Med-Surg Ch.41, Gastrointestinal Practice Questions

The client with type 2 diabetes is prescribed prednisone, a steroid, for an acute exacerbation of inflammatory bowel disease. Which intervention should the nurse discuss with the client? 1. Take this medication on an empty stomach. 2. Notify the HCP if experiencing a moon face. 3. Take the steroid medication as prescribed. 4. Notify the HCP if the blood glucose is over 160.

3

The clinic nurse is talking on the phone to a client who has diarrhea. Which intervention should the nurse discuss with the client? 1. Tell the client to measure the amount of stool. 2. Recommend the client come to the clinic immediately. 3. Explain the client should follow the BRAT diet. 4. Discuss taking an over-the-counter histamine-2 blocker.

3

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

3

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

2

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

2

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

2

The client who had abdominal surgery tells the nurse, "I felt something give way in my stomach." Which intervention should the nurse implement first? 1. Notify the surgeon immediately. 2. Instruct the client to splint the incision. 3. Assess the abdominal wound incision. 4. Administer pain medication intravenously.

3

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

3

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

3

The nurse has received the a.m. shift report. Which client should the nurse assess first? 1. The 44-year-old client diagnosed with peptic ulcer disease who is complaining of acute epigastric pain. 2. The 74-year-old client diagnosed with acute gastroenteritis who has had four (4) diarrhea stools during the night. 3. The 65-year-old client diagnosed with IBD who has tented skin turgor and dry mucous membranes. 4. The 15-year-old client diagnosed with food poisoning who has vomited several times during the night shift.

3

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

3

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

3

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

3

The nurse is caring for the immediate postoperative client who had a laparoscopic cholecystectomy. Which task could the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Check the abdominal dressings for bleeding. 2. Increase the IV fluid if the blood pressure is low. 3. Ambulate the client to the bathroom. 4. Auscultate the breath sounds in all lobes.

3

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

3

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

3

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

3

The nurse is working in an outpatient clinic. Which client is most likely to have a diagnosis of diverticulosis? 1. A 60-year-old male with a sedentary lifestyle. 2. A 72-year-old female with multiple childbirths. 3. A 63-year-old female with hemorrhoids. 4. A 40-year-old male with a family history of diverticulosis.

3

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

3

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

3

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

3

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

3

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

3

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Draw the serum liver function test. 2. Evaluate the client's intake and output. 3. Perform the bedside glucometer check. 4. Help the ward clerk transcribe orders.

3

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

4

The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? 1. Discuss the importance of drinking 1,000 mL of water daily. 2. Instruct the client to exercise at least three (3) times a week. 3. Teach the client about a eating a low-residue diet. 4. Explain the need to have daily bowel movements.

4

The 85-year-old male client diagnosed with cancer of the colon asks the nurse, "Why did I get this cancer?" Which statement is the nurse's best response? 1. "Research shows a lack of fiber in the diet can cause colon cancer." 2. "It is not common to get colon cancer at your age; it is usually in young people." 3. "No one knows why anyone gets cancer, it just happens to certain people." 4. "Women usually get colon cancer more often than men but not always."

1

The charge nurse is monitoring client laboratory values. Which value is expected in the client with cholecystitis who has chronic inflammation? 1. An elevated white blood cell count. 2. A decreased lactate dehydrogenase. 3. An elevated alkaline phosphatase. 4. A decreased direct bilirubin level.

1

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

1

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

1

The client diagnosed with liver failure is experiencing pruritus secondary to severe jaundice. Which action by the unlicensed assistive personnel (UAP) warrants intervention by the nurse? 1. The UAP is assisting the client to take a hot soapy shower. 2. The UAP applies an emollient to the client's legs and back. 3. The UAP puts mittens on both hands of the client. 4. The UAP pats the client's skin dry with a clean towel.

1

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

1

The client has dark, watery, and shiny-appearing stool. Which intervention should the nurse implement first? 1. Check for a fecal impaction. 2. Encourage the client to drink fluids. 3. Check the chart for sodium and potassium levels. 4. Apply a protective barrier cream to the perianal area.

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

The nurse is caring for a client diagnosed with rule-out peptic ulcer disease. Which test confirms this diagnosis? 1. Esophagogastroduodenoscopy. 2. Magnetic resonance imaging. 3. Occult blood test. 4. Gastric acid stimulation.

1

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

1

The nurse is caring for clients on a medical unit. Which client information should be brought to the attention of the HCP immediately? 1. A serum sodium of 128 mEq/L in a client diagnosed with obstipation. 2. The client diagnosed with fecal impaction who had two (2) hard formed stools. 3. A serum potassium level of 3.8 mEq/L in a client diagnosed with diarrhea. 4. The client with diarrhea who had two (2) semiliquid stools totaling 300 mL.

