Lower GI

1. which of the following guidelines reflects the current american and canadian cancer societies' recommendations for screening for colon cancer in individuals who are NOT at high risk? a. annual digital rectal exam should begin at age 40 b. annual fecal testing for occult blood should begin at age 50 c. individuals should obtain a baseline barium enema at age 40 d. individuals should obtain a baseline colonoscopy at age 45

B. annual fecal testing for occult blood should begin at age 50

9. while changing the client's colostomy bag and dressing, the nurse assesses that the client is ready to participate in self-care by noting which of the following? a. the client asks what time the doctor will visit that day b. the client asks about the supplies used during the dressing change c. the client talks about the news on the TV d. the client is upsets about the way the night nurse changed the dressing

B. the client asks about the supplies used during the dressing change

29. a client who has ulcerative colitis has persistent diarrhea, and has lost 12 lbs since the exacerbation of the disease. which of the following will be most effective in helping the client meet nutritional needs? a. continuous enteral feedings b. following a high-calorie, high-protein diet c. total parenteral nutrition (TPN) d. eating six small meals a day

C. total parenteral nutrition (TPN)

82. the nurse is taking care of a client with C. diff. the nurse should do which of the following to prevent the spread of infection? select all that apply. a. wear a particulate respirator b. wear sterile gloves when providing care c. cleanse hands with alcohol based hand sanitizer d. wash hands with soap and water e. wear a protective gown when in the client's room

D, E

74. a nurse is providing wound care to a client 1 day following an appendectomy. a drain was inserted into the incisional site during surgery. which action should the nurse perform when providing wound care? a. remove the dressing and leave the incision open to air b. remove the drain if wound drainage is minimal c. gently irrigate the drain to remove exudate d. clean the area around the drain moving away from the drain

D. clean the area around the drain moving away from the drain

3. which of the following is a potential risk factor for the development of colon cancer? a. chronic constipation b. long-term use of laxatives c. hx of smoking d. hx of IBD

D. history of inflammatory bowel disease

11. a client is recovering from an abdominal-perineal resection. which of the following measures would MOST effectively promote wound healing after the perineal drains have been removed? a. taking sitz baths b. taking daily showers c. applying warm, moist dressings to the area d. applying a protected heating pad to the area

A. taking sitz baths

73. a client with diverticulitis has developed peritonitis following diverticular rupture. when assessing the client, the nurse should do which of the following? select all that apply. a. percuss the abdomen to note resonance and tympany b. percuss the liver to note lack of dullness c. monitor the vital signs for fever, tachypnea, and bradycardia d. assess presence of polyphagia and polydipsia e. auscultate bowel sounds to note frequency

A, B, E

39. a client is admitted with a bowel obstruction. the client has nausea, vomiting, and crampy abdominal pain. the physician has written the following prescriptions: for the client to be up ad lib, have narcotics for pain, and have a NG tube inserted if needed, and for IV ringer's lactate and hyperalimentation fluids. the nurse should do the following in order of priority from first to last. a. assist with ambulation to promote perisalsis b. insert a NG tube c. administer IV ringer's lactate d. start an infusion of hyperalimnetation of fluids

A, C, B, D

14. a client with colon cancer has developed ascites. the nurse should conduct a focused assessment for which of the following? select all that apply. a. respiratory distress b. bleeding c. fluid and electrolyte imbalance d. weight gain e. infection

A, D

38. a nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. the nurse should assess the client for which of the following? select all that apply. a. projectile vomiting b. significant abdominal distention c. copious diarrhea d. rapid onset of dehydration e. increased bowel sounds

A, D, E

17. the nurse instructs the client who has had a hemorrhoidectomy not to use sitz baths until at least 12 hours postop to avoid inducing which of the following complications? a. hemorrage b. rectal spasm c. urine retention d. constipation

A. hemorrhage

40. the physician prescribes intestinal decompression with a Cantor tube for a client with an intestinal obstruction. in order to determine the effectiveness of intestinal decompression, the nurse should evaluate the client to determine if: a. intestinal fluid and gas have been removed b. the client has had a bowel movement c. the client's urinary output is adequate d. the client can sit up without pain

A. intestinal fluid and gas have been removed

23. when planning care for a client with ulcerative colitis who is experiencing an exacerbation of symptoms, which client care activities can the nurse appropriately delegate to the unlicensed assistant? select all that apply. a. assessing the client's bowel sounds b. providing skin care following bowel movements c. evaluating the client's response to antidiarrheal medications d. maintaining I&O e. obtaining the client's weight

