T4 PN-NCLEX Gastrointestinal System

A nurse is reviewing preoperative instructions with a client who is scheduled for orthopedic surgery at 8:00 am the next day. Which dietary instructions would the nurse provide?

"Consume a light evening meal tonight and then no food or fluids after midnight." Eating a light meal and eliminating food and fluids after midnight limit complications during and after surgery, which could include aspiration, nausea, dehydration, and possible ileus.

Which statement by the nurse reflects an understanding of Crohn disease?

"Crohn disease can affect any area of the gastrointestinal tract." Crohn disease can affect any area of the gastrointestinal tract, from the mouth to the anus, but most commonly affects the terminal ileum or proximal cecum.

Which statement by a client prescribed a low-sodium diet indicates an understanding of the nurse's teaching?

"I eat shredded wheat cereal for breakfast."

Which client statement indicates that teaching about managing chronic pain with acetaminophen has been effective?

"I have to be careful about which over-the-counter cold preparations I take when I have a cold."

The nurse provides medication teaching on diuretic therapy to a client who receives a prescription for potassium supplements. Which statement by the client causes the nurse to conclude that the teaching was effective?

"I should report any abdominal distress."

A nurse has provided teaching to a client with a newly prescribed proton pump inhibitor (PPI). Which statement by the client indicates an understanding of why a PPI is prescribed?

"I take this to prevent stomach pain."

"Which statement by the client who recently had a colostomy indicates a need for further teaching?

"I wanted another child, and now pregnancy is not an option for me."

Which statement by the client indicates understanding of the nurse's postoperative teaching about avoidance of straining during defecation?

"I will eat more green vegetables."

Which client statement indicates to the nurse that a client who is receiving cyanocobalamin (vitamin B12) therapy for an intrinsic factor deficiency understands the treatment?

"I will have a vitamin B12 injection every month."

The nurse concludes that the teaching about home gastrostomy feedings was effective when the client makes which statement?

"I will measure the residual volume before starting the feedings."

The nurse is providing teaching to a client who has received a prescription for an oral pancreatic enzyme. The nurse evaluates that teaching is understood when the client makes which statement?

"I will take it with meals." The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place.

Which response would a nurse give to a client who asks about the mechanism of famotidine?

"It inhibits gastric acid secretion." Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors.

Which statement by a participant during a health symposium signals to the nurse an understanding of how to prevent food poisoning?

"Meats and cream-based foods need to be refrigerated."

Which response by the nurse is appropriate when a client who is newly diagnosed with cancer of the pancreas is scheduled for surgery and asks, "Wouldn't I be better off with some other treatment instead of surgery?"

"Surgery is the recommended approach. Let me contact the health care provider so you can discuss this further with the provider."

Which complication would the nurse monitor for development in a client receiving total parenteral nutrition (TPN)? SATA

1,2 Phlebitis; Infection

Which food would the nurse offer to a client who is prescribed a clear-liquid diet after surgery? SATA

1,2,5 Jell-O; Broth; Ginger ale

A nurse teaching a client about low-calcium foods concludes that the teaching is effective when the client selects which food item from the menu? SATA

1,4. Baked chicken; Roast beef with mashed potatoes

A nurse provides education to a client about how to prevent constipation. The nurse concludes that the teaching has been understood when the client makes which statement? SATA

2,4,5. "I should drink 8 glasses of water everyday." ; "I can include bran muffins in my breakfast daily." ; "I will walk every day as part of my exercise regimen."

Which drug is contraindicated in a client with infectious diarrhea? SATA

2,5. Loperamide, Diphenoxylate with atropine Loperamide and diphenoxylate with atropine are contraindicated in clients with infectious diarrhea.

Which instruction regarding diet and lifestyle changes would a nurse include in discharge teaching for a client with gastroesophageal reflux disease (GERD)? SATA

3,5. Avoid caffeine-containing products; Chew thoroughly while eating slowly

Which sign or symptom is expected with advanced cirrhosis?