1

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

1

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

1

The public health nurse is teaching day-care workers. Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis D.

1

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

1

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

1

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

1

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

1

Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis? 1. Twenty bloody stools a day. 2. Oral temperature of 102˚F. 3. Hard, rigid abdomen. 4. Urinary stress incontinence.

1

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

The nurse is caring for a client who uses cathartics frequently. Which statement made by the client indicates an understanding of the discharge teaching? 1. "In the future I will eat a banana every time I take the medication." 2. "I don't have to have a bowel movement every day." 3. "I should limit the fluids I drink with my meals." 4. "If I feel sluggish, I will eat a lot of cheese and dairy products."

2

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

4

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

4

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

4

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

4

The client diagnosed with end-stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication? 1. Restrict sodium intake to 2 g/day. 2. Limit oral fluids to 1,500 mL/day. 3. Decrease the daily fat intake. 4. Reduce protein intake to 60 to 80 g/day.

4

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

4

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

4

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

4

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

4

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

4

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

4

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

4

The male client had abdominal surgery and the nurse suspects the client has peritonitis. Which assessment data support the diagnosis of peritonitis? 1. Absent bowel sounds and potassium level of 3.9 mEq/L. 2. Abdominal cramping and hemoglobin of 14 g/dL. 3. Profuse diarrhea and stool specimen shows Campylobacter. 4. Hard, rigid abdomen and white blood cell count 22,000/mm3.

4

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

4

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

4

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

4

The nurse writes a problem "low self-esteem" for a 16-year-old client diagnosed with anorexia. Which client goal should be included in the plan of care? 1. The client will spend one (1) hour a day with the parents. 2. The client eats 50% of the meals provided. 3. Dietary will provide high-protein milk shakes t.i.d. 4. The client will verbalize one positive attribute.

4

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

2

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

3

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

3

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

3

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

3

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

3

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

3

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

3

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

3

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

3

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

3

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

42 gtts/min

The nurse is preparing to hang a new bag of total parental nutrition for a client with an abdominal perineal resection. The bag has 1,500 mL of 50% dextrose, 10 mL of trace elements, 20 mL of multivitamins, 20 mL of potassium chloride, and 500 mL of lipids. The bag is to infuse over the next 24 hours. At what rate should the nurse set the pump? _________

85 mL/hr

Which medication should the nurse expect the HCP to order to treat the client diagnosed with botulism secondary to eating contaminated canned goods? 1. An antidiarrheal medication. 2. An aminoglycoside antibiotic. 3. An antitoxin medication. 4. An ACE inhibitor medication.

3

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

2

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

1, 2, 3

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

1, 2, 3, 4

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

1, 2, 4

Which signs and symptoms should the nurse report to the health-care provider for the client recovering from an open cholecystectomy? Select all that apply. 1. Clay-colored stools. 2. Yellow-tinted sclera. 3. Amber-colored urine. 4. Wound approximated. 5. Abdominal pain.

1, 2, 5

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

1, 3, 5

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

1, 4, 5

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

170 mL/hr

The 22-year-old female who is obese is discussing weight loss programs with the nurse. Which information should the nurse teach? 1. Jog for two (2) to three (3) hours every day. 2. Lifestyle behaviors must be modified. 3. Eat one (1) large meal every day in the evening. 4. Eat 1,000 calories a day and don't take vitamins.

2

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

2

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

2

The client complains to the nurse of unhappiness with the health-care provider. Which intervention should the nurse implement next? 1. Call the HCP and suggest he or she talk with the client. 2. Determine what about the HCP is bothering the client. 3. Notify the nursing supervisor to arrange a new HCP to take over. 4. Explain the client cannot request another HCP until after discharge.

2

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

2

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

2

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

2, 4, 5

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

2, 5

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

3

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

3

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

3

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

3

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

3

The nurse is caring for a client diagnosed with hemorrhaging duodenal ulcer. Which collaborative interventions should the nurse implement? Select all that apply. 1. Perform a complete pain assessment. 2. Assess the client's vital signs frequently. 3. Administer a proton pump inhibitor intravenously. 4. Obtain permission and administer blood products. 5. Monitor the intake of a soft, bland diet.

3, 4

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

4

The school nurse is discussing methods to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important to teach the high school teachers? 1. Do not allow students to eat or drink after each other. 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Sing the happy birthday song while washing hands.

4

Which assessment data support to the nurse the client's diagnosis of gastric ulcer? 1. Presence of blood in the client's stool for the past month. 2. Reports of a burning sensation moving like a wave. 3. Sharp pain in the upper abdomen after eating a heavy meal. 4. Complaints of epigastric pain 30 to 60 minutes after ingesting food.

4

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

4

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

4

Which outcome should the nurse identify for the client scheduled to have a cholecystectomy? 1. Decreased pain management. 2. Ambulate first day postoperative. 3. No break in skin integrity. 4. Knowledge of postoperative care.

4

Which problem is highest priority for the nurse to identify in the client who had an open cholecystectomy surgery? 1. Alteration in nutrition. 2. Alteration in skin integrity. 3. Alteration in urinary pattern. 4. Alteration in comfort.

4

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

4

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

4

The history and physical examination of a patient being admitted to a long-term care center indicates a diagnosis of alcoholic cirrhosis several years ago. The health care staff is aware that this type of cirrhosis is caused by which factor? A. Exposure to alcohol B. Obstruction of bile flow C. Complication of hepatitis D. Venous congestion and hypoxia

A -Alcoholic cirrhosis is caused by exposure to excessive amounts of alcohol. Biliary cirrhosis develops as a result of obstruction to bile flow. Postnecrotic cirrhosis can be a complication of hepatitis during which massive liver cell necrosis occurs. Cardiac cirrhosis develops after severe right-sided heart failure. Venous congestion and hypoxia lead to necrosis of liver cells. p. 850

When reading through a patient's history and physical report, a student nurse notices that the patient has frequent dyspepsia. While preparing research, the student notes that dyspepsia is a medical term with which meaning? Heartburn Constipation Shortness of breath Difficulty swallowing

A -Dyspepsia refers to heartburn. Constipation is the medical term for less frequent or absent bowel movements. Dyspnea is the term for shortness of breath. Dysphagia is the term for difficulty swallowing. p. 861

The nurse is caring for a patient who recently received a liver transplant. Patient education instructions include information regarding how to monitor for signs of rejection. Which is sometimes the only sign of rejection? Fever Anorexia Muscle aches Abdominal pain

A -Signs of rejection may include fever, anorexia, depression, vague abdominal pain, muscle aches, and joint pain. Sometimes the only sign of rejection is fever; therefore the patient must carefully monitor vital signs after discharge. pp. 869-870

Which is the most appropriate Nursing Intervention while caring for a patient who underwent T-tube cholangiography? Providing a fatty meal Administering an antihistamine drug Maintaining strict bed rest for 8 hours Encouraging the patient to drink fluids

A -T-tube cholangiography is a test that is used to evaluate the bile ducts after gallbladder surgery. A fatty meal helps to eliminate the dye after the procedure and is the most appropriate intervention. An antihistamine drug is administered for allergic symptoms. A patient who underwent percutaneous transhepatic cholangiography, not T-tube cholangiography, requires strict bed rest for 8 hours. The nurse encourages the intake of fluids in the patient who has been injected with a radionuclide for a gallbladder scan or hepatobiliary imaging because the increased intake of fluid promotes the elimination of the radionuclide. p. 853, Table 41-1

A patient is having blood drawn for suspected liver disease. The PT is 12, and the INR is 1. The laboratory has called the nurse with the results. What is the nurse's best action? Place the results in the chart. Call the care provider immediately. Prepare for assisting with a liver biopsy. Institute safety precautions due to increased risk for bleeding.

A -The PT of 11.0 to 12.6 seconds and the INR of 1 to 1.2 are within normal limits, so no further action is needed unless the care provider has specifically instructed to do so. The patient's results are not indicative of a prolonged clotting time or evidence of liver disease, therefore a liver biopsy may not be done. The results of the PT and INR do not demonstrate increased risk for bleeding. p. 853, Table 41-1

A patient who is diagnosed with acute pancreatitis is to receive propantheline bromide to assist with decreasing pancreatic enzyme secretion. Which nursing intervention by the nurse is appropriate when administering this medication? A. Administer the medication 30 minutes before a meal. B. Place the capsule in applesauce or fruit juice to mask the taste. C. Monitor the patient's blood glucose level before meals and at bedtime. D. Give the medication along with the ordered antacid to increase effectiveness.

A -This medication is more effective if administered 30 minutes prior to a meal or snack. There is no reason to mask the taste of this medication. Blood glucose is typically not affected by this medication. This medication must not be administered within 1 hour of an antacid or antidiarrheal as it interferes with absorption. p. 881, Table 41-6

A patient is scheduled for a needle biopsy of the liver in the radiology department. What nursing interventions would the nurse identify as being a priority for this patient postprocedure? A. Position the patient on the right side. B. Palpate the abdomen for tenderness. C. Monitor for tachycardia and hypotension. D. Have blood drawn for coagulation profile. E. Maintain a pressure dressing over the site.

A, C, E

While assisting with data collection for a patient with suspected liver disease, which findings would be of concern? Pruritus Scleral icterus Palmar erythema Nondistended abdomen Practices the Mormon religion Liver palpable under right rib cage

A, B, C, F -Pruritus is the itching caused by a buildup of toxins associated with liver disease. This would be determined by the patient complaining of itching or presenting with scratch marks during physical assessment. Scleral icterus is a yellowing of the eyes associated with liver disease or bile obstruction. Palmar erythema is redness of the palms associated with liver disease or excess hormones. A nondistended abdomen is a normal finding. Alcohol consumption is prohibited in the Mormon religion, making it unlikely that the patient would be imbibing. Unless the liver is enlarged, it should not be palpable. p. 851

A patient with cirrhosis of the liver is admitted to the hospital. Which patient symptoms are most closely associated with cirrhosis? . A. Pruritus B. Jaundice C. Enlarged testes D. Bruises and epistaxis E. Heaviness in the left upper abdominal quadrant

A, B, D -A patient with cirrhosis would likely have bruises and epistaxis due to thrombocytopenia and prothrombin deficiency. Jaundice is likely due to elevated serum bilirubin levels. Intense pruritus or itching results from the deposits of bile salts under the skin. The patient would have heaviness in the right upper abdominal quadrant. The testes tend to atrophy, not enlarge, with cirrhosis. pp. 860-861

The nurse is caring for a patient who was admitted with severe nausea and vomiting as a complication of hepatitis A. Which interventions by the nurse are appropriate for this patient? Apply a cool damp cloth to the face and neck. Remove the emesis basin as soon as the patient vomits. Administer an oral antiemetic as ordered by the health care provider. Measure the amount and characteristic of any vomitus and document. Have dietary deliver a meal tray at the regular times in case the patient wants to eat.

A, B, D -Comfort measures for this patient would include a cool damp cloth applied to the face and neck. Removing the emesis basin is important so that the patient does not become more nauseated with it in the room. It is important to measure output of vomitus to detect early intake and output imbalances. The nurse should consult with the health care provider regarding a route of antiemetic that is not oral. Dietary should hold trays until the patient is feeling less nauseated, as food in the room may create an unpleasant experience. p. 859

A patient who was recently diagnosed with cirrhosis reports to the nurse a decrease in appetite. Which interventions by the nurse would be appropriate for this patient? Encourage the patient to eat small amounts even when not hungry. Arrange a dietary consult for the patient to report likes and dislikes. Alcohol taken in small amounts may act as a stimulant to the appetite. Eating one large meal daily and supplementing with snacks may help appetite. Make mealtimes as pleasant as possible with emesis basins and bedpans out of sight. Omit foods that are known to cause gastrointestinal upsets or that are not appetizing to the patient.

A, B, E, F -Sometimes small amounts of food can stimulate the appetite, even when the patient is not hungry. A dietary consult will help plan delivery of foods that the patient enjoys. Omission of foods known to create discomfort is important. Eating smaller more frequent meals may be more acceptable. Alcohol, even in small amounts, is discouraged due to toxic effects on the liver. p. 867

A patient with cancer of the head of the pancreas is admitted to the hospital. Which patient symptoms are most closely associated with this diagnosis? . Jaundice Constipation Liver enlargement Upper abdominal pain Unexplained weight gain

A, C, D -A patient with pancreatic cancer frequently has symptoms of jaundice, upper abdominal pain, and liver enlargement. The patient usually has anorexia and unexplained weight loss. Diarrhea, not constipation, is a common symptom. pp. 884-885

A nurse is providing care for a patient who has been diagnosed with acute pancreatitis. In addition to nausea and vomiting, what other signs and symptoms may this patient be experiencing? Elevation of the heart rate Decrease of the respiratory rate Pain in the right lower abdomen Low-grade fever and restlessness Epigastric discomfort radiating to the back Hyperactive bowel sounds in all quadrants

A, D, E -Acute pancreatitis may result in left upper-quadrant pain or epigastric pain that radiates to the back. The heart rate and respiratory rate will both be elevated. A low-grade fever and restlessness are common. The abdomen may be tender with absent bowel sounds, which may indicate an ileus. pp. 879-880

The nurse learns in morning report that one patient has viral hepatitis. The nurse knows that which virus most likely caused the patient's hepatitis? A B C D

A. -Hepatitis A is the most common type of viral hepatitis. The incidence of hepatitis B has dramatically declined since the 1980s as a result of a comprehensive preventive program. Hepatitis C and D are not the most common types of viral hepatitis. p. 856

The nurse is providing discharge instructions that include education for a patient who was recently diagnosed with hepatitis B. Which information should be included in the teaching plan for this patient? The diet should be regular with added vitamin and mineral supplements. Activity levels will depend on the patient's signs and symptoms and liver function tests. Once the patient has completed an antiviral medication, he or she will no longer be contagious. It is important to take a medication such as diphenhydramine (Benadryl) around the clock to prevent severe itching.

B -Activity levels are dependent upon the individual patient's signs and symptoms. The diet for a patient who has hepatitis should be high-calorie, high-carbohydrate, moderate- to high-protein, and moderate- to low-fat with supplementary vitamins. Antiviral medications may help to lessen symptoms; however, the patient may still be contagious. Benadryl is helpful for itching when it occurs; however, there is no need to take it routinely. pp. 858-860

Percutaneous transhepatic cholangiography has been ordered for a patient. Which information must be communicated to other members of the health care team? A. Prothrombin time of 11.2 B. Allergy to clams and mussels C. Pulse of 76 and blood pressure of 128/74 D. Anaphylactic reaction to doxycycline (Vibrox)

B -Allergies to iodine or seafood must be reported before the test, as there may be an allergic reaction to the dye used. The information should be noted on an allergy band, chart, and communication to persons ordering and performing the test.

Which medication is used to prevent breakdown of ammonia in the intestines in a patient who has esophageal varices? A. Vitamin K B. Lactulose C. Propranolol D. Pantoprazole

B -Lactulose is a laxative agent used to promote elimination of ammonia in stool and to prevent or treat hepatic encephalopathy. Propranolol is a beta-adrenergic blocker used to reduce blood pressure in long-term management. Pantoprazole is a proton pump inhibitor. Vitamin K is used to manage serious bleeding disorders.

The licensed practical nurse (LPN) is caring for a patient with hepatic encephalopathy who is being treated with neomycin sulfate. Which is the priority instruction that the nurse should give related to this medication? A.Report any changes in gastrointestinal function. B.Report any ringing in the ears or loss of balance. C.Report frequent episodes of nausea and vomiting. D.Take the medication as ordered by this health care provider.

B -The patient should immediately report symptoms of ringing in the ears or loss of balance because these signs are indicative of toxicity. Although reporting changes in gastrointestinal function and taking the medication as ordered are important, these are not the priority instructions. While the patient may experience nausea, the patient is not likely to experience vomiting associated with this medication. p. 863, Table 41-3

Which factors predispose a patient to disorders of the gallbladder? A.Male B.Fertile C.Obesity D.Sedentary E.Family history F.40 years of age

B-F -The age of 40 is one of the five factors used to describe persons at risk for gallbladder disorders. Obesity or being overweight is a factor, as is being fertile. A sedentary lifestyle is also a risk factor. Family history can show a tendency toward gallbladder issues. Being female is a greater risk factor than being male. p. 871

The nurse is providing instructions for a patient who will be having a percutaneous transhepatic cholangiography in 2 days. Which statement by the patient indicates understanding of this procedure? A. "I will be able to leave the facility as soon as the procedure is finished." B. "The nurses will monitor me for dye allergies and I will eat a fatty meal to eliminate the dye." C. "This procedure requires that I be on bed rest for a minimum of 12 hours afterward." D. "Results of the test will be discussed with my family while I am recovering from the procedure."

B -The percutaneous transhepatic cholangiography is an invasive procedure performed while a needle is inserted into the liver and dye injected. The nurse must closely monitor the puncture site for bleeding and must also monitor vital signs frequently. The nurses will monitor the patient for dye allergies and will provide a fatty meal to help eliminate the dye. The patient will be maintained on bed rest for a minimum of 8 hours and will stay at the facility while this is accomplished. The results of the test will be discussed with the patient after the procedure.

The nurse is providing instructions to a certified nursing assistant (CNA) regarding care for a patient who has hepatitis. Due to extreme fatigue, the patient will be on bed rest. Which interventions are appropriate? Maintain bed rest, and turn the patient every 4 hours. Assist the patient to cough and deep-breathe at least every 2 hours. Apply moisturizing lotion to the skin to assist with protection and itching. Gently massage the lower extremities occasionally to increase circulation. Promote rest by planning activities to allow times when the patient is not disturbed.

B, C, E -Coughing and deep breathing every two hours will help prevent respiratory complications. Applying lotion to the skin will assist with dryness and itching. Planning activities to allow periods of rest are important in the recovery process. If bed rest is maintained, the patient should be turned at least every 2 hours. Massaging of the extremities is discouraged so that any clots that may have formed will not be dislodged. pp. 858-860

A nurse in a health clinic is providing education regarding risk factors associated with the development of pancreatic cancer. Which are considered risk factors of this disease? A. Obesity B. Cigarette smoking C. Intake of a high-fat diet D. History of hypertension E. Exposure to toxic chemicals

B, C, E -Risk factors for the development of cancer of the pancreas include having chronic pancreatitis, smoking, high-fat diet, African-American heritage, and exposure to toxic chemicals. There does not appear to be a correlation to pancreatic cancer in patients who are obese or who have hypertension.

The nurse is providing care for a patient following a cholecystectomy with T-tube placement. Which interventions regarding the T-tube should the nurse perform? A. Position patient in high Fowler position B. Cleanse area around the drain using aseptic technique C. Clamp T-tube 4 to 6 hours before a meal so bile will be available for digestion D.Assess drain for normal greenish-brown drainage immediately postoperatively E. Provide patient care instructions for how to care for T-tube if the patient is discharged with it

B, E

Which medication would be given to promote elimination of ammonia in fecal matter and to treat hepatic encephalopathy in a patient with cirrhosis? Furosemide Lactulose Propranolol Spironolactone

B. -Lactulose is used to help eliminate ammonia in feces and to prevent or treat hepatic encephalopathy. Furosemide is used for excretion of excess fluid. Propanolol reduces pressure in veins, decreasing the risk for bleeding. Spironolactone is used to decrease excess fluid. p. 863, Table 41-3

A college student presents to the university health services department with sudden onset of flulike symptoms. The nurse practitioner does a physical exam and orders laboratory work. When the health nurse reviews the laboratory work, which elevated level would suggest a possible liver disorder? Prothrombin time (PT) Blood urea nitrogen (BUN) Alanine aminotransferase (ALT) Carcinoembryonic antigen (CEA)

C -Alanine aminotransferase (ALT) detects elevation in enzymes related to liver disease. Prothrombin time (PT) can be prolonged in liver disease but can also be prolonged with anticoagulation disorders and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulation medications. BUN reflects kidney function and hydration status. Carcinoembryonic antigen (CEA) increases with many types of cancer. pp. 853, Table 41-1, 858

The LPN is caring for a patient who has undergone a liver biopsy. Which should be the nurse's priority action after the patient has completed the procedure? A. Maintain the patient on bed rest. B. Maintain the patient on the right side. C. Check the pressure dressing for bleeding. D. Reinforce the pressure dressing as needed.

C -Although all of the nursing actions are important and should be implemented at some point postprocedurally, checking the pressure dressing for bleeding is the first intervention that the nurse would implement after the test. Keeping the patient on the right side maintains the pressure on the puncture site. Bed rest may be maintained even after the patient is allowed to turn off of the right side. The nurse should also reinforce the pressure dressing as needed, but only after checking the pressure dressing for bleeding. pp. 855-856

The nurse is caring for a patient who is suspected of having acute pancreatitis. Which is the most important diagnostic finding in acute pancreatitis? Elevated lipid levels Elevated glucose levels Elevated serum amylase Elevated white blood cell count

C -Although each of these laboratory values may be elevated with a diagnosis of acute pancreatitis, elevated serum amylase along with serum lipase and urinary amylase levels are the most important diagnostic finding. pp. 879-880

The nurse is reviewing the medical record for a newly admitted patient. Which finding best correlates with the presence of ascites mentioned in the record? A. Enlargement of the liver B. Golden-yellow skin color C. Fluid accumulation in the peritoneal cavity D. Enlargement of breast tissue in a male patient

C -Ascites is fluid accumulation in the peritoneal cavity. Hepatomegaly is liver enlargement. Jaundice is a golden-yellow skin color associated with liver dysfunction or bile obstruction. Gynecomastia is an enlargement of breast tissue in men.

The LPN is caring for a patient who is scheduled to undergo abdominal ultrasonography. Which is the priority preprocedural instruction that the nurse should give? A. "You will be lying on a table during the procedure." B. "You will feel a technician apply gel to the abdomen." C. "Take nothing by mouth for 8 to 12 hours before the test." D. "You can see images projected onto a screen during the test."

C -Asking the patient to avoid taking anything by mouth for 8 to 12 hours before the test is the most important preprocedural instruction for the patient. If this status is not maintained, the test cannot take place. After this instruction is given, the nurse can inform the patient that he or she will be lying on a table during the procedure, feel a technician apply gel to the abdomen, and see images projected onto a screen during the test.

Blood from the aorta is delivered to the liver via which structure? Portal vein Kupffer cells Hepatic artery Parenchymal cells

C -Blood from the aorta is delivered to the liver via the hepatic artery. The portal vein delivers blood from the intestines to the liver. Reticuloendothelial cells, called Kupffer cells, ingest old red blood cells and bacteria. Parenchymal cells carry out various metabolic functions, including metabolism of carbohydrates, fats, proteins, and steroids, and they detoxify potentially harmful substances. p. 848

The nurse is preparing to assist with data collection at the start of a shift on a patient who was diagnosed with cholecystitis. Based on a knowledge of cholecystitis, the nurse would expect the patient to complain of pain in which quadrant? Left lower Left upper Right upper Right lower

C -Pain of cholecystitis is located in the right upper quadrant and radiates to the shoulder. Patients with appendicitis often complain of pain in the right lower quadrant. Cholecystitis does not cause pain in the left lower or left upper quadrants. pp. 871-872

A patient had a cholecystectomy and now has a T-tube in place. Which finding warrants further action by the nurse? A. Drainage from the T-tube has turned to a greenish-brown color. B. The patient has tolerated the T-tube being clamped for an 8-hour period. C. The amount of drainage in the T-tube was 1100 mL during a 24-hour period. D. The amount of drainage from the T-tube has decreased to 150 mL in 24 hours.

C -The physician should be notified if drainage is more than 1000 mL in 24 hours.

The student nurse is studying the clotting cascade and recognizes that clotting cannot occur without which two essential elements? Fats and protein Albumin and globulin Prothrombin and fibrinogen Aldosterone and prothrombin

C -Two essential elements for coagulation, prothrombin and fibrinogen, are synthesized by the liver. Fats and protein are broken down in response to low blood glucose levels, and molecules are used to make more glucose. Some nonessential amino acids, plasma proteins (albumin and globulin), and clotting factors are synthesized in the liver. The liver plays an important role in the metabolism of adrenocortical hormones, estrogen, testosterone, and aldosterone. If these hormones are not metabolized, they accumulate, which causes an exaggerated effect on target organs. p. 850

The nurse is assigned to observe a patient immediately after a needle biopsy of the liver is performed. Which nursing action would be most appropriate? Monitor vital signs every 15 minutes for 1 hour, and then hourly. Position the patient on the left side. Monitor vital signs every 30 minutes for 2 hours, and then hourly. Position the patient in the right side-lying position. Monitor vital signs every 15 minutes four times, and then every 30 minutes two times. Position the patient on the right side. Monitor vital signs every 15 minutes for 1 hour, followed by every 30 minutes for the next hour. Position the patient on the left side.

C -Vital signs should be monitored every 15 minutes for the first hour, then every 30 minutes for the next hour, and then hourly. While assessing vital signs, the pressure dressing should be assessed for bleeding. The patient is placed on the right side for at least 2 hours. The patient would be placed on the right side rather than the left side to maintain pressure on the puncture site. p. 855

A patient who has a diagnosis of cirrhosis is at risk for development of infection. Which are reasons for potential development of infection? A. Adequate fluid volume is present. B. Cognitive changes are present in the late stage. C. The liver is no longer able to filter bacteria from the blood. D. The function of the spleen is impaired, which lowers resistance. E. Malnourishment causes the lack of nutrients needed to repair tissue.

C, D, E -Impairment of the liver and spleen as well as malnourishment will certainly affect the body's ability to fight infection.

A patient with newly diagnosed hepatitis B infection asks the nurse how he could have been infected with this virus. What risk factors would the nurse identify? A. Patient drank contaminated water. B. There is a family history of the disorder. C. Patient had a recent surgical procedure. D. Patient had intimate contact with a carrier of the virus. E. Patient shook hands with a person who had hepatitis B.

C,D -Modes of transmission of hepatitis B include contaminated medical equipment and intimate contact with carriers. Hepatitis A is found in contaminated water, not hepatitis B. Casual contact will not spread the virus; transmission is by exposure to blood and other body fluids. p. 856

A patient returns to the nursing unit after a liver biopsy. The nurse should immediately place the patient in which position? Prone Supine Semi-Fowler Right side-lying

D -After a liver biopsy, the patient is kept on the right side for at least 2 hours to maintain pressure on the puncture site. After being allowed to change positions, the patient may still be kept in a supine position for up to 14 hours. The prone and semi-Fowler positions are not appropriate for a patient immediately after a liver biopsy. pp. 855-856

The LPN is caring for a patient who has been diagnosed with cholelithiasis. The nurse is contributing to the discharge plan for the patient. Which priority discharge instruction would the nurse give the patient? Maintain a low-fat diet supplemented with fat-soluble vitamins. Keep appointments to have blood drawn for liver function tests. Use a second form of birth control other than oral contraceptives. Report experiencing light stools, dark urine, jaundice, and itching.

D -Although all of the instructions are important, reporting light stools, dark urine, jaundice, and itching is the most important instruction because these symptoms are indicative of bile duct obstruction. The patient should also be instructed to maintain a low-fat diet supplemented with fat-soluble vitamins, keep appointments to have blood drawn for liver function tests, and use a second form of birth control other than oral contraceptives, but these instructions are not the most important. p. 875

The LPN is caring for a patient who is scheduled to undergo magnetic resonance imaging (MRI). Which is the most important instruction related to preparing the patient for this procedure? "You may feel claustrophobic." "MRI is painless and noninvasive." "You must lie still on the narrow surface." "You must remove all metal before the procedure."

D -Because the risk for significant injury to the patient exists, asking the patient to remove all metal before the procedure is the most important instructional point. After the nurse stressed the importance of removing all metal before the procedure, the nurse would inform the patient that he or she may feel claustrophobic, that the MRI is painless and noninvasive, and that he or she must lie still on the narrow surface. p. 854, Table 41-1

What color would the nurse expect stool to be in a patient with a bile obstruction? A. Black B. Green C. Dark red D. Clay-colored

D -Clay-colored stool is characteristic of bile obstruction. Green stool may indicate extra bile, which would not occur with obstruction. Dark red stool may be caused by some food coloring, or a lower gastric bleed. Black stools are indicative of gastrointestinal bleeding or may be caused by iron supplements. p. 850

The nurse is caring for a patient who has been recently diagnosed with hepatitis B. While assisting with data collection on this patient, the nurse may expect to observe which signs or symptoms of hepatitis B? Light-colored urine Dark-colored urine Dark-colored stools Enlarged lymph nodes Left upper-quadrant pain Right upper-quadrant pain

D -Patients who have been diagnosed with hepatitis B may have dark-colored urine and light-colored stools as a result of impaired bile production and secretions. Pain is usually located in the right upper quadrant where the liver is located. Many patients experience enlarged lymph nodes. p. 856

The nurse is providing discharge instructions for a patient who had a laparoscopic cholecystectomy. Which instructions should be included? A. Avoid heavy lifting for the first 48 hours. B. Low-fat diet is recommended for 2 weeks. C. Remove the dressings and shower after 7 days. D. Sexual activity may be resumed when you feel well enough.

D -The patient recovering from a laparoscopic cholecystectomy should avoid heavy lifting for 4 to 6 weeks. The dressing may be removed and the patient may shower normally the day after surgery. Sexual activity may be resumed when the patient feels well enough. A low-fat diet is recommended for at least 4 to 6 weeks.

A patient has a T-tube in place 1 day after a cholecystectomy. Which is the best description of the expected drainage from the T-tube? Bloody Purulent Yellow brown Greenish brown

D -When a patient first returns from a cholecystectomy, the drainage from the T-tube may be bloody, but it should soon become greenish brown. If the drainage is bloody or purulent, the nurse would notify the health care provider immediately. Yellow brown drainage is not an expected finding. p. 873

The nurse is assisting with data collection on a patient who has been diagnosed with the early stage of cirrhosis. Which sign or symptom is usually seen in the early stages of this disease?

Dull heaviness in the right upper quadrant of the abdomen

The nurse is caring for a patient in the icteric phase of hepatitis and knows that which symptoms will most likely be seen?

Jaundice, light- or clay-colored stools, and dark urine

The nurse is assisting with data collection on a patient with cholecystitis. On the provided figure, what anatomic areas would the nurse expect the patient to identify when the patient is asked to locate the pain?

RUQ & Shoulder -Pain can vary; however, cholecystitis pain is mostly identified as being in the right upper quadrant where the gallbladder is located and will also radiate to the right shoulder. #3 isolates the liver area; #4 isolates the area of the transverse colon. p. 849

A patient who was recently diagnosed with chronic pancreatitis is discharged with a prescription for pancreatin pancrelipase. Which information should be included in the patient education instructions? Wipe the lips with a wet cloth to prevent skin irritation. Mix the medication in milk or ice cream to mask the taste. Take the medication on an empty stomach 1 hour prior to a meal. Capsule contents may be sprinkled on food but should not be chewed. Evaluate drug effectiveness by observing the number and consistency of stools.

Wiping the lips after administration prevents breakdown of the sensitive skin of the lips. Capsule contents may be sprinkled on food, but not chewed. The medication may be mixed in fruit juice or applesauce but should not be given with a protein substance such as milk or ice cream. The medication should be taken with a meal or snack in order for the enzymes to be effective. The stools will be frothy and bulky if the enzymes are inadequate. p. 882, Table 41-6