B, D, E

36. the nurse is developing a plan of care for a client with crohn's disease who is receiving TPN. which of the following interventions should the nurse include? select all that apply a. monitoring vital signs once a shift b. weighing the client daily c. changing the central venous line dressing daily d. monitoring the IV infusion rate hourly e. taping all IV tubing connections securely

B, D, E

52. the nurse finds the client who has had an ileostomy crying. the client explains to the nurse, "I'm upset because I know I won't be able to have children now that i have an ileostomy." Which of the following would be the BEST response for the nurse? a. "many women with ileostomies decide to adopt. why don't you consider that option?" b. "Having an ileostomy does not necessarily mean that you can't bear children. let's talk about your concerns." c. "I can understand your reasons for being upset. having children must be important to you." d. "I'm sure you will adjust to this situation with time. Try not to be too upset."

B. "Having an ileostomy does not necessarily mean that you can't bear children. let's talk about your concerns."

28. a client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. the nurse should tell the client: a. "ulcerative colitis can be cured by the use of steroids" b. "steroids are used in severe flare-ups because they can decrease the incidence of bleeding" c. "long-term use of steroids will prolong periods of remission" d. "the side effects of steroids outweigh their benefits to clients with ulcerative colitis"

B. "steroids are used in severe flare-ups because they can decrease the incidence of bleeding"

45. the nurse is teaching the client how to care for an ileostomy. the client asks the nurse how long to wear the pouch before changing it. the nurse should tell the client which of the following? a. "the pouch is changed only when it leaks" b. "you can wear the pouch for about 4-7 days" c. "you should change the pouch every evening before bedtime" d. "it depends on your activity level and your diet"

B. "you can wear the pouch for about 4-7 days"

80. a male client has just had an inguinal herniorrhaphy. which of the following instructions would be MOST appropriate to include in the discharge plan? a. turning, coughing, and deep breathing every 2 hours b. applying an ice bag to the scrotum c. applying a truss before the client ambulates d. maintaining a high fowler's position while resting

B. applying an ice bag to the scrotum

43. the client with an intestinal obstruction continues to have acute pain even though the nasoenteric tube is patent and draining. which action by the nurse would be MOST appropriate? a. reassure the client that the nasoenteric tube is functioning b. assess the client for a rigid abdomen c. administer an opioid as prescribed d. reposition the client on the left side

B. assess the client for a rigid abdomen

86. a client has received numerous different antibiotics and now is experiencing diarrhea. the physician has prescribed a transmission-based precaution. which of the following types of precautions would be most appropriate for all personnel to use? a. airborne precautions b. contact precautions c. droplet precautions d. needlestick precautions

B. contact precautions

37. which of the following should be a priority focus of care for a client experiencing an exacerbation of crohn's disease? a. encouraging regular ambulation b. promoting bowel rest c. maintaining current weight d. decreasing episodes of rectal bleeding

B. promoting bowel rest

35. a client with crohn's disease has concentrated urine; decreased urinary output; dry skin with decreased turgor; hypotension; and weak, thready pulses. the nurse should do which of the following FIRST? a. encourage the client to drink at least 1000 mL/day b. provide parenteral rehydration therapy prescribed by the physician c. turn and reposition every 2 hrs d. monitor vital signs every shift

B. provide parenteral rehydration therapy prescribed by the physician

41. after insertion of a nasoenteric tube, the nurse should place the client in which position? a. supine b. right side-lying c. semi-fowlers d. upright in a bedside chair

B. right side-lying

71. after instructing a client with diverticulosis about appropriate self-care activities, which of the following client comments indicate effective teaching? select all that apply. a. "with careful attention to my diet, my diverticulosis can be cured." b. "using a cathartic laxative weekly is okay to control bowel movements" c. "I should follow a diet that's high in fiber" d. "it is important for me to drink at least 2L/day" e. "I should exercise regularly"

C, D, E

12. when planning diet teaching for the client with a colostomy, the nurse should develop a plan that emphasizes which of the following dietary instructions? a. foods containing roughage should not be eaten. b. liquids are best limited to prevent diarrhea c. clients should experiment to find the diet that is best for them d. a high-fiber diet will produce a regular passage of stool

