3130 EXAM #3 set 2

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The nurse is monitoring a client admitted to the hospital with a dx of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is appropriate nursing intervention? "A. Notify the physician B. Administer the prescribe pain medication C. Call and ask the operating room team to perform the surgery as soon as possible D. Reposition the client and apply a heating pad on warm setting to the clients abdomen"

Answer A The health-care provider should be noti-ﬁed when the nurse has the needed infor-mation.`

A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level. C. Performing a fecal occult blood test and administering IV calcium gluconate. D. Starting parenteral nutrition and placing the patient in high-Fowler's position

Answer A *A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube.* Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term.

"The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? "a. Rovsing sign b. referred pain c. Chvostek's sign d. rebound tenderness correct answer: A"

Answer A In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

"A patient with a history of peptic ulcer disease has presented to the ED with complaints of severe abdominal pain and a rigid, boardlike abdome, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticiptate? source: http://quizlet.com/20002414/nclex-review-lower-gi-problems-ibd-crohns-disease-ulcerative-colitis-flash-cards/ or Lewis chapt. 42 Upper GI NCLEX" "A: Providing IV fluids and inserting a nasogastric tube B:Administering oral bicarbonate and testing patient's gastric pH level C:Performing a fecal occult blood test and administering IV calcium gluconate D: Starting parenteral nutrition and placing the patient in high-fowler's position

Answer A, "A: providing IV fluids and inserting a nasogastric tube rationale: A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevent to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term

"A patient with a history of peptic ulcer disease has presented to the ED with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticiptate? "A: Providing IV fluids and inserting a nasogastric tube B:Administering oral bicarbonate and testing patient's gastric pH level C:Performing a fecal occult blood test and administering IV calcium gluconate D: Starting parenteral nutrition and placing the patient in high-fowler's position

"A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position

Answer A, A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term

Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings

Answer A, Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings

Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? "a. Change the tube feeding solutions and tubing at least every 24 hours b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings

The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products b. avoiding taking aspirin and drugs containing aspirin c. taking only drugs prescribed by the health care provider d. taking all drugs 1 hour before mealtime to prevent further bleeding e. reading all OTC drug labels to avoid those containing stearic acid and calcium

Answer A, C Aspirin contributes to thinning the blood and is linked to causing things like peritonitis further increasing the risk for bleeding. Taking only health care prescribed drugs can greatly reduce the risk from accidentally using OTC meds that might contribute to bleeding

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods? A) Fats, B)Carbohydrates, C) High-calcium foods, D) High-Sodium foods

Answer A, Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux

"The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to note documented in the client's record? "a. Diarrhea b. Chronic constipation c. Constipation alternating with diarrhea d. Stool constantly oozing from the rectum

Answer A,"(A) Crohns disease is characterized by nonbloody diarrhea of usually not more than 4 or 5 stools daily. overtime the stools increase frequency duration and severity

A female client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? a. Fast for 8 hours before the test b. Eat a regular supper and breakfast c. Continue to take all oral medications as scheduled d. Monitor own bowel movement pattern for constipation

Answer A. A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Most oral medications also are withheld before the test. After the procedure, the nurse must monitor for constipation, which can occur as a result of the presence of barium in the gastrointestinal tract.

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record? a. Diarrhea b. Chronic constipation c. Constipation alternating with diarrhea d. Stools constantly oozing form the rectum

Answer A. Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options B, C, and D are not characteristics of Crohn's disease.

The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? a. Sweating and pallor b. Bradycardia and indigestion c. Double vision and chest pain d. Abdominal cramping and pain

Answer A. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D

Answer A. Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted? a. 3.5 b. 7.0 c. 7.35 d. 7.5

Answer A. If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intension to increase the intake of: a. Pork b. Milk c. Chicken d. Broccoli

Answer A. The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid

The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? a. Increase fluid intake b. Place heat on the abdomen c. Perform the irrigation in the evening d. Reduce the amount of irrigation solution

Answer A. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and to take other measures to prevent constipation. Options B, C and D will not enhance the effectiveness of this procedure.

Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take? a. Hold the feeding b. Reinstill the amount and continue with administering the feeding c. Elevate the client's head at least 45 degrees and administer the feeding d. Discard the residual amount and proceed with administering the feeding

Answer A. Unless specifically indicated, residual amounts more than 100 mL require holding the feeding. Therefore options B, C, and D are incorrect. Additionally, the feeding is not discarded unless its contents are abnormal in color or characteristics.

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

Answer B Most clients with GERD have been self medicating with over-the counter medications prior to seeking advice from a healthcare provider. It is important to know what the client has been using to treat the problem.

The nurse has instructed the client who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the client understands the dietary changes if the client selects which of the following menu choices? a) Yogurt, crackers and sweet tea b) Salad with chicken, whole wheat crackers c) Bacon, tomato, lettuce with mayonnaise and a soft drink d) Tuna on white bread and coconut cake

Answer B Rationale: Bacon tomato lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar both contributing to diarrhea. *Salad, whole wheat crackers may decrease diarrhea due to increased fiber.* Dairy increases diarrhea. Food high in carbohydrates increase diarrhea. Coconut may increase diarrhea

The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products b. avoiding taking aspirin and drugs containing aspirin c. taking only drugs prescribed by the health care provider d. taking all drugs 1 hour before mealtime to prevent further bleeding. e. reading all OTC drug labels to avoid those containing stearic acid and calcium

Answer B & C Aspirin contributes to thinning the blood and is linked to causing things like peritonitis further increasing the risk for bleeding. Taking only health care prescribed drugs can greatly reduce the risk from accidentally using OTC meds that might contribute to bleeding

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 ml PO. The nurse would evaluate its effectiveness by questioning the patient as to whether which of the following symptoms has been resolved? A-Diarrhea B.Heartburn C.Constipation D. Lower abdominal pain

Answer B, "Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as with heartburn associated with GERD

What statement made by the client indicates to the nurse the client may be experiencing GERD?n "A. ""My chest hurts when I walk up the stairs in my home"" B. ""I take antacid tablets with me wherever I go"" C. ""My spouse tells me I snore very loudly at night"" D. ""I drink 6 to 7 soft drinks every day

Answer B, (B) Frequent use of antacids indicates an acid reflux problem

"The nurse has instructed the client who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the client understands the dietary changes if the client selects which of the following menu choices? a) Yogurt, crackers and sweet tea b) Salad with chicken, whole wheat crackers c) Bacon, tomato, lettuce with mayonnaise and a soft drink d) Tuna on white bread and coconut cake

Answer B,Rationale: Bacon tomato lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar both contributing to diarrhea. Salad, whole wheat crackers may decrease diarrhea due to increased fiber. Dairy increases diarrhea. Food high in carbohydrates increase diarrhea. Coconut may increase diarrhea

"The nurse is caring for a patient following an appendectomy. The patient takes a deep breath, coughs, and then winces in pain. Which of the following statements, if made by the nurse to the patient, is BEST? "A.) "Take three deep breaths, hold your incision, and then cough." B.) "That was good. Do that again and soon it won't hurt as much." C.) "It won't hurt as much if you hold your incision when you cough." D.) "Take another deep breath, hold it, and then cough deeply."

"(1) correct-most effective way of deep breathing and coughing, dilates airway and expands lung surface area (2) should splint incision before coughing to reduce discomfort and increase efficiency (3) partial answer, should take three deep breaths before coughing (4) implies coughing routine is adequate, incision needs to be splinted"

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

"1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach.CORRECT 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux

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

Which assessment data support the client's diagnosis of gastric ulcer? 1. Presence of blood in the client's stool for the past month. 2.Complaints of a burning sensation that moves like a wave. 3.Sharp pain in the upper abdomen after eating a heavy meal. 4.Comparison of complaints of pain with ingestion of food and sleep

"1. The presence of blood does not speciﬁcally indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer that would result in the presence of blood. 2. A wavelike burning sensation is a symptom of gastroesophageal reflus. 3. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. 4. (CORRECT) In a client diagosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain durin ghte night that is often relieved by eating food. Pain occurs 1-3 hours after meals

Which assessment data support the client's diagnosis of gastric ulcer?"1. Presence of blood in the client's stool for the past month. 2.Complaints of a burning sensation that moves like a wave. 3.Sharp pain in the upper abdomen after eating a heavy meal. 4.Comparison of complaints of pain with ingestion of food and sleep

In planning care for the patient with Crohn's disease, the nurse recognizees that a mojor difference between ulcdrative colitis and Crohn's disease is that Crohn's disease "a. frequently results in toxic megacolon b. causes fewer nutritional deficiencies than does ulcerative colitis C. Often recurs after surgery whereas UC is curable with colectomy d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis

"4. Correct answer: c Rationale: Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment

A client is admitted with right lower quadrant pain, anorexia, nausea, low-grade fever, and elevated white blood cell count. Which complication is most likely the cause? 1. A. fecalith 2. Bowel Kinking 3. Internal blowel occlusion 4. Abdominal wall swelling

"Answer 1 Rational: The client is experiencing appendicitis. A. fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion not internal occlusion, of the bowel by adhesions can also be cause of appendicitis."

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

"Avoid lying down for an hour after eating."

"A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for: a) colonoscopy. b) surgery. c) nasogastric (NG) tube insertion. d) barium enema."

"B) Surgery The client should be prepared for surgery because his signs and symptoms indicate bowel perforation. Appendicitis is the most common cause of bowel perforation in the United States. Because perforation can lead to peritonitis and sepsis, surgery wouldn't be delayed to perform other interventions, such as colonoscopy, NG tube insertion, or a barium enema. These procedures aren't necessary at this point."

The nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. The nurse should make which accurate statement to the client?

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

The pernicious anemia that may accompany gastritis is due to which of the following? a. Chronic autoimmune destruction of cobalamin stores in the body b. Progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss c. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa d. Hyperchlorhydria resulting from an inrease in acid-secreting parietal cells and degradation of RBC's

"Correct answer: c Rationale: Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lostthe loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin is depleted, and a deficiency state exists. Because it is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications

"During the assessment of a patient with acute abdominal pain, the nurse should: a. Perform deep palpation before ascultation b. Obtain blood pressure and pulse rate to determine hypervolemic changes c. Ascultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus d. Measure body temperature because an elevated temperature may indicate an inflammatory or infectious process"

"Correct answer: d Rationale: For the patient complaining of acute abdominal pain, the nurse should take vital signs immediately. Increased pulse and decreasing blood pressure (BP) are indicative of hypovolemia. An elevated temperature suggests an inflammatory or infectious process. Intake and output measurements provide essential information about the adequacy of vascular volume. Inspect the abdomen first and then auscultate bowel sounds. Palpation is performed next and should be gentle."

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

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

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

"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 important for the nurse to follow up?

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

A calcium supplement is prescribed for a client 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?

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

The nurse has given the client with hepatitis instructions about postdischarge management during convalescence. The nurse determines that the client needs further teaching if the client makes which statement?

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

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 supports the diagnosis of gastric ulcer?

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

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

"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 should be helpful initially in obtaining information for the nursing care plan?

"What is your understanding of celiac disease?"

"The nurse explains to the patient with gastroesophageal reflux disease that this disorder: "A. results in acid erosion of the esophagus caused by frequent vomiting B. Will require surgical wrapping of the pyloric sphincter to control the symptoms C. Is the protrusion of a portion of the stomach into the esophagus through the opening in the diaphragm D. Often involves relaxation of the lower esophageal sphincter, allowing the stomach contents to back up into the esophagus

"right answer: d Rationale: Gastroesophageal reflux disease (GERD) results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux

"Which assessment data support the client's diagnosis of gastric ulcer? 1.Presence of blood in the client's stool for the past month.2.Complaints of a burning sensation that moves like a wave.3.Sharp pain in the upper abdomen after eating a heavy meal.(4).Comparison of complaints of pain with ingestion of food and sleep

(4) In a client diagnosed with a gastric ulcer,pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during thenight that is often relieved by eating food.Pain occurs 1-3 hours after meals

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

- Answer: D In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating foods. Other answers: the presence of blood does not specifically indicate diagnose of an ulcer. The client could have hemorrhoids or cancer. A waveline burning sensation is a symptom of GERD. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease

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

-Administer antacids, as prescribed. -Encourage coughing and deep breathing -Administer anticholinergics, as prescribed

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 are most likely to promote coping? Select all that apply.

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

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

-Avoid potentially hepatotoxic over-the-counter drugs -Teach symptoms of complications and when to seek prompt medical attention -Explain that cirrhosis of the liver is a chronic illness and the importance of continuous health care. -Avoid spicy and rough foods and activities that increase portal pressure such as straining at stool, coughing, sneezing and vomiting.

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

-Chemical - Absorption -Mechanical -Active transport

The nurse who is reinforcing instructions to a client following gastric resection should include which suggestions? Select all that apply.

-Eat small frequent meals. -Take action to prevent dumping syndrome

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

-Eat smaller and more frequent meals -Drink fluids between meals not with them.

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 should the nurse collect to assist in validating this suspicion? Select all that apply.

-Inspect the abdomen for rigidity. -Check for the presence of hiccups. -Inspect the client's mucous membranes.

A client has had a partial gastrectomy and the nurse is reinforcing discharge instructions. The nurse should tell the client about the need for which? Select all that apply.

-Iron supplements -Calcium supplements -Vitamin B12 injections

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

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

The nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression. Which settings will the health care provider prescribe? Select all that apply.

-Low -Intermittent

A client in the 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.

-Milk of magnesia -Heat pad to the abdomen

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 should perform the following actions/prescriptions in which priority order? Arrange the actions in the order they should be performed. All options must be used.

-Obtain vital signs and draw blood for laboratory analysis. -Ensure the client receives intravenous pain medication. -Hydrate the client with intravenous fluids. -Place a nasogastric tube. Client is NPO (nothing by mouth). -Inquire about when pain occurs and previous history including medications and alcohol.

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. Which findings validate this suspicion? Select all that apply.

-Oliguria -Restlessness -Abdominal pain -Unexplained tachycardia

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

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

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

-Pyrosis (heartburn), water brash, and flatulence Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas-all symptoms of GERD.

The nurse is administering morning medications at 0730. Which medication should have priority? A. a proton pump inhibitor B. A nonnarcotic analgesicC. A histamine receptor antagonist D. A mucosal barrier agent

...CORRECT ANSWER: D.A. PPI's can be administered routinely. B. Pain medication is important but can be adminstered after a medication that is timed. C. A histamine receptor antagonist can be administered at routine dosing time. D. A mucosal barrier agent must be adminstered on an empty stomach for the medication to coat the stomach lining

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

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

33. Which oral medication should the nurse question before administering to the client with PUD? 1. E-mycin, an antibiotic 2. Prilosec, a PPI 3. Flagyl, an antimicrobial agent 4. Tylenol, a nonnarcotic analgesic

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

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

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

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

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

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8°F (38.8°C). What should the nurse do in response to these reported assessment data? 1.Promptly assess the client for potential perforation. 2.Tell the assistant to change thermometers and retake the temperature. 3.Plan to give the client acetaminophen (Tylenol) to lower the temperature. 4.Ask the UAP to bathe the client with tepid water.

1 A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers is not an appropriate action and only further delays the appropriate action of assessing the client. The nurse would not administer acetaminophen without further assessment of the client or without a physician's prescription; a suspected perforation would require that the client be placed on nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the nurse is inappropriate.

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply. 1. Obtain adequate rest to reduce stimulation. 2. Eat small, frequent meals throughout the day. 3. Take all medications on time as ordered. 4. Sit up for one hour when awakened at night. 5. Stay away from crowded areas.

1, 2, 3, 4. The nurse should encourage the client to reduce stimulation that may enhance gastric secretion. The nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. Medications should be administered promptly to maintain optimum levels. After awakening during the night, the client should eat a small snack and return to bed, keeping the head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

A client with a peptic ulcer reports epigastric pain that frequently causes the client to wake up during the night. The nurse should instruct the client to do which activities? Select all that apply. 1.Obtain adequate rest to reduce stimulation. 2.Eat small, frequent meals throughout the day. 3.Take all medications on time as prescribed. 4.Sit up for 1 hour when awakened at night. 5.Stay away from crowded areas.

