Saunders NCLEX - gastrointestinal

A clear liquid diet has been prescribed for a client with gastroenteritis. Which item is appropriate to offer to the client?

4. Fat-free beef broth

A client with Crohns's disease has just had surgery to create an ileostomy. The nurse assesses the client in the postoperative period for which most frequent complication of this type of surgery?

4. Fluid and electrolyte imbalance

The nurse is assessing a client who fell at home and is complaining of abdominal pain. The nurse notes ecchymosis on the client's flanks and documents this as which assessment finding?

4. Grey Turner's sign

The client is to receive a soapsuds enema. Which is the best position for administering an enema? Refer to figure.

1. A

A sexually active 20-year-old client has been diagnosed with viral hepatitis. Which statement made by the client would indicate a need for further teaching?

1. "I can never drink alcohol again."

A client is seen in the ambulatory care office for a routine examination. Which statement by the client would be most important for the nurse to follow up?

1. "I just lost a family member to gastrointestinal cancer."

The nurse is providing discharge instructions to a client following hemorrhoidectomy. Which statement, if made by the client, indicates a need for further instruction?

1. "I should use a doughnut to relieve pressure while sitting down."

The nurse is providing instructions to a client that has an esophagogastroduodenoscopy (EGD) ordered to confirm the diagnosis of esophageal stricture. Which statement by the client indicates a need for further teaching?

1. "I will be awake during the procedure."

The nurse has been reinforcing dietary teaching for a client diagnosed with gastroesophageal reflux disease (GERD) who has a routine follow-up visit. Which behavior is the best indicator of a successful outcome for this client?

1. A decrease in sour eructation

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed? Select all that apply.

1. Administer antacids, as prescribed. 2. Encourage coughing and deep breathing. 3. Administer anticholinergics, as prescribed.

The nurse is assisting in caring for a client with a large penetrating wound to the abdomen and several smaller wounds containing shrapnel. The nurse plans for which appropriate nursing interventions? Select all that apply.

1. Apply pressure to bleeding wounds 2. Obtain blood for a type and crossmatch 3. Apply supplemental oxygen as ordered 4. Establish intravenous access with 2 large-bore catheters

A client with viral hepatitis states to the nurse, "I am so yellow." The nurse would best respond by taking which action?

1. Assist the client in expressing feelings.

The nurse is getting a client who underwent umbilical hernia repair ready for discharge. The nurse explains to the client that it is important to continue to do which action after discharge?

1. Avoid coughing.

The nurse is asked to assist with preparing a client who will be receiving a continuous total parenteral nutrition (TPN) solution via a central line. The nurse plans to institute which interventions for this client related to the TPN? Select all that apply.

1. Central line dressing changes per protocol 2. Blood glucose monitoring around the clock 4. Using an electronic infusion pump with the infusion 6. Reviewing prescribed blood laboratory values including electrolytes

The nurse is reviewing the medical record for a client with peritonitis. Which prescription would prompt the nurse to contact the registered nurse to seek clarification from the gastroenterologist?

1. Clear liquid diet

The nurse is providing education to a client regarding foods that can aggravate the symptoms of gastroesophageal reflux disease (GERD). The nurse identifies a need for further teaching when the client states which foods are acceptable to consume? Select all that apply.

1. Coffee 3. Chocolate 5. Fried chicken

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic would the nurse expect to see documented in the record?

1. Diarrhea

The nurse who is reinforcing instructions to a client who has had a gastric resection would include which considerations? Select all that apply.

1. Eat small frequent meals. 3. Take action to prevent dumping syndrome.

A client who has undergone a subtotal gastrectomy is being prepared for discharge. Which considerations concerning ongoing self-management would the nurse reinforce to the client? Select all that apply.

1. Eat smaller and more frequent meals. 3. Drink fluids between meals, not with them.

The nurse would document that a client diagnosed with a hiatal hernia is implementing effective health maintenance measures after the client reports doing which action?

1. Eating low-fat or nonfat foods

A client is admitted from the emergency department with a diagnosis of bowel perforation. Which treatment strategies would the nurse anticipate based on this admitting diagnosis? Select all that apply.

1. Electrocardiogram monitoring 2. Broad-spectrum antibiotic therapy 4. Insertion of an indwelling urinary catheter 6. Fluid replacement with lactated Ringer's solution

The nurse is reviewing the client's medical records for the shift and notes that which clients are at risk for dehydration? Select all that apply.

1. The client with dementia 3. The client with Clostridium difficile infection 5. The client in acute heart failure exacerbation taking furosemide

The client arrives at the clinic complaining of dyspepsia and pain that occurs about 90 minutes after eating. The client also reports that the pain became worse this afternoon about 3 hours after eating a large bowl of spaghetti with tomato sauce. Laboratory tests reveal the presence of Helicobacter pylori (H. pylori). The nurse anticipates that the primary health care provider would prescribe which medications? Select all that apply.

1. Esomeprazole 2. Metronidazole 3. Clarithromycin

The nurse is caring for a client with dehydration. The nurse is aware that dehydration is associated with which imbalances?

1. Extracellular fluid volume deficit and hypernatremia

A client is admitted to the hospital with a diagnosis of acute viral hepatitis. Which sign/symptom would the nurse expect to observe based on this diagnosis?

1. Fatigue

The nurse caring for a client with a diagnosis of cholelithiasis observes for signs of obstruction of the bile ducts. Which assessment findings are indicative of this complication? Select all that apply.