C. clients should experiment to find the diet that is best for them

84. the nurse is to administer ampicillin 500 mg orally to a client with a ruptured appendix. the nurse checks the capsule in the client's medication box, which is located inside the client's room. the dosage of the medication is not labeled, but the nurse recognizes the color and shape of the capsule. the nurse should next: a. administer the medication to maintain blood levels of the drug b. ask another RN to verify the capsule is ampicillin c. contact the pharmacy to bring a properly labeled med d. notify the unit manager to report the problem

C. contact the pharmacy to bring a properly labeled medicine

50. three weeks after the client has had an ileostomy, the nurse is following up with instructions about using a skin barrier around the stoma at all times. the client has been applying the skin barrier correctly when: a. there is no odor from the stoma b. the client is adequately hydrated c. there is no skin irritation around the stoma d. the client only changes the ostomy pouch once a day

C. there is no skin irritation around the stoma

2. a client refuses to look at or care for her colostomy. which of the following statements by the nurse would be MOST appropriate. a. "it has been 4 days since your surgery, and you will soon be discharged. you have to learn to care for your colostomy before you leave the hospital." b. "I think we will need to teach your husband to care for your colostomy if you are not going to be able to do it" c. "i understand how you are feeling. it is important for you to feel attractive and you think having a colostomy changes your attractiveness" d. "i can see that you are upset. would you like to share your concerns with me?

D. "I can see that you are upset. would you like to share your concerns with me?"

27. a client who has ulcerative colitis says to the nurse, "I can't take this anymore; I'm constantly in pain, and I can't leave my room because I need to stay by the toilet. I don't know how to deal with this." based on these comments, the nurse should determine the client is experiencing: a. extreme fatigue b. disturbed thought c. a sense of isolation d. difficulty coping

D. difficulty coping

44. before abdominal surgery for an intestinal obstruction, the nurse monitors the client's urine output and finds that the total output for the past 2 hours was 35 mL. the nurse then assess the client's total intake and output for the last 24 hours and notes 2,000 mL of IV fluid for intake, 500 mL of drainage from the NG tube, and 700 mL of urine for a total output of 1,200 mL. these findings indicate which of the following? a. decreased renal function b. inadequate pain relief c. extension of the obstruction d. inadequate fluid replacement

D. inadequate fluid replacement

54. a client with well-managed ileostomy has sudden onset of abdominal cramps, vomiting, and watery discharge from the ileostomy. the nurse should: a. tell the client to take an antiemetic b. encourage the client to increase fluid to 3 L/day to replace fluid lost through vomiting c. instruct the client to take 30 mL of milk of magnesia to stimulate a bowel movement d. notify the physician

D. notify the physician

76. a client with acute appendicitis develops a fever, tachycardia, and hypotension. based on these findings, the nurse should further assess the client for which of the following complications? a. deficient fluid volume b. intestinal obstruction c. bowel ischemia d. peritonitis

D. peritonitis

70. the nurse should teach the client with diverticulitis to integrate which of the following into a daily routine at home? a. using enemas to relieve constipation b. decreasing fluid intake to increase the formed consistency of the stool c. eating a high-fiber diet when symptomatic with diverticulitis d. refraining from straining and lifting activities

D. refraining from straining and lifting activities

5. a client with colon cancer is having a barium enema. the nurse should instruct the client to take which of the following after the procedure is completed? a. laxative b. anticholinergic c. antacid d. demulcent

A. Laxative

4. the nurse is conducting a community presentation on the early detection of colon cancer. which of the following should the nurse encourage members of the audience to report to their HCP? select all that apply. a. fatigue. b. unexplained weight loss with adequate nutritional intake c. rectal bleeding d. bowel changes e. positive fecal occult blood testing

A, B, C, D, E

33. which of the following diets would be MOST appropriate for the client with ulcerative colitis? a. high-calorie, low-protein b. high-protein, low-residue c. low-fat, high-fiber d. low-sodium, high-carb

B. high-protein, low-residue

46. a client is scheduled for an ileostomy. which of the following interventions would be MOST helpful in preparing the clients psychologically for the surgery? a. include family members in preoperative teaching sessions b. encourage the client to ask questions about managing an ileostomy c. provide a brief, thorough explanation of all preoperative and postoperative procedures d. invite a member of an ostomy association to visit the client

C. provide a brief, thorough explanation of all preoperative and postoperative procedures

16. which position would be BEST for the client in the early postop period after a hemorrhoidectomy? a. high fowler's b. supine c. side-lying d. trendelenburg's

C. side-lying

10. which of the following skin preparations would be BEST to apply around the client's colostomy? a. stomahesive b. petroleum jelly c. cornstarch d. antiseptic cream