ALL Ascites, Jaundice, Esophageal varices, Decreased consciousness, Numbness and tingling in extremities.

Which complication of peritonitis would cause a client to be admitted to the intensive care unit? SATA

ALL Organ failure; Severe hypotension; Shock occurring due to septicemia; Deficient intravascular fluid volume; Cardiac output falling with a reduction in perfusion of vital organs

Which abnormal laboratory test would the nurse monitor in a client with cirrhosis who is receiving a neomycin enema?

Ammonia level Increased ammonia levels indicate that the liver is unable to detoxify protein byproucts.

Which test is most significantly related to the client's response to treatment of acute pancreatitis?

Amylase level In 90% of clients with acute pancreatitis, the amylase level is elevated up to three times over baseline; serum amylase usually returns to expected adult levels within 3 days after treatment begins.

The nurse determines that a client who becomes shaky after an episode of dumping syndrome does so because of which response in the body?

An overproduction of insulin that occurs in response to the rise in blood glucose

A client with gastroesophageal reflux disease (GERD) is being treated with dietary management. The client states, "I like to have a glass of juice every day." Which juice is the most appropriate for the client on dietary intervention for GERD?

Apple Apple juice is nonirritating to the stomach and intestines.

Which is the best nursing action to evaluate whether nasogastric continuous tube feeding is being absorbed?

Aspirate for a residual volume.

During administration of an antibiotic, the client becomes restless and flushed, and begins to wheeze. Which action would the nurse do after stopping the antibiotic infusion?

Assessing the client's respiratory status

Which information would the nurse include in the discharge teaching plan for a client hospitalized with gastritis?

Avoid alcohol and tobacco use

Which deficiency would a nurse conclude is causing a client to have difficulty digesting fatty foods?

Bile

Which nutrient deficiency would result in ketosis?

Carbohydrate

Which factor is most related to why cholesterol is important in the human body in normal levels?

Cellular membranes

Which factor increases the risk for wound dehiscence in a client who had major abdominal surgery 1 day ago?

Client being overweight

Which test is commonly prescribed to assess for diverticulitis?

Computed tomography (CT) scan

Which therapeutic effect would the nurse identify as the reason for administration of neomycin sulfate to a client before colon surgery?

Destroys intestinal bacteria

Which condition refers to the rapid gastric emptying of undigested food from the stomach into the small intestine?

Dumping syndrome

Which information would a nurse include when teaching a client with pancreatitis about dietary restrictions?

Eat small meals frequently.

Which important strategy that will most likely be a requirement for life will the nurse include in the discharge teaching for a client after a total gastrectomy?

Eat small, frequent meals.

Which would the nurse expect the health care provider to prescribe for a client admitted to the hospital with a diagnosis of acute salmonellosis?

Electrolytes

Which nursing action would be included in the plan of care for a client who is diagnosed with cancer of the pancreas and is apprehensive and restless?

Encouraging expression of concerns

When assessing a client's abdomen, the nurse palpates the area directly above the umbilicus. Which area is this known as?

Epigastric The stomach is located within the sternal angle, known as the epigastric area.

Which nutrients are heavily influenced by the effects of surgery for cancer of the pancreas?

Fats and carbohydrates Fats and carbohydrates should be limited because the exocrine function of the pancreas is the formation of lipase for fat digestion, and the endocrine function of the pancreas is the secretion of insulin, which is a hormone that is essential for carbohydrate metabolism.

Which factor does the nurse consider most likely associated with the client's ulcerative colitis?

Genetic predisposition Studies indicate that inflammatory bowel diseases, which include ulcerative colitis and Crohn disease, are familial, which suggests that they are hereditary.

Which finding on the medical record of a client with chest pain to rule out myocardial infarction indicates an increased risk for cardiovascular disease?