1,2,3,4 The nurse should encourage the client to reduce stimulation that may enhance gastric secretion. The nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. Medications should be administered promptly to maintain optimum levels. After awakening during the night, the client should eat a small snack and return to bed, keeping the head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

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

1,2,4

64. Which signs and symptoms should the nurse report to the health-care provider for the client recovering from an open cholecystectomy? Select all that apply. 1. Clay-colored stools 2. Yellow-tinted sclera 3. Amber-colored urine 4. Wound approximated 5. Abdominal pain1

1,2,5

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the nurse do in response to this reported assessment data? 1. Promptly assess the client for potential perforation. 2. Tell the assistant to change thermometers and retake the temperature. 3. Plan to give the client acetaminophen (Tylenol) to lower the temperature. 4. Ask the assistant to bathe the client with tepid water.

1. A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers is not an appropriate action and only further delays the appropriate action of assessing the client. The nurse would not administer acetaminophen without further assessment of the client or without a physician's order; a suspected perforation would require that the client be placed on nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the nurse is inappropriate.

The nurse instructs the client on health maintenance activities to help control symptoms from her hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1. "I'll avoid lying down after a meal." 2. "I can still enjoy my potato chips and cola at bedtime." 3. "I wish I didn't have to give up swimming." 4. "If I wear a girdle, I'll have more support for my stomach."

1. "I'll avoid lying down after a meal." A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided.

When providing instructions to a patient recently diagnosed with diverticulosis, the nurse should be sure to include which information? 1. A diet high in fiber and without spicy foods can be beneficial. 2. It is characterized by inflammation and ulceration of the colon. 3. Steroids are commonly prescribed and should be taken with food. 4. Treatment usually includes surgery and the creation of a colostomy.

1. A diet high in fiber and without spicy foods can be beneficial. A diet high in fiber and without spicy foods is recommended for patients with diverticulosis. Ulcerative colitis is characterized by inflammation and ulceration in the colon. Steroids are not commonly prescribed for diverticulosis. Treatment of diverticulosis does not usually include a colostomy.REF: p. 841

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

1. A history of problems the client has experienced with medications is taken during the admission interview. This information does not specifically address peptic ulcer disease. 2. Use of NSAIDs places the client at risk for peptic ulcer disease and hemorrhage. NSAIDs suppress the production of prostaglandin in the stomach, which is a protective mechanism to prevent damage from hydrochloric acid. 3. Allergies are included for safety, but this is not specific for peptic ulcer disease. 4. Information needs to be obtained about past generations so the nurse can analyze any potential health problems, but this is not specific for peptic ulcer disease TEST-TAKING HINT: The words "specific data" indicate there will be appropriate data in one (1) or more of the answer options but only one (1) is specific to peptic ulcer disease

The client has been on a therapeutic regimen for an H. pylori infection. Which data suggests the medication is not effective? 1. The client states that the midepigastric pain has been relieved. 2. The client's Hgb level is 15 g/dL and Hct level is 44%. 3. The client has gained 3 pounds in 1 week. 4. The client's pulse is 124 beats per minute and blood pressure is 92/48.

1. A lack of epigastric pain would indicate the medication is effective. The question asks which data indicates the medication is not effective. 2. An Hgb level of 15 g/dL and Hct level of 44% are within normal limits and would indicate that the client is not bleeding as a result of the ulcer. 3. Clients who experience a gastric ulcer lose weight because of the pain associated with eating. A weight gain would indicate less pain and the client being able to consume nutrients. 4. The client has a rapid pulse and low blood pressure, which indicate shock. This could be caused by hemorrhage from the ulcer. This client's treatment has not been effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

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

1. A pain assessment is an independent intervention the nurse should implement frequently. 2. Evaluating vital signs is an independent intervention the nurse should implement. If the client is able, BPs should be taken lying, sitting, and standing to assess for orthostatic hypotension. 3. This is a collaborative intervention the nurse should implement. It requires an order from the HCP. 4. Administering blood products is collaborative, requiring an order from the HCP. 5. The diet requires an order by the health-care provider, but a diet will not be ordered because the client is NPO. TEST-TAKING HINT: Descriptive words such as "collaborative" or "independent" can be the deciding factor when determining if an answer option is correct or incorrect. These

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

1. Auscultation should be used prior to palpation or percussion when assessing the abdomen. Manipulation of the abdomen can alter bowel sounds and give false information. 2. Palpation gives appropriate information the nurse needs to collect, but if done prior to auscultation, the sounds will be altered. 3. Percussion of the abdomen does not give specific information about peptic ulcer disease. 4. Tender areas should be assessed last to prevent guarding and altering the assessment. This includes palpation, which should be done after auscultation. TEST-TAKING HINT: The word "first" requires the test taker to rank in order the interventions needing to be performed. The test taker should visualize caring for the client. This will assist the test taker in making the correct choice.

An LPN is instructing a class of patients on the prevention of constipation. What is an example of a meal that would be MOST effective at preventing constipation? 1. Chef salad, whole grain roll, and strawberries 2. Scrambled eggs with bagels and cream cheese 3. Spaghetti made with white pasta and a salad 4. Pork chop, carrot-and-raisin-salad, and mashed potatoes

1. Chef salad, whole grain roll, and strawberries A meal high in fiber is the most appropriate meal for preventing constipation. A meal consisting of a chef salad, whole grain roll, and strawberries is the most appropriate choice because of the use of whole grains, raw vegetables, and raw fruits. Scrambled eggs and bagels with cream cheese would be an inappropriate meal selection because of the overall lack of fiber. Spaghetti with white pasta and a salad would be inappropriate because of the lack of fiber in white pasta. Although there is fiber in the carrot-and-raisin salad, the mashed potatoes and pork chop make this meal choice incorrect because of the lack of fiber. REF: p. 831

The client diagnosed with severe congestive heart failure (CHF) is reporting indigestion. Which antacid medication should the nurse administer? 1. Sodium bicarbonate. 2. Aluminum hydroxide. 3. Magaldrate. 4. Calcium carbonate/magnesium carbonate.

1. Clients with CHF are limited in the amount of sodium they should consume. Sodium bicarbonate has sodium as an ingredient. 2. Aluminum hydroxide (Amphojel), an antacid, is not a low-sodium preparation. This client requires a low-sodium antacid. 3. Magaldrate (Riopan), a low-sodium antacid, is the antacid of choice for clients who need to limit their sodium intake. 4. Calcium carbonate/magnesium carbonate (Mylanta), a combination antacid, is not a low-sodium preparation. This c

A patient asks if surgery would cure her Crohn disease. She states that her friend's ulcerative colitis was cured with surgery. The nurse should explain that surgery is used to treat Crohn disease less often than to treat ulcerative colitis for what reason? 1. Crohn disease usually returns near the site of the anastomosis 2. Crohn disease typically involves the entire small and large intestines 3. Crohn disease usually can be cured with combination drug therapy 4. Crohn disease is associated with an increased risk of surgical complications

1. Crohn disease usually returns near the site of the anastomosis Recurrence is so common that surgery is not usually done unless necessitated by serious complications. Postoperatively, the disease typically reappears at the site of anastomosis within 1 year. Newly affected areas also may appear in other sections of the intestine. Crohn disease can affect any area of the gastrointestinal tract. It is most often treated with a combination of drug therapy. There is no increased risk of surgical complications for Crohn disease. Patients with Crohn disease also are thought to have an increased risk of colon cancer.

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

1. Decreasing the alcohol intake indicates the client is making some lifestyle changes. 2. The client with peptic ulcer disease (PUD) is prescribed a regular diet, but the type of diet does not determine if the medication is effective. 3. The return to previous activities indicates the client has not adapted to the lifestyle changes and has returned to the previous behaviors which precipitated the peptic ulcer disease. 4. Antibiotics, proton pump inhibitors, and Pepto-Bismol are administered to decrease the irritation of the ulcerative area and cure the ulcer. A decrease in gastric distress indicates the medication is effective. TEST-TAKING HINT: To determine the effectiveness of a medication, the test taker must know the scientific rationale for administering the medication. Peptic ulcer disease causes gastric distress. If gastric distress is relieved, then the medication is effective.

The nurse is reviewing the record of a female client with Crohn disease. Which stool characteristics should the nurse expect to find in the patient's history? 1. Diarrhea 2. Chronic constipation 3. Constipation alternating with diarrhea 4. Stools constantly oozing from the rectum

1. Diarrhea With Crohn disease, an inflamed colon typically causes abdominal pain, cramping, rectal bleeding, and diarrhea. Many factors can contribute to constipation. When stool is present in the rectum, the urge to defecate occurs. If the urge is ignored, then stool remains in the rectum longer than usual and becomes dry. It is then more difficult, and sometimes painful, to have a bowel movement. People who frequently ignore the urge to defecate may become chronically constipated. The frequent use of laxatives or enemas also may contribute to chronic constipation. These medications keep the lower digestive tract empty and eventually interfere with the normal pattern of elimination. Constipation alternating with diarrhea may be a symptom of bowel obstruction. Stool consistently oozing from the rectum may a symptom of fecal impaction.

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

1. E-mycin is irritating to the stomach, and its use in a client with peptic ulcer disease should be questioned. 2. Prilosec, a proton pump inhibitor, decreases gastric acid production, and its use should not be questioned by the nurse. 3. Flagyl, an antimicrobial, is administered to treat peptic ulcer disease secondary to H. pylori bacteria. 4. Tylenol can be safely administered to a client with peptic ulcer disease. TEST-TAKING HINT: The test taker needs to understand how medications work, adverse effects of medications, when to question administering a specific medication, and how to administer the medication safely. By learning classifications, the test taker should be able to make a knowledgeable selection in most cases.

Which of the following dietary measures would be useful in preventing esophageal reflux? 1. Eating small, frequent meals. 2. Increasing fluid intake. 3. Avoiding air swallowing with meals. 4. Adding a bedtime snack to the dietary plan.

1. Eating small, frequent meals. Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals.

A nurse is caring for a client diagnosed with suspected acute pancreatitis. When reviewing the client's laboratory results, the nurse interprets that which finding will support the diagnosis? 1. Elevated serum lipase level 2. Elevated serum bilirubin level 3. Decreased serum trypsin level 4. Decreased serum amylase level

1. Elevated serum lipase level

A resident in a nursing home requests information on how to reduce problems with constipation. What would be some teaching techniques to help regulate stool frequency? Select all that apply. 1. Exercise daily. 2. Drink less water. 3. Drink more water. 4. Take laxatives daily. 5. Eat more high-fiber foods.

1. Exercise daily. 3. Drink more water. 5. Eat more high-fiber foods. The patient should exercise daily, drink more water, and include high-fiber foods. Drinking less water would exacerbate constipation as high-fiber foods absorb water. Daily laxatives are not an appropriate way to reduce constipation.REF: p. 831

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods? 1. Fats. 2. High-sodium foods. 3. Carbohydrates. 4. High-calcium foods.

1. Fats. Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss.

The intensive care nurse is preparing to administer ranitidine IV piggyback (IVPB) to a client with severe burns. Which statement is the scientific rationale for administering this medication? 1. Ranitidine IVPB will prevent an H. pylori infection. 2. The client has a history of ulcer disease. 3. It is for prophylaxis to prevent Curling's ulcer. 4. There is no rationale; the nurse should question the order

1. H. pylori is a bacterial infection. Ranitidine (Zantac) is an H2 receptor blocker, not an antibiotic, and would not prevent an infection. 2. In this situation, Zantac or a PPI would be administered to all clients, not just those with a history of ulcer disease. 3. Ranitidine (Zantac) is an H2 receptor blocker. Because of the fluid shifts that occur as a result of severe burn injuries, the blood supply to the gastrointestinal tract is diminished, while the stress placed on the body increases the gastric acid secretion, leading to gastric ulcers, a condition called Curling's ulcer. Ranitidine (Zantac) would be administered to decrease the production of gastric acid. 4. The nurse should request an H2 receptor blocker or a PPI if one is not ordered. The nurse would not question the order.

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1. Heartburn. 2. Jaundice. 3. Anorexia. 4. Stomatitis.

1. Heartburn. Heartburn, the most common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms.

The physician prescribes metoclopramide hydrochloride (Reglan) for the client with hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.

1. Increase tone of the esophageal sphincter. Metoclopramide hydrochloride (Reglan) increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux.

The male client diagnosed with PUD has been taking magnesium hydroxide for indigestion. The client reports that he has been having diarrhea. Which intervention should the nurse implement? 1. Suggest that the client use magnesium hydroxide with aluminum hydroxide. 2. Encourage the client to discuss the problem with the HCP. 3. Tell the client to take loperamide, over the counter (OTC). 4. Discuss why the client is concerned about experiencing diarrhea

1. Magnesium hydroxide (Milk of Magnesia) is the most potent antacid, but it is usually used as a laxative because of the actions of magnesium hydroxide on the bowel. A combination antacid—magnesium hydroxide (produces diarrhea) and aluminum hydroxide (produces constipation)—is preferred to balance the side effects. 2. The nurse can answer the client's question. It is only necessary to discuss this with the HCP if antacids are not resolving the client's report of indigestion. 3. The Milk of Magnesia is causing the problem and changing antacids should resolve the situation. 4. Most clients are concerned about diarrhea and the nurse should be concerned about fluid and electrolyte imbalances resulting from diarrhea

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

1. Maintaining a strict record of intake and output is important to evaluate the progression of the client's condition, but it is not the most important intervention. 2. Inserting a nasogastric tube and lavaging the stomach with saline is the most important intervention because this directly stops the bleeding. 3. A calorie count is important information assisting in the prevention and treatment of a nutritional deficit, but this intervention does not address the client's immediate and lifethreatening problem. 4. Promoting a quiet environment aids in the reduction of stress, which can cause further bleeding, but this will not stop the bleeding. TEST-TAKING HINT: The test taker is required to rank the importance of interventions in the question. Using Maslow's hierarchy of needs to rank physiological needs first, the test taker should realize inserting a nasogastric tube and beginning lavage is solving a circulation or fluid deficit problem

Which condition occurs when the large intestine loses the ability to contract effectively enough to propel the fecal mass toward the rectum? 1. Megacolon 2. Obstipation 3. Fecal impaction 4. Intestinal obstruction

1. Megacolon Megacolon is a condition in which the large intestine loses the ability to contract effectively enough to propel the fecal mass toward the rectum. Obstipation is severe constipation. Fecal impaction can occur when severe constipation is accompanied by mild diarrhea. Intestinal obstruction can be caused by many factors including a volvulus, intussusception, hernia, or tumor.REF: p. 832

The nurse is administering 0900 medications to a client diagnosed with PUD. Which medication should the nurse question? 1. Metronidazole 2. Bismuth subsalicylate 3. Lansoprazole 4. Sucralfate

1. Metronidazole (Flagyl), a gastrointestinal anti-infective, is administered in combination with Pepto Bismol, Prevacid, and one other antibiotic to treat PUD. The nurse would not question this medication. 2. Bismuth subsalicylate (Pepto Bismol), an antimicrobial, is administered in combination with Flagyl, Prevacid, and one other antibiotic to treat PUD. The nurse would not question this medication. 3. Lansoprazole (Prevacid), a PPI, is administered with a combination of antibiotics to treat PUD. The nurse would not question this medication. 4. Sucralfate (Carafate) is a mucosal barrier agent and must be administered on an empty stomach for the medication to coat the stomach lining. The nurse should question the time the medication is scheduled for and arrange for the medication to be administered at 0730.

The nurse is administering 0800 medications. Which medication should the nurse question? 1. Misoprostol to a 29-year-old female with an NSAID-produced ulcer. 2. Omeprazole to a 68-year-old male with a duodenal ulcer. 3. Furosemide to a 56-year-old male with a potassium level of 4.2 mEq/L. 4. Acetaminophen to an 84-year-old female with a frontal headache.

1. Misoprostol (Cytec) is a prostaglandin analog. A 29-year-old female is of childbearing age. The nurse should determine that the client is not pregnant before administering this medication. Misoprostol can be used ina combination with mifepristone to produce an abortion. 2. Omeprazole (Prilosec), a PPI, is prescribed to treat duodenal and gastric ulcers; therefore, the nurse would not question this medication. 3. Furosemide (Lasix) is a loop diuretic. The potassium level is within normal range (3.5-5.5 mEq/L); therefore, the nurse would not question this medication. 4. Acetaminophen (Tylenol), a non-narcotic analgesic, is frequently administered for headaches; therefore, the nurse would not question this medication.

