Reducing the hernia and suturing the defect in the abdominal wall

b. Sewing synthetic mesh over the abdominal wall defect to reduce the hernia Hernioplasty is a surgical intervention in which the hernia is reduced and a synthetic mesh is sewn over the defect in the wall to prevent reoccurrence.

44. The nurse is aware that patients who have chronic gastritis from renal failure may present with which first sign of this disorder? a. An increase in the white blood cell count b. Sudden massive hemorrhage c. Asthma-like symptoms d. Extreme dyspnea

b. Sudden massive hemorrhage Sudden massive GI hemorrhage may be the first indication of chronic gastritis. Many of these patients do not have any symptoms at all until the hemorrhage.

72. The nurse explains which advantage benefits patients with a Kock pouch ileostomy? a. The patient can expel feces from the rectum in the normal fashion. b. The patient does not have to wear a collection device. c. The patient only has to evacuate the pouch once a day. d. The patient can have the pouch reanastomosed to the colon at a later time.

b. The patient does not have to wear a collection device. The major advantage of the Kock pouch is that the patient does not have to wear a collection device. The feces are collected in the pouch and emptied by the patient inserting a catheter into the pouch every 3 or 4 h.

51. A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate? a. "This is common after the type of surgery you had." b. "How much, if any, alcohol do you consume each day?" c. "Avoid large meals, limit sweets, and drink small amounts of liquids between meals." d. "You may be experiencing a postoperative infection."

c. "Avoid large meals, limit sweets, and drink small amounts of liquids between meals." Some patients who have had a gastrectomy experience a complication known as the "dumping syndrome." The patient has nausea, weakness, abdominal pain, and diarrhea and may feel faint and perspire profusely or experience palpitations after eating. These sensations are caused by the rapid passage of large amounts of food and liquid into the jejunum. When a patient experiences dumping syndrome, instruction is given to avoid eating large meals and to drink a minimum of fluids during the meal. Fluids may be taken in small amounts later, between meals. If sweet foods seem to aggravate the condition—and they sometimes do—the patient should try to avoid them. Although this is not an uncommon manifestation after this type of surgery, informing the patient that this is common provides limited information to the patient and is not the best response. This problem is not connected to alcohol consumption and is not a symptom of a postoperative infection.

93. The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make? a. "Is there a reason that you want to have lithotripsy?" b. "Your doctor decides which procedure will be best." c. "Gallstones are usually treated with surgery. Tell me more about your concerns." d. "I understand that you are upset. Would you like to speak with a chaplain?"

c. "Gallstones are usually treated with surgery. Tell me more about your concerns." Lithotripsy, or "shock wave" therapy, is rarely used for gallstones. The treatment of choice is gallbladder removal. By explaining that surgery is the treatment of choice but also asking the patient to elaborate, the nurse provides information and uses an open-ended statement to acknowledge the patient's feelings. Asking the patient to list the reasons that he wants lithotripsy is not therapeutic or effective since the patient requires a cholecystectomy. While the physician does choose which procedure is best indicated, the nurse should not dismiss the patient's concerns or deflect them and suggest that he speak with someone else.

39. The nurse is educating a patient with Barrett esophagus. Which statement indicates that the patient requires a need for further instruction? a. "I should eat smaller meals and avoid foods that cause reflux." b. "I can still have a small glass of wine with dinner." c. "I should consider switching to smokeless tobacco." d. "I should stay upright after eating."

c. "I should consider switching to smokeless tobacco." Care of the patient with Barrett esophagus is focused on encouraging measures to prevent GERD and on regular checkups. Patients should be encouraged not to use tobacco products and not to indulge in heavy alcohol use.

103. The physician has prescribed rifaximin (Xifaxan) for a patient with cirrhosis. The patient questions why he must take this medication. Which response by the nurse is most appropriate? a. Rifaximin (Xifaxan) helps prevent infection. b. Rifaximin (Xifaxan) helps reduce straining during a bowel movement. c. Rifaximin (Xifaxan) kills intestinal flora. d. Rifaximin (Xifaxan) aids in reducing ascites.

c. Rifaximin (Xifaxan) kills intestinal flora. Rifaximin (Xifaxan) decreases the bowel flora, colonic bacteria that breakdown protein. This treatment lowers the formation of ammonia. This medication may cause headaches or flatulence and is taken twice daily with food.

64. The nurse is educating a patient with diverticulitis. Which statement indicates that the nurse's teaching about the importance of seeking treatment has been successful? a. "If left untreated, the inflamed bowel could spread to the entire bowel." b. "If left untreated, the inflamed bowel could cause ulcers." c. "If left untreated, the inflamed bowel can perforate and cause peritonitis." d. "If left untreated, the inflamed bowel can cause appendicitis."

c. "If left untreated, the inflamed bowel can perforate and cause peritonitis." The term diverticulum refers to a small, blind pouch resulting from a protrusion of the mucous membranes of a hollow organ through weakened areas of the organ's muscular wall. Diverticula occur most often in the intestinal tract, especially in the esophagus and colon. The infected diverticula can perforate through the bowel wall and cause peritonitis. Diverticulitis does not result in ulcers or appendicitis.

50. The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen. The patient is receiving total parenteral nutrition (TPN), and the physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response is best for the nurse to make? a. "It is likely you have developed diabetes as a result of your illness." b. "Do you have a family history for diabetes?" c. "The TPN you are receiving has high amounts of glucose." d. "Insulin is needed to manage your stomach's inability to adequately metabolize food at this time."

c. "The TPN you are receiving has high amounts of glucose." People on TPN are prone to hyperglycemia from the high glucose content of the solution.

107. The nurse is caring for a patient being treated for new onset of gallstones. The patient asks the nurse if he will have to have surgery. How should the nurse respond? a. "You will have to have surgery if you continue to have gallstones." b. "Tell me more about your concern." c. "Treatment for gallstones may include diet modification and weight loss, medications, or surgery." d. "You need to ask the doctor about your concerns."

c. "Treatment for gallstones may include diet modification and weight loss, medications, or surgery." The patient should be aware that treatment varies according to severity and frequency of symptoms in conjunction with the patient's response to various treatments. Conservative therapy includes low-fat diets and weight loss, along with restriction of alcohol intake. Oral medications may be given to dissolve gallstones. If the patient does not respond to this therapy, or if bile obstruction occurs, correction of the obstructed biliary tract is indicated. Gallbladder removal is indicated with patients with ongoing symptoms or complications. The nurse should not tell the patient that surgery is inevitable. The patient has already expressed his concern (whether he will require surgery). The nurse can address the patient's concern and should not deflect them to the physician.

48. The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur at which time? a. In the morning b. Erratically, without pattern c. At bedtime d. With meals

c. At bedtime Pain occurs at bedtime because the stomach is empty, but the gastric juices are still high. Pain is absent in the morning when the digestive juices are low and when the stomach is filled with food.

101. The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention? a. Shiny, tight abdomen b. Yellow sclera c. Confusion d. Paired horizontal bands on the fingernails

c. Confusion Mental confusion and coma result from hepatic encephalopathy. Encephalopathy occurs from liver failure that leads to circulating toxins. This finding is an indicator of deteriorating patient condition. Ascites and jaundice are expected findings in cirrhosis and do not necessarily indicate an urgent change in condition. Fingernails that feature horizontal bands in pairs that alternate with normal nail color occur due to hypoalbuminemia from cirrhosis; this finding does not indicate an urgent change in condition.

37. A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 h. Before giving the bolus, the nurse aspirates a residual of 100 mL. Which action is most appropriate? a. Give the 200 mL feeding. b. Record the residual and give 100 mL of the feeding. c. Document the residual and hold the feeding. d. Position the patient in high Fowler position and give the feeding.

c. Document the residual and hold the feeding. On finding a large residual, the nurse should return the residual to the patient, document the amount of the residual, and hold the feeding to avoid possible aspiration.

69. The nurse caring for a patient admitted with peritonitis who has developed a paralytic ileus. While auscultating bowel sounds, the nurse assesses flatus. What is the significance of this finding? a. Gas has formed in bowel contents. b. Flatus results from forceful vomiting. c. Flatus indicates returning peristalsis. d. Flatus indicates inadequate decompression.

c. Flatus indicates returning peristalsis. Paralytic ileum is a common complication of peritonitis. The nurse should auscultate at least once a shift for the return of bowel sounds. If the patient passes flatus or feces rectally, it indicates return of peristalsis.

Most likely to lead to cirrhosis a. HAV b. HBV c. HCV d. HDV e. HEV

c. HCV

49. The nurse is caring for a patient with a Salem sump tube for decompression. The patient displays dyspnea and reports feeling full and nauseated. What action should the nurse take first? a. Increase suction from low to high. b. Notify the charge nurse. c. Irrigate the tube with normal saline. d. Withdraw the tube about three inches.

c. Irrigate the tube with normal saline. Irrigation of the tube to restore patency is the first intervention when assessment indicates inadequate decompression. The suction should remain on low. Withdrawing the tube may cause inappropriate placement. Notifying the charge nurse is not necessary at this time. Irrigating an obstructed sump tube is a standard of care.

74. The nurse is caring for a patient with a 4-day-old ileostomy. The patient complains of cramping, the nurse notes a drop in the effluent for the ileostomy, and the bowel sounds are rapid with a "tinkling" sound. What action should the nurse take? a. Ambulate the patient to help expel gas. b. Irrigate the ileostomy with 500 mL of warm water. c. Notify the charge nurse immediately. d. Turn the patient on the left side to help drain the ileostomy.

c. Notify the charge nurse immediately. Cramping and reduced effluent from a new ileostomy should be reported immediately as these are signs of obstruction, which could lead to perforation. Ileostomies are not irrigated except by the physician or an enterostomal therapist.

47. The nurse is caring for a patient with a peptic ulcer. The patient also has a history of chronic bronchitis, diabetes, and arthritis. Which component of the patient's history is the most likely contributing factor to the patient's ulcer? a. The patient requires insulin to manage his diabetes. b. The patient uses a daily inhaler to decrease incidence of asthma attacks. c. The patient takes ibuprofen daily for arthritis pain. d. The patient takes a multivitamin daily.

c. The patient takes ibuprofen daily for arthritis pain. About 4.5 million people in the United States have experienced a peptic ulcer. Helicobacter pylori infection is the major cause. Smoking and the continued use of nonsteroidal antiinflammatory drugs (NSAIDs) are other causes

92. The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan? a. To visualize the location of gallstones b. To assess amounts of inflammation and swelling c. To diagnose abnormal contraction of the gallbladder d. To assess composition of gallstones

c. To diagnose abnormal contraction of the gallbladder The HIDA scan can diagnose abnormal contractions of the gallbladder, which occur in the presence of gallstones or a gallbladder that is not functioning properly.

43. The nurse is preparing a teaching plan for a patient with gastroesophageal reflux disease (GERD) who has been prescribed multi-drug therapy for treatment. Which information is most important for the nurse to obtain? a. "Can you identify triggers for your reflux?" b. "Can you commit to changing your diet?" c. "Do you understand how each type of medication works?" d. "Do you think you can afford these prescriptions?"

d. "Do you think you can afford these prescriptions?" Drug therapy may include antacids, H2-receptor antagonists, proton pump inhibitors, and prokinetic drugs. Priorities related to education about medication include checking for possible drug interactions with other drugs the patient is taking and verifying that the patient can afford the drugs prescribed. (If the patient cannot afford the medications, compliance is an unrealistic expectation.) While it is important for the patient to attempt to identify triggers, commit to dietary and lifestyle modifications, and understand each medication, those are questions that can be answered over time.

90. The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse's teaching has been successful? a. "I should call my doctor if I have any pain." b. "I should be able to go back to work tomorrow." c. "I should avoid fatty foods for a few weeks." d. "I should let these Steri-Strips fall off on their own."

d. "I should let these Steri-Strips fall off on their own." The nurse should teach the patient to remove the bandages from the puncture site(s) the day after surgery and shower, leaving the Steri-Strips intact. Steri-Strips will fall off in 7 to10 days. The patient should notify the physician in cases of severe abdominal pain that is not relieved by medication or is worsening. Return to work is probable at 1 week postsurgery. The patient should adhere to a low-fat diet for several weeks and slowly introduce fattier foods to determine if they cause unpleasant symptoms.