Gingivitis

Which prescription would the nurse question when reviewing the plan of care for a client with inadequate nutritional intake?

Give one can of diet supplement at 8:00 am and 4:00 pm

A client who is about to have a blood transfusion asks the nurse, "Which type of hepatitis is most frequently transmitted by transfusions?" Which type would the nurse respond with?

Hepatitis C Hepatitis C is caused by a ribonucleic acid (RNA) virus that is transmitted parenterally.

Which would the nurse consider to be the main reason a client may experience diarrhea from hypertonic tube feedings?

High osmolarity of the feedings

Which potential side effect would the nurse monitor for in a client with cirrhosis of the liver who develops ascites and is prescribed spironolactone?

Hyperkalemia

For which clinical indicator would the nurse assess in a client with cirrhosis of the liver who has an increased risk for hepatic coma?

Icterus Bile deposits will impart a yellowish tinge (jaundice or icterus) to the skin, often first observed in the sclerae.

Which action is most important for the nurse to focus on when caring for a client after abdominal surgery?

Identifying signs of bleeding

Which information about malignant tumors of the colon would the nurse consider when caring for a client admitted with cancer of the colon?

Intestinal obstructions are usually malignant. Mechanical obstruction is most often caused by obliteration of the lumen of the intestine by malignant cells.

Which finding is more likely to be identified in a client with ulcerative colitis than in a client with Crohn disease?

Involvement starting distally with rectal bleeding that spreads continuously up the colon

Which information would be determined before cholecystectomy surgery for an obstructed bile duct is scheduled?

Is the client deficient in vitamins A, D, and K?

Which information about vitamin A would the nurse consider when assessing a client for clinical indicators of vitamin A deficiency?

It is a necessary element of rhodopsin, which controls responses to light and dark environments. Vitamin A is used in the formation of retinol, a component of the light-sensitive rhodopsin (visual purple) molecule.

Which associated risk factor would the nurse assess for when collecting a health history on a client with tongue cancer?

Large amount of alcohol consumption. A large amount of alcohol consumption predisposes an individual to the development of oral cancer because it is a mucosal irritant.

Which frequently prescribed antidiarrheal drug would the nurse expect the health care provider to prescribe for a client with severe diarrhea?

Loperamide Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines.

A client who has had upper right quadrant pain for several months in now experiencing clay-colored stools. Laboratory results reveal elevated liver enzymes, and a needle biopsy of the liver is scheduled. Which education would the nurse include in the client's teachings about the procedure?

Lying on the right side after the procedure is required because it will decrease the risk for hemorrhage.

Which effect is the nurse trying to prevent when teaching a client to avoid regular use of bicarbonate of soda?

Metabolic alkalosis

A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. Which diet would the health care provider prescribe for this client based on the nurse's assessment?

Moderate protein

How would the nurse expect a client's stoma to appear on the second day after an abdominoperineal resection?

Most, red, and raised above the skin surface

What is the priority nursing intervention for a client with hepatic cirrhosis, ascites, and an elevated serum ammonia?

Observing the client for increasing confusion

The nurse recognizes that which female client is at the greatest risk of developing gallbladder disease?

Older than 40 years of age and obese

Which is the most serious complication associated with chronic inflammation of the bowel?

Perforation

Which condition would be a major complication of the ileal pouch anal anastomosis (IPAA) procedure?

Peritonitis

A client who recently had an abdominoperineal resection and colostomy accuses the nurse of being uncomfortable during a dressing change because the "wound looks terrible." Which defense mechanism would the nurse identify in this client?

Projection

A client who had a choledochostomy is returned to the surgical unit with a T-tube in place. Which intervention is the priority when caring for this client?

Protecting the abdominal skin from bile drainage.

A client is admitted with an acute onset of lower right quadrant pain. Appendicitis is suspected. Which clinical indicator is associated with appendicitis?

Rebound tenderness

A nurse is teaching menu planning to a client who has a high triglyceride level. Which food avoided by the client indicates that teaching about foods that are high in saturated fat was understood?

Red meat

Which reason for elevating the head when providing postoperative care for a client with esophageal cancer would a nurse explain to the nurse assistant?

Reduces the risk for reflux of gastric materials into the esophagus

Which information about a new client would indicate to the nurse that screening for hepatitis C is appropriate?

Reports a one-time use of intravenous drugs 20 years ago

A client with a ruptured appendix is scheduled for an appendectomy. Which position is best for a client returning from appendectomy for a ruptured appendix?

Semi-Fowler The semi-Fowler position localizes the spilled contents of the ruptured appendix in the lower part of the abdominal cavity.

Which clinical manifestation is an early sign of inguinal hernia strangulation?

Sharp abdominal pain

For which reason would the nurse question a client taking megadoses of vitamin A?

Since the liver can store vitamin A, the vitamin can reach toxic levels in the body if taken above the recommended daily dosage.

Which diet would the nurse teach a client scheduled for gastric bypass to maintain because it will help minimize the clinical manifestations of dumping syndrome?

Small, frequent feeding schedule

Which substance would a nurse teach a group of clients with irritable bowel syndrome to minimize in the diet to decrease gastrointestinal (GI) irritability?

Soda

The nurse responds to a client inquiring about how salmonellosis is diagnosed by telling the client that the medical diagnosis is established best by which diagnostic test?

Stool culture

Which response would be given by a nurse to a client diagnosed with hepatitis A who asks about current treatment options?

Supportive care There is no current treatment for hepatitis A except for supportive care and rest.

Which nursing action is appropriate when a client appears depressed after an extensive abdominal surgery?

Talking with the client and encouraging exploration of feelings

Which explanation would a nurse use to describe the cause of intussusception to a client?

Telescoping of a proximal loop of bowel into a distal loop intussusception is the telescoping or prolapse of a segment of the bowel into the lumen of an immediately connecting segment of the bowel.

Which explanation would a nurse give to a jaundiced client who has hepatitis and is expressing concern over the change in skin color?

The liver is unable to remove normal amounts of bilirubin from the blood.

Which information about antacid tablets would a nurse teach a client being treated for gastroesophageal reflux disease (GERD)?

They are known to interfere with the absorption of other drugs.

A 66-year-old woman who has a history of a 30-lb weight loss in 3 months with periods of constipation and diarrhea is diagnosed with cancer of the colon. Which information would the nurse incorporate into the client's teaching plan about malignant tumors of the colon and rectum?

They are the third most common cause of cancer in women. Colorectal cancer in women in common in the United States with approximately 68,000 women diagnosed each year.

While educating a client who is scheduled for a bowel resection, which explains the purpose of antibiotics prior to the surgery?

To decrease the number of bacteria in the gastrointestinal (GI) tract

Which is the primary nutritional goal for a client who has cholelithiasis with possible obstruction of the common bile duct?

To determine if the client is deficient in vitamins A, D, and K

A client is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver. The nurse suspects which type of toxicity?

Vitamin A

The nurse concludes that the client needs which additional vitamin when the client reports bleeding gums and has small hemorrhagic lesions on the face?

Vitamin K

Which prescribed vitamin is essential for the synthesis of prothrombin by the liver?

Vitamin K prothrombin, which is present in the plasma, is synthesized in the liver in the presence of vitamin K from the amino acid glutamine; vitamin K initiates

For which life-threatening postoperative problem would the nurse monitor a client with a fractured mandible that is immobilize with wires?

Vomiting

Which item included on a list of foods to avoid by a client with hypercholesterolemia supports the nurse's conclusion that teaching has been effective?

Whole milk and hard cheeses Milk and milk products are high in fat and should be limited to reduce cholesterol levels.

The nurse explains to the abdominal surgical client that a progressive postsurgical diet is characterized by which progressive alterations?

texture and digestibility of food