The nurse is asked to speak at a support group for people with ulcerative colitis. Which content should be included in the presentation? (Select all that apply) 1. Stress management may help to control symptoms 2. Ulcerative colitis is caused by bacterial infection 3. Avoid caffeine and any food that causes symptoms 4. Have regular colon screening examinations 5. Medications are needed only when acute symptoms occur

1. Stress management may help to control symptoms 3. Avoid caffeine and any food that causes symptoms 4. Have regular colon screening examinations 5. Medications are needed only when acute symptoms occur Content that needs to be included in a presentation to an ulcerative colitis support group includes: stress reduction measures to help control symptoms, avoidance of caffeine and other irritating fluids and foods, regular colon screening because of an increased risk of cancer, and drugs to treat acute attacks and preventing future attacks. After an acute attack has subsided, the drug dosage is gradually reduced. There may also be periods of remission lasting several weeks to several years. The exact cause of ulcerative colitis is unknown.

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

1. Sudden sharp pain felt in the substernal area indicates angina or myocardial infarction. 2. A rigid, boardlike abdomen with rebound tenderness is the classic sign/symptom of peritonitis, which is a complication of a perforated gastric ulcer. 3. Clay-colored stools indicate liver disorders, such as hepatitis. 4. Clients with gallbladder disease report vague to sharp abdominal pain in the right upper quadrant. TEST-TAKING HINT: The only two (2) answer options that refer to the abdomen are options "2" and "4." Therefore, the test taker should select one (1) of these two (2) because a gastric ulcer involves the stomach.

The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1. Take a laxative. 2. Follow a clear liquid diet. 3. Administer an enema. 4. Take an antiemetic.

1. Take a laxative. The client should take a laxative after an upper gastrointestinal series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction.

The client is diagnosed with a Helicobacter pylori infection and peptic ulcer disease (PUD). Which discharge instructions should the nurse teach? Select all that apply. 1. Discuss placing the head of the bed on blocks to prevent reflux. 2. Teach to never use NSAIDs again. 3. Encourage the client to quit smoking cigarettes. 4. Instruct the client to eat a soft, bland diet. 5. Take the combination of medications for 14 days as directed.

1. The client has PUD, not GERD, for which elevating the head of the bed would be recommended. 2. The client's ulcer is caused by a bacterial infection, not NSAID use. The client should limit use of NSAIDs until the ulcer has healed to prevent complicating the healing process, but the client should be able to use NSAID medications once the H. pylori infection has been treated. 3. Smoking decreases prostaglandin production and results in decreased protection of the mucosal lining. Smoking should be stopped. 4. A soft, bland diet is not ordered for a client with PUD. 5. H. pylori is a bacterial infection that is treated with a combination of medications. At least two antibiotics and an antisecretory medication will be ordered. As with all antibiotic prescriptions, the client should be taught to take all the medications as ordered. Resistant strains of H. pylori are being documented in clients who have not been compliant with the treatment program.

1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach.CORRECT 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux

The client diagnosed with PUD is admitted to the medical unit with a hemoglobin (Hgb) level of 6.2 g/dL and a hematocrit (Hct) level of 18%. Which intervention should the nurse prepare to implement first? 1. Obtain an order for an oral PPI. 2. Instruct the client to save all stools for observation. 3. Initiate an IV with 0.9% normal saline (NS) with an 18-gauge catheter. 4. Place a bedside commode in the client's room

1. The client would need an IV PPI at first and then later could be changed to an oral PPI. The client may also need a nasogastric tube or to be NPO. This client has very low Hgb and Hct levels, indicating active bleeding and the need for a fast route for the delivery of fluids and medications. 2. The nurse should observe the stool for color (black) and consistency (tarry) indicating blood, but this is not the first action. 3. This client has very low blood counts; is at risk for shock; and should be assessed for hypotension, tachycardia, and cold clammy skin. The client will need fluid and blood cell replacement. The nurse should start the IV as soon as possible. 4. The client should have a bedside commode for safety, but it is not the first intervention. Prevention of or treating shock is the first intervention. MEDICATION MEMORY JOGGER: The stem told the test taker the client's Hgb and Hct levels, which were levels indicating a "crisis" situation. The first step in many crises is to make sure that an IV access is available to administer fluids and medications

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

1. The esophagogastroduodenoscopy (EGD) is an invasive diagnostic test that visualizes the esophagus, stomach, and duodenum to accurately diagnose an ulcer and evaluate the effectiveness of the client's treatment. 2. Magnetic resonance imaging (MRI) shows cross-sectional images of tissue or blood flow. 3. An occult blood test shows the presence of blood but not the source. 4. A gastric acid stimulation test is used to understand the pathophysiology of ulcer disease, but it has limited usefulness. TEST-TAKING HINT: If the test taker has no idea what the correct answer is, knowledge of anatomy can help identify the answer. A peptic ulcer is an ulcer in the stomach, and in option "1" the word "esophagogastroduodenoscopy" has "gastro," which refers to the stomach. Therefore, this would be the best option to select as the correct answer.

A patient who was admitted with severe abdominal pain is being evaluated for possible appendicitis. The physician should be notified immediately if the nurse's assessment reveals which of the following? 1. The patient's WBC count is 15,000/mm3 2. Palpation at McBurney point causes pain 3. The patient keeps both hips flexed 4. The patient's abdomen is rigid

1. The patient's WBC count is 15,000/mm3 2. Palpation at McBurney point causes pain 3. The patient keeps both hips flexed 4. The patient's abdome A diagnosis of appendicitis is based on classic signs and symptoms and a white blood cell (WBC) count of 10,000 to 15,000/mm3. The classic symptom of appendicitis is pain at the McBurney point, which is located midway between the umbilicus and the iliac crest. The patient may also assume a position of hip flexion and be unable to straighten the right leg without pain. The abdomen may be rigid, although this sign is often absent with peritonitis in older patients.

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

1. The presence of blood does not specifically indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer resulting in the presence of blood. 2. A wavelike burning sensation is a symptom of gastroesophageal reflux Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease 4. In a client diagnosed with a gastric ulcer, pain usually occurs 30 to 60 minutes after eating but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating food. Pain occurs one (1) to three (3) hours after meals. TEST-TAKING HINT: This question asks the test taker to identify assessment data specific to the disease process. Many diseases have similar symptoms, but the timing of symptoms or their location may help rule out some diseases and provide the health-care provider with a key to diagnose a specific disease—in this case, peptic ulcer disease. Nurses are usually the major source for information to the health-care team

1. The presence of blood does not speciﬁcally indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer that would result in the presence of blood. 2. A wavelike burning sensation is a symptom of gastroesophageal reflus. 3. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. 4. (CORRECT) In a client diagosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain durin ghte night that is often relieved by eating food. Pain occurs 1-3 hours after meals

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

1. The range for normoactive bowel sounds is from five (5) to 35 times per minute. This would require no intervention. 2. Belching after a heavy, fatty meal is a symptom of gallbladder disease. Eating late at night may cause symptoms of esophageal disorders. 3. A decrease of 20 mm Hg in blood pressure after changing position from lying, to sitting, to standing is orthostatic hypotension. This could indicate the client is bleeding. 4. A decrease in the quality and quantity of discomfort shows an improvement in the client's condition. This would not require further intervention. TEST-TAKING HINT: When the question asks about further intervention, the test taker should examine the answer options for an unexpected out

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

1. There is no indication from the question there is a problem or potential problem with bowel elimination. 2. Knowledge deficit does not address physiological complications. 3. This client may have problems from changing roles within the family, but the question asks for potential physiological complications, not psychosocial problems. 4. Potential for alteration in gastric emptying is caused by edema or scarring associated with an ulcer, which may cause a feeling of "fullness," vomiting of undigested food, or abdominal distention TEST-TAKING HINT: This question asks the test taker to identify a physiological problem identifying a complication of the disease process. Therefore, options "2" and "3" could be eliminated because they do not address physiological problems.

The female client diagnosed with low back pain has been self-medicating with ibuprofen around the clock. The client calls the clinic and tells the nurse that she has been getting dizzy and light-headed. Which intervention should the nurse implement? 1. Tell the client to get up from a sitting or lying position slowly. 2. Have the client come to the clinic for lab work immediately. 3. Suggest the client take the ibuprofen with food or an antacid. 4. Discuss changing to a different NSAID.

1. This is information to teach when the client is taking antihypertensive medications, not NSAIDs. 2. Ibuprofen (Motrin) is an NSAID. A life-threatening complication of NSAID use is the development of gastric ulcers that can hemorrhage. Dizziness and light-headedness could indicate a bleeding problem. The client has been taking the medications "around the clock," indicating use during the night when it would be unusual for the client to consume food along with the medication. 3. NSAID medications should be taken with food or something to coat the stomach lining, but this client is symptomatic and should be seen by an HCP. 4. There is no reason to suggest a change in NSAID. The nurse should be concerned that the client has developed an NSAID-produced ulcer.

As the nurse, you teach your patient with diverticulosis to: (Select all that apply) 1. Use anticholinergic medications to prevent bowel spasm 2. Get an annual colonoscopy to detect any possible changes that may be cancerous 3. Keep eating a high-fiber diet and using bulk laxatives to increase fecal volume 4. Not consume whole-grain breads and cereals to prevent further irritation of the bowel

1. Use anticholinergic medications to prevent bowel spasm 2. Get an annual colonoscopy to detect any possible changes that may be cancerous 3. Keep eating a high-fiber diet and using bulk laxatives to increase fecal volume Anticholinergic drugs may be given to decrease spasms in the colon. Patients with diverticulosis need to get an annual colonoscopy to detect any possible changes that may be cancerous. Stool softeners or bulk-forming laxatives are used to treat constipation, and antidiarrheals are prescribed for those who have diarrhea. Other high-fiber foods are dried beans, most vegetables, and fruits. Diverticulosis is currently being treated with a high-residue, high-fiber diet without spicy foods. Whole-grain breads, brown rice, and whole-grain cereals are recommended.

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

1. Use of NSAIDs increases and causes problems associated with peptic ulcer disease. 2. Maintaining lifestyle changes such as following an appropriate diet and reducing stress indicate the client is complying with the medical regimen. Compliance is the goal of treatment to prevent complications. 3. Hemoptysis is coughing up blood, which is not a sign or symptom of peptic ulcer disease. This would not be an expected outcome. 4. Antacids should be taken one (1) to three (3) hours after meals, not with each meal. TEST-TAKING HINT: Expected outcomes are positive completion of goals; maintaining lifestyle modifications would be an appropriate goal for any client with any chronic illness

Residents of an assisted living facility have asked how they can reduce the risk of colon cancer. The nurse should recommend a high intake of which of the following? (Select all that apply.) 1. Vegetables 2. Fruits 3. Fat 4. Fiber 5. Proteins

1. Vegetables 2. Fruits 4. Fiber 5. Proteins The diet should include high-fiber foods such as fruits, raw vegetables, greens, whole grains, and lean proteins in the diet. Animal proteins and fats should be avoided, along with irritating foods and alcohol.

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

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

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

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

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

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

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

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

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from a briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1.Involvement with the job will keep the client from becoming bored. 2.A relaxed environment will promote ulcer healing. 3.Not keeping up with the job will increase the client's stress level. 4.Setting limits on the client's behavior is an important nursing responsibility.

2 A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1.Demonstrate appropriate use of analgesics to control pain. 2.Explain the rationale for eliminating alcohol from the diet. 3.Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4.Eliminate engaging in contact sports.

2 Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease. Analgesics are not used to control ulcer pain; many analgesics are gastric irritants. The client's hemoglobin and hematocrit typically do not need to be monitored every 3 months, unless gastrointestinal bleeding is suspected. The client can maintain an active lifestyle and does not need to eliminate contact sports as long as they are not stress inducing.

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.

2, 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. 1. The client has a sore throat. 2. The client has a temperature of 100 ° F (37.8 ° C). 3. The client appears drowsy following the procedure. 4. The client has epigastric pain. 5. The client experiences hematemesis.

2, 4, 5. Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

A client with peptic ulcer disease reports being nauseated most of the day and now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1.Administering an antacid hourly until nausea subsides. 2.Monitoring the client's vital signs. 3.Notifying the physician of the client's symptoms. 4.Initiating oxygen therapy. 5.Reassessing the client in an hour.

2,3 The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if prescribed by the physician.

The nurse is caring for a client who has had a gastroscopy. Which of the following may indicate that the client is developing a complication related to the procedure? Select all that apply. 1.The client has a sore throat. 2.The client has a temperature of 100°F (37.8°C). 3.The client appears drowsy following the procedure. 4.The client has epigastric pain. 5.The client experiences hematemesis

2,4,5 Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1. Involvement with his job will keep the client from becoming bored. 2. A relaxed environment will promote ulcer healing. 3. Not keeping up with his job will increase the client's stress level. 4. Setting limits on the client's behavior is an important nursing responsibility.

2. A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate contact sports from his or her lifestyle.

2. Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease. Analgesics are not used to control ulcer pain; many analgesics are gastric irritants. The client's hemoglobin and hematocrit typically do not need to be monitored every 3 months, unless gastrointestinal bleeding is suspected. The client can maintain an active lifestyle and does not need to eliminate contact sports as long as they are not stress-inducing.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? 1. Ineffective coping related to fear of diagnosis of chronic illness. 2. Deficient knowledge related to unfamiliarity with significant signs and symptoms. 3. Constipation related to decreased gastric motility. 4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2. Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.

The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate? 1. "Surgery is usually required, although medical treatment is attempted first." 2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." 3. "Surgery is not performed for this type of hernia." 4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications.

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

2. "I take antacid tablets with me wherever I go." Frequent use of antacids indicates an acid reflux problem.

A patient in the clinic is prescribed an immunosuppressant drug for treatment of inflammatory bowel disease (IBD). Which patient teaching point related to this drug is appropriate? 1. Always take your medication with food or milk 2. Avoid people with active infections 3. Stop the medication if you have diarrhea 4. Take this medication only when you have symptoms

2. Avoid people with active infections Patients taking immunosuppressants need to avoid contact with people with active infection. Corticosteroids are used in inflammatory bowel disease (IBD) for their ability to reduce inflammation. Unfortunately, this action also decreases the ability of the body to resist infection. Patients on steroids must be monitored for any signs and symptoms of infections. A low-roughage diet without milk products is prescribed for mild to moderate IBD. A low-maintenance dose of the immunosuppressant may be given for as long as 1 year, so discontinuing the drug early may result in another acute attack. Frequently, patients have diarrhea with frequent bloody stools and abdominal cramping. Medications should not be stopped if diarrhea occurs. The patient needs to report this to the physician.

Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1. Having a sedentary desk job. 2. Being 5 feet, 3 inches tall and weighing 190 lb. 3. Using laxatives frequently. 4. Being 40 years old.

2. Being 5 feet, 3 inches tall and weighing 190 lb. Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men.

In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? 1. Number and length of breaks. 2. Body mechanics used in lifting. 3. Temperature in the work area. 4. Cleaning solvents used.

2. Body mechanics used in lifting. Bending, especially after eating, can cause gastroesophageal reflux. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications.

A nurse is providing instructions for a patient regarding the collection of a stool sample for occult blood. Which instructions should be included? (Select all that apply.) 1. Avoid eating red meat on the day the sample is to be collected. 2. Collect the specimen in a clean, dry container supplied by the facility. 3. Store the specimen in the refrigerator until it can be returned to the laboratory. 4. Certain medications such as salicylate and anticoagulants may interfere with the test results. 5. If more than one sample is required, wait until all are obtained before returning them to the laboratory.

2. Collect the specimen in a clean, dry container supplied by the facility. 4. Certain medications such as salicylate and anticoagulants may interfere with the test results. Red meat should be avoided for 2 to 3 days before the test because it may interfere with the test results. It is best to deliver the stool specimens to the laboratory as soon as possible. The specimen should be collected in the clean, dry container that is provided by the laboratory. The samples do not need to be refrigerated for this test. Medications including salicylate, anticoagulants, ascorbic acid, and steroids may interfere with the test and should be reported.REF: pp. 823-824

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1. Limit caffeine intake to two cups of coffee per day. 2. Do not lie down for 2 hours after eating. 3. Follow a low-protein diet. 4. Take medications with milk to decrease irritation.

2. Do not lie down for 2 hours after eating. The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux.

Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living? 1. Daily aerobic exercise. 2. Eliminating smoking and alcohol use. 3. Balancing activity and rest. 4. Avoiding high-stress situations.

2. Eliminating smoking and alcohol use. Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia.

Bethanechol (Urecholine)- Prokinetic- has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects? 1. Constipation. 2. Urinary urgency. 3. Hypertension. 4. Dry oral mucosa.