A. stomahesive

24. which goal for the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? a. promoting self-care and independence b. managing diarrhea c. maintaining adequate nutrition d. promoting rest and comfort

B. managing diarrhea

77. postoperative nursing care for a client after an appendectomy should include which of the following? a. administering sitz bath four times a day b. noting the first bowel movement after surgery c. limiting the client's activity to bathroom privileges d. measuring abdominal girth every 2 hours

B. noting the first bowel movement after surgery

78. a client who had an appendectomy for a perforated appendix returns from surgery with a drain inserted in the incisional site. the purpose of the drain is to: a. provide access for wound irrigation b. promote drainage of wound exudates c. minimize development of scar tissue d. decrease postoperative discomfort

B. promote drainage of wound exudates

8. the nurse assesses the client's stoma during the initial postoperative period. which of the following observations should be reported immediately to the physician? a. the stoma is slightly edematous b. the stoma is dark red to purple c. the stoma oozes a small amount of blood d. the stoma does not expel stool

B. the stoma is dark red to purple

18. the nurse teaches the client who has had a rectal surgery the proper timing for sitz baths. the client has understood the teaching when the client states that it is MOST important to take a sitz bath: a. first thing each morning b. as needed for discomfort c. after a bowel movement d. at bedtime

C. after a bowel movement

81. after an inguinal herniorrhaphy, the nurse should assess the male client carefully for which of the following likely complications? a. hypostatic pneumonia b. DVT c. paralytic ileus d. urine retention

D. urine retention

13. which of the following is an expected outcome for a client who is recovering from an abdominal-perineal resection with a colostomy? the client will: a. maintain a fluid intake of 3,000 mL/day b. eliminate fiber from the diet c. limit physical activity to light exercise d. accept that sexual activity will be diminished

A. maintain a fluid intake of 3 L/day

72. a client with diverticular disease is receiving psyllium hydrophilic mucilloid (Metamucil). the drug has been effective when the client: a. passes stool without cramping b. does not have diarrhea c. is no longer anxious d. does not expel gas

A. passes stool without cramping

47. the nurse should instruct a client who is scheduled for an ileostomy to do which of the following 2 wks before surgery? a. stop taking drugs that will interfere with clotting (aspirin, ibuprofen) b. follow a low-residue diet c. abstain from having sex d. wear a mask when in public to prevent infection

A. stop taking drugs that will interfere with clotting (aspirin, ibuprofen)

21. a client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. which of the following factors is MOST likely of greatest significance in causing an exacerbation of ulcerative colitis? a. a demanding and stressful job b. changing to a modified vegetarian diet c. beginning a weight-training program d. walking 2 miles every day

A. a demanding and stressful job

69. a barium enema is not prescribed as a diagnostic test for a client with diverticulitis because a barium enema: a. can perforate an intestinal abscess b. would greatly increase the client's pain c. is a minimal diagnostic value in diverticulitis d. is too lengthy a procedure for the client to tolerate

A. can perforate an intestinal abscess

30. a client with ulcerative colitis is to take sulfasalazine. which of the following instructions should the nurse provide for the client about taking this medication at home? select all that apply. a. drink enough fluids to maintain a urine output of at least 1200 to 1500 mL/day b. D/C therapy if symptoms of acute intolerance develop and notify HCP c. stop taking the medication if urine turns orange-yellow d. avoid activities that require alertness e. if dose is missed, skip and continue with the next dose

A, B, D

19. a client has been placed on long-term sulfasalazine therapy for treatment of ulcerative colitis. the nurse should encourage the client to eat which of the following foods to help avoid the nutrient deficiencies that may develop as a result of this medication a. citrus fruits b. green, leafy vegetables c. eggs d. milk products

B. green, leafy vegetables

7. the client with colon cancer has an abdominal-perineal resection with a colostomy. which of the following nursing interventions is MOST appropriate for this client in the postoperative period? a. maintain the client in a semi-fowler's position b. assist the client with a warm sitz baths c. administer 30 mL of milk of magnesia to stimulate peristalsis d. remove the ostomy pouch as needed so the stoma can be assessed

B. assist the client with a warm sitz bath

49. the client asks the nurse, "Is it really possible to lead a normal life with an ileostomy?" which action by the nurse would be MOST effective to address this question? a. have the client talk with a member of the clergy about these concerns b. tell the client to worry about those concerns after surgery c. arrange for a person with an ostomy to visit the client preoperatively d. notify the surgeon of the client's questions

