NCLEX-RN (GASTROINTESTINAL)

During the admission assessment of a client with a small bowel obstruction, the nurse anticipates which clinical manifestation? SATA 1. Abdominal distention 2. Absolute constipation 3. Colicky abdominal pain 4. Frequent vomiting 5. Pain during defection

1. Abdominal distention 3. Colicky abdominal pain 4. Frequent vomiting Nursing management of an obstruction includes placing patient on NPO, inserting NG tube, administering IV fluids and pain control measures.

The nurse is reinforcing discharge instructions with a client following a partial gastrectomy. Which of the following instructions should the nurse include to prevent dumping syndrome? SATA 1. Add high protein foods to diet 2. Consume high carb meals 3. Eat small frequent meals 4. Increase intake of fluid with meals 5. Lie down after eating

1. Add high protein foods to diet 3. Eat small frequent meals 5. Lie down after eating

The nurse is caring for a client with liver cirrhosis who was admitted for cellulitis of the leg. Which nursing assessment would the nurse perform to determine if the client's condition has progressed to hepatic encephalopathy? SATA 1. Ask if the client knows what day it is 2. Ask the client to extend the arms 3. Assess for telangiectasia (spider nevi) 4. Determine if the conjunctiva is jaundcied 5. Note amylase and lipase serum levels

1. Ask if the client knows what day it is 2. Ask the client to extend the arms **Hepatic encephalopathy is a complication of liver cirrhosis.

The nurse understands that which of these body substances are modes of transmission for hepatitis B? SATA 1. Blood 2. Feces 3. Semen 4. Urine 5. Vaginal secretions

1. Blood 3. Semen 5. Vaginal secretions

A client with diabetes receiving peritoneal dialysis experiences chills and abdominal discomfort. The nurse assess the client's abdomen by pressing one hand firmly into the abdominal wall. The client experiences pain when the nurse quickly withdraws the hand. The client's most recent blood glucose level is 210. What is the priority action by the nurse? 1. Collect peritoneal fluid for culture and sensitivity 2. Heat the remaining dialysate fluid and increase the dwell time 3. Place the client in high Fowler's position 4. Prepare to administer regular insulin IV

1. Collect peritoneal fluid for culture and sensitivity **Peritonitis early signs is presence of cloudy effluent. Later manifestations are low grade fever, chills, abdominal pain, rebound tenderness.

A client with a history of diverticular disease is being discharged after an episode of acute diverticulitis. Which instructions should be included in the discharge teaching plan to reduce the risk of future episodes? SATA 1. Drink plenty of fluids 2. Exercise regularly 3. Follow a low residue diet 4. Include whole grains, fruits and vegetables in the diet 5. Increase intake of red meat

1. Drink plenty of fluids 2. Exercise regularly 4. Include whole grains, fruits and vegetables in the diet Diverticular disease of the colon is a condition which there are sac like protrusions in the large intestine (diverticula) Diverticulitis includes abscess, fistula formation, intestinal obstruction, peritonitis and sepsis.

The nurse is teaching about the importance of dietary fiber at a community health fair. Which health benefits of consuming a fiber rich diet should the nurse include in the teaching plan? SATA 1. Helps prevent colorectal cancer 2. Improves glycemic control 3. Promotes weight loss 4. Reduces risk of vascular disease 5. Regulates bowel movements

1. Helps prevent colorectal cancer 2. Improves glycemic control 3. Promotes weight loss 4. Reduces risk of vascular disease 5. Regulates bowel movements **Dietary fiber increases stool bulk and makes stool softer and easier to pass.

The nurse is preparing a client who had a Roux-en-Y bypass for discharge from the hospital. What information should the nurse plan to include related to the prevention of dumping syndrome? 1. Meals should be small and low in carbohydrate content 2. Fluids should be encouraged with each meal 3. Talk a multivitamin with iron and calcium supplements daily 4. You will need to take your cobalamin injection monthly

1. Meals should be small and low in carbohydrate content

The nurse is caring for a client with cirrhosis of the liver. Which blood test values would the nurse anticipate to be elevated when reviewing the client's morning laboratory results? SATA 1. Albumin 2. Ammonia 3. Bilirubin 4. Prothrombin time 5. Sodium

2. Ammonia 3. Bilirubin 4. Prothrombin time Cirrhosis, end stage chronic liver disease is characterized by diffuse hepatic fibrosis with replacement. **Elevated bilirubin (jaundice) **Coagulation factors are produced in liver. Liver cannot produce factors for blood clotting. As a result, PT/INR/aPTT are elevated **Elevated Ammonia as cirrhosis progresses; ammonia results in hepatic encephalopathy

The nurse is providing nutritional teaching for a client with a new ileostomy. Which foods should the nurse instruct the client to avoid? SATA 1. Bananas 2. Broccoli w/cheese 3. Multigrain bagel 4. Popcorn 5. Spaghetti w/ sauce

2. Broccoli w/cheese 3. Multigrain bagel 4. Popcorn

A nurse is preparing a presentation about behavioral modifications to support weight loss for clients at an obesity clinic. Which of the following points should the nurse include in the teaching plan? SATA 1. Avoid social gatherings that occur in restaurants or around meals 2. Create multiple small goals with reward for achievement 3. Identify a list of desired outcomes not directly related to weight loss 4. Perform anxiety reducing activities rather than using food to cope with stress 5. Utilize visual cues such as motivational quotes to encourage positive behavior

2. Create multiple small goals with reward for achievement 3. Identify a list of desired outcomes not directly related to weight loss 4. Perform anxiety reducing activities rather than using food to cope with stress 5. Utilize visual cues such as motivational quotes to encourage positive behavior

The nurse is caring for a client with a balloon tamponade tube in place due to bleeding esophageal varices. The client suddenly develops respiratory distress and the nurse finds that the tube has been partially pulled out. Which intervention should be the nurse's priority? 1. Contact the HCP 2. Cut the tube with scissors 3. Increase gastric suction level 4. Place the client in high fowler position

2. Cut the tube with scissors Scissors are kept at the bedside as a precaution, in the event of airway obstruction, the nurse can emergently cut the tube for rapid balloon deflation and tube removal.

A student nurse asks why enteral tube feeding rather than total parenteral nutrition are being administered to a client with sepsis and respiratory failure. Which is the best response by the RN? 1. Enteral feedings have no complications 2. Enteral feedings maintain gut integrity and help prevent stress ulcers 3. Enteral feedings provide higher calorie content 4. Risk of hypoglycemia is lower with enteral feedings than TPN

2. Enteral feedings maintain gut integrity and help prevent stress ulcers

The nurse is providing postoperative care to a client returning from a hemorrhoidectomy. Which action is the priority for the nurse to perform? 1. Administer docusate and teach the client to avoid straining during defecation 2. Give pain medications and instructions related to pain control 3. Remove the rectal dressing and check the client for bleeding 4. Teach the client how to self administer a sitz bath 2-3 times daily

2. Give pain medications and instructions related to pain control

A client is receiving an infusion of TPN with 20% dextrose through a central line at 75% ml/hr. The nurse responds to the client's IV pump alarm, which indicates that the bag is empty. The new bag is not expected to arrive from the pharmacy for an hour. What is the most appropriate nursing action? 1. Hang 0.9% NS until new bad arrives, then increases TPN to 150 mL/hr for 1 hr 2. Hang 10% dextrose in water until the new bag arrives, then resume TPN at 75 mL/hr 3. Hang dextran in saline until the new bag arrives, then resume TPN 75 mL/hr 4. Hang Lactated Ringer's until the new bag arrives then resume TPN at 75 mL.hr

2. Hang 10% dextrose in water until the new bag arrives, then resume TPN at 75 mL/hr

The nurse assesses a client with suspected acute pancreatitis and anticipates the client reporting pain in which anatomical area? 1. Left flank radiating to the left groin area 2. Left upper quadrant radiating to the back 3. Perumbilical area shifting to the right lower quadrant 4. Right upper quadrant radiating to the right shoulder.

2. Left upper quadrant radiating to the back

The nurse is caring for a client with cirrhosis. Assessment finding include ascites, peripheral edema, shortness of breath, fatigue and generalized discomfort. Which intervention would be appropriate for the nurse to implement to promote client's comfort? SATA 1. Encourage adequate sodium intake 2. Place client in semi-fowler position 3. Place client in trendelenburg 4. Provide alternating air pressure mattress 5. Use music to provide a distraction

2. Place client in semi-fowler position 4. Provide alternating air pressure mattress 5. Use music to provide a distraction

The hospitalized client with anorexia nervosa is started on nutrition via enteral and parenteral routes. Which client assessment is the most important for the nurse to check during the first 24-48 hours of administration? 1. Serum albumin level and body weight 2. Serum potassium and phosphate 3. Symptoms of dumping syndrome 4. WBC and neutrophils

2. Serum potassium and phosphate Refeeding syndrome is a fatal complication of nutritional rehabilitation in chronically malnourished clients (anorexia nervosa, alcoholism) The client's lack of oral intake results in pancreas making LESS insulin. Hypophosphatemia causes muscle weakness and respiratory failure. Deficiencies in potassium and magnesium can cause cardiac arrhythmias.

The nurse is assessing 4 clients in the ED. Which client should the nurse prioritize for care? 1. Client with liver cirrhosis and ascites who has increasing abdominal distention and needs therapeutic paracentesis 2. Client with new onset ascites from a suspected ovarian mass who needs paracentesis for diagnostic studies 3. Client with ulcerative colitis who has fever, bloody diarrhea, and abdominal distention and needs an x-ray 4. Nursing come client with dementia who has stool impaction and abdominal distension and needs stool disimpaction

3. Client with ulcerative colitis who has fever, bloody diarrhea, and abdominal distention and needs an x-ray

A 78 year old client recovering from a hip fracture tells the home health nurse, I haven't had much of an appetite lately and have been really tired. I'm worried I'm not eating enough" Which question is the priority for the nurse to ask? 1. Are you able to prepare your own meals 2. Are you feeling lonely or depressed 3. Have you lost any weight unintentionally 4. How many meals do you eat each day

3. Have you lost any weight unintentionally

The nurse receives new prescriptions for a client with right lower quadrant pain and suspected acute appendicitis. Which prescriptions should the nurse implement first? 1. Administer 0.25 mg hydromorphone IV push for pain 2. Draw blood for CBC and electrolyte levels 3. Initiate IV access and infuse NS 100mL/hr 4. Obtain urine specimen for urinalysis

3. Initiate IV access and infuse NS 100mL/hr

A client calls the primary care clinic reporting diarrhea for 4 days and a low grade fever. What instruction is most important for the nurse to give to the client? 1. Encourage client to eat bulk forming foods such as whole grain bread 2. Encourage rest, fluids and acetaminophen for the fever 3. Make an appointment for the client with HCP today 4. Take 2 tablets of loperamide followed by 1 tablet after each loose stool

3. Make an appointment for the client with HCP today Diarrhea lasting longer than 48 hours requires assessment of fluid status, electrolyte and underlying cause.

The nurse assessing a client's pain would expect the client to make which statement when describing the abdominal pain associated with appendicitis? 1. My pain is a burning sensation in my upper abdomen 2. My pain is an 8 out of 10 and on my left side below my belly button 3. My pain is excruciating in my lower abdomen above my right hip 4. My pain is intermittent in my abdomen and right shoulder

3. My pain is excruciating in my lower abdomen above my right hip

A client with a 10 year history of unipolar major depression has relapsed and is now hospitalized. The client is currently on phenelzine and weighs 115 lb but weighed 150 lb 3 months prior to admission. Which foods would be best for this client? 1. Crackers and cheddar cheese 2. Hard boiled egg with tomatoes 3. Steamed fish and potatoes 4. Tortilla chips and avocado dip

3. Steamed fish and potatoes

An adult diagnosed with celiac disease 3 weeks ago was placed on a gluten free diet. The client returns for ambulatory care follow up, reports continuation of symptoms, and does not seem to be responding to therapy. Which is the best response by the nurse? 1. I will refer you to the dietitian 2. It should take about 6-8 weeks before you see improvement in your symptoms 3. Tell me what you had to eat yesterday 4. You must not be following your diet

3. Tell me what you had to eat yesterday BROW Barley, Rye, Oats, Wheat.

The clinic nurse provides teaching for a client scheduled for a barium enema the next day. Which statement by the client shows a need for further instruction? 1. I can expect chalky white stool after the procedure 2. I cannot eat/drink 8 hours before the procedure 3. I may have abdominal cramping during the procedure 4. I will avoid laxatives after the procedure

4. I will avoid laxatives after the procedure

Which prescription should the nurse question when caring for a hospitalized client diagnosed with acute diverticulitis? 1. Metronidazole 500 mg IV every 8 hr 2. NG tube to suction 3. NPO 4. Prepare for barium enema

4. Prepare for barium enema in AM Acute care for diverticulitis is allowing colon to rest, and inflammation to resolve. IV antibiotics therapy, NPO status, NG suction, IV fluids, Bed rest.

The nurse is reinforcing education to a client with IBS who is experiencing diarrhea. Which of these meals selected by the client indicates an understanding of diet management? 1. Beans, yogurt and a fruit cup 2. Beef, broccoli and a glass of wine 3. Eggs, a bagel and black coffee 4. Steak, tomato basil soup and cornbread

4. Steak, tomato basil soup and cornbread Clients should gradually increase fiber intake, proteins, breads and bland food.

A client comes to the clinic for a follow up visit after a Billroth II surgery (gastrojejunostomy) The client reports occasional episodes of sweating, palpitations and dizziness 30 minutes after eating. Which nursing action is most appropriate? 1. Check serum blood glucose for hypoglycemia 2. Ensure that the client consumes fluids with meals 3. Take the client's BP while lying and standing 4. Teach the client to lie down after eating

4. Teach the client to lie down after eating

The nurse prepares to assess a newly admitted client diagnosed with chronic alcohol abuse who lab report shows a magnesium level of 1.0. Which assessment finding does the nurse anticipate? 1. Constipation and polyuria 2. Increased thirst and dry mucous membranes 3. Leg weakness and soft, flabby muscles 4. Tremors and brisk DTR

4. Tremors and brisk DTR Hypomagnesemia is associated with alcohol abuse. It causes ventricular arrhythmia, neuromuscular excitability (tremors, trousseai/chvostek, seizures)

The nurse is evaluating a client with liver cirrhosis who received IV albumin after a paracentesis to drain ascites. Which assessment finding indicates that the albumin has been effective? 1. Abdominal circumference reduced from admission recording 2. Flapping tremor no longer visible with arm extension 3. Shortness of breath no longer experienced in supine position 4. Vital signs remain with the client's normal parameters

4. Vital signs remain with the client's normal parameters