2. Urinary urgency.

An LPN is teaching a patient with Crohn disease about nutrition. Which selection by the patient indicates a need for further teaching? 1. Applesauce 2. Whole-grain muffin 3. Decaffeinated coffee 4. Cream of chicken soup

2. Whole-grain muffin The patient with Crohn disease is placed on a low-residue diet without caffeine, pepper, or alcohol. Foods that are not allowed include whole grains, nuts, and raw fruits and vegetables. REF: p. 840

"The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate? "1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen

2.Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin, and nonsteroidal anti- inflammatory drugs suchs as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding

The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate? 1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen

2.Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin and nonsteroidal anti- inflammatory drugs, suchs as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding.

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

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

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

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

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

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

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

A client has been taking aluminum hydroxide 30 mL six times per day at home to treat a peptic ulcer. The client has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1.The client has not been including enough fiber in the diet. 2.The client needs to increase the daily exercise. 3.The client is experiencing an adverse effect of the aluminum hydroxide. 4.The client has developed a gastrointestinal obstruction

3 It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client is to take one daily dose of ranitidine (Zantac) at home to treat a peptic ulcer. The client understands proper drug administration of ranitidine when the client will take the drug at which of the following times? 1.Before meals. 2.With meals. 3.At bedtime. 4.When pain occurs.

3 Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the client should eat which of the following? 1.Bland foods. 2.High-protein foods. 3.Any foods that are tolerated. 4.A glass of milk with each meal.

3 Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order should the nurse assess these clients? 1. The client awaiting hiatal hernia repair at 11 am. 2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests. 3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain. 4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

3, 4, 2, 1 The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. It is also important for the nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is experiencing pain and should be assessed next. The nurse should then assess the client who is NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before surgery.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.

3, 4, 5. Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

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

3,4

The nurse has been assigned to provide care for four clients. In what order should the nurse assess these clients? 1. A client awaiting surgery for a hiatal hernia repair at 11 am. 2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests. 3. A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain. 4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

3,4,2,1 The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. It is also important for the nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is experiencing pain and should be assessed next. The nurse should then assess the client who is NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before surgery.

When obtaining a nursing history from a client with a suspected gastric ulcer, which signs and symptoms should the nurse assess? Select all that apply. 1.Epigastric pain at night. 2.Relief of epigastric pain after eating. 3.Vomiting. 4.Weight loss. 5.Melena

3,4,5 Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to have a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to have pain that occurs during the night and is frequently relieved by eating.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following? 1. Bland foods. 2. High-protein foods. 3. Any foods that are tolerated. 4. Large amounts of milk.

3. Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1. The client has not been including enough fiber in his diet. 2. The client needs to increase his daily exercise. 3. The client is experiencing an adverse effect of the aluminum hydroxide. 4. The client has developed a gastrointestinal obstruction.

3. It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.

3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.

The nurse recognizes the need for additional teaching when a patient with celiac disease states: 1. "I should suggest that my sister be screened for celiac disease." 2. "If I do not follow the gluten-free diet, I may develop a lymphoma." 3. "I really don't need to restrict my diet of gluten-containing foods, as I am not having diarrhea." 4. "It will be difficult to find gluten-free foods, as gluten is part of the so many types of food."

3. "I really don't need to restrict my diet of gluten-containing foods, as I am not having diarrhea." Additional teaching about celiac disease is needed when a patient says, "I really don't need to restrict my diet of gluten-containing foods as I am not having diarrhea." Celiac disease is treated by avoiding products that contain gluten (i.e., wheat, barley, oats, rye). In the case of celiac sprue, it is helpful to teach the patient how to eliminate gluten from the diet. Genetic testing cannot diagnose celiac disease, but it can tell you whether celiac disease is a possibility. Testing is recommended for anyone who has a parent, sibling, or child with celiac disease. Lymphoma of the small intestine is a rare type of cancer but may be 30 times more common in people with celiac disease. Today, there are many products that are free of gluten that can be purchased from specialty food stores and supermarkets.

A 16-year-old female presents to the camp clinic with abdominal pain in the right lower quadrant. She has a low-grade fever. The camp nurse should suspect which of the following? 1. Colon cancer 2. Pancreatitis 3. Appendicitis 4. Ascites

3. Appendicitis The initial symptom of appendicitis is usually pain in the epigastric region or around the umbilicus, which then shifts to the right lower quadrant. Signs and symptoms of colorectal cancer depend on the location of the disease. If the cancer is located on the right side of the abdomen, then the patient may have only vague cramping until the disease is advanced. Unexplained anemia, weakness, and fatigue related to blood loss may be the only early symptoms of right-sided colon cancer. The pancreas is a large gland located behind the stomach and next to the duodenum (the first section of the small intestine). Pancreatitis is where the pancreas becomes inflamed and damage occurs when the digestive enzymes are activated before they are secreted into the duodenum and begin attacking the pancreas. Ascites is an accumulation of fluid in the peritoneal cavity most commonly due to cirrhosis, severe liver disease, or metastatic cancer. Diagnosis of the cause is usually with blood tests, an ultrasound scan of the abdomen, and direct removal of the fluid by needle or paracentesis (which may also be therapeutic). Treatment may be with medication (diuretics), paracentesis, or other treatments directed at the cause.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia? 1. Introduce the client to other people who are successfully managing their care. 2. Include the client's daughter in the teaching so that she can help implement the plan. 3. Ask the client to identify other situations in which he demonstrated responsibility for himself. 4. Reassure the client that he will be able to implement all aspects of the plan successfully.

3. Ask the client to identify other situations in which he demonstrated responsibility for himself. Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting.

Inflammatory bowel disease (IBD) includes which conditions? Select all that apply. 1. Appendicitis 2. Diverticulosis 3. Crohn disease 4. Ulcerative colitis 5. Irritable bowel syndrome

3. Crohn disease 4. Ulcerative colitis IBD refers to ulcerative colitis and Crohn disease. The other conditions listed are not classified as IBD.REF: p. 837

The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids? 1. Anorexia. 2. Weight gain. 3. Diarrhea. 4. Constipation.

3. Diarrhea. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea.

Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? 1. Esophageal reflux. 2. Dysphagia. 3. Esophagitis. 4. Ulcer formation.

3. Esophagitis. Cimetidine (Tagamet) is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux.

A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1. Lean beef. 2. Air-popped popcorn. 3. Hot chocolate. 4. Raw vegetables.

3. Hot chocolate. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol.

Prioritize the assessment techniques below in the order they should be performed: 1. Palpation 2. Auscultation 3. Inspection 4. Percussion

3. Inspection 2. Auscultation 4. Percussion 1. Palpation The prioritized techniques that must be performed are: inspection, auscultation, percussion, and palpation.

A patient who came to the emergency room with right lower quadrant pain is suspected of having appendicitis. Which physician order should an LPN question? 1. NPO status 2. Cold pack to the abdomen 3. Milk of magnesia 30 mL po now 4. IV fluids: N/S at 80 mL per hour

3. Milk of magnesia 30 mL po now Laxative agents and heat applications should never be used for undiagnosed abdominal pain. The NPO status and IV fluids are done in preparation for surgery. The cold pack may decrease abdominal discomfort. REF: p. 834

To reduce the pain experienced by a patient with acute appendicitis, the nurse should assist the patient into what position? 1. Prone 2. Supine 3. Semi-Fowler 4. Reverse Trendelenburg

3. Semi-Fowler Before surgery, the patient will probably be most comfortable in the semi-Fowler position or the side-lying position with the hips flexed. The prone position is face down. The supine position is face up. The reverse Trendelenburg position is with the head elevated and is not helpful in reducing pain from appendicitis.REF: p. 834

A patient was admitted with abdominal cramps and has been passing very large, bulky, foamy, and foul-smelling stools. How is this condition documented? 1. Diarrhea 2. Obstipation 3. Steatorrhea 4. Constipation

3. Steatorrhea With steatorrhea, fat malabsorption is present and stools are large, bulky, foamy, and foul smelling. Diarrhea could cause excessive liquid-like stools. Obstipation is severe constipation. Constipation is an inability or difficulty defecating, and when defecation occurs it is often hard to pass and dry.REF: p. 828

The nurse is checking a client for the correct placement of a nasogastric (NG) tube. The nurse aspirates the client's stomach contents and checks its pH level. Which pH value indicates the correct placement of the tube?

3.5

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

30 minutes before meals

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

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

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

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

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

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

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

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

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

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1."I should take my antacid before I take my other medications." 2."I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3."My antacid will be most effective if I take it whenever I experience stomach pains." 4."It is best for me to take my antacid 1 to 3 hours after meals.

4 Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.

A client admitted to the hospital with peptic ulcer disease tells the nurse about having black, tarry stools. The nurse should: 1.Encourage the client to increase fluid intake. 2.Advise the client to avoid iron-rich foods. 3.Place the client on contact precautions. 4.Report the finding to the health care provider

4 Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black; the odor of the stool is very offensive. The nurse should instruct the client to report the incidence of black stools promptly to the primary health care provider. Increasing fluids or avoiding iron-rich foods will not change the stool color or consistency if the stools contain digested blood. Until other information is available, it is not necessary to initiate contact precautions

A client with peptic ulcer disease is taking ranitidine. What is the expected outcome of this drug? 1.Heal the ulcer. 2.Protect the ulcer surface from acids. 3.Reduce acid concentration. 4.Limit gastric acid secretion.

4 Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole, help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate, protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? 1.Conduct physical activity in the morning in order to be able to rest in the afternoon. 2.Have the family agree to perform the necessary yard work at home. 3.Give up jogging and substitute a less demanding hobby. 4.Incorporate periods of physical and mental rest in the daily schedule.

4 It would be most effective for the client to develop a health maintenance plan that incorporates regular periods of physical and mental rest in the daily schedule. Strategies should be identified to deal with the types of physical and mental stressors that the client needs to cope with in the home and work environments. Scheduling physical activity to occur only in the morning would not be restful or practical. There is no need for the client to avoid yard work or jogging if these activities are not stressful.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. The nurse should do which of the following first? 1.Administer pain medication as prescribed. 2.Raise the head of the bed. 3.Prepare to insert a nasogastric tube 4.Notify the physician.

4 The client is experiencing a perforation of the ulcer, and the nurse should notify the physician immediately. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. Administering pain medication is not the first action, although the nurse later should institute measures to relieve pain. Elevating the head of the bed will not minimize the perforation. A nasogastric tube may be used following surgery."

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. "I should take my antacid before I take my other medications." 2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3. "My antacid will be most effective if I take it whenever I experience stomach pains." 4. "It is best for me to take my antacid 1 to 3 hours after meals."

4. Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.

4. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? 1. Conduct physical activity in the morning so that he can rest in the afternoon. 2. Have the family agree to perform the necessary yard work at home. 3. Give up jogging and substitute a less demanding hobby. 4. Incorporate periods of physical and mental rest in his daily schedule.

4. It would be most effective for the client to develop a health maintenance plan that incorporates regular periods of physical and mental rest in the daily schedule. Strategies should be identified to deal with the types of physical and mental stressors that the client needs to cope with in the home and work environments. Scheduling physical activity to occur only in the morning would not be restful or practical. There is no need for the client to avoid yard work or jogging if these activities are not stressful.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? 1. An intestinal obstruction has developed. 2. Additional ulcers have developed. 3. The esophagus has become inflamed. 4. The ulcer has perforated.

4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.

The nurse is providing patient education for a patient who will be undergoing bowel resection surgery. Which information should be included in the teaching? 1. A gastrostomy tube will be inserted into the abdomen. 2. Expect blood in the stool for 3 to 5 days postoperatively. 3. It is common to have diarrhea for several days afterward. 4. A nasogastric tube is inserted into the nose during surgery.

4. A nasogastric tube is inserted into the nose during surgery. The patient will have a nasogastric tube inserted into the nose during surgery for decompression. A gastrostomy tube is not necessarily indicated after a bowel resection. Blood in the stool 3 to 5 days after surgery is not a common finding. It can take 3 to 5 days for bowel sounds to return to normal frequency.REF: p. 835

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 1. Antacids. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.

4. Alcohol. Metoclopramide hydrochloride (Reglan) can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug.

The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? 1. Development of laryngeal cancer. 2. Irritation of the esophagus. 3. Esophageal scar tissue formation. 4. Aspiration of gastric contents.

4. Aspiration of gastric contents. Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

Which gastrointestinal cancer has the highest rate of incidence and is responsible for the highest number of deaths? 1. Esophageal 2. Stomach 3. Pancreatic 4. Colorectal

4. Colorectal Colorectal cancer, or cancer of the large intestine, is the third most common cancer. People at greater risk for colorectal cancer are those with histories of inflammatory bowel disease (IBD) or family histories of colorectal cancer or multiple intestinal polyps. Cancer of the esophagus is not common, but when it does occur, it has a very poor prognosis. Most esophageal cancers are located in the middle or lower portion of the esophagus. No known cause exists, but predisposing factors are cigarette smoking, excessive alcohol intake, chronic trauma, poor oral hygiene, and eating spicy foods. Cancer of the stomach is diagnosed in more than 21,000 people in the United States each year. The incidence is highest among men, people older than 70 years, and people of lower socioeconomic status. Cancer of the pancreas is very serious. Pancreatic cancer quickly spreads to the duodenum, stomach, spleen, and left adrenal gland. About 42,000 new cases are diagnosed each year in the United States. Only 24% of these people will survive for 1 year; 4% will be alive after 5 years.

A licensed practical nurse (LPN) is contributing to an assessment of a patient who is experiencing digestive symptoms. The nurse is unable to auscultate bowel sounds in one quadrant of the abdomen. What should be the HIGHEST priority nursing action by the LPN? 1. Record bowel sounds as absent in that quadrant. 2. Notify the physician that bowel sounds are absent. 3. Notify the charge nurse that bowel sounds are absent. 4. Listen for a full 5 minutes to the abdominal quadrant with absent bowel sounds.

4. Listen for a full 5 minutes to the abdominal quadrant with absent bowel sounds. The nurse should listen to a particular abdominal quadrant for a full 5 minutes before recording that bowel sounds are absent in that quadrant. If the nurse determines that bowel sounds are absent after listening for a full 5 minutes in the quadrant, then the nurse should notify the physician. This finding should also be documented in the patient's chart and the charge nurse should be kept informed of the situation, but only after the nurse has listened to the quadrant for 5 minutes. REF: p. 822

The nurse is providing care for a patient who has been receiving laxative agents and stimulants to treat chronic constipation. Which nursing intervention is appropriate in caring for this patient? 1. Warm the castor oil to make it easier to swallow. 2. Tell the patient that cascara can make the urine look green. 3. Have the patient monitor fluid intake and decrease the amount if stools become watery. 4. Monitor the characteristics of the stool and compare them with the patient's baseline normal.

4. Monitor the characteristics of the stool and compare them with the patient's baseline normal. Warming the castor oil is incorrect; it should be chilled to make it more palatable. Cascara does not make the urine look green; it makes the urine look pink or brownish in color. Decreasing fluid intake with watery stools is incorrect; intake should be increased with watery stools. It is correct to monitor the characteristics of the stool and compare them to the baseline normal.REF: p. 831

The nurse is planning to teach the client with GERD about substance that will increase the lower esophageal sphincter pressure. Which item should the nurse include on this list? Saunders NCLEX Examination Review 1. Coffee 2. Chocolate 3. Fatty Foods 4.Nonfat milk

4. Nonfat milk Foods that increase LES pressure will decrease reflux and decrease symptoms. Milk will increase LES pressure

The nurse is monitoring the client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in Legs 3. Nausea and Vomiting 4. A rigid, board-like abdomen

4. Perforation of an ulcer is a surgical emergency and is a sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the leg is not an associated finding

A patient just had a right inguinal herniorrhaphy. Which physician order should an LPN question? 1. Keep intake and output records. 2. Note passage of flatus. 3. Apply scrotal support and ice. 4. Turn, cough, and deep breathe q2h.

4. Turn, cough, and deep breathe q2h. Although turning and deep breathing is allowed, coughing or sneezing will put strain on the surgical incision. Because there can be temporary problems with urination, intake and output records should be kept. The passage of flatus indicates return of bowel function after general anesthesia and manipulation of the bowel during surgery. A scrotal support and an ice pack are used to prevent painful scrotal swelling. REF: p. 837

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

42 gtts/min.

A nurse teaches a client experiencing heartburn to take 1½ oz of Maalox when symptoms appear. How many milliliters should the client take? _________________________ mL.

45 mL

A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to a. collect a stool specimen. b. prepare for colonoscopy. c. schedule a barium enema. d. have blood cultures drawn.