75. A 36-year-old woman who had an ascending colostomy angrily declares, "I don't want this hateful thing on my body! This nasty thing is not me." Which response is most appropriate for the nurse to make? a. "The colostomy is part of you now." b. "Let me change the collection bag so you don't stay nasty." c. "All ostomates feel this way at first. I'll go get a list of support groups you may want to join." d. "What about this colostomy concerns you the most?"

d. "What about this colostomy concerns you the most?" Asking the patient to name the specific concerns helps to conceptualize where the adjustment problem lies. All other options negate the patient's feelings, reinforce the patient's negative feelings, and do not offer any therapeutic response

32. The nurse explains that the diagnosis of morbidly obese is reserved for people who exceed which percentage of their recommended weight? a. 50% b. 70% c. 90% d. 100%

d. 100% Those people who weigh 100% over their recommended weight are considered morbidly obese.

46. The nurse is caring for a patient who is being treated for extensive burns. The nurse notes the presence of coffee-ground material in the Salem sump catheter. The nurse correctly recognizes which factor as the likely cause? a. Esophagitis b. Perforated gastric ulcer c. Gastric irritation from the Salem sump tube d. A physiologic stress ulcer

d. A physiologic stress ulcer Prolonged physiologic stress produces what is known as a physiologic stress ulcer, which is believed to be the result of unrelieved stimulation of the vagus nerves and decreased perfusion to the stomach. A stress ulcer is pathologically and clinically different from a chronic peptic ulcer. It is more acute and more likely to produce hemorrhage. Perforation occurs occasionally, and pain is rare. Stress ulcers are a hazard for patients who are severely ill and in intensive care units for prolonged periods. Patients with multiple trauma, burns, or multisystem disorders are subject to physiologic stress ulcers, which may produce blood that has been in contact with gastric juices.

73. The nurse is caring for a patient 1-day postoperative after a transverse colostomy. When assessing the stoma, which finding requires the nurse's immediate action? a. A wet, glistening stoma b. A stoma with scant marginal bleeding c. An edematous stoma d. A purplish-red stoma

d. A purplish-red stoma The purple hue in the new stoma is an indication of reduced perfusion to the stoma and should be reported immediately. A new stoma should have a pink or beefy red color, be slightly edematous, and have some small bleeding around the stoma.

98. A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse anticipates that the health care provider will likely recommend which treatment? a. A prescription for a broad-spectrum antibiotic b. A prescription for an antiviral agent c. The first of the three immunizations for HBV d. An injection of hepatitis B immune globulin (HBIG)

d. An injection of hepatitis B immune globulin (HBIG) HBIG will give immediate passive immunity. Immunization for HBV takes too long for immediate coverage. Oral medications are of little value at this stage.

29. Repair of body tissue a. Absorption b. Peristalsis c. Metabolism d. Anabolism e. Catabolism

d. Anabolism

96. The nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology? a. Liver ischemia in hepatitis causes jaundice. b. Increased bile production by the enlarged Kupffer cells causes jaundice. c. The hepatitis virus destroys red blood cells and causes jaundice. d. Hepatitis causes liver congestion that obstructs bile flow.

d. Hepatitis causes liver congestion that obstructs bile flow. Congestion from the inflammation obstructs the bile from entering the duodenum and keeps it in the circulating volume.

97. The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis? a. Decreased aspartate aminotransferase (AST) b. Decreased alanine aminotransferase (ALT) c. Decreased gamma-glutamyl transpeptidase (GGT) d. Increased prothrombin time

d. Increased prothrombin time During the acute phase of hepatitis, the patient will likely display prolonged prothrombin times. Levels of aspartate aminotransferase (AST), alanine aminotransferase, and GGT will be elevated.

Prevalent in less developed countries a. HAV b. HBV c. HCV d. HDV e. HEV

e. HEV

31. Breaking down larger molecules into smaller molecules a. Absorption b. Peristalsis c. Metabolism d. Anabolism e. Catabolism

e. catabolism