1. Fever 2. Jaundice 3. Dark, foamy urine 4. Clay-colored stools

The nurse is assisting in caring for a client that has arrived to the post-anesthesia care unit following an esophagogastroduodenoscopy (EGD) to confirm diagnosis of esophageal stricture. Which findings are signs of esophageal perforation? Select all that apply.

1. Fever 2. Tachypnea 4. Hypotension

The nurse is administering pantoprazole to a client with gastroesophageal reflux disease (GERD). The nurse understands that pantoprazole has which potential adverse effects? Select all that apply.

1. Fractures 2. Pneumonia 5. Hypomagnesemia

The nurse is providing dietary instructions to a client with a diagnosis of ulcerative colitis. The client is prescribed to follow a low residue diet during episodes of diarrhea. Which food would the nurse instruct the client to avoid?

1. Fresh corn on the cob

The nurse is caring for a client following an esophagogastroduodenoscopy (EGD) done to confirm the diagnosis of esophageal stricture. Which assessment is priority after this procedure to promote client safety?

1. Gag reflex

The client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting, and a gastric ulcer is suspected. The nurse would gather which additional data from the client to support this diagnosis?

1. History of alcohol use, smoking, and weight loss

A client with Crohn's disease is scheduled to receive an infusion of infliximab. The nurse assisting with caring for the client would take which action to monitor the effectiveness of treatment?

2. Checking the frequency and consistency of bowel movements

The nurse is collecting data during an assessment on a client. Which of the following assessment findings are typical for a malnourished client? Select all that apply.

1. Glossitis 2. Cheilosis 3. Bleeding gums

The nurse is interpreting the laboratory results of a client who has a history of diagnosed chronic ulcerative colitis. The nurse would determine that which result indicates a complication of ulcerative colitis?

1. Hemoglobin 10.2 g/dL

It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing?

1. Hepatitis A

Which infection control method would the nurse determine to be the priority to include in the plan of care to prevent hepatitis B in a client considered to be at high risk for exposure?

1. Hepatitis B vaccine

The nurse is caring for a client with a diagnosis of anal fistula. Which condition would the nurse most likely expect to note in the client's medical history?

3. Crohn's disease

A client with a diagnosis of acute pancreatitis is experiencing severe pain. After noting an absence of an analgesic prescription on the primary health care provider prescription sheet, the nurse would suggest contacting the primary health care provider to request a prescription for which medication?

1. Hydromorphone

The nurse is reinforcing dietary instructions for a client diagnosed with peptic ulcer disease. Which statement made by the client indicates a need for further teaching?

1. I will eat a bland diet only.

The nurse caring for a client diagnosed with acute pancreatitis and has a history of alcoholism is monitoring the client for complications. The nurse determines that which data collected is most likely indicative of paralytic ileus?

1. Inability to pass flatus

The nurse working on the medical-surgical unit admits a client with acute appendicitis scheduled for an appendectomy the following morning. Which interventions would the nurse implement in managing care for this client in the pre-operative period? Select all that apply.

1. Monitor vital signs 2. Administer antiemetics 3. Administer pain medications 4. Administer intravenous fluids 5. Nothing by mouth (NPO) status

A client receiving iron supplements is complaining of constipation and the stool that is passed is black. Which information is appropriate for the nurse to share with the client? Select all that apply.

1. Increase your fluid intake. 2. Include more fiber in your diet. 3. Ferrous sulfate changes the color of stool to black. 4. Iron slows colonic acid and often leads to constipation.

The nurse is reviewing a client's laboratory results. The nurse notes that which results support a diagnosis of dehydration? Select all that apply.

1. Increased creatinine 2. Increased hemoglobin 3. Increased serum sodium 5. Decreased estimated glomerular filtration rate (eGFR)

The nurse is caring for a client diagnosed with anal fistula and is monitoring for complications of this problem. Which priority complication would the nurse monitor for while managing care for this client?

1. Infection

An acutely ill-looking client arrives at the emergency department. The client complains of "the worst pain I ever felt in my belly. I can't get comfortable." The client is quiet but with each movement the client cries out in pain. The nurse suspects the client has peritonitis. Which data would the nurse collect to assist in validating this suspicion? Select all that apply.

1. Inspect the abdomen for rigidity. 2. Check for the presence of hiccups. 5. Inspect the client's mucous membranes.

The nurse is reinforcing discharge instructions to a client with a hiatal hernia. Which considerations would the nurse include in the teaching session? Select all that apply.

1. It is advisable to stop smoking cigarettes. 3. Wait at least 1 hour after meals to perform chores. 4. Be sure to elevate the head of the bed during sleep.

The nurse is reviewing a client's medications. The nurse determines which medications increase the client's risk of dehydration? Select all that apply.

1. Lactulose 4. Spironolactone 5. Polyethylene glycol

The nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression in a client with a bowel obstruction. Which settings would the nurse anticipate to be prescribed by the primary health care provider? Select all that apply.

1. Low 5. Intermittent

A client with hiatal hernia chronically experiences heartburn after meals. Which would the nurse teach the client to avoid?

1. Lying recumbent after meals

The nurse understands that the client with a Clostridium difficile (C. difficile) infection is at increased risk for which acid-base imbalance?

1. Metabolic acidosis

The nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse would question which prescription?

1. Milk of magnesia

The client in an emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse should question which prescriptions? Select all that apply.

1. Milk of magnesia 2. Heat pad to the abdomen

The nurse is assisting in caring for a client who suffered blows to the face with a baseball bat and a gunshot wound to the abdomen. The nurse is reviewing the prescriptions in the client's medical record and determines there is a need for follow-up with the primary health care provider if which prescription is noted?