A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? a. Fever b. Nausea c. Joint pain d. Headache

A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer?* A. Duodenal B. Gastric C. Esophageal D. Refractory

A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take? a. Encourage the patient to ambulate. b. Instill a mineral oil retention enema. c. Administer the ordered IV morphine sulfate. d. Offer the ordered promethazine (Phenergan) suppository.

A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to advance the patient's diet to solid foods. The patient's lunch tray arrives. Which food should the patient avoid eating?* A. Orange B. Milk C. White rice D. Banana

A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI?* A. Pantoprazole B. Famotidine C. Magnesium Hydroxide D. Metronidazole

The nurse is assessing a 31-year-old female patient with abdominal pain. The nurse,who notes that there is ecchymosis around the area of umbilicus, will document this finding as a. Cullen sign. b. Rovsing sign. c. McBurney sign. d. Grey-Turner's signt.

Which statement is INCORRECT about Histamine-receptor blockers?* A. "H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric acid." B. "Ranitidine and Famotidine are two types of histamine-receptor blocker medications." C. "Antacids and H2 blockers should not be given together." D. All the statements are CORRECT.

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs *more* teaching? A: "I will be able to regulate when I have stools." B: "I will be able to wear the pouch until it leaks." C: "The drainage from my stoma can damage my skin." D: "Dried fruit and popcorn must be chewed very well."

A * "I will be able to regulate when I have stools." * An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? A: "I need to limit my intake of dietary fiber." B: "I need to drink plenty, at least 8 to 10 cups daily." C: "I need to eat regular meals and chew my food well." D: "I will take the prescribed medications because they will regulate my bowel patterns."

A *"I need to limit my intake of dietary fiber"* IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for *further instruction*? A: "I should increase the fiber in my diet." B: "I will need to avoid caffeinated beverages." C: "I'm going to learn some stress reduction techniques." D: "I can have exacerbations and remissions with Crohn's disease."

A *"I should increase the fiber in my diet"* Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? A: "The tube will help to drain the stomach contents and prevent further vomiting." B: "The tube will push past the area that is blocked and thus help to stop the vomiting." C: "The tube is just a standard procedure before many types of surgery to the abdomen." D: "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

A *"The tube will help to drain the stomach contents and prevent further vomiting."* The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? A: Fecal impaction B: Perineal hygiene C: Dietary fiber intake D: Antidiarrheal agent use

A *Fecal impaction* Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

Two days after a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? A: Impaired peristalsis B: Irritation of the bowel C: NG auctioning D: Inflammation of the incision site

A *Impaired peristalsis* Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? A: Maintain a high intake of fluid and fiber in the diet. B: D/C intake of medications causing constipation C: Eat several small meals per day to maintain bowel motility D: Sit upright during meal to increase bowel motility by gravity.

A *Maintain a high intake of fluid and fiber in the diet* Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? A: Notify the health care provider (HCP). B: Administer the prescribed pain medication. C: Call and ask the operating room team to perform surgery as soon as possible. D: Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

A *Notify the HCP* On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

The nurse is assessing a client in end-stage liver failure who is diagnosed with portal hypertension. Which intervention should the nurse include in the plan of care? A. Assess the abdomen for a tympanic wave B. Monitor the client's blood pressure C. Percuss the liver for size and location D. Weigh the client twice each week

A A client who has been diagnosed with portal hypertension should be assessed for a tympanic (fluid) wave to check for ascites

Which data should the nurse report to the healthcare provider when assessing the oral cavity of an elderly client? A. The client's tongue is rough and beefy red B. The client's tonsils are +1 on the grading scale C. The client's mucousa are pink and moist D. The client's uvula rises with the mouth open

A A rough, beefy-red tongue may indicate pernicious anemia and should be evaluated by the healthcare provider

A client 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? A: This is a normal, expected event. B: The client is experiencing early signs of ischemic bowel. C: The client should not have the nasogastric tube removed. D: This indicates inadequate preoperative bowel preparation.

A As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy.

The nurse is caring for a client with common bile duct obstruction. The nurse should anticipate that the health care provider (HCP) will prescribe which diet for this client? A: Low fat B: High protein C: High carbohydrate D: Low in water-soluble vitamins

A Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum. Bile acids or bile salts are produced by the liver to emulsify or break down fats

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? A: Decreased diarrhea B: Decreased cramping C: Improved intestinal tone D: Elimination of peristalsis

A Diphenoxylate hydrochloride with atropine sulfate is an antidiarrheal product that decreases the frequency of defecation, usually by reducing the volume of liquid in the stools.

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this client? A: NPO (nothing by mouth) status B: Ambulation at least 4 times daily C: Cholinergic medications to reduce pain D: Coughing and deep breathing every 2 hours

A During the acute phase of diverticulitis, the goal of treatment is to rest the bowel and allow the inflammation to subside. The client remains NPO and is placed on bed rest. Pain occurs from bowel spasms, and increased intra-abdominal pressure (coughing and deep breathing) may precipitate an attack. Ambulation and cholinergics will increase peristalsis.

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively? A: Low fiber B: Low calorie C: High protein D: High carbohydrate

A For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food.

The client diagnosed with a hiatal hernia is scheduled for a Nissen fundoplication. Which statement indicates the nurse's teaching is effective? A. "I will have 4 to 5 small incisions." B. I will be in the hospital for at least one week C. I will not have any pain because this is a laparoscopic surgery D. I will be returning to work the day after my surgery

A In a laparoscopic Nissen fundoplication, there are 4 to 5 incisions approximately 1 inch apart allowing for the passage of equipment to visualize the abdominal organs and perform the operation

The nurse is caring for an elderly client with acute gastritis. Which client problem is priority for this client? A. Fluid volume deficit B. Altered nutrition; less than body requirements C. Impaired tissue perfusion D. Alteration in comfort

A Pediatric and geriatric clients have an increased risk of fluid volume deficit. The nurse should always be alert to this possible complication

After performing an initial abdominal assessment on a client with nausea and vomiting, the nurse should expect to note which finding? A: Waves of loud gurgles auscultated in all 4 quadrants B: Low-pitched swishing auscultated in 1 or 2 quadrants C: Relatively high-pitched clicks or gurgles auscultated in all 4 quadrants D: Very high-pitched, loud rushes auscultated especially in 1 or 2 quadrants

A Rationale: Although frequency and intensity of bowel sounds vary depending on the phase of digestion, normal bowel sounds are relatively high-pitched clicks or gurgles. Loud gurgles (borborygmi) indicate hyperperistalsis and are commonly associated with nausea and vomiting. A swishing or buzzing sound represents turbulent blood flow associated with a bruit. Bruits are not normal sounds. Bowel sounds are very high-pitched and loud (hyperresonance) when the intestines are under tension, such as intestinal obstruciton

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? A: "The medication will cause constipation." B: "I need to take the medication with meals." C: "I may have increased sensitivity to sunlight." D: "This medication should be taken as prescribed."

A Sulfasalazine is an antiinflammatory sulfonamide. Constipation is not associated with this medication. It can cause photosensitivity, and the client should be instructed to avoid sun and ultraviolet light. It should be administered with meals, if possible, to prolong intestinal passage. The client needs to take the medication as prescribed and continue the full course of treatment even if symptoms are relieved

Which intervention should the nurse implement specifically for the client in end-stage liver failure who is experiencing hepatic encephalopathy? A. Assess the client's neurological status B. Prepare to administer a loop diuretic C. Check the client's stool for blood D. Assess for an abdominal fluid wave

A The increased serum ammonia level associated with liver failure causes the hepatic encephalopathy, which, in turn, leads to neurological deficit

The nurse is caring for a client who is one day post-upper GI series. Which assessment data warrants intervention? A. No bowel movement B. Oxygen saturation of 96% C. Vital signs with normal baseline D. Intact gag reflex

A The nurse should monitor the client for the first bowel movement to document elimination of barrium, which should be eliminated within two days. If the client does not have a bowel movement, a laxative may be needed to help the client eliminate the barrium before it becomes too hard to pass

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis? A: "Does the pain in your stomach radiate to your back?" B: "Does the pain in your lower abdomen radiate to your hip?" C: "Does the pain in your lower abdomen radiate to your groin?" D: "Does the pain in your stomach radiate to your lower middle abdomen?"

A The pain that is associated with acute pancreatitis is often severe, is located in the epigastric region, and radiates to the back. The remaining options are incorrect because they are not specific for the pain experienced by the client with pancreatitis.

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information should the nurse include in the teaching plan? A: Use 500 to 1000 mL of warm tap water. B: Suspend the irrigant 36 inches above the stoma. C: Insert the irrigation cone ½ inch into the stoma. D: If cramping occurs, open the irrigation clamp farther.

A The usual procedure for colostomy irrigation includes using 500 to 1000 mL of warm tap water. The solution is suspended 18 inches above the stoma. The cone is inserted 2 to 4 inches into the stoma but should never be forced. If cramping occurs, the client should decrease the flow rate of the irrigant as needed by closing the irrigation clamp.

The nurse has been reinforcing dietary teaching for a client 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?

A decrease in sour eructation

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse suggests which diet?

A low-fiber diet

The nurse is caring for a client 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?

A pair of scissors

A client with peptic ulcer disease is scheduled for a pyloroplasty, and the client asks the nurse about the procedure. The nurse bases the response on which information?

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

After a liver biopsy, the nurse should place the client in which position?

A right side-lying position with a small pillow or folded towel under the puncture site

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

A tube with a larger lumen and an air vent

Which of the following statements are accurate as they relate to medications used to manage GERD? "A)Magnesium-containing antacids can cause diarrhea. B) Aluminum-containing antacids can cause constipation. C) Cimetidine (Tagamet HB) causes osteomalacia and hypophosphatemia. D)Misoprostol's (Cytotec) major side effect is G.I. bleeding

A&B. Rationale: Magnesium-containing antacids can cause diarrhea, and should be used with caution in older persons with renal dysfunction. Aluminum-containing antacids can cause constipation, osteomalacia, and hypophosphatemia. Cimetidine has the greatest chance for adverse reactions, including erectile dysfunction, Gynecomastia, and confusion. Misoprostol's major side effects are diarrhea and abdominal pain

A client's stool are light gray in color. The nurse should asses the client for which of the following? Select all that apply. a. Intolerance to fatty foods b. Fever c. Jaundice d. Respiratory distress e. Pain at McBurney's point f. Peptic ulcer disease

A, B, C: Bile is created in the liver, stored in the gallbladder, and released into the duodenum, giving stool its brown color. A bile duct obstruction can cause pale-colored stool. Respiratory distress is not a symptom. Pain at McBurney's point is associated with appendicitis. Bleeding ulcers produce black tarry stool.

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? a. Many over-the-counter (OTC) medications can cause constipation. b. Stimulant and saline laxatives can be used regularly. c. Bulk-forming laxatives are an excellent source of fiber. d. Walking or cycling frequently will help bowel motility. e. A good time for a bowel movement may be after breakfast.

A, C, D, E

The client is admitted to the ED complaining of acute epigastric pain and reports vomiting a large amount of bright red blood at home. Which interventions should the nurse implement? List in order of priority. A. Assess the client's vital signs B. Insert an NG tube C. Begin iced saline lavage D. Start an IV with an 18-gauge needle E. Type and crossmatch for a blood transfusion

A, D, E, B, C

Nursing management of the patient with acute pancreatitis includes: (SATA) A. Check for signs of hypocalcemia B. Provide a diet low in carbohydrates C. Giving insulin based on sliding scale D. Observing stools for signs of steatorrhea E. Monitoring for infection, particularly respiratory tract infection

A, E Rationale: During the acute phase, it is important to monitor vital signs. Hemodynamic stability may be compromised by hypotension, fever, and tachypnea. Injection fluids are ordered, and the response to therapy is monitored. Fluid and electrolyte balances are closely monitored. Frequent vomiting, along with gastric suction, may result in decreased levels of chloride, sodium, and potassium. Because hypocalcemia can occur in acute pancreatitis, the nurse should observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. Numbness or tingling around the lips and in the fingers is an early indicator of hypocalcemia. The patient should be assessed for Chvostek's sign or Trousseau's sign. A patient with acute pancreatitis should be observed for fever and other manifestations of infection. Respiratory infections are common because the retroperitoneal fluid raises the diaphragm, which causes the patient to take shallow, guarded abdominal breaths.

Select all the medications a physician may order to treat a H. Pylori infection that is causing a peptic ulcer?* A. Proton-Pump Inhibitors B. Antacids C. Anticholinergics D. 5-Aminosalicylates E. Antibiotics F. H2 Blockers G. Bismuth Subsalicylates

A, E, F, G

A nurse is completing nutritional teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (SATA) A. I plan to eat small, frequent meals. B. I will eat easy-to-digest foods with limited spice C. I will use skim milk when cooking D. I plan to drink regular cola E. I will limit alcohol intake to two drinkers per day

A,B C Rationale: Patients with pancreatitis should eat small, frequent, easy to digest, low-fat meals. Pt should avoid alcohol and caffeinated beverages.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions should the nurse include in the instructions? Select all that apply. A: Eat yogurt. B: Take loperamide to treat diarrhea. C: Use stress management techniques. D: Avoid foods such as cabbage and broccoli. E: Decrease fiber intake to less than 15 g/day.

A,B,C,D clients diagnosed with IBS whose primary symptoms are abdominal distention and flatulence should be advised to avoid common gas-producing foods such as broccoli and cabbage and to consume yogurt, as it may be better tolerated than milk. In addition, the probiotics found in yogurt may be beneficial because alterations in intestinal bacteria are believed to exacerbate IBS. The client should be advised to take loperamide, a synthetic opioid that slows intestinal transit and treats diarrhea when it occurs. Also, psychological stressors are associated with development and exacerbation of IBS, so stress management techniques are important. Option 5, decrease fiber intake, is incorrect, as clients should be encouraged to have a dietary fiber intake of at least 20 g/day.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. A: Maintain NPO (nothing by mouth) status. B: Encourage coughing and deep breathing. C: Give small, frequent high-calorie feedings. D: Maintain the client in a supine and flat position. E: Give hydromorphone intravenously as prescribed for pain. F: Maintain intravenous fluids at 10 mL/hour to keep the vein open.

A,B,E *NPO, Cough and deep breathing, Hydromorphone* The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is necessary. Because abdominal pain is a prominent symptom of pancreatitis, pain medications such as morphine or hydromorphone are prescribed. Meperidine is avoided, as it may cause seizures. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help to ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted.

A hospitalized patient has just been diagnosed with diarrhea due to Clostridium difficile. Which nursing interventions should be included in the patient's plan of care (select all that apply.)? A: Initiate contact isolation precautions B: Place the patient on a clear liquid diet C: Disinfect the room with 10% bleach solution D: Teach any visitors to wear gloves and gowns E: Use hand sanitizer before and after patient or body fluid contact

A,C,D *Contact isolation, disinfect with 10% bleach, teach visitors to wear gowns and gloves* Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. A: Administer stool softeners as prescribed. B: Instruct the client to limit fluid intake to avoid urinary retention. C: Encourage a high-fiber diet to promote bowel movements without straining. D: Apply cold packs to the anal-rectal area over the dressing until the packing is removed. E: Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

A,C,D *Stool softeners, high fiber, apply ice packs* Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture. Stool softeners and a high-fiber diet will help the client to avoid straining, thereby reducing the chances of rupturing the incision. An ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect interventions.

The nurse is caring for a hospitalized client with pancreatitis. Which findings should the nurse look for and expect to note when reviewing the laboratory results? Select all that apply. A: Elevated lipase level B: Elevated lactase level C: Elevated trypsin level D: Elevated amylase level E: Elevated sucrase level

A,C,D Lipase, trypsin, and amylase are produced in the pancreas and aid in the digestion of fats, starches, and proteins, respectively. Lactase is produced in the small intestine and aids in splitting neutral fats into glycerol and fatty acids. Sucrase is produced in the small intestine and converts sucrose into glucose and fructose.