C. arrange for a person with an ostomy to visit the client preoperatively

68. which of the following lab findings are expected when a client has diverticulitis? a. elevated RBC b. decreased platelet count c. elevated WBC d. elevated serum BUN concentration

C. elevated WBC

42. the nurse preparing a client for insertion of a nasoduodenal tube should teach which of the following? select all that apply. a. the nose and throat will be numbed with a viscous anesthetic b. the tube will be placed at the bedside c. x-rays with the use of a contrast dye will be used to verify placement d. the client will be closely monitored for 30 minutes following the procedure e. the tube will be taped to the nose

B. the tube will be placed at bedside

15. a 36 y/o female client has been diagnosed with hemorrhoids. which of the following factors in the client's history would MOST likely be a primary cause of her hemorrhoids? a. her age b. three vaginal delivery pregnancies c. her job as a school teacher d. varicosities in her legs

B. three vaginal delivery pregnancies

85. on the 2nd day following an abdominal perineal resection, the nurse notes that the wound edges are not approximated and one-half the incision has torn apart. the nurse should take what action FIRST? a. flush the wound with sterile water b. apply an abdominal binder c. cover the wound with sterile dressing moistened with normal saline d. apply strips of tape

C. cover the wound with sterile dressing moistened with normal saline

26. a client has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting longer than 1 week. the nurse should assess the client for which of the following complications? a. heart failure b. deep vein thrombosis c. hypokalemia d. hypocalcemia

C. hypokalemia

34. a client who has a hx of crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. the nurse should monitor for: a. hyperalbuminemia b. thrombocytopenia c. hypokalemia d. hypercalcemia

C. hypokalemia

48. immediately after having surgery to create an ileostomy, which goal has the HIGHEST priority? a. providing relief from constipation b. assisting the client with self-care activities c. maintaining fluid and electrolyte balance d. minimizing odor formation

C. maintaining fluid and electrolyte balance

6. a client has a NG tube inserted at the time of abdominal perineal resection with permanent colostomy for colon cancer. this tube will most likely be removed when the client demonstrates: a. absence of nausea and vomiting b. passage of mucus from the rectum c. passage of flatus and feces from the colostomy d. absence of stomach drainage for 24 hours

C. passage of flatus and feces from the colostomy

75. the nurse is admitting a client with acute appendicitis to the ED. the client has abdominal pain of 10 on a pain scale of 1 to 10. the client will be going to surgery ASAP. the nurse should: a. contact the surgeon to request a prescription for a narcotic for the pain b. maintain the clint in a recumbent position c. place the client on NPO status d. apply heat to the abdomen in the area of the pain

C. place the client on NPO status

79. a client who has a history of an inguinal hernia is admitted to the hospital with sudden, severe abdominal pain, vomiting, and abdominal distention. the nurse should assess the client further for which of the following complications? a. peritonitis b. incarcerated hernia c. strangulated hernia d. intestinal perforation

C. strangulated hernia

31. the physician prescribes sulfasalazine for the client with ulcerative colitis. which instruction should the nurse give the client about taking this medication? a. avoid taking it with food b. take the total dose at bedtime c. take it with a full glass (240 mL) of water d. stop taking it if urine turns orange-yellow

C. take it with a full glass of water

67. following the acute stage of diverticulosis, which foods should the nurse encourage a client to incorporate into the diet? select all that apply. a. bran cereal b. broccoli c. tomato juice d. navy beans e. cheese

A, B, D

25. the client with ulcerative colitis is to be on bed rest with bathroom privileges. when evaluating the effectiveness of this level of activity, the nurse should determine if the client has: a. conserved energy b. reduced intestinal peristalsis c. obtained needed rest d. minimized stress

B. reduced intestinal peristalsis

53. which of the following statements about ileostomy care indicates that the client understands the discharge instruction? a. "I should be able to resume weight lifting in 2 weeks" b. "i can return to work in 2 weeks" c. "i need to drink at least 3L/day" d. "I will need to avoid getting my stoma wet while bathing"

C. "I need to drink at least 3 L/day"

51. the nurse should instruct the client with an ileostomy to report which of the following immediately? a. passage of liquid stool from the stoma b. occasional presence of undigested food in the effluent c. absence of drainage from the ileostomy for 6 or more hours d. temperature of 99.8 F

C. absence of drainage from the ileostomy for 6 or more hours