1. Nasogastric tube insertion

A client has been receiving parenteral nutrition at 125 mL/hr for 5 days. On data collection, the nurse notes bilateral crackles and 2+ pedal edema and that the client has gained 3 pounds in 5 days. Which would be appropriate as the initial nursing action?

1. Notify the registered nurse of the findings.

A client with a diagnosis of viral hepatitis has no appetite, and food makes the client nauseated. The nurse would conclude that which intervention is most appropriate?

1. Offer small, frequent meals.

A morbidly obese client, 3 days postoperative gastric bypass surgery, comes to the clinic complaining of pain. The nurse suspects that the client has an anastomotic leak requiring hospitalization. The nurse would determine that which findings best validate this suspicion? Select all that apply.

1. Oliguria 2. Restlessness 3. Abdominal pain 5. Unexplained tachycardia

The nurse is caring for a postoperative client who had a colon resection for colon cancer. Which complication is most likely to occur after this procedure?

1. Paralytic ileus

The nurse has inserted a nasogastric (NG) tube in a client and is checking for the correct placement of an NG tube. Which is the most reliable data to ensure that the end of the tube is in the stomach?

1. Placement is verified on x-ray

The nurse is reviewing the health care record of a client with a diagnosis of chronic pancreatitis. The nurse would determine that which data noted in the record indicate poor absorption of dietary fats?

1. Steatorrhea

The nurse provides information to a client following a gastrectomy who is now diagnosed with pernicious anemia. Which instructions about pernicious anemia would the nurse reinforce to the client? Select all that apply.

1. Provide meticulous and frequent oral hygiene. 2. Use additional lightweight blankets as needed. 4. Check blood serum vitamin B12 levels every 1 to 2 years.

The nurse is collecting data on a client admitted to the hospital with a diagnosis of hepatitis. The nurse would determine which data indicates the client may have liver damage?

1. Pruritus

The nurse is caring for a client with a diagnosis of acute anal fissure. Which characteristic assessment finding would the nurse expect to note?

1. Recent constipation

The nurse has been providing care for a client with a Sengstaken-Blakemore tube. While the tube is inflated the nurse would monitor for which priority sign/symptom?

1. Respiratory distress

A client has undergone subtotal gastrectomy, and the nurse is preparing the client for discharge. Which item would be included when reinforcing instructions to the client about ongoing self-management?

1. Smaller, more frequent meals should be eaten.

The nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. The nurse would take which appropriate action?

1. Stop the irrigation temporarily

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

1. Sweating and pallor

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which indicates this occurrence?

1. Sweating and pallor

A client presents to the urgent care center with complaints of abdominal pain. Suddenly the client vomits bright red blood. The nurse would take which immediate action?

1. Take the client's vital signs.

The nurse is assessing a client with a suspected Clostridium difficile infection. The nurse notes that which clinical manifestations are consistent with this diagnosis? Select all that apply.

1. The client's temperature is 101.7°F (38.2°C). 2. The client is having watery bowel movements. 5. The client grimaces while the nurse palpates the abdomen.

A client with ulcerative colitis had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

1. This is a normal, expected event

A primary health care provider is about to perform a paracentesis on a client diagnosed with abdominal ascites. The nurse would assist the client to assume which position?

1. Upright

The nurse is caring for a client with a diagnosis of acute appendicitis. Which physical assessment finding consistent with this diagnosis would the nurse expect to be documented in the client's medical record?

3. Pain at McBurney's point

The nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement is most appropriate to be included in the teaching?

2. "Avoid lying down for an hour after eating."

The nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. Which statement would the nurse make to the client for consideration?

2. "Be sure to sleep with your head elevated in bed."

The nurse evaluates that there is a need for further teaching on bowel elimination when the client makes which statement?

2. "I need to decrease fiber in my diet."

Psyllium is prescribed for the client diagnosed with a cardiac disorder to facilitate defecation and prevent straining with bowel movements. The nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

2. "I should mix the medication with a full glass of water."

The nurse is caring for a client with suspected esophageal stricture. Which statement from the client supports this diagnosis?

2. "I've been having trouble swallowing meat."

The nurse is reviewing concepts related to irritable bowel syndrome (IBS) with a nursing student. Which statement by the nursing student indicates there is a need for further teaching?

2. "IBS is characterized by only episodes of diarrhea."

A caregiver states that the client eats only about 25% of the food that is offered and is losing weight. The caregiver asks the nurse about feeding the client by a tube into the stomach. Which initial response by the nurse would be appropriate?

2. "Tube feedings can provide adequate amounts of required nutrients."

The nurse is collecting physical assessment data for a patient with possible splenomegaly. The nurse should palpate which abdominal quadrant? Refer to figure.

2. 2

The nurse is collecting data about how well a client diagnosed with a gastrointestinal (GI) disorder is able to digest food. The nurse determines that which processes are involved in the complete digestive process? Select all that apply.

2. Chemical 4. Absorption 5. Mechanical 6. Active transport

A client is admitted to the hospital with a diagnosed bowel obstruction secondary to a recurrent diagnosed malignancy. The primary health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, which action would the nurse determine is best?

2. Remain with the client and be silent.

A primary health care provider asks the licensed practical nurse (LPN) to reinforce preprocedure instructions to a client who will undergo a barium swallow (esophagography) in a few days. The LPN would include which instruction in this discussion?

2. Remove all metal and jewelry before the test.

The nurse would recognize that which type of enema has the highest risk of water intoxication?

2. Tap water

A generally healthy 63-year-old man is seen in the primary health care provider's office for a routine examination. Which statement made by the client is most important for the nurse to follow up on?

3. "Everyone in my immediate family has died from gastrointestinal cancer."

The nurse has given the client diagnosed with hepatitis instructions about post discharge management during convalescence. The nurse determines a need for further teaching if the client makes which statement?

3. "I should resume a full activity level within 1 week."

The nurse working in an outpatient clinic is providing teaching to a client on preventive measures for hemorrhoids. Which statement, if made by the client, indicates a need for further teaching?

3. "I will sit or lie down throughout the day as much as I can."

A primary health care provider places a Miller-Abbott tube in a client who has a diagnosed bowel obstruction. Six hours later, the nurse measures the length of the tube outside of the nares and notes that the tube has advanced 6 cm since it was first placed. Based on this finding, which action would the nurse take next?

3. Document the finding in the client's record.

The nurse is reinforcing dietary instructions for a client diagnosed with peptic ulcer disease. Which action would the nurse encourage the client to do?

3. Eat anything as long as it does not aggravate or cause pain.

The nurse working in the emergency department is assisting with an initial assessment on a client who is complaining of severe upper abdominal pain that spreads throughout the abdomen and radiates to the back and shoulders. The client has tried taking antacids with no relief. On assessment the abdomen is rigid and bowel sounds are absent. Which data in the client's history would the nurse be most concerned about in connection with these assessment findings?

3. Peptic ulcer disease

A client that is postgastrectomy is at high risk for hyperglycemia related to uncontrolled gastric emptying of fluid and food into the small intestine (dumping syndrome). Because of this risk, the nurse would plan to monitor which data?

3. Postprandial blood glucose readings

The nurse is reinforcing home care instructions to a client following a gastric resection. The nurse would include which instruction to the client?

3. Take actions to prevent dumping syndrome.

A calcium supplement is prescribed for a client diagnosed with hypoparathyroidism in the management of hypocalcemia. The client arrives at the clinic for a follow-up visit and complains of chronic constipation, and the nurse reinforces instructions to the client about measures to alleviate the constipation. Which comment by the client would indicate a need for further teaching?

4. "I need to add 0.5 ounce of mineral oil to my daily diet."

The nurse is teaching a client with nonalcoholic fatty liver disease about measures to manage the condition. The nurse determines the client has a need for further teaching if the client makes which statement?

4. "I should stop taking my cholesterol medication as it puts stress on my liver."

The nurse is collecting data from a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement made by the client would the nurse recognize as best supporting the diagnosis of gastric ulcer?

4. "My pain comes shortly after I eat, maybe a half hour or so later."

The nurse reinforces medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?

4. "The nizatidine will cause me to produce less stomach acid."

Which ostomy location would most likely need to be irrigated? Refer to figure.

4. D

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. The nurse would determine that which data would further support this diagnosis?

4. History of chronic obstructive pulmonary disease with weight loss

The nurse is collecting data on a client with a diagnosis of peptic ulcer disease. Which history would the nurse determine is least likely associated with this disease?

4. History of the use of acetaminophen for pain and discomfort

The nurse assigned to care for a client diagnosed with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care knowing that which client position will best assist in facilitating breathing?

4. Semi-Fowler's

The nurse is caring for a client with a diagnosis of dehydration. Which laboratory finding, as noted in the client's medical record, supports this diagnosis?

4. Sodium level of 149 mEq/L (149 mmol/L)

A postoperative client has regained bowel sounds and is ready to start a clear liquid diet. The nurse is told that the primary health care provider has written a prescription to remove the nasogastric (NG) tube. The nurse assists in the procedure and would ask the client to do which during tube removal?

4. Take a breath and hold it until the tube is out.

The nurse is monitoring the intake and output of a client diagnosed with fatty liver disease that is exhibiting ascites. The nurse documents that the client has consumed 4 ounces of apple juice and 8 ounces of coffee with breakfast, 8 ounces of water and 8 ounces of tea with lunch, and 10 ounces of water with dinner. Additionally, the client received two doses of intravenous antibiotics mixed in 50 mL of normal saline. Also noted is 675 mL of urine output documented in the client's chart. What is the client's fluid balance in mL? Fill in the blank.

565 mL

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse would plan care knowing that most likely, which problem will occur with this disorder?

2. Alteration in comfort related to abdominal pain

When reinforcing dietary instructions to a client with irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea, which foods would the nurse tell the client are best to include in the diet for this disorder? Select all that apply.

2. Apples 5. Whole-grain bread

The nurse has a prescription to give 30 mL of an antacid through a nasogastric (NG) tube connected to wall suction. The nurse would do which best action to perform this procedure correctly?

3. Clamp the NG tube for 30 minutes following administration of the medication.

The nurse is assigned to care for a client receiving total parenteral nutrition via the subclavian vein. The nurse would identify which intervention in the plan of care for the client as the priority?

2. Monitoring the insertion site for signs of infection

Implemented treatment measures for a client with a diagnosis of bleeding esophageal varices have been unsuccessful. The primary health care provider states that a Sengstaken-Blakemore tube will be used to control the resulting hemorrhage. The nurse would prepare for insertion of this tube via which route?

2. Nasogastric

The nurse reviewing a client's medical record would recognize which conditions as risk factors for nonalcoholic fatty liver disease (NAFLD)? Select all that apply.

2. Obesity 3. Diabetes 6. Hyperlipidemia

The nurse is reviewing the risk factors for Clostridium difficile (C. difficile) infection with a student nurse. The nurse would determine there is a need for further teaching if the student nurse identifies which clients as being at risk for developing a C. difficile infection? Select all that apply.

2. A client with coronary artery disease 3. A client receiving total parenteral nutrition

A client who has undergone a colostomy several days ago is reluctant to leave the hospital and has not yet looked at the ostomy site. Which measures will most likely promote coping? Select all that apply.

1. Ask a member of the local ostomy club to visit with the client before discharge. 2. Ask the enterostomal nurse specialist to consult with the client before discharge. 5. Ask the client to begin doing one part of the ostomy care each day and increase tasks daily.

The nurse notes that the medical record of a client diagnosed with cirrhosis states that the client has asterixis. To effectively verify this information the nurse would take which action?

1. Ask the client to extend the arms.

The nurse is collecting assessment data on an assigned client. Which assessment findings support that the client is experiencing dehydration? Select all that apply.

1. Dark urine 2. Cracked lips 4. Urine output of 20 ml in the past hour

The nurse is assigned to assist in caring for a client who is receiving parenteral nutrition with fat emulsion. The nurse is instructed to monitor the client for signs of fat overload. The nurse monitors for which signs and symptoms of this complication?

1. Fever and pruritic urticaria

The nurse is reinforcing instructions to a client and his family about alcohol abuse and chronic cirrhosis. The nurse determines to include which essential elements in the discharge teaching guide? Select all that apply.

2. Avoid potentially hepatotoxic over-the-counter drugs. 3. Teach symptoms of complications and when to seek prompt medical attention. 4. Explain that cirrhosis of the liver is a chronic illness and the importance of continuous health care. 5. Avoid aspirin and non-steroidal anti-inflammatory drugs to prevent hemorrhage when esophageal varices are present and substitute with acetaminophen.

The nurse is teaching a client with irritable bowel syndrome (IBS) about food items that may exacerbate the condition. The nurse identifies a need for further teaching if the client states which food item is acceptable to consume?

2. Cauliflower

The nurse is caring for a client in the pre-operative period scheduled for a hemorrhoidectomy. The nurse would inform the surgeon about which medication, if noted in the client's home medication list?

2. Clopidogrel

A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse would instruct the client to avoid which behavior?

2. Drinking liquids with meals

The nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which would the nurse suggest to the client to prevent swelling?

2. Elevate the scrotum.

Which information would the nurse include when reinforcing client teaching regarding ostomy care? Select all that apply.

2. Empty pouch when 1⁄3 to 1⁄2 full. 4. The stoma should be moist and pink to red. 5. The skin barrier should be within 1⁄16 to 1⁄8 inch of the stoma. 6. Change the appliance about every 3 days, or sooner, if it is leaking effluent.

A client diagnosed with pernicious anemia asks the nurse what caused the deficiency. The nurse replies that it is most likely a result of which condition that is part of the client's health history?

2. Hemigastrectomy

The nurse analyzes the results of laboratory studies performed on a client with diagnosed peptic ulcer disease (PUD). Which laboratory value would most indicate a complication associated with the disease?

2. Hemoglobin 10.2 g/dL

The nurse is reviewing a client's laboratory studies. Which laboratory studies support that the client is experiencing malnutrition? Select all that apply.

2. Hemoglobin 8.6 g/dL (86 mmol/L) 4. Serum magnesium 1.3 mEq/L (0.53 mmol/L) 5. Alanine aminotransferase (ALT) 57 U/L (57 U/L)

The nurse is reviewing the medication record of a client with a diagnosis of acute gastritis. Which medication noted on the client's record would the nurse most likely question?

2. Ibuprofen

The nurse would include which instruction in a teaching plan for a client who has been diagnosed with peptic ulcer disease?

2. Learn to use stress reduction techniques.

The nurse is caring for a client within the first 24 hours following a total gastrectomy for gastric cancer. During this time frame, the nurse would focus on which priority intervention?

2. Maintaining a patent nasogastric (NG) tube

The nurse caring for a client with a small bowel obstruction monitors for complications of this condition. Which acid-base imbalance would the nurse most likely expect to occur in this condition?

2. Metabolic alkalosis

The nurse is caring for a client that received a new diet prescription from the primary health care provider (PHCP) for nothing-by-mouth (NPO) except ice chips. Which actions would the nurse take to alleviate the effects of dehydration? Select all that apply.

2. Observe mucous membranes for drynessisinterest 4. Provide frequent oral care with moist swabs 5. Apply lubricant to the lips and oral mucous membranes

The nurse is assisting with admitting a client to the hospital for the treatment of diagnosed dehydration. The client reports nausea, vomiting, diarrhea, and cramping for the past week. The nurse asks the client about medications being taken. The client denies taking prescription medications but states he has been taking some herbs given to him by a cousin. The nurse would alert the registered nurse when the client states he has been taking which herb?

2. Senna

A client calls the clinic and asks the nurse about measures to minimize pain and swelling for hemorrhoids. What is the correct response by the nurse?

2. Sitz baths for 15 to 20 minutes 2 to 3 times a day

The nurse is reinforcing teaching to a client diagnosed with an anal fissure. The nurse discusses the possible treatment measures for this problem. The nurse accurately identifies which measures during the teaching session? Select all that apply.

2. Topical nitrates 3. Fiber supplements 4. Lateral sphincterotomy 5. Botulinum toxin injection 6. Topical calcium channel blockers

A client reports excessive sweating, muscular weakness, diarrhea, and achiness in the bones. The nurse suspects the client is deficient in which vitamin?

2. Vitamin D

A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse would schedule the medication so that each dose is taken at which time?

3. 30 minutes before meals

The nurse is talking to a nursing student about primary versus secondary peritonitis. The nurse determines that the student understands if the nursing student states which client is at risk for primary peritonitis?