The nurse assesses a client for the risk for gastric cancer. Which of these factors would likely increase the client's risk? Select all that apply. A. Having a history of untreated gastroesophageal reflux disease B. Being an adult between 20 and 40 years of age C. Eating a diet high in smoked and pickled foods D. Eating a diet with high-fiber foods E. Eating a diet high in salt and adding salt to food

A,C,E Gastric cancer seems to be correlated with eating pickled foods, nitrates from processed foods, and salt added to food. The ingestion of these foods over a long period can lead to atrophic gastritis, a precancerous condition. Clients with Barrett's esophagus from prolonged or severe GERD have an increased risk for cancer in the cardia (at the point where the stomach connects to the esophagus). The average age for developing gastric cancer is 70 years of age. Increasing the intake of high-fiber foods will decrease a person's risk for development of gastric cancer. Reference: p(

The nurse is administering a PPI to a client diagnosed with peptic ulcer disease. Which statement supports the rationale for administering this medication? A. It prevents the final transport of hydrogen ions into the gastric lumen B. It blocks receptors controlling hydrochloric acid secretions by parietal cells C. It protects the ulcer from the destructive action of the digestive enzyme pepsin D. It neutralizes the hydrochloric acid secreted by the stomach

A. This statement is the rationale for proton pump inhibitors

The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

A. "Nizatidine (Axid) needs to be taken three times a day to be effective." Nizatidine (Axid) is most effective if administered twice daily.

. The client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your doctor told you about participating in hospice?" C. "I can speak to your physician about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

A. "Pain control is a major component of the care provided by hospice and its staff members." This response correctly describes the services provided by hospice and its staff members, and helps reassure the client about their expertise in pain management.

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

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

The nurse is doing pre-op teaching with the client who is about to undergo creation of a Kock pouch. The nurse interprets that the client has the best understanding of the nature of the surgery if the client makes which of the following statements? A. "I will need to drain the pouch regularly with a catheter." B. "I will need to wear a drainage bag for the rest of my life." C. "The drainage from this type of ostomy will be formed." D. "I will be able to pass stool from my rectum eventually."

A. A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the client drains it every 3 to 4 hours and then decreases the draining to about 3 times a day or as needed when full. The client does not need to wear a drainage bag but should wear an absorbent dressing to absorb mucus drainage from the stoma. Ileostomy drainage is liquid. The client would be able to pass stool only from the rectum if an ileal-anal pouch or anastamosis were created. This type of operation is a two-stage procedure.

The client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test? A. Fast for 8 hours before the test B. Eat a regular supper and breakfast C. Continue to take all oral medications as scheduled. D. Monitor own bowel movement pattern for constipation

A. A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the GI tract. The client should fast for 8 to 12 hours before the test, depending on the physician instructions. Most oral medications also are withheld before the test. After the procedure the nurse must monitor for constipation, which can occur as a result of the presence of barium in the GI tract.

A client with which of the following conditions may be likely to develop rectal cancer? A. Adenomatous polyps B. Diverticulitis C. Hemorrhoids D. Peptic ulcer disease

A. A client with adenomatous polyps has a higher risk for developing rectal cancer than others do. Clients with diverticulitis are more likely to develop colon cancer. Hemorrhoids don't increase the chance of any type of cancer. Clients with peptic ulcer disease have a higher incidence of gastric cancer.

Which of the following complications is thought to be the most common cause of appendicitis? A. A fecalith B. Bowel kinking C. Internal bowel occlusion D. Abdominal bowel swelling

A. A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis.

Which of the following diets is most commonly associated with colon cancer? A. Low-fiber, high fat B. Low-fat, high-fiber C. Low-protein, high-carbohydrate D. Low carbohydrate, high protein

A. A low-fiber, high-fat diet reduced motility and increases the chance of constipation. The metabolic end products of this type of diet are carcinogenic. A low-fat, high-fiber diet is recommended to prevent colon cancer.

You explain to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is A. A sigmoid colostomy B. A transverse colostomy C. A descending colostomy D. An ascending colostomy

A. A sigmoid colostomy The more distal the ostomy, the more the intestinal contents resemble feces that are eliminated from an intact colon and rectum. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear a collection bag.

The patient is admitted to the hospital with a severe exacerbation of ulcerative colitis. What finding is most important for you to act on? A. Blood urea nitrogen (BUN): 50 mg/dL B. Hemoglobin (Hb): 12 g/dL C. White blood cells (WBC): 11,000/μL D. Sodium (Na+): 148 mEq/L

A. Blood urea nitrogen (BUN): 50 mg/dL Patients with severe ulcerative colitis frequently have bloody diarrhea. Dehydration is present as evidenced by the high BUN. This must be treated first before the mild anemia and mild inflammation are addressed.

A client has just had surgery for colon cancer. Which of the following disorders might the client develop? A. Peritonitis B. Diverticulosis C. Partial bowel obstruction D. Complete bowel obstruction

A. Bowel spillage could occur during surgery, resulting in peritonitis. Complete or partial bowel obstruction may occur before bowel resection. Diverticulosis doesn't result from surgery or colon cancer.

Which of the following symptoms indicated diverticulosis? A. No symptoms exist B. Change in bowel habits C. Anorexia with low-grade fever D. Episodic, dull, or steady midabdominal pain

A. Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms of diverticulitis.

What is a classic diagnostic finding in a patient with appendicitis? A. Elevated white blood cell (WBC) count B. Elevated level of lipase C. Left lower quadrant tenderness D. Positive Kernig's sign

A. Elevated white blood cell (WBC) count The WBC count is mildly to moderately elevated in about 90% of cases. The classic location for appendicitis is McBurney's point in the right lower quadrant.

Which of the following areas is the most common site of fistulas in client's with Crohn's disease? A. Anorectal B. Ileum C. Rectovaginal D. Transverse colon

A. Fistulas occur in all these areas, but the anorectal area is most common because of the relative thinness of the intestinal wall in this area.

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

A. Impaired peristalsis Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention.

A patient is suspected of having a large intestine obstruction. What is the best indication that an obstruction is present? A. Lack of flatus B. Nausea C. Temperature of 100.4° F (38° C) D. Thirst

A. Lack of flatus Inability to pass gas or constipation is a common manifestation of a large intestinal obstruction.

Which of the following types of diets is implicated in the development of diverticulosis? A. Low-fiber diet B. High-fiber diet C. High-protein diet D. Low-carbohydrate diet

A. Low-fiber diets have been implicated in the development of diverticula because these diets decrease the bulk in the stool and predispose the person to the development of constipation. A high-fiber diet is recommended to help prevent diverticulosis. A high-protein or low-carbohydrate diet has no effect on the development of diverticulosis.

The elderly patient was informed that outpouches were found in the descending colon during the screening colonoscopy. The patient asks you what this finding means. What is the best explanation? A. Most people get these outpouchings as they age. B. These findings respond well to treatment with sulfa antibiotics. C. It is a precursor to colon cancer, and routine screening is essential. D. They contribute to malabsorption of cobalamin (vitamin B12) and fat.

A. Most people get these outpouchings as they age. It is believed that 65% of people have the saccular dilations or outpouchings of the mucosa by the time they are 85 years old. It is believed to be from high intraluminal pressure on weakened areas of the bowel wall from inadequate dietary fiber. It is typically asymptomatic and not a concern unless inflamed or diverticulitis develops.

What is the nursing priority in the management of a patient with an active upper G.I. bleed? A. Obtain vital signs. B. Apply oxygen by nasal cannula. C. Type and crossmatch the patient for blood products. D. Notify the physician.

A. Obtain vital signs. All other interventions can be applied after vital signs have been checked because this will help determine the other intervention...

. The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1 1/2 to 3 hours after a meal, usually at night. B. Pain is worsened by the ingestion of food. C. The client has a malnourished appearance. D. The client is a man older than 50 years.

A. Pain occurs 1 1/2 to 3 hours after a meal, usually at night. A key symptom characteristic of duodenal ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.

Which of the following aspects is the priority focus of nursing management for a client with peritonitis? A. Fluid and electrolyte balance B. Gastric irrigation C. Pain management D. Psychosocial issues

A. Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance is the priority focus of nursing management. Gastric irrigation may be needed periodically to ensure patency of the nasogastric tube. Although pain management is important for comfort and psychosocial care will address concerns such as anxiety, focusing on fluid and electrolyte imbalance will maintain hemodynamic stability.

The client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician B. Asking the physician for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician Providing the spouse with both oral and written instructions on symptoms to report to the physician, as well as on how to perform the dressing change, will reinforce important points and boost the spouse's confidence.

Radiation therapy is used to treat colon cancer before surgery for which of the following reasons? A. Reducing the size of the tumor B. Eliminating the malignant cells C. Curing the cancer D. Helping the bowel heal after surgery

A. Radiation therapy is used to treat colon cancer before surgery to reduce the size of the tumor, making it easier to be resected. Radiation therapy isn't curative, can't eliminate the malignant cells (though it helps define tumor margins), can could slow postoperative healing.

The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority A. Starting a large-bore intravenous (IV) B. Administering intravenous (IV) pain medication C. Preparing equipment for intubation D. Monitoring the client's anxiety level

A. Starting a large-bore intravenous (IV) A large-bore IV should be placed as requested, so that blood products can be administered.

The patient with Crohn's disease has had multiple intestinal resections. Which symptom indicates that short bowel syndrome has developed? A. Steatorrhea B. Constipation C. Hypercholesteremia D. Hypercalcemia

A. Steatorrhea The predominant manifestation is diarrhea or steatorrhea. Diarrhea, not constipation, is a concern because there is decreased intestinal surface to absorb fluid and nutrients. Decreased absorption of bile salts is the issue; increased cholesterol is not related to short bowel syndrome.

The client with a new colostomy is concerned about the odor from the stool in the ostomy drainage bag. The nurse teaches the client to include which of the following foods in the diet to reduce odor? A. Yogurt B. Broccoli C. Cucumbers D. Eggs

A. The client should be taught to include deodorizing foods in the diet, such a beet greens, parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas forming food as well. Broccoli, cucumbers, and eggs are gas forming foods.

Fistulas are most common with which of the following bowel disorders? A. Crohn's disease B. Diverticulitis C. Diverticulosis D. Ulcerative colitis

A. The lesions of Crohn's disease are transmural; that is, they involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don't develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don't progress to fistula formation as in Crohn's disease.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which of the following most frequent symptom(s) of duodenal ulcer? A. Pain that is relieved by food intake B. Pain that radiated down the right arm C. N/V D. Weight loss

A. The most frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as burning, heavy, sharp, or "hungry" pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or N/V. These symptoms are usually more typical in the client with a gastric ulcer.

The client with Crohn's disease has a nursing diagnosis of acute pain. The nurse would teach the client to avoid which of the following in managing this problem? A. Lying supine with the legs straight B. Massaging the abdomen C. Using antispasmodic medication D. Using relaxation techniques

A. The pain associated with Crohn's disease is alleviated by the use of analgesics and antispasmodics and also is reduced by having the client practice relaxation techniques, applying local cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate the inflamed intestinal tissues as the abdominal muscles are stretched.

The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is: A. Severe and unrelenting, located in the epigastric area and radiating to the back. B. Severe and unrelenting, located in the left lower quadrant and radiating to the groin. C. Burning and aching, located in the epigastric area and radiating to the umbilicus. D. Burning and aching, located in the left lower quadrant and radiating to the hip.

A. The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back.

The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma? A. Cleanse the peristomal skin meticulously B. Take in high-fiber foods such as nuts C. Massage the area below the stoma D. Limit fluid intake to prevent diarrhea.

A. The peristomal skin must receive meticulous cleansing because the ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. The area below the ileostomy may be massaged if needed if the ileostomy becomes blocked by high fiber foods. Fluid intake should be maintained to at least six to eight glasses of water per day to prevent dehydration.

The nurse is teaching the client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? A. Increase fluid intake B. Reduce the amount of irrigation solution C. Perform the irrigation in the evening D. Place heat on the abdomen

A. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and prevent constipation.

When teaching a community group about measures to prevent colon cancer, which instruction should the nurse include? A. "Limit fat intake to 20% to 25% of your total daily calories." B. "Include 15 to 20 grams of fiber into your daily diet." C. "Get an annual rectal examination after age 35." D. "Undergo sigmoidoscopy annually after age 50."

A. To help prevent colon cancer, fats should account for no more than 20% to 25% of total daily calories and the diet should include 25 to 30 grams of fiber per day. A digital rectal examination isn't recommended as a stand-alone test for colorectal cancer. For colorectal cancer screening, the American Cancer society advises clients over age 50 to have a flexible sigmoidoscopy every 5 years, yearly fecal occult blood tests, yearly fecal occult blood tests PLUS a flexible sigmoidoscopy every 5 years, a double-contrast barium enema every 5 years, or a colonoscopy every 10 years.

A client has a percutaneous endoscopic gastrostomy tube inserted for tube feedings. Before starting a continuous feeding, the nurse should place the client in which position? A. Semi-Fowlers B. Supine C. Reverse Trendelenburg D. High Fowler's

A. To prevent aspiration of stomach contents, the nurse should place the client in semi-Fowler's position. High Fowler's position isn't necessary and may not be tolerated as well as semi-Fowler's.

The nurse working during the day shift on the medical unit has just received report. Which client will the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with Zollinger-Ellison syndrome who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy This client is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or repositioning.

A client with gastroesophageal reflux disease complains about having difficulty sleeping at night, what should the nurse instruct the client to do? A. sleep on several pillows B. eliminate carbohydrates from the diet C. suggest a glass of milk before retiring D. take antacids such as sodium bicarbonate

A. sleeping on pillows raises the upper torso and minimizes reflux of the gastic contents

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

A: A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to a. administer IV fluids. b. give stool softeners and enemas. c. order a diet high in fiber and fluids. d. prepare the patient for colonoscopy.

A: A patient with acute diverticulitis will be NPO and given parenteral fluids

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions.

A: Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD)

A female patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

A: There is less peritoneal irritation with the knees flexed, which will help decrease pain

A 34-year-old female patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups. a. 2 b. 3 c. 4 d. 5

A: the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Educate the patient about the use of alosetron (Lotronex) to reduce symptoms. d. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).

A:Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention.

10. A nurse identifies a risk factor in an older man that places him at risk for developing diverticulosis. What patient information indicates such a risk factor? a. Eats a low-fiber diet b. Chronic diarrhea c. History of using nonsteroidal antiinflammatory drugs (NSAIDs) d. Family history of colon cancer

ANS: A A low-fiber diet increases the risk for diverticulitis. DIF: Cognitive Level: Comprehension REF: p. 841 OBJ: 4 TOP: Diverticulitis KEY: Nursing Process Step: Assessment

11. Which foods should an individual with diverticulosis avoid? a. Peanuts and raspberries b. Apples and pears c. Red meat and dairy products d. Bran and whole grains

ANS: A Foods containing seeds or small hard particles could become lodged in small pouches. DIF: Cognitive Level: Application REF: p. 841 OBJ: 3 | 4 TOP: Diverticulosis KEY: Nursing Process Step: Implementation

16. A patient reports severe pain after an abdominoperineal resection. What position should the nurse assist this patient into in order to promote comfort? a. Side-lying b. Supine c. Prone d. Semi-Fowler

ANS: A Pain is severe for several days after an abdominoperineal resection. At first, the patient will be most comfortable in a side-lying position. DIF: Cognitive Level: Application REF: p. 842 OBJ: 3 | 4 TOP: Abdominoperineal resection KEY: Nursing Process Step: Implementation

3. A nurse has collected several stool specimens for ova and parasites that are to be sent to the laboratory. What action is most appropriate for the nurse to implement? a. Immediately take the specimens to the laboratory to be tested for parasites and ova. b. Take the specimens to the laboratory to be tested for culture and sensitivity and leave them for later pickup. c. Take the specimens to the refrigerator to be tested later for parasites and ova. d. Leave the specimens in a warm place until convenient time to deliver to the laboratory.

ANS: A Parasite and ova specimens should be immediately taken to the laboratory while the parasites are still alive. Specimens for evaluating pathogenic organisms should be kept cool. DIF: Cognitive Level: Application REF: p. 823 OBJ: 1 TOP: Care of Stool Specimens KEY: Nursing Process Step: Planning

1. What is the most current endoscopic procedure for examining the small intestine? a. Capsule camera b. Fiberoptic light probe c. Rigid lighted tubes d. Flat plate

ANS: A The capsule camera is swallowed and transmits information about the small bowel to a receiver on a belt around the patient's waist. DIF: Cognitive Level: Knowledge REF: p. 823 OBJ: 1 TOP: Endoscopy KEY: Nursing Process Step: Planning

6. Which set of findings best indicates that a patient with intestinal obstruction has achieved normal hydration? a. Pulse and blood pressure are within the patient's norms, mucous membranes are moist, and fluid intake and output are equal. b. Pulse rate is strong (at least 60 beats/min), bowel sounds are normal, and a respiratory rate of 22 breaths/min is recorded. c. Blood pressure is within the patient's norm, the temperature is below normal, and adequate tissue turgor is observed. d. Mucous membranes are moist, the 24-hour fluid intake is higher than the 24-hour output, and the pulse rate is elevated.

ANS: A Vital sign within normal limits, moist mucous membranes, and equal fluid intake and output are indicative of normal hydration. DIF: Cognitive Level: Comprehension REF: p. 833 OBJ: 4 TOP: Hydration KEY: Nursing Process Step: Evaluation

20. A home health nurse is instructing an older adult patient regarding dietary changes to help prevent constipation. What changes should the nurse indicate when providing this education? (Select all that apply.) a. Addition of whole-grain cereal b. Cessation of laxative use c. Increase in liquid intake d. Increase in sugar intake e. Eating fresh vegetables

ANS: A, B, C, E A decrease in sugar intake will help stem diarrhea. DIF: Cognitive Level: Comprehension REF: p. 831 OBJ: 3 | 4 TOP: Nutrition to Avoid Constipation KEY: Nursing Process Step: Implementation

18. A nurse notes a diagnosis of pilonidal cyst on a patient's admission assessment. What anatomical location should the nurse expect to assess this cyst? a. Rectum b. Sacrococcygeal area c. Abdomen d. Anus

ANS: B A pilonidal cyst is located in the sacrococcygeal area. DIF: Cognitive Level: Knowledge REF: p. 845 OBJ: 3 TOP: Pilonidal Cyst KEY: Nursing Process Step: Implementation

15. A nurse is performing an assessment of a patient after an abdominoperineal resection. How many incision sites will be present? a. Two b. Three c. Four d. Five

ANS: B After an abdominoperineal resection, the patient will have three incisions: one on the abdomen, a second for the colostomy, and a third on the perineum. DIF: Cognitive Level: Knowledge REF: p. 842 OBJ: 3 | 4 TOP: Abdominoperineal resection KEY: Nursing Process Step: Assessment

14. A patient is diagnosed with cancer of the large intestine. What is the most likely initial recommended medical intervention? a. Repeat colonoscopy b. Surgery c. Radiation therapy d. Chemotherapy

ANS: B Colorectal cancers are usually initially treated surgically. DIF: Cognitive Level: Knowledge REF: p. 842 OBJ: 3 | 4 TOP: Colorectal Cancer KEY: Nursing Process Step: Planning

4. A nurse is caring for a 34-year-old patient admitted with severe diarrhea that has been going on for 2 weeks. What assessment should the nurse anticipate? a. Edema of lower legs and feet b. Hypotension and fatigue c. Hypertension and hunger d. Metabolic alkalosis

ANS: B Diarrhea of long-standing duration will cause dehydration and fatigue with accompanying hypotension. The patient will most likely be in metabolic acidosis as a result of the loss of the essentially basic bowel contents. DIF: Cognitive Level: Application REF: p. 829 OBJ: 3 TOP: Diarrhea KEY: Nursing Process Step: Assessment

7. After abdominal surgery, a patient must cough and take deep breaths. How can the nurse best achieve this with this patient? a. Withhold analgesics until the patient performs this task. b. Help the patient splint the incision with a pillow. c. Explain that pneumonia occurs if deep breathing is not carried out every 4 hours. d. Ambulate the patient 40 feet to increase his need for oxygen.

ANS: B Splinting decreases pain by supporting the muscles, thereby allowing for better lung expansion. DIF: Cognitive Level: Application REF: p. 834 OBJ: 3 | 4 TOP: Abdominal Surgery KEY: Nursing Process Step: Implementation

2. Which instruction given to a patient with irritable bowel syndrome (IBS) should lessen discomfort? a. Eat only whole grains. b. Take small bites and chew well. c. Include dietary fiber in at least two meals per day. d. Drink herbal teas and low-calorie cola drinks.

ANS: B Taking small bites, chewing food well, and eating slowly will reduce some of the discomfort associated with IBS. Caffeine and high-fiber foods should be avoided. DIF: Cognitive Level: Comprehension REF: p. 839 OBJ: 3 | 4 TOP: IBS KEY: Nursing Process Step: Implementation

12. Colonoscopy results indicate the diagnosis of irritable bowel disease (IBD) in a patient admitted to the hospital with diarrhea. What information should the nurse include when preparing patient education regarding diet? a. Dairy products are encouraged. b. No added salt is required. c. Low roughage should be followed. d. Protein foods are restricted.

ANS: C A low-roughage diet without milk products is prescribed for mild to moderate IBD. DIF: Cognitive Level: Comprehension REF: p. 838 OBJ: 3 | 4 TOP: IBD KEY: Nursing Process Step: Implementation

5. Stool softeners are prescribed to promote normal elimination of feces. What is the most appropriate way to ensure effectiveness of this type of drug? a. Mouth care b. Ambulation c. Adequate fluid intake d. High-fiber diet

ANS: C Adequate fluids must be maintained to ensure the liquid is available; otherwise, the fecal mass will remain hard. DIF: Cognitive Level: Comprehension REF: p. 831 OBJ: 3 TOP: Constipation KEY: Nursing Process Step: Implementation

8. A nurse describes a patient as morbidly obese because the patient has a weight of 387 lb and a height of 2 meters. What is the patient's body mass index (BMI)? a. 58.4 b. 52.8 c. 43.9 d. 31.6

ANS: C Body mass index is calculated by dividing the weight in kilograms by the height in meters squared. Anyone weighing more than 30 kg is considered obese; 387 lb ÷ 2.2 lb/kg = 176 kg; 176 kg ÷ 4 m = BMI of 43.9. DIF: Cognitive Level: Analysis REF: p. 825 OBJ: 4 TOP: Inguinal Hernia KEY: Nursing Process Step: Assessment

13. A nurse is caring for a patient diagnosed with diverticulosis and assesses a temperature of 102.4° F and abdominal rigidity. What should the nurse be aware is the most likely cause of these signs and symptoms? a. Infection b. Constipation c. Perforation d. Obstruction

ANS: C The nurse caring for a patient diagnosed with diverticulosis should be alert for signs of perforation including fever, abdominal distention, and rigidity. DIF: Cognitive Level: Application REF: p. 841 OBJ: 3 | 4 TOP: Diverticulosis KEY: Nursing Process Step: Assessment

17. A nurse provides education to a patient after a hemorrhoidectomy. Which statement by the patient demonstrates the need for further instruction? a. "Sitz baths are ordered to soothe the area." b. "Imagery may help control pain." c. "Bleeding should be reported." d. "Fluids are restricted."

ANS: D After hemorrhoidectomy, the patient should be encouraged to ingest a high-fiber diet and drink plenty of fluids to promote regular, soft stools. DIF: Cognitive Level: Comprehension REF: p. 844 OBJ: 3 | 4 TOP: Hemorrhoidectomy KEY: Nursing Process Step: Assessment

19. A patient is being seen for the first time at a physician's office. When assisting with the assessment, a nurse notices abdominal striae. What alternative term should the nurse use when the patient asks what it is all over her abdomen? a. Scarring b. Lesions c. Rashes d. Stretch marks

ANS: D Striae is the medical term for stretch marks. DIF: Cognitive Level: Knowledge REF: p. 822 OBJ: 3 TOP: Inspection KEY: Nursing Process Step: Assessment

9. Which statement by a patient with an ileostomy as a remedy for ulcerative colitis indicates the need for further teaching? a. "I will avoid milk products." b. "I should select food with less dietary fiber." c. "I'll miss my martini before dinner." d. "I will be glad when the surgeon closes this ileostomy."

ANS: D The ileostomy is permanent. The diet of a person prone to ulcerative colitis is low roughage, no milk products, and no alcohol. DIF: Cognitive Level: Comprehension REF: p. 838 OBJ: 4 TOP: Inflammatory Bowel Disease KEY: Nursing Process Step: Evaluation

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

ANSWER: B Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. *Milk may exacerbate PUD and alcohol is best avoided because it can delay healing.*

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

ANSWER: B For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns to prevent aspiration.

ANSWER: B For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns

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

Acetaminophen (Tylenol)

A client arrives at the emergency department and complains 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 health care provider's prescriptions. Which prescription should the nurse question if written on the health care provider's prescription form?

Administration of an opioid analgesic

A nurse has taught a client with chronic pancreatitis about risk factor modification to reduce the incidence of recurrences. The nurse concludes that the client has understood the information if the client states that it will be necessary to control which of the following? a. diabetes mellitus b. alcohol intake c. duodenal ulcer d. Crohns Disease

Alcohol intake Chronic pancreatitis is aggravated by continued alcohol intake. Each of the other options is not specifically associated with pancreatitis.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse plans care, knowing that which problem occurs with this disorder?

Alteration in comfort related to abdominal pain

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

Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing

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

The client with hiatal hernia chronically experiences heartburn following meals. The nurses plans to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of bed on 6-inch blocks 4. Taking H2-receptor antagonist medication

Answer 1 Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. *The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals.* Relief is obtained with the intake of small, frequent meals, use of H2-receptor antagonists and antacids, and elevation of the thorax following meals and during sleep

A patient has a vagotomy with antrectomy to treat a duodenal ulcer. Postoperatively, the patient develops dumping syndrome. Which of the following statements, if made by the patient, should indicate to the nurse that further dietary teaching is needed? 1. I should eat bread with each meal 2. I should eat smaller meals more frequently. 3. I should lie down after eating. 4. I should avoid drinking fluids with my meals

Answer 1 Patient should decrease intake of carbohydrates.

The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." which intervention should be included for this problem? d. 2. encourage the client to decrease the amount of smoking. 3. instruct the client to take over the counter medication for relief of pain. 4. discuss the need to attend alcoholics anonymous to quit drinking

Answer 1 (correct): the client should elevate the hdad of the bed on blocks or use afoam wedge to use gravity to help keep the grastric acid in the stomach and prevent reflux into the esophagus. behavior modification is changing one's behavior. 2. client should not reduce but quite smoking altogether. 3. nurse should be careful when suggesting OTC meds. 4. should stem alcohol but no indication client is an alcoholic

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

Answer 1, "1. CORRECT - Of adult-onset asthma cases, 80%-90% are caused by gastroesophageal reﬂux disease(GERD) 2. Pancreatitis is not related to GERD 3. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levelsof gastric acid, but it is not related to reﬂux. 4.GERD is not related to increased gastricemptying. Increased gastric emptying would bea beneﬁt to a client with decreased functioningof the lower esophageal sphincter

Answer 1, Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent meals, use of H2-receptor antagonists and antacids, and elevation of the thorax following meals and during sleep

Answer 1, Patient should decrease intake of carbohydrates

The client with hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals. 2. Taking in small, frequent bland meals. 3. Raising the head of the bed on 6-inch block. 4. Taking H2-receptor antagonist medication

Answer 1,Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus is normally positioned. he client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Option 2-4, and actually elevating the thorax after a meal, provide relief

"A nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which of the following laboratory results would the nurse expect to note if the client does have appendicitis? 1. Leukopenia with a shift to the right 2. Leukocytosis with a shift to the right 3.Leukocytosis with a shift to the left 4. Leukopenia with a shift to the left"

Answer 2 - no rationale

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

Answer 2, "1. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss, but not weight gain. 2. Most clients with GERD have been self- medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. 3. Milk and dairy products contain lactose, which are important if considering lactose intolerance, but are not important for "heartburn." 4. Heartburn is not a symptom of a viral illness

The client is diagnosed with an acute exacerbation of ulcerative colitis. Which inter- vention should the nurse implement? 1. Provide a low-residue diet. 2.Monitor intravenous ﬂuids. 3.Assess vital signs daily.4.Administer antacids orally

Answer 2, "1. The client's bowel should be placed on rest andno foods or ﬂuids should be introduced intothe bowel. 2. (Correct) The client requires ﬂuids to help prevent dehydration from diarrhea and to replacethe ﬂuid lost through normal body func-tioning. 3.The vital signs must be taken more often thandaily in a client who is having an acute exacer-bation of ulcerative colitis. 4.The client will receive anti-inﬂammatory andantidiarrheal medications, not antacids, whichare used for gastroenteritis

"The nurse is caring for the client diagnosed with chronic gastritis. Which symptom(s) would support this diagnosis? 1. Rapid onset of mid-sternal discomfort. 2. Epigastric pain relieved by eating food 3. Dyspepsia and hematemesis. 4. Nausea and projectile vomiting

Answer 2, "Rationale by answer: 1. Acute gastritis is characterized by sudden epigastric pain or discomfort, not mid-sternal chest pain. 2. Chronic pain in the epigastric area that is relieved by ingesting food is a sign of chronic gastritis (CORRECT). 3. Dyspepsia (heartburn) and hematemesis (vomiting blood) are frequent symptoms of acute gastritis. 4. Projective vomiting is not a sign of chronic gastritis

Answer 2, 1. Pain in the chest when walking up stairs indicates angina. 2. Frequent use of antacids indicates an acid reflux problem. 3. Snoring loudly could indicate sleep apnea, but not GERD. 4. Carbonated beverages increase stomach pressure. Six to seven soft drinks a day would not be tolerated by a client with GERD

What response should a nurse offer to a client who asks why he's having a vagotomy to treat his ulcer? 1. To repair a hole in the stomach 2. to reduce the ability of the stomach to produce acid 3. to prevent the stomach from sliding into the chest 4. to remove a potentially malignant lesion in the stomach

Answer 2: A vagotomy is perfomred to elimniate the acid-secreting stimulus to gastric cells. a perforation would be repaired with a gastric resection. Repair of hiatal hernia (fundoplication) prevents the stomach from sliding through the diaphragm. Removal of a potentially malignant tumor wouldn't reduce the entire acid-producing mechanism

The nurse is assessing the client diagnosed with chronic gastritis. Which symptom(s) support this diagnosis? 1. Rapid onset of midsternal discomfort 2. Epigastric pain relieved by eating food 3. Dyspepsia and hematemesis 4. Nausea and projectile vomiting

Answer 2: Chronic pain in the epigastric area relieved by ingesting food is a sign of chronic gastritis

A male client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. When obtaining the client's history, the nurse gives priority to the client's statement that: 1) His pain increases after meals. 2) He experiences nausea frequently. 3) His stools have a black appearance. 4) He recently joined Alcoholics Anonymous

Answer 3, 1) Investigation of bleeding takes prioritylater the nurse should help to identify irritating foods that are to be avoided. 2) Nausea is a common symptom of gastritis, but it is not life threatening. 3) Black (tarry) stools indicate upper GI bleedingdigestive enzymes act on the blood resulting in tarry stools. Hemorrhage can occur if erosion extends to blood vessels. 4) Attempts to control alcoholism should be supported but this is a long-term goalassessment of bleeding takes priority

Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? 1. Decrease daily intake of vegetables and water, and ambulate frequently 2. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. 3. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating 4. Avoid over-the-counter drugs that have antacids in them

Answer 3, Eating small and frequent meals requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus which is often exacerbated when lying down, expecially after a large meal which makes the patient tired

which is the most common upper GI problem? " 1. peptic ulcer disease 2. Crohns 3. Gerd 4. ulcerative colitis

Answer 3, Gerd is the only upper GI problem

which is the most common upper GI problem? "1. peptic ulcer disease 2. Crohns 3. Gerd 4. ulcerative colitis

Answer 3, Gerd is the only upper GI problem

"A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these assessment findings, the nurse should further assess the client for which of the following complications?" " 1. Deficient fluid volume. 2. Intestinal obstruction. 3. Bowel ischemia. 4. Peritonitis.

Answer 4 Complications of acute appendicitis are perforation, peritonitis, and abscess development. Signs of the development of peritonitis include abdominal pain and distention, tachycardia, tachypnea, nausea, vomiting, and fever. Because peritonitis can cause hypovolemic shock, hypotension can develop. Deficient fluid volume would not cause a fever. Intestinal obstruction would cause abdominal distention, diminished or absent bowel sounds, and abdominal paIn. Bowel ischemia has signs and symptoms similar to those found with intestinal obstruction.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen

Answer 4 Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which become rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding

The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? "1. Development of laryngeal cancer. 2. Irritation of the esophagus. 3. Esophageal scar tissue formation. 4. Aspiration of gastric contents

Answer 4, "Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing

The doctor has ordered Tagamet for a client admitted with gastroesophageal reflux disease (GERD). After looking up the drug in the Physician's Desk Reference, you understand it is being used to:1. Neutralize stomach acid. 2. Treat a hiatal hernia. 3. Aid in the digestion of food. Decrease stomach acid production

Answer 4, 4. Treatment for GERD includes medications such as Tagamet to decrease stomach acid production and promote healing of esophagus

Answer 4, Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which become rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ucler? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen

Answer 4, Rationale: Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understands the discharge instructions?7 1. I should not eat for 24 hours following this procedure. 2 I can lie down whenever iI want after a meal. It own't make a difference. 3. The stomach contents won't bother my esophagus but will make me nauseous. 4. I should avoid drinking orange jice and eating tomatoes until my esophagus heals.

Answer 4, oragne and tomato juices are acidic, and the client diagnosed with GERD shouldavoid acidic foods until the esophagus hashad a chance to heal - A client hospitalized with a gastric ulcer is scheduled for discharge.

the nurse is monitoring a client with a diagnosis of peptic ulcer. which assessment finding would most likely indicate perforation of the ulcer? 1. bradycardia 2. numbness in legs 3. N&V 4. a rigid board-like abdomen

Answer 4, perforation of ulcer is a surgical emergency and is characterized by sudden, sharp, intolderable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. nausea and vomiting may also occur. tachycardia may occur as hypovolemic shock develops. numbness of the legs is not an associated finding

The nurse is monitoring a female client with a diagnosis of peptic ulcer. 1.Bradycardia 2.Numbness in the legs 3.Nausea and vomiting 4.A rigid, board-like abdomen

Answer 4,1.Tachycardia may occur as hypovolemic shock develops. 2.Numbness in the legs is not an associated finding. 3.Nausea and vomiting may occur. 4.Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like

"When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? "a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage."

Answer B. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.

"When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage."

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?"a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage."

The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? a. Sexual dysfunction b. Body image, disturbed c. Fear related to poor prognosis d. Nutrition: more than body requirements, imbalanced

Answer B. Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). No data in the question support options A and C. Nutrition: less than body requirements, imbalanced is the more likely nursing diagnosis.

The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E

Answer B. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for vitamin A, C, or E deficiency

The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? a. Irrigating the drain b. Avoiding coughing c. Maintaining bed rest d. Restricting pain medication

Answer B. Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure. Bed rest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure, although the client may be instructed in simple dressing changes.

The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? a. Limit oral fluid b. Elevate the scrotum c. Apply heat to the abdomen d. Remain in a low-fiber diet

Answer B. Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed. Heat will increase swelling. Limiting oral fluids and a low-fiber diet can cause constipation.

The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? a. Notify the physician b. Stop the irrigation temporarily c. Increase the height of the irrigation d. Medicate for pain and resume the irrigation

Answer B. If cramping occurs during a colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. The physician does not need to be notified. Increasing the height of the irrigation will cause further discomfort. Medicating the client for pain is not the appropriate action in this situation.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level b. Elevated serum bilirubin level c. Elevated blood urea nitrogen level d. Decreased erythrocycle sedimentation rate

Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis? a. RBC 5.5 x 106/mm3 b. Hct 44 % c. WBC 13, 000/mm3 d. Hgb 15 g/dL"

Answer C "Rationale: Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and inflammation. Normal WBC count is 5, 000 - 10, 000/mm3. Other options are normal values."

Which of the following drugs is a histamine blocker and reduces levels of gastric acid?" A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox)

Answer C Cimetidine bind to H2 in the tissue and decreases the production of gastric acid

The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? " A) Nausea B) Belching C) Epigastric pain D) Difficulty swallowing

Answer C Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain

"The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? " A) Nausea B) Belching C) Epigastric pain D) Difficulty swallowing

Answer C, "Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain

"The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? "A) Nausea B) Belching C) Epigastric pain D) Difficulty swallowing

Answer C, "Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. regular diet b. skim milk c. nothing by mouth d. clear liquids

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

5. Which of the following drugs is a histamine blocker and reduces levels of gastric acid?" A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox)

Answer C, Cimetidine bind to H2 in the tissue and decreases the production of gastric acid

5. Which of the following drugs is a histamine blocker and reduces levels of gastric acid?"A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox)

Answer C, Cimetidine bind to H2 in the tissue and decreases the production of gastric acid

The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? " a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal)

Answer C, Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.

The most frequently used diagnostic test for persons with GERD is:a) Barium enema b) upper endoscopy c) barium swallow d) acid perfusion test

Answer C, Persons with GERD should be referred to a primary care provider for a thorough cardiac evaluation to rule out cardiac disease. The most frequently used diagnostic test is barium swallow. Upper endoscopy is the best method to assess mucosal injury. Acid perfusion tests usually are not necessary, and require the placement of an esophageal probe above the esophageal sphincter to collect esophageal contents

Gastroesophageal reflux disease (GERD) weakens the lower esophageal spinchter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? A. Decrease daily intake of vegetables and water and ambulate frequently, B. drink coffee diluted with milk at each meal and remain in an upright position for thirty minutes, C. Eat small, frequent meals and remain in an upright position for thirty minutes D. Avoid OTC drugs that have antacids in them

Answer C, Rationale: Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus

Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? A) Decrease daily intake of vegetables and water, and ambulate frequently. B) Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. C) Eat small frequent meals, and remain in an upright position for at least 30 minutes after eating. D) Avoid over-the-counter drugs that have antacids in them

Answer C, Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus

"The nurse is teaching a client with a gastric ulcer about dietary management for the disease. Teaching is successful when the client states... Source: Lippincott's Review for NCLEX-RN" "A: "I should eat a low fiber diet to delay gastric emptying." B: "I cannot eat fruits and veggies because they cause too much gas." C: "As long as they don't bother my stomach, I can eat most foods. D: "I can eat bland foods to help my stomach heal

Answer C, The correct answer is C. The antiulcer diet is not severely restricted. it is the ideal to have small frequent feedings but the client can eat foods as long as they do not cause upset. Low fiber diets are more so used in Ulcerative Colitis. A bland diet is used for severe inflammation

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

A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? a. Halts stress reactions b. Heals the gastric mucosa c. Reduces the stimulus to acid secretions d. Decreases food absorption in the stomach

Answer C. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect descriptions of a vagotomy.

The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? a. Ambulate following a meal b. Eat high carbohydrate foods c. Limit the fluid taken with meal d. Sit in a high-Fowler's position during meals

Answer C. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client? a. Tea b. Gelatin c. Custard d. Popsicle

Answer C. Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in options A, B, and D are clear liquids.

Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: a. Position the client supine to assist in medication absorption b. Aspirate the nasogastric tube after medication administration to maintain patency c. Clamp the nasogastric tube for 30 minutes following administration of the medication d. Change the suction setting to low intermittent suction for 30 minutes after medication administration

Answer C. If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the nasogastric tube will remove the medication just administered. Low intermittent suction also will remove the medication just administered. The client should not be placed in the supine position because of the risk for aspiration.

The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? a. Leg exercises b. Early ambulation c. Irrigating the nasogastric tube d. Coughing and deep-breathing exercises

Answer C. In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse should clarify the order. Options A, B, and D are appropriate postoperative interventions.

The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal)

Answer C. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.

The nurse is reviewing the physician's orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client's chart? a. NPO status b. Nasogastric tube inserted c. Morphine sulfate for pain d. An anticholinergic medication

Answer C. Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate interventions for the client with acute pancreatitis.

The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? a. Hypotension b. Bloody diarrhea c. Rebound tenderness d. A hemoglobin level of 12 mg/dL

Answer C. Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? a. Palpates the abdomen for size b. Palpates the liver at the right rib margin c. Listens to bowel sounds in all for quadrants d. Percusses the right lower abdominal quadrant

Answer C. The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.

Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: a. 45 units/L b. 100 units/L c. 300 units/L d. 500 units/L

Answer C. The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.

A nurse is preparing to remove a nasogartric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? a. Exhale b. Inhale and exhale quickly c. Take and hold a deep breath d. Perform a Valsalva maneuver

Answer C. When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.

22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: A. a sedentary lifestyle and smoking. B. a history of hemorrhoids and smoking, C. alcohol abuse and a history of acute renal failure. D. alcohol abuse and smoking

Answer D, Answer D. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers

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

Answer D, Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back-diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, resulting in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (i.e., certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage leading to peptic ulcer disease. The response to H. pylori is likely influenced by a variety of factors, including genetics, environment, and diet. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients on corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors (e.g., fluoxetine [Prozac]) are also at increased risk for ulcers. High-alcohol intake is associated with acute mucosal lesions. Alcohol stimulates acid secretion. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion. Psychologic distress, including stress and depression, can negatively influence the healing of ulcers after they have developed. Smoking also delays ulcer healing. Infection with herpes and cytomegalovirus (CMV) in immunocompromised patients may also lead to gastric ulcers

A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? a. Quickly insert the tube b. Notify the physician immediately c. Remove the tube and reinsert when the respiratory distress subsides d. Pull back on the tube and wait until the respiratory distress subsides

Answer D. During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate action because, in this situation, it may be likely that the tube has entered the bronchus.

The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? a. Clamp the T tube b. Irrigate the T tube c. Notify the physician d. Document the findings

Answer D. Following cholecystectomy, drainage from the T tube is initially bloody and then turns to a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.

The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen

Answer D. Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? a. Start an IV infusion b. Administer an enema c. Cancel the diagnostic test d. Explain that diarrhea is expected

Answer D. The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours. Options A, B, and C are inappropriate actions.

A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? a. An obturator b. Kelly clamp c. An irrigation set d. A pair of scissors

Answer D. When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside, but it is not the priority item.

Answer is C, Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders

The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? "a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal)

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?" a) The ostomy bag should be adjusted. b) Blood supply to the stoma has been interrupted. c) An intestinal obstruction has occurred. d) This is a normal finding 1 day after surgery

Answer: (B) An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. *The stoma should appear cherry red, indicating adequate arterial perfusion.* A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color

A nurse is caring for a child who had a laproscopic appendectomy. What interventions should the nurse document on the child's clinical record? Select all that apply. 1) Intake and Output 2) Measurement of Pain 3) Tolerance to low-residue diet 4) Frequency of dressing changes 5) Auscultation of bowel sounds

Answer: 1, 2, 5 1) Assessment and documentation of fluid balance are critical aspects of all postoperative care. 2) Laparoscopic surgery involves insufflating the abdominal cavity with air, which is painful until it is absorbed. The amount of pain should be measured and documented with either a 1-10 scale or the Wong's FACES for younger children. 3) A special diet is not indicated after this surgery. 4) After a laparoscopic appendectomy there is little drainage and no dressings. 5) Auscultating for bowel sounds and documenting their presennce or absence evaluate the child's adaptation to the intestinal trauma caused by the surgery.

The nurse is assessing an adolescent who is admitted to the hospital with appendicitis. The nurse should report which of the following to the HCP? "1) change in pain rating of 7 to 8 on a 10 point scale. 2) sudden relief of sharp pain, shifting to diffuse pain. 3)shallow breathing with normal vital signs. 4) decrease of pain rating from 8 to 6 when parents visit.

Answer: 2 Rationale: The nurse notifies the HCP if the client has sudden relief of sharp pain and on presence of more diffuse pain. this change in the pain indicates the appendix has ruprured. The diffuse pain is typically accompanied by rigid guarding of the abdomen, progressive abdominal distension, tachycardia, pallor, chills, and irritability. The slight increase pain can be expected; the decrease in pain when parents visit may be attributed to being distracted from the pain. shallow breathing is likely due to the pain and is insignificant when other vital signs are normal

"Which of the following types of gastritis is associated with Helicobacter pylori and duodenal ulcers? 1. Erosive (hemorrhagic) gastritis 2. Fundic gland gastritis (type A) 3. Antral gland gastritis (type B) 4.Aspiring-induced gastric ulcer

Answer: 3 - Erosive (hemorrhagic) gastritis can be caused by ingestion of substances that irritate the gastric mucosa. Fundic gland gastritis (type A) is associated with diffuse severe mucosal atrophy and the presence of pernicious anemia. Antral gland gastritis (type B) is the most common form of gastritis, and is associated with Helicobacter pylori and duodenal ulcers

A school-aged child has an emergency appendectomy. The nurse should report which of the following to the HCP if notes in the immediate postoperative period. 1. abdominal pain, 2. tugging at the incision line, 3. thirst, 4 a rigid abdomen

Answer: 4 Rationale: A tense, rigid abdomen is an early symptom of peritonitis. The other findings are expected in the immediate postoperative period.

A client is experiencing severe upper abdominal pain and jaundice. Which finding on the cholescintigraphy should indicate to the nurse that the client has cholelithiasis? A. Obstruction of the cystic duct by a gallstone B. Viral infection of the gallbladder C. Accumulation of fat in the wall of the gallbladder D. Accumulation of bile in the hepatic duct

Answer: A Rationale: Cholelithiasis is almost always caused by a gallstone lodged in the cystic duct. Accumulation of bile in the hepatic duct would not lead to cholecystitis. Neither the accumulation of fat nor a viral infection leads to cholecystitis.

The nurse is teaching a client with cholelithiasis about lifestyle modification. Which statement made by the client indicates that the nurse's teaching has been successful? A. "I will walk three times a week for 20 minutes each day." B. "I will eliminate salt from my diet." C. "I can fry food as long as I use olive oil instead of vegetable oil." D. "I will use more ground beef in my meal preparation."

Answer: A Rationale: Obesity is commonly associated with the development of gallbladder disease. A balanced diet and exercise will help keep the client's weight within normal limits. There is no reason to eliminate salt from the diet. Ground beef is high in fat and should be limited. Frying adds additional fat and should be avoided.

A client is experiencing pain and nausea related to biliary colic. Which statement should the nurse make to manage this client's symptoms? (Select all that apply.) A. "Medication will help with the nausea and vomiting." B. "Intravenous fluids will ensure that you are well hydrated." C. "It's important for you to be comfortable so that you can rest." D. "Pain medication will be prescribed." E. "A bland diet helps with nausea."

Answer: A, B, C, D Rationale: Clinical therapies for treating biliary colic include administering analgesics, getting adequate rest, correcting fluid and electrolyte imbalances, and administering antiemetics.

The nurse prepares discharge teaching for a client recovering from a cholecystectomy. Which topic should the nurse include in this teaching? (Select all that apply.) A. Surgical incision care B. Manifestations of postoperative complications C. Pain control measures D. Activity level E. High-fat diet

Answer: A, B, C, D Rationale: The nurse will instruct the client on the prescribed activity level, manifestations of postoperative complications that must be reported to the healthcare provider, pain control measures, and surgical incision care. A low-fat, not high-fat, diet must be followed by this client after discharge.

A client is recovering from a laparoscopic cholecystectomy. Which nursing action should the nurse use to reduce this client's risk of infection? (Select all that apply.) A. Monitor vital signs, including temperature, every 4 hours. B. Administer antibiotics as prescribed. C. Coach to take deep breaths every 1dash2 hours while awake. D. Assess the abdomen every 4 hours. E. Place in Fowler position.

Answer: A, B, C, D Rationale: To reduce the risk of infection, the nurse will monitor vital signs, including temperature, every 4 hours, because changes may be the first sign of infection. Assessment of the abdomen can reveal signs of a surgical wound infection. Turning, breathing, and incentive spirometry help prevent postsurgical atelectasis and subsequent pneumonia. Antibiotics are used to control infection. Fowler position may enhance the client's comfort but will have no effect on postsurgical infection.

A client with acute cholecystitis is experiencing nausea and vomiting. Which nursing action should the nurse use to address this client's nutritional status? (Select all that apply.) A. Counseling regarding low-fat menu choices B. Administering antiemetics as prescribed C. Assessing height and weight D. Advising to consume a low-protein diet E. Reviewing serum electrolytes

Answer: A, B, C, E Rationale: Assessing height and weight, reviewing serum electrolytes, counseling on low-fat menu choices, and administering antiemetics as prescribed are all nursing actions that address the client's nutritional status. A high-protein, not low-protein, diet is used to treat cholecystitis.

A client with cholelithiasis is not a surgical candidate at this time. Which pharmacologic treatment should the nurse expect to be prescribed for this client? (Select all that apply.) A. Ursodiol B. Chenodiol C. Antibiotics D. Antipyretics E. Cholestyramine

Answer: A, B, C, E Rationale: Pharmacologic treatment for gallstones is used for clients who refuse surgery or for whom surgery is contraindicated. Medications used in the treatment of gallstones include ursodiol, chenodiol, antibiotics, cholestyramine, and opioid analgesics. Antipyretics are a pharmacologic treatment for fever, not cