NCLEX » Altered GI Part 1

Which of the following is an accurate statement regarding cancer of the esophagus? a) Chronic irritation of the esophagus is a known risk factor. b) It is three times more common in women in the U.S. than men. c) It is seen more frequently in Caucasian Americans than in African Americans. d) It usually occurs in the fourth decade of life.

*A. Chronic irritation of the esophagus is a known risk factor.*

Diagnostic testing is planned for a patient with a suspected peptic ulcer. The nurse explains to the patient that the most reliable test for determining the presence and location of an ulcer is a(n) 1. Endoscopy. 2. Gastric analysis. 3. Barium swallow. 4. Serologic test for Helicobacter pylori.

*1. Endoscopy.* Endoscopy is the primary tool for diagnosing the source of upper gastrointestinal bleeding.

The health care provider orders a 10% fat emulsion solution to be administered to a critically ill patient who is currently receiving peripheral parenteral nutrition. Which of the following assessment findings would alert the nurse to a systemic problem related to lipid administration? 1. The onset of vomiting and fever 2. Retention of fluid with peripheral edema 3. A random capillary blood glucose level of 148 mg/dl 4. Erythema, tenderness, and exudate at the catheter insertion site

*1. The onset of vomiting and fever* Patients receiving lipids are at extreme risk for infection because fat emulsions at room temperature are a medium for microorganism growth. Catheter-related infections can occur in patients receiving parenteral nutrition; local or systemic manifestations of infection may occur. Adverse reactions from lipid administration include allergic reactions, dyspnea, cyanosis, fever, flushing, phlebitis, chest and back pain, and pain at the IV site. Hyperglycemia and fluid overload are other potential complications; however, infection would be the highest risk for patients receiving lipids.

A patient with persistent vomiting of 3 days' duration is seen at the urgent care center because of increasing weakness. Intravenous therapy with lactated Ringer's solution is started, and arterial blood gases (ABGs) are ordered. Which of the following ABG results would the nurse expect? 1. pH 7.4; PaCO2 40 mm Hg; HCO3- 25 mEq/L 2. pH 7.3; PaCO2 50 mm Hg; HCO3- 20 mEq/L 3. pH 7.6; PaCO2 30 mm Hg; HCO3- 40 mEq/L 4. pH 7.48; PaCO2 40 mm Hg; HCO3- 30 mEq/L

*3. pH 7.6; PaCO2 30 mm Hg; HCO3- 40 mEq/L* Vomiting is a cause of metabolic alkalosis; the arterial blood gases indicate partially compensated metabolic alkalosis. The pH is greater than 7.45 (alkalosis); the HCO3- is above 26 mEq/L (metabolic); and the PaCO2 is less than 35 mm Hg (partially compensated).

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? 1."I can have a glass of low-fat milk at bedtime." 2."I will have to eliminate all spicy foods from my diet." 3."I will have to use herbal teas instead of caffeinated drinks." 4."I should keep something in my stomach all the time to neutralize the excess acids."

*3."I will have to use herbal teas instead of caffeinated drinks."* Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking.

When teaching a patient with a history of upper GI bleeding to check the stools for blood, the nurse informs the patient that 1. If vomiting of bright red blood occurs, stools will not be black and sticky. 2. Blood is never obvious in stools and must be detected by fecal occult blood testing. 3. Acute bleeding in the upper GI tract will result in bright red blood in the stools. 4. Stools that are black and tarry occur with prolonged bleeding from the stomach or small intestine.

*4. Stools that are black and tarry occur with prolonged bleeding from the stomach or small intestine.* Melena (black, tarry stools) indicates slow bleeding from an upper gastrointestinal source. The longer the passage of blood through the intestines, the darker the stool color, because of the breakdown of hemoglobin and the release of iron.

The nurse is checking the residual content for a client who is receiving intermittent feedings. Which residual content, if obtained, would lead the nurse to delay the feeding? a) 120 mL b) 60 mL c) 30 mL d) 90 mL

*A) 120 mL*

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Chloride c) Creatinine d) Urobilinogen

*A) Albumin*

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to: a) Assess the client's abdomen and vital signs. b) Irrigate the client's NG tube. c) Place the client in the high-Fowler's position. d) Notify the health care provider.

*A) Assess the client's abdomen and vital signs* Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: a) black and tarry. b) coffee-ground-like. c) bright red. d) clay-colored.

*A) Black and tarry* Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? a) Black b) Red c) Dark brown d) Green

*A) Black*

Which of the following is the primary symptom of achalasia? a) Difficulty swallowing b) Pulmonary symptoms c) Chest pain d) Heartburn

*A) Difficulty swallowing* The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? a) Encourage plenty of fluids. b) Order a high-fiber diet. c) Serve dairy products. d) Serve the client his usual diet.

*A) Encourage plenty of fluids*

Which diagnostic test is used first to evaluate a client with upper GI bleeding? a) Hemoglobin levels and hematocrit (HCT) b) Endoscopy c) Arteriography d) Upper GI series

*A) Hemoglobin levels and hematocrit* Hemoglobin and HCT are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Hypotension b) Bradycardia c) Warm moist skin d) Polyuria

*A) Hypotension * Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Hypotension b) Bradycardia c) Polyuria d) Warm moist skin

*A) Hypotension*

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following? A) Impaired peristalsis B) Irritation of the bowel C) Nasogastric suctioning D) Anastomosis site inflammation

*A) Impaired peristalsis*

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? A) Low pitched and rumbling above the area of obstruction B) High pitched and hypoactive below the area of obstruction C) Low pitched and hyperactive below the area of obstruction D) High pitched and hyperactive above the area of obstruction

*A) Low pitched and rumbling above the area of obstruction* Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy? a) Low platelet count b) Low hemoglobin c) Decreased prothrombin time d) Low sodium level

*A) Low platelet count* Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to: a) Notify the surgeon about the tube's removal. b) Reinsert the nasogastric tube to the stomach. c) Document the discontinuation of the nasogastric tube. d) Place the nasogastric tube to the level of the esophagus.

*A) Notify the surgeon about the tube's removal* If the nasogastric tube is removed accidently in a client who has undergone esophageal or gastric surgery, it is usually replaced by the physician. Care is taken to avoid trauma to the suture line. The nurse will not insert the tube to the esophagus or to the stomach in this situation. The nurse needs to do more than just document its removal. The nurse needs to notify the physician who will make a determination of leaving out or inserting a new nasogastric tube.

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura? a) Pneumothorax b) Sepsis c) Fluid overload d) Air embolism

*A) Pneumothorax* A pneumothorax is caused by improper catheter placement and inadvertent puncture of the pleura. Air embolism can occur from a missing cap on a port. Sepsis can be caused by the separation of dressings. Fluid overload is caused by fluids infusing too rapidly.

The most common cause of esophageal varices includes which of the following? a) Portal hypertension b) Asterixis c) Jaundice d) Ascites

*A) Portal hypertension*

The percentage of daily calories for a healthy individual consists of: a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids

*A. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids*

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care? a) Provide frequent mouth care. b) Keep the feeding formula refrigerated. c) Ensure adequate hydration with additional water. d) Flush the tube with water before adding the feedings.

*A) Provide frequent mouth care* Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections

A patient scheduled to undergo an abdominal ultrasonography is advised to do which of the following? a) Restrict eating of solid food for 6 to 8 hours before the test. b) Do not consume anything sweet for 24 hours before the test c) Do not undertake any strenuous exercise for 24 hours before the test d) Avoid exposure to sunlight for at least 6 to 8 hours before the test

*A) Restrict eating of solid food for 6 to 8 hours before the test.*

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a) The client is free from esophagitis and achalasia. b) The client reports diminished duodenal inflammation. c) The client has normal gastric structures. d) The client doesn't exhibit rectal tenesmus.

*A) The client is free from esophagitis and achalasia.* Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention? a) The client lying in a lateral position, with the head of bed flat b) Foley catheter bag containing 500 ml of amber urine c) Serosanguineous drainage on the dressing d) A piggyback infusion of levofloxacin (Levaquin)

*A) The client lying in a lateral position, with the head of bed flat* A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

Which outcome indicates effective client teaching to prevent constipation? a) The client reports engaging in a regular exercise regimen. b) The client limits water intake to three glasses per day. c) The client verbalizes consumption of low-fiber foods. d) The client maintains a sedentary lifestyle.

*A) The client reports engaging in a regular exercise regimen.* The client having a regular exercise program indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet, a sedentary lifestyle, and limited water intake would predispose the client to constipation.

The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate? A) "The tube will help to drain the stomach contents and prevent further vomiting." B) "The tube will push past the area that is blocked, and thus help to stop the vomiting." C) "The tube is just a standard procedure before many types of surgery to the abdomen." D) "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."

*A) The tube will help drain the stomach contents and prevent further vomiting* The nasogastric tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting.

A client with GERD develops espophagitis. Which diagnostic test would the nurse expect the physician to order to confirm the diagnosis? A) Upper endoscopy with biopsy B) Stool testing for occult blood C) 24-hour esophageal pH monitoring D) Barium swallow

*A) Upper endoscopy with biopsy* Upper endoscopy with biopsy confirms esophagitis. Barium-swallow would reveal inflammation or stricture formation from chronic esophagitis. Tests of stool may show positive findings of blood. Ambulatory 24-hour esophageal pH monitoring allows for observation of the frequency of reflux episodes and their associated symptoms.

The nurse inserts a nasoduodenal tube for feeding of the client. To check best for placement, the nurse: a) Verifies location with an abdominal x-ray b) Aspirates contents and checks the color of the aspirate c) Auscultates when injecting air d) Adds 8 to 10 inches of the tube after inserting to the xiphoid process

*A) Verifies location with an abdominal x-ray*

Which of the following methods should be used to confirm the placement of a patient's newly-inserted nasogastric (NG) feeding tube? A) X-ray B) Aspiration C) Air auscultation D) Measurement of external length

*A) X-ray*

A physician plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which of the following medications while collecting stool for the test? a) ibuprofen (Advil) b) ciprofloxacin (Cipro XR) c) docusate sodium (Colace) d) acetaminophen (Tylenol)

*A) ibuprofen (Advil)*

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). The nurse performs the following actions while the client receives PN (select all that apply): a) Document intake and output. b) Use clean technique for all catheter dressing changes. c) Weigh the client every day. d) Cover insertion site with a transparent dressing that is changed daily. e) Check blood glucose level every 6 hours.

*A, C, E* A) Document intake and output; C) Weigh the client every day; E) Check blood glucose level every 6 hours When a client is receiving PN through a central line, the nurse weighs the client daily, checks blood glucose level every 6 hours, and documents intake and output. These actions are to ensure the client is receiving optimal nutrition. The nurse also performs activities to prevent infection, such as covering the insertion site with a transparent dressing that is changed weekly and/or prn and using sterile technique during catheter site dressing changes.

The health care provider orders a 10% fat emulsion solution to be administered to a critically ill patient who is currently receiving peripheral parenteral nutrition. Which of the following assessment findings would alert the nurse to a systemic problem related to lipid administration? A. The onset of vomiting and fever B. Retention of fluid with peripheral edema C. A random capillary blood glucose level of 148 mg/dl D. Erythema, tenderness, and exudate at the catheter insertion site

*A. The onset of vomiting and fever* Patients receiving lipids are at extreme risk for infection because fat emulsions at room temperature are a medium for microorganism growth. Catheter-related infections can occur in patients receiving parenteral nutrition; local or systemic manifestations of infection may occur. Adverse reactions from lipid administration include allergic reactions, dyspnea, cyanosis, fever, flushing, phlebitis, chest and back pain, and pain at the IV site. Hyperglycemia and fluid overload are other potential complications; however, infection would be the highest risk for patients receiving lipids.

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The physician has ordered a visualization of the small intestine via a capsule endoscopy. Which of the following will the nurse include in the client education about this procedure? a) "An x-ray machine will use a capsule ray to follow your intestinal tract." b) "You will need to swallow a capsule." c) "The physician will use a scope called a capsule to view your intestine." d) "A capsule will be inserted into your rectum."

*B) "You will need to swallow a capsule."* A capsule endoscopy allows for noninvasive visualization of the small intestinal mucosa. The technique consists of the client swallowing a capsule that is embedded with a wireless miniature camera, which is propelled through the intestine by peristalsis. The capsule passes from the rectum in 1 to 2 days.

A 61-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 4:00 am. The nurse shares in the morning report that the day shift staff should check the tube for patency at which of the following times? A) 7:00 am, 10:00 am, and 1:00 pm B) 8:00 am and 12:00 pm C) 9:00 am and 3:00 pm D) 9:00 am, 12:00 pm, and 3:00 pm

*B) 8:00 am and 12:00 pm* A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 am, it would be due to be checked at 8:00 am and 12:00 pm.

A colectomy is scheduled for a 68-year-old woman with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient? A) Instruction on irrigating a colostomy B) Administration of a cleansing enema C) A high-fiber diet the day before surgery D) Administration of IV antibiotics for bowel preparation

*B) Administration of a cleansing enema* Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas.

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to: a) Change the nasal tape every 2 to 3 days. b) Auscultate lung sounds every 4 hours. c) Inspect the nose daily for skin irritation. d) Apply water-based lubricant to the nares daily

*B) Auscultate lung sounds every 4 hours.*

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction? a) "Eat three balanced meals every day." b) "Avoid aspirin and products that contain aspirin." c) "Stop taking the drugs when your symptoms subside." d) "Increase your intake of fluids containing caffeine."

*B) Avoid aspirin and products that contain aspirin* The nurse should instruct the client to avoid aspirin because it's a gastric irritant and should not be taken by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids and ranitidine prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach

A patient scheduled to undergo an abdominal ultrasonography is advised to do which of the following? a) Do not undertake any strenuous exercise for 24 hours before the test b) Restrict eating of solid food for 6 to 8 hours before the test. c) Avoid exposure to sunlight for at least 6 to 8 hours before the test d) Do not consume anything sweet for 24 hours before the test

*B) Avoid eating of solid food for 6 to 8 hours before the test.* For a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict herself from solid food for 6 to 8 hours to avoid having images of her test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which of the following characteristics would the nurse be most likely to find? a) Green color and texture b) Black and tarry appearance c) Clay-like quality d) Bright red blood in stool

*B) Black and tarry appearance* Black and tarry stools (melena) are a sign of bleeding in the upper gastrointestinal (GI) tract. As the blood moves through the GI system, digestive enzymes turn red blood to black. Bright red blood in the stool is a sign of lower GI bleeding. Green color and texture is a distractor for this question. Clay-like stools are a characteristic of biliary disorders

A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral nutrition (PN). Which of the following principles should guide the nurse's administration of the patient's nutrition? A) Administration of PN requires clean technique. B) Central PN requires rapid dilution in a large volume of blood. C) Peripheral PN delivery is preferred over the use of a central line. D) Only water-soluble medications may be added to the PN by the nurse.

*B) Central PN requires rapid dilution in a large volume of blood.*

A client comes into the emergency department with complaints of abdominal pain. Which of the following should the nurse ask first? a) Family history of ruptured appendix b) Characteristics and duration of pain c) Concerns about impending hospital stay d) Medications taken in the last 8 hours

*B) Characteristics and duration of pain*

Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube? a) Buccal or sublingual tablets b) Enteric-coated tablets c) Soft gelatin capsules filled with liquid d) Simple compressed tablets

*B) Enteric-coated tablets* Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change in the form of medication is necessary for patients with tube feedings. Simple compressed tablets may be crushed and dissolved in water for patients receiving oral medications by feeding tube. Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended to the patient undergoing tube feedings. The nurse may make an opening in the capsule and squeeze out contents for administration by feeding tube.

A patient who has dysphagia as a consequence of a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the following interventions should the nurse integrate into this patient's care? A) Flush the tube with 30 ml of normal saline every 4 hours. B) Flush the tube before and after feedings if the patient's feedings are intermittent. C) Flush the PEG with 100 ml of sterile water before and after medication administration. D) To prevent fluid overload, avoid flushing when the patient is receiving continuous feeding.

*B) Flush the tube before and after feedings if the patient's feedings are intermittent.*

A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort? a) Positioning the client flat on the abdomen or side. b) Keeping the head of the bed elevated. c) Turning the client's head to the side. d) Providing a tracheostomy tray near the bed

*B) Keeping the head of the bed elevated* It is essential to position the client with the head of the bed elevated because it is easier for the client to breathe deeply and cough up secretions after recovering from the anesthetic. Positioning the client flat either on the abdomen or side with the head turned to the side will facilitate drainage from the mouth. A tracheostomy tray is kept by the bed for respiratory distress or airway obstruction. When mouth irrigation is carried out, the nurse should turn the client's head to the side to allow the solution to run in gently and flow out.

If a client has abdominal surgery and a portion of the small intestine is removed, the client is at risk for which of the following? a) Gastric ulcers b) Malabsorption syndrome c) Constipation d) Cirrhosis

*B) Malabsorption syndrome*

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a) Skim milk b) Nothing by mouth c) Regular diet d) Clear liquids

*B) NPO* Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? a) Notify the physician. b) Remove the dressing, clean the site, and apply a new dressing. c) Remove the catheter, check for catheter integrity, and send the tip for culture. d) Draw a circle around the moist spot and note the date and time.

*B) Remove dressing, clean the site, and apply a new dressing.* A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. She should notify the physician if she observes any catheter-related complications. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.

A nurse is providing postprocedure instructions for a client who had an esophagogastroduodenoscopy. The nurse should perform which action? a) Tell the client to call back in the morning so she can give him instructions over the phone. b) Review the instructions with the person accompanying the client home. c) Tell the client there aren't specific instructions for after the procedure. d) Give instructions to the client immediately before discharge.

*B) Review the instructions with the person accompanying the client home* A client who undergoes an esophagogastroduodenoscopy receives sedation during the procedure, and his memory becomes impaired. Clients tend not to remember instructions provided after the procedure. The nurse's best course of action is to give the instructions to the person who is accompanying the client home. It isn't appropriate for the nurse to tell the client to call back in the morning for instructions. The client needs to be aware at discharge of potential complications and signs and symptoms to report to the physician.

The nurse is preparing to examine the abdomen of a client complaining of a change in his bowel pattern. The nurse would place the client in which position? a) Lithotomy b) Supine with knees flexed c) Knee-chest d) Left Sim's lateral

*B) Supine with knees flexed*

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a) The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns c) The client should be monitored for cramping or abdominal distention d) The client's fluid output should be measured for at least 24 hours after the procedure

*B) The client should not be given any food and fluids until the gag reflex returns.* For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns.

A 24-year-old athlete is admitted to the trauma unit following a motor-vehicle collision. The client is comatose and has developed ascites as a result of the accident. You are explaining the client's condition to his parents. In your education, what do you indicate is the primary function of the small intestine? a) Digest proteins b) Digest fats c) Absorb nutrients d) Absorb water

*C) Absorb nutrients* The primary function of the small intestine is to absorb nutrients from the chyme.

X, a 63-year-old retired teacher, had oral cancer and had extensive surgery to excise the malignancy. While is surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to he and his family? a) Knowing that everything will work out just fine b) Time to mourn, accept, and adjust to the loss c) Not giving in to anger d) Having a courageous attitude

*B) Time to mourn, accept, and adjust to the loss* The first time family members or clients see the effects of surgery, the experience usually is traumatic. The nurse needs to promote effective coping and therapeutic grieving at this time. Responses may range from crying or extreme sadness and avoiding contact with others to refusing to talk about the surgery or changes in appearance. Allowing the client time to mourn, accept, and adjust to losses is essential.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a) restrict fluid intake to 1 qt (1,000 ml)/day. b) drink liquids only between meals. c) don't drink liquids 2 hours before meals. d) drink liquids only with meals.

*B) drink liquids only between meals.* A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? A. "You'll need to drink at least two to three glasses of milk daily." B. "It would likely be beneficial for you to eliminate drinking alcohol." C. "Many people find that a minced or pureed diet eases their symptoms of PUD." D. "Your medications should allow you to maintain your present diet while minimizing symptoms."

*B. "It would likely be beneficial for you to eliminate drinking alcohol."*

A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse administers: A. 20% intralipids B. 5% dextrose solution C. 5% Ringer's lactate solution D. 0.45% normal saline solution

*B. 5% dextrose solution*

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that: A.the gallbladder is unable to contract to release stored bile B. Bilirubin is not being conjugated and excreted into the bile by the liver C. The Kupffer cells in the liver are unable to remove bilirubin from the blood D. There is an obstruction in the biliary tract preventing flow of bile into the small intestine

*B. Bilirubin is not being conjugated and excreted into the bile by the liver*

Which of the following assessments should the nurse prioritize in the care of a patient who has recently begun receiving parenteral nutrition (PN)? A. Skin integrity and bowel sounds B. Electrolyte levels and daily weights C. Auscultation of the chest and tests of blood coagulability D. Peripheral vascular assessment and level of consciousness (LOC)

*B. Electrolyte levels and daily weights*

During starvation, the order in which the body obtains substrate for energy is: a. visceral protein, skeletal protein, fat, glycogen b. glycogen, skeletal protein, fat stores, visceral protein c. visceral protein, fat stores, glycogen, skeletal protein d. fat stores, skeletal protein, visceral protein, glycogen

*B. glycogen, skeletal protein, fat stores, visceral protein*

An 80-year-old man states that although he adds a lot of salt to his food it still does not have much taste. The nurse's response is based on the knowledge that the older adult: a. should not experience changes in taste b. has a loss of taste buds, especially sweet and salt c. has some loss of taste but no difficulty chewing food d. loses the sense of taste because the ability to smell is decreased

*B. has a loss of taste buds, especially sweet and salt*

During an examination of the abdomen the nurse should: A. position the patient in the supine position with the bed flat and the knees straight B. listen in the epigastrium and all found quadrants for 2 to 5 minutes for bowel sounds C. use the following order of techniques: inspections, palpation, percussion, auscultation D. describe bowel sounds if no sound is heard in the lower right quadrant after two minutes

*B. listen in the epigastrium and all found quadrants for 2 to 5 minutes for bowel sounds*

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the: A. inhibition of secretin release B. release of bicarbonate by the pancreas C. release of pancreatic digestive enzymes D. release of gastrin by the duodenal mucosa

*B. release of bicarbonate by the pancreas*

In preparing a patient for a colonoscopy, the nurse explains that: A. a signed permit is not necessary B. sedation may be used during the procedure C. only one cleansing enema is necessary for preparation D. a light meal should be eaten the day before the procedure

*B. sedation may be used during the procedure*

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client? a) "Take the medication with milk." b) "Do not drive when taking this medication." c) "Be sure to wear sunscreen while taking this medicine." d) "Expect a metallic taste when taking this medicine, which is normal."

*C) "Be sure to wear sunscreen while taking this medicine."* Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

A nurse is receiving report from the emergency room regarding a new client being admitted to the medical-surgical unit with a diagnosis of peptic ulcer disease. The nurse expects the age of the client will be between: a) 20 and 30 years b) 15 and 25 years c) 40 and 60 years d) 60 and 80 years

*C) 40 and 60 years*

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To which of the following diagnoses does the nurse attribute these findings? A) Malnutrition B) Osteomyelitis C) Alcohol abuse D) Diabetes mellitus

*C) Alcohol Abuse* The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.

The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure? a) At the lower border of the liver b) In the right upper quadrant c) At the umbilicus d) Just below the last rib

*C) At the umbilicus*

Which of the following terms is used to refer to intestinal rumbling? a) Diverticulitis b) Tenesmus c) Borborygmus d) Azotorrhea

*C) Borborygmus*

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure? a) Signs of perforation b) Gag reflex c) Client's tolerance for pain and discomfort d) Client's ability to retain the barium

*C) Client's tolerance for pain and discomfort* The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? a) Computer tomography b) Small bowel series c) Colonoscopy d) Upper GI series

*C) Colonoscopy* A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? a) Slowed heart beat b) Hyperglycemia c) Diarrhea d) Dry skin

*C) Diarrhea* Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Increased serum calcium levels c) Elevated urine amylase levels d) Decreased liver enzyme levels

*C) Elevated urine amylase levels*

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a) Cystic duct b) Duodenum c) Gallbladder d) Common bile duct

*C) Gallbladder*

The client is receiving a 25% dextrose solution of parenteral nutrition. The infusion machine is beeping, and the nurse determines the intravenous (IV) bag is empty. The nurse finds there is no available bag to administer. It is most important for the nurse to: a) Request a new bag from the pharmacy department. b) Flush the line with 10 mL of sterile saline. c) Infuse a solution containing 10% dextrose and water. d) Catch up with the next bag when it arrives.

*C) Infuse a solution containing 10% dextrose and water* If the parenteral nutrition solution runs out, a solution of 10% dextrose and water is infused to prevent hypoglycemia. The nurse would then order the next parenteral nutrition bag from the pharmacy. Flushing a peripherally inserted catheter is usually prescribed every 8 hours or per hospital established protocols. It is not the most important activity at this moment. The infusion rate should not be increased to compensate for fluids that were not infused, because hyperglycemia and hyperosmolar diuresis could occur.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor? a) Famotidine (Pepcid) b) Metronidazole (Flagyl) c) Omeprazole (Prilosec) d) Sucralfate (Carafate)

*C) Omeprazole* Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Maintaining adequate nutritional status b) Preventing fluid volume overload c) Relieving abdominal pain d) Teaching about the disease and its treatment

*C) Relieving abdominal pain*

Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse? A) Notify the physician. B) Auscultate for bowel sounds. C) Reposition the tube and check for placement. D) Remove the tube and replace it with a new one.

*C) Reposition the tube and check for placement.* The tube may be resting against the stomach wall. The first action by the nurse, since this intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) black, tarry stools. b) circumoral pallor. c) light amber urine. d) yellow sclerae.

*D) Yellow sclerae* Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the: a) rectum. b) stomach. c) small intestine. d) large intestine.

*C) Small intestine* The small intestine absorbs products of digestion, completes food digestion, and secretes hormones that help control the secretion of bile, pancreatic juice, and intestinal secretions. The stomach stores, mixes, and liquefies the food bolus into chyme and controls food passage into the duodenum; it doesn't absorb products of digestion. Although the large intestine completes the absorption of water, chloride, and sodium, it plays no part in absorbing food. The rectum is the portion of the large intestine that forms and expels feces from the body; its functions don't include absorption.

After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected? a) Large intestine b) Ileum c) Stomach d) Liver

*C) Stomach* The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient? a) Instruct the patient to keep a record of food intake b) Instruct the patient to avoid prune or apple juice c) Suggest fluid intake of at least 2 L per day d) Assist the patient regarding the correct diet or to minimize food intake

*C) Suggest fluid intake of at least 2 L per day* For constipation the nurse should suggest a fluid intake of at least 2L per day. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the patient to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the patient to keep a record of food intake in case of diarrhea because this helps identify specific foods that irritate the GI tract

When caring for a patient who has had most of the stomach surgically removed, the nurse plans to teach the client: a) that extra iron will need to be taken to prevent anemia b) to avoid foods with lactose to prevent diarrhea and bloating c) that lifelong supplementation of cobalamin will be needed d) that, because of the absence of digestive enzymes, protein malnurition is likely

*C) That lifelong supplementation of cobalamin will be needed* The stomach secretes intrinsic factor necessary for cobalamin absorption in the intestine. In removal of part or all of the stomach, cobalamin must be supplemented for life.

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience a) weight loss. b) vomiting. c) pain 2 to 3 hours after a meal. d) hemorrhage.

*C) pain 2 to 3 hours after a meal.*

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following? a) "The examination will take only 15 minutes." b) "You must be NPO for the day before the examination." c) "Do you experience any claustrophobia?" d) "You must remove all jewelry but can wear your wedding ring."

*C. "Do you experience any claustrophobia?"*

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration? a) Administering 15 to 30 mL of water every 4 hours. b) Aspirating for residual contents every 4 to 8 hours. c) Keeping the client in a semi-Fowler's position at all times. d) Giving the feedings at room temperature.

*C. Keeping the client in a semi Fowler's position at all times* With continuous tube feedings, the nurse needs to keep the client in a semi-Fowler's position at all times to reduce regurgitation and the risk for aspiration. Aspirating for residual contents helps to ensure adequate nutrition and prevent overfeeding. Administering 15 to 30 mL of water every 4 hours helps to maintain tube patency. Giving the feedings at room temperature reduces the risk for diarrhea.

When assessing the patient's nutritional status, the nurse asks which drugs the patient takes primarily because: A. Foods alter the absorption or bioavailability of every drug. B. If the patient skips a meal, medications may not be taken. C. Some drugs increase the requirements for essential nutrients. D. Medications should be taken with food to prevent GI irritation

*C. Some drugs increase the requirements for essential nutrients.* Certain drugs (such as folic acid, riboflavin, and fat-soluble vitamins) may increase nutrient requirements. Some medications can be taken with food; other medications must be taken without food. Food may alter the absorption or bioavailability of some drugs, but not all drugs.

The pernicious anemia that may accompany gastritis is due to which of the following? A. chronic autoimmune destruction of cobalamin stores in the body B. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss C. a lack of intrinsic factor normally produced by acid-secreting cells in the gastric mucosa D. hyperchlorhydria resulting from an increase in acid-secreting parietal cells and degradations of RBCs

*C. a lack of intrinsic factor normally produced by acid-secreting cells in the gastric mucosa*

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of: A. An intolerance to the feedings B. Extension of the tumor into the aorta C. Leakage of fluid or foods into the mediastinum D. Esophageal perforation with fistula formation into the lung

*C. leakage of fluid or foods into the mediastinum*

Which of the following is an outcome of histamine 2 (H2)-receptor antagonists blocking the action of histamine in the stomach? a) Blood phosphate levels are elevated. b) Symptoms of gastroesophageal reflux are relieved. c) Acid indigestion is relieved. d) Acid secretion is reduced.

*D) Acid secretion is reduced* H2-receptor antagonists decrease the amount of hydrochloric acid that the stomach produces by blocking the action of histamine on histamine receptors of potential cells in the stomach.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a) alcohol abuse and a history of acute renal failure. b) a history of hemorrhoids and smoking. c) a sedentary lifestyle and smoking. d) alcohol abuse and smoking.

*D) alcohol abuse and smoking.*

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Anxiety related to unknown outcome of hospitalization c) Deficient knowledge related to prevention of disease recurrence d) Acute pain related to biliary spasms

*D) Acute pain related to biliary spasms* The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

The nurse is reviewing the laboratory test results for a 71-year-old patient with metastatic lung cancer. The patient was admitted with a diagnosis of malnutrition. Serum albumin level is 4.0 g/dl and prealbumin is 10 mg/dl. The nurse should draw which of the following conclusions? A) The albumin level is normal, and therefore the patient does not have protein malnutrition. B) The albumin level is increased, which is a common finding in patients with cancer who have malnutrition. C) Both the serum albumin and prealbumin levels are reduced, consistent with the admitting diagnosis of malnutrition. D) Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status.

*D) Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status.*

What kind of feeding should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions? a) Bolus feeding b) Intermittent feeding c) Cyclic feeding d) Continuous feedings

*D) Continuous feedings.* Continuous feedings should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions.

To ensure patency of central venous line ports, diluted heparin flushes are used in which of the following situations? a) Before drawing blood b) With continuous infusions c) When the line is discontinued d) Daily when not in use

*D) Daily when not in use* Daily instillation of dilute heparin flush when a port is not in use will maintain the port. Continuous infusion maintains the patency of each port. Heparin flushes are used after each intermittent infusion. Heparin flushes are used after blood drawing in order to prevent clotting of blood within the port. Heparin flush of ports is not necessary if a line is to be discontinued.

What are medium-length nasoenteric tubes are used for? a) Aspiration b) Emptying c) Decompression d) Feeding

*D) Feeding.* Placement of the tube must be verified prior to any feeding. A gastric sump and nasoenteric tube are used for gastrointestinal decompression. Nasoenteric tubes are used for feeding. Gastric sump tubes are used to decompress the stomach and keep it empty.

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following? a) Jejunostomy tube b) Nasogastric tube c) Orogastric tube d) Gastrostomy tube

*D) Gastrostomy tube* A gastrostomy tube enters the stomach through a surgically created opening into the abdominal wall. A jejunostomy tube enters jejunum or small intestine through a surgically created opening into the abdominal wall. A nasogastric tube passes through the nose into the stomach via the esophagus. An orogastric tube passes through the mouth into the stomach.

A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? a) "I'll drink full liquids the day before the test." b) "There is no need for special preparation before the test." c) "I'll take a laxative to clear my bowels before the test." d) "I'll avoid eating or drinking anything 6 to 8 hours before the test."

*D) I'll avoid eating or drinking anything 6 to 8 hours before the test* The client demonstrates understanding of a barium swallow when he states that he must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.

Which of the following terms describes a gastric secretion that combines with vitamin B12 so that it can be absorbed? a) Amylase b) Trypsin c) Pepsin d) Intrinsic factor

*D) Intrinsic factor*

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? a) Hydrochloric acid b) Histamine c) Liver enzyme d) Intrinsic factor

*D) Intrinsic factor* Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? a) Left lower quadrant b) Left upper quadrant c) Right upper quadrant d) Right lower quadrant

*D) Right lower quadrant* The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

The patient is on a continuous tube feeding. The tube placement should be checked every: a) 24 hours. b) 12 hours. c) hour. d) shift.

*D) Shift* Each nurse caring for the patient is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the patient is extremely restless or there is basis for rechecking the tube based on other patient activities. Checking for placement every 12 or 24 hours does not meet the standard of care due the patient receiving continuous tube feedings.

The most common symptom of esophageal disease is: a) nausea. b) odynophagia. c) vomiting. d) dysphagia.

*D) dysphagia*

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds: a) furosemide b) digoxin c) vitamin E d) enteric coated aspirin

*D) enteric coated aspirin*

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a) elevated liver enzymes and low serum protein level. b) subnormal clotting factors and platelet count. c) elevated blood urea nitrogen and creatinine levels and hyperglycemia. d) subnormal serum glucose and elevated serum ammonia levels.

*D) Subnormal serum glucose and elevated serum ammonia levels.* In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis? a) Such clients can digest high-fat foods. b) Such clients are at risk for hepatic encephalopathy. c) Such clients are at risk for gallbladder contraction. d) Such clients cannot tolerate high-glucose concentration.

*D) Such clients cannot tolerate high glucose concentration* Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge? a) Hold his breath b) Bear down as if having a bowel movement c) Pant like a dog d) Take long, slow breaths

*D) Take long, slow breaths* During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

Blood shed in sufficient quantities into the upper GI tract, produces which color of stool? a) Bright red b) Milky white c) Green d) Tarry-black

*D) Tarry-black* Blood shed in sufficient quantities into the upper GI tract produces a tarry-black stool. Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. A milky white stool is indicative "of" a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? a) Insulin has an adverse effect of constipation. b) The nerve fibers of the intestinal lining are experiencing neuropathy. c) Elevated glucose levels cause bacteria overgrowth in the large intestine. d) The pancreas secretes digestive enzymes.

*D) The pancreas secretes digestive enzymes.*

The most significant complication related to continuous tube feedings is a) an interruption in fat metabolism and lipoprotein synthesis. b) a disturbance in the sequence of intestinal and hepatic metabolism. c) the interruption of GI integrity, d) the potential for aspiration

*D) The potential for aspiration* Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings. Tube feedings preserve GI integrity by intraluminal delivery of nutrients. Tube feedings preserve the normal sequence of intestinal and hepatic metabolism. Tube feedings maintain fat metabolism and lipoprotein synthesis.

A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor? a) The client may eat a light meal before either test. b) Both tests need to be done before breakfast. c) The upper GI should be scheduled before the ultrasonography. d) The ultrasonography should be scheduled before the GI procedure.

*D) The ultrasonography should be scheduled before the GI procedure* Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). Which of the following would be the most appropriate response by the nurse? A) "This will prevent air from accumulating in the stomach, causing gas pains." B) "This will prevent the heartburn that occurs as a side effect of general anesthesia." C) "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D) "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again."

*D) This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again* Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease? a) To increase pepsin activity b) To maintain a regular bowel pattern c) To promote client compliance d) To keep gastric pH at 3.0 to 3.5

*D) To keep gastric pH at 3.0 to 3.5* To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately? a) Hematocrit 42% b) Serum potassium 4.2 mEq/L c) Serum sodium 135 mEq/L d) White blood cell (WBC) count 22.8/mm3

*D) White blood cell (WBC) count 22.8/mm3*

Regarding oral cancer, the nurse provides health teaching to inform the patient that: a) most oral cancers are painful at the outset. b) blood testing is used to diagnose oral cancer. c) a typical lesion is soft and craterlike. d) many oral cancers produce no symptoms in the early stages.

*D) many oral cancers produce no symptoms in the early stages.*

Which of the following patients should the nurse to refer to the dietitian for a complete nutritional assessment? A. A 24-year-old who has been taking corticosteroid therapy for 1 week for treatment of an asthma exacerbation B. A 38-year-old diabetic who is undergoing laser eye surgery C. A 45-year-old hospitalized with nausea and abdominal pain who has had no oral intake and has received only intravenous fluids of D5½NS for 6 days D. A thin 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall

*D. A thin 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall* The young patient taking one week of steroid therapy is likely to have good baseline nutritional status. One week of increased need for calories associated with periods of dyspnea and steroids (which increase catabolism) is unlikely to have a longstanding impact on nutritional status. Although the 38 year old diabetic may or may not benefit from diabetes education, a complete nutritional assessment is not indicated before a minor operation for this patient. The 45 year old patient who is NPO receiving IV fluids for less than 10 days, will likely have adequate nutritional stores to sustain her for a short period of time. If she were elderly, NPO, and receiving IV fluids for 5 days, then a referral to a dietician would be indicated, and the patient could require parenteral nourishment. The patient with the history of alcoholism, who will likely require surgery, is the highest risk patient from a nutritional standpoint. This patient most likely had a poor nutritional status at baseline, and will need optimization of his nutritional status in order to promote wound healing, and optimize muscle strength to recovery his mobility status post-operatively

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about A. Cancer support groups, alopecia, and stomatitis B. Avitaminosis, ostomy care, and community resources C. Prosthetic devices, skin conductance, and grief counseling D. Wound and skin care, nutrition, drugs, and community resources

*D. Wound and skin care, nutrition, drugs, and community resources*

The nurse explains to the patient with gastroesophageal reflux disease that this disorder: A. results in acid erosion and ulceration of the esophagus caused by frequent vomiting B. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms C. is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm D. often involves relation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus

*D. often involves relation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus*

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognized that increased peristalsis resulting in diarrhea can be related to: a. sympathetic inhibition b. mixing and propulsion c. sympathetic stimulation d. parasympathetic stimulation

*D. parasympathetic stimulation*

The nurse is teaching the patient and family about possible causative factors for peptic ulcers. The nurse explains that ulcer formation is: A. caused by a stressful lifestyle and other acid producing factors such as h.pylori B. inherited within families and reinforced by bacterial spread of staph aureus in childhood C. promoted by factors that tend to cause oversecretion of acid such as excess dietary fats, smoking and h.pylori D. promoted by a combination of possible factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol

*D. promoted by a combination of possible factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol*

The optimal way to administer medications via a feeding tube is to: a. use only sustained-release medications b. pour medications into the enteral formula c. grind all the pills together and dilute with water d. remover powder from a gelatin capsule and dilute with water

*D. remover powder from a gelatin capsule and dilute with water*

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? a) Computer tomography b) Colonoscopy c) Small bowel series d) Upper GI series

*b) Colonoscopy*

When assessing the health perception-health maintenance pattern as related to GI function, an appropriate question by the nurse is: a. what is your usual bowel elimination pattern? b. what percentage of your income is spent on food? c. have you traveled to a foreign country in the last year? d. do you have diarrhea when you are under a lot of stress?

*c. have you traveled to a foreign country in the last year?*

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: a) Absent. b) High-pitched. c) Mild. d) Hyperactive.

A) Absent Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

A normal physical assessment finding of the GI system is/are: (select all the apply) A. nonpalpable liver and spleen B. borborygmi in upper right quadrant C. tympany on percussion of the abdomen D. liver edge 2 to 4 cm below the costal margin E. finding a firm nodular edge on the rectal exam

A, C

The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will include information concerning the importance of (select all that apply) A. Only taking aspirin with milk or bread products B. Avoiding taking aspirin and drugs containing aspirin C. Taking only drugs prescribed by the health care provider D. Taking all drugs 1 hour before mealtime to prevent further bleeding E. Reading all OTC drug labels to avoid those containing stearic acid and calcium

B + C *B. Avoiding taking aspirin and drugs containing aspirin* *C. Taking only drugs prescribed by the health care provider*

The nurse who inserted a nasogastric tube for a 68-year-old patient with suspected bowel obstruction should write which of the following priority nursing diagnoses on the patient's problem list? A) Anxiety related to nasogastric tube placement B) Abdominal pain related to nasogastric tube placement C) Risk for deficient knowledge related to nasogastric tube placement D) Altered oral mucous membrane related to nasogastric tube placement

D) Altered oral mucous membrane related to nasogastric tube placement With nasogastric tube placement, the patient is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, the nurse should plan preventive measures based on this nursing diagnosis.

A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carfully assesses the patient for: A. Hyperkalemia B. Hypoglycemia C. Hypercalcemia D. Hypophosphatemia

D. Hypophosphatemia

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a) "Lie down after meals to promote digestion." b) "Avoid coffee and alcoholic beverages." c) "Limit fluid intake with meals." d) "Take antacids with meals."

b) "Avoid coffee and alcoholic beverages."