3. A client with ascites related to cirrhosis

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse would most appropriately suggest which diet during the acute phase?

3. A low-fiber diet

The nurse is assisting in assessing a client who was in a motor vehicle crash and experienced blunt trauma to the abdomen. The nurse is told that on auscultation of the abdomen, a bruit is heard. Which complication would the nurse suspect?

3. Aortic aneurysm

The nurse gathers data from a client admitted to the hospital with a diagnosis of gastroesophageal reflux disease (GERD) scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse would determine that the client may be most at risk for which complication?

3. Aspiration

The nurse is teaching the client with vitamin B12 deficiency about foods that are good sources of vitamin B12. The nurse identifies a need for further teaching if the client states which foods are good sources of vitamin B12? Select all that apply.

3. Broccoli 4. Citrus fruits

The nurse is preparing to administer a soapsuds enema to a client. Into which position would the nurse place the client to administer the enema? Refer to figure.

3. C

A client with cirrhosis admitted to the hospital diagnosed with severe jaundice is having diagnostic testing. Because the client has no complaints of fatigue, the client is encouraged to ambulate in the hall to maintain muscle strength. The client paces around the room but will not enter the hall. The nurse would determine which concern is most likely the reason for the client's reluctance to walk in the hall?

3. Feeling self-conscious about appearance

A licensed practical nurse (LPN) is assisting in the insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by performing which measurement?

3. From the tip of the client's nose to the earlobe and then down to the xiphoid process

The nurse is caring for a client with a history of peptic ulcer disease admitted to the medical-surgical unit with abdominal pain that is worse towards the end of the day. The client tells the nurse that he has had a bowel perforation in the past that healed on its own. Given the client's history, which condition would the nurse suspect?

3. Gastric outlet obstruction

The nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). Based on the procedure done, the nurse would plan to do which action first?

3. Monitor for return of the gag reflex.

Atropine sulfate is prescribed for the client diagnosed with gastrointestinal hypermotility, and the nurse reviews the client's record before administering the medication. Which finding, if noted on the client's record, most indicates the need to contact the primary health care provider before administering the medication?

3. Narrow-angle glaucoma

A client diagnosed with a peptic ulcer scheduled for a vagotomy asks the nurse about the purpose of this procedure. The nurse would explain to the client that a vagotomy primarily serves which purpose?

3. Reduces the stimulation of acid secretions

A client that is postgastrectomy being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work, and I may lose my job." Based on the client's statement, the nurse would determine that at this time, it is most appropriate to discuss which topic?

3. Reducing stressors in life

The nurse is reviewing the chart for a client with Clostridium difficile (C. difficile) infection. The nurse would contact the primary health care provider (PHCP) regarding which priority finding?

3. Serum potassium 2.9 mEq/L (2.9 mmol/L)

A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN would assist the client into which most appropriate position?

3. Supine with the head raised slightly and the knees slightly flexed

The nurse is caring for a client with a neurogenic bowel due to a lower motor neuron spinal cord injury below T12 resulting in flaccid functionality. Besides triggering or facilitating techniques for defecation, what are some of the strategies the nurse needs to address to reestablish defecation patterns? Select all that apply.

3. Suppository use4 4. Manual disimpaction5 5. Consistent toileting schedule

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates and is unable to obtain any residual tube feeding. Which action would the nurse take next?

3. Turn the client to the side and attempt to aspirate again

The nurse working in an outpatient clinic is assisting with the admission intake on a client. The nurse asks about the reason for the visit, and the client describes a dull abdominal pain with diminished appetite and nausea. On further assessment, the pain is described as right sided and low, persistent, and continuous; the abdomen is tender, rigid with guarding and rebound tenderness. Based on the assessment findings, the nurse anticipates which diagnostic tests to be prescribed?

3. White blood cell count with differential

The nurse is caring for a client diagnosed with esophageal varices who is going to have a Sengstaken-Blakemore tube inserted. The nurse brings which priority item to the bedside so that it is available at all times?

4. A pair of scissors

A client diagnosed with peptic ulcer disease and scheduled for a pyloroplasty asks the nurse about the procedure. The nurse would base the response on which information?

4. A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.

The nurse is reviewing the primary health care provider's prescriptions for a client admitted to the hospital with a diagnosis of liver disease. Which medication prescription would the nurse most question?

4. Acetaminophen

The nurse observes that a client's nasogastric tube has suddenly stopped draining. The tube is connected to suction, the machine is on and functioning, and all connections are snug. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse would conclude which is the problem, and what action would be taken?

4. Channels of gastric secretions may be bypassing the holes in the tube; turning the client will promote stomach emptying.

The nurse is reinforcing medication instructions to a client with peptic ulcer disease. Which represents correct information given by the nurse?

4. Cimetidine results in decreased secretion of stomach acid.

A client receiving a high cleansing enema complains of pain and cramping. Which corrective action is most appropriate for the nurse to take?

4. Clamp the tubing for 30 seconds and restart the flow at a slower rate.

A client is receiving bolus feedings via a nasogastric tube. The nurse plans to place the client's head of the bed (HOB) in which optimal position once the feeding is completed?

4. Elevated 30 to 45 degrees with the client in the right lateral position for 60 minutes

The nurse is caring for a client with a small bowel obstruction. The nurse would notify the surgeon based on which findings noted on the physical assessment?

4. Muscle guarding on palpation

A client arrives at the emergency department complaining of severe abdominal pain and is placed on NPO status. During a quick assessment the nurse observes that the client has both Cullen's sign and Grey Turner's sign, and pancreatitis is suspected. The nurse would assist to implement which action first?

4. Obtain vital signs and draw blood for laboratory analysis.

The client has a prescription for sucralfate 1 g by mouth 4 times daily. The nurse would best schedule the administration of the medication at which time?

4. One hour before meals and at bedtime

The nurse is reviewing a chart of a client with irritable bowel syndrome (IBS) that is taking linaclotide. Which item documented in the client's history would prompt the nurse to consult with the registered nurse?

4. Partial bowel obstruction

The nurse is participating in a health screening clinic and is preparing materials about colorectal cancer. The nurse would include which risk factor for colorectal cancer in the material?

4. Personal history of ulcerative colitis or gastrointestinal (GI) polyps

The nurse is caring for a client diagnosed with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed the nasogastric tube to be discontinued. To best determine the client's readiness for discontinuation of the nasogastric tube, which measure would the nurse check?

4. Presence of bowel sounds in all four quadrants

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation would indicate that a prolapse has occurred?

4. Protruding and swollen

The client is taking docusate sodium. The nurse would monitor which result to determine if the client is having a therapeutic effect from this medication?

4. Regular bowel movements

The nurse would reinforce instructions to a client that has had a gastrectomy about the signs and symptoms of pernicious anemia, knowing what information?

4. Regular monthly injections of vitamin B12 will prevent this complication.

The nurse has assisted the primary health care provider with a liver biopsy, which was done at the bedside. Upon completion of the procedure, the nurse would assist the client into which position?

4. Right side-lying with a small pillow or towel under the puncture site

The nurse is caring for a client with fatty liver disease who is scheduled for a paracentesis to treat ascites. The client has an indwelling urinary catheter in place to aid in the healing of a sacral pressure injury. The nurse assesses the client and would notify the registered nurse regarding which priority finding?

4. The client has pink-tinged urine in the indwelling urinary drainage bag.

A client diagnosed with hepatic encephalopathy is receiving lactulose. The nurse determines that the medication is effective if which finding is observed?

4. The client who was previously oriented to person only can now state name, year, and present location.

A primary health care provider asks the nurse to obtain a Salem sump tube for gastric intubation for a client with a bowel obstruction. The nurse would select which tube from the unit storage area?

4. Tube with a lumen and an air vent

The nurse is caring for a client with a diagnosis of pneumonia and a history of bleeding esophageal varices. Based on this information, the nurse would plan care knowing that which could most result in a potential complication?

4. Vigorous coughing

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency?

4. Vitamin B12

A client diagnosed with chronic gastritis has been told that there is too little intrinsic factor being produced. The nurse would explain to the client that which therapy will be prescribed to treat the problem?

4. Vitamin B12 injections

A client diagnosed with acute pancreatitis is experiencing severe pain from the disorder. The nurse would instruct the client to avoid which position that could aggravate the pain?

2. Lying flat

The nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The test results indicate a pH of 5. The nurse would determine this indicates which information?

2. Placement of the NG tube is accurate.

The client admitted to the hospital with a diagnosis of viral hepatitis is complaining of a loss of appetite. In order to provide adequate nutrition, which action would the nurse encourage the client to take?

2. Increase intake of fluids.

A client has had a partial gastrectomy, and the nurse is reinforcing discharge instructions. The nurse would reinforce instructions to the client about the need for which supplements? Select all that apply.

2. Iron supplements 4. Calcium supplements 5. Vitamin B12 injections

The nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer would avoid which intervention?

2. Irrigating the nasogastric (NG) tube

A client has been diagnosed with acute gastroenteritis. Which diet would the nurse anticipate to be prescribed for the client?

2. Low fiber

A client has undergone esophagogastroduodenoscopy (EGD). The nurse would place highest priority on which action as part of the client's care plan?

2. Checking for return of a gag reflex

A client with possible hiatal hernia complains of frequent heartburn and regurgitation. The nurse would gather further information about the presence of which sign or symptom?

2. Difficulty swallowing

The nurse is collecting admission data on the client with a diagnosis of hepatitis. Which finding would the nurse recognize to be a direct result of this client's condition?

2. Drowsiness

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. Which interventions would be included in the procedure? Select all that apply.

2. Explain the procedure to the client. 3. Ask the client to take a deep breath and hold. 4. Pull the tube out in one continuous steady motion. 5. Remove the device or tape securing the tube from the nose.

A client has a diagnosis of asymptomatic diverticular disease. Which type of diet would the nurse anticipate being prescribed?

2. High-fiber diet

The nurse is providing care for a client with with ulcerative colitis who underwent the creation of a transverse colostomy. Which observation requires immediate notification of the surgeon?

2. Stoma has a purple discoloration

A client had a Miller-Abbott tube inserted 24 hours ago. The nurse is asked to check the client to determine whether the tube is in the appropriate location at this time. Which data finding best indicates adequate location of the tube?

2. The aspirate from the tube has a pH of 7.45.

The nurse is providing care for a client with a nasogastric tube. Which observation is most appropriate in determining that the tube is correctly placed?

2. The pH of the aspirate is 5.

A client has had extensive surgery on the gastrointestinal tract and has been started on total parenteral nutrition (TPN). The client tells the nurse, "I think I'm going crazy. I feel like I'm starving, and yet that bag is supposed to be feeding me." Which is the best response from the nurse?

3. "That is because the empty stomach sends signals to the brain to stimulate hunger."

Which statement by the spouse of a client with diagnosed end-stage liver failure indicates the need for further teaching by the multidisciplinary team regarding management of the client's pain?

3. "This opioid will cause very deep sleep, which is what my husband needs."

A client is admitted to an acute care facility with complications of celiac disease. Which question asked by the nurse initially would be most helpful in obtaining information for the nursing care plan?

3. "What is your understanding of celiac disease?"

The client arrives at an emergency department complaining of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the primary health care provider's prescriptions. Which prescription would the nurse most likely question if written on the primary health care provider's prescription form?

3. Administration of an opioid analgesic

Before administering an intermittent tube feeding through a nasogastric tube, the nurse checks for gastric residual volume. Which is the best rationale for checking gastric residual volume before administering the tube feeding?

3. Evaluate absorption of the last feeding

A client who is receiving total parenteral nutrition (TPN) complains of a headache. The nurse notes that the client has an increased blood pressure and a bounding pulse. The nurse reports the findings, knowing that these signs/symptoms are indicative of which complication of this therapy?

3. Fluid overload

The nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse would place the client in which position during and after the feedings?

3. Fowler's

A client with a possible hiatal hernia complains of difficulty swallowing. Which other sign/symptom associated with a hiatal hernia would the nurse recognize?

3. Heartburn and regurgitation

The nurse is assisting with the insertion of a nasogastric tube into a client. The nurse would place the client in which position for insertion?

3. High-Fowler's position

An older client complains of chronic constipation. Which instructions would the nurse reinforce with the client? Select all that apply.

3. Increase fluids to at least 8 glasses a day. 5. Respond in a timely manner to the urge to defecate.

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. During review of the postoperative prescriptions, which would the nurse clarify?

3. Irrigating the nasogastric (NG) tube

The nurse should include which most appropriate information when reinforcing home care instructions for a client who has been diagnosed with peptic ulcer disease?

3. Learn to use stress reduction techniques.

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure would the nurse include during client teaching to help prevent dumping syndrome?

3. Limit the fluids taken with meals.

The nurse has assisted in the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse would anticipate a prescription to set the suction to which pressure?

3. Low and intermittent

The nurse is caring for a client with a Sengstaken-Blakemore tube. To effectively prevent ulceration and necrosis of oral and nasal mucosa, the nurse would plan to implement which action?

3. Provide frequent oral and nasal care on a regular basis.

The nurse is reviewing the primary health care provider's (PHCP'S) prescriptions written for a client admitted with acute pancreatitis. Which PHCP prescription would the nurse verify if noted in the client's chart?

3. Supine and flat client positioning

The nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse asks the client to assume a modified left lateral recumbent position. The nurse explains that this positioning is preferred because of which reason?

3. The enema will flow into the bowel easily

A client is receiving total parenteral nutrition and has been NPO. The primary health care provider (PHCP) prescribed small amounts of clear liquids today. The nurse's priority is to collect data regarding which criterion before giving the client anything by mouth?

3. The presence of the swallow reflex

The nurse is reinforcing instructions to a client about insertion of a Sengstaken-Blakemore tube. Which statement by the client indicates a need for further teaching?

3. The tube will be inserted through my mouth to my stomach.

A primary health care provider asks the nurse to obtain a Salem sump tube for gastric intubation. The nurse would correctly select which tube from the unit storage area?

4. A tube with a larger lumen and an air vent

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The primary health care provider inserts a nasogastric tube and prescribes a tube feeding of a standard formula feeding to run at 50 mL/hr. The nurse plans care, knowing that which is true regarding enteral feedings?

4. Enteral feedings require the normal digestive capabilities of the gastrointestinal (GI) tract.

The nurse is assigned to care for a client who had a Sengstaken-Blakemore tube inserted when more conservative treatment failed to alleviate the condition. The nurse would most likely suspect that the client has which diagnosis?

4. Esophageal varices

After the deflation of the balloon of a client's Sengstaken-Blakemore tube, the nurse would monitor the client closely for which priority esophageal complication?

4. Hemorrhage

The nurse is assisting in planning stress management strategies for the client diagnosed with irritable bowel syndrome. Which suggestion is most appropriate for the nurse to give to the client?

4. Learn measures such as biofeedback or progressive relaxation.

After a client undergoes a liver biopsy, the nurse places the client in the prescribed right-side lying position. The nurse understands that the purpose of this intervention is to accomplish which?

4. Limit bleeding from the biopsy site

A nurse organizing care for a client diagnosed with hepatitis plans to meet the client's safety needs by performing which action?

4. Monitoring prothrombin and partial thromboplastin values

The nurse is providing care for a client suspected of having appendicitis. Which priority intervention would the nurse anticipate will be prescribed for this client?

4. No oral intake of liquids or food

A client receiving enteral feedings develops abdominal distention and diarrhea shortly after initiation of the feedings. Which is the appropriate intervention for the nurse to implement?

4. Notify the primary health care provider (PHCP) of the client's signs and symptoms.

The nurse is collecting data about how well a client diagnosed with a gastrointestinal (GI) disorder is able to absorb food. While doing this, the nurse recalls that absorption is most concerned with which bodily function?

4. The transfer of digested food molecules from the GI tract into the bloodstream

The nurse is evaluating the effect of dietary counseling on the client diagnosed with cholecystitis. The nurse determines the client understands the instructions given if the client states that which food item is most appropriate to include in the diet?

4. Turkey and lettuce sandwich

The nurse observes that a client with a nasogastric tube connected to continuous gastric suction is mouth breathing, has dry mucous membranes, and has a foul breath odor. When planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?

4. Use diluted mouthwash and water to swab the mouth after brushing teeth

The nurse is reinforcing discharge instructions to a client who has had a total gastrectomy. The nurse instructs the client about the importance of returning as scheduled to the health care clinic for which priority assessment?

4. Vitamin B12 and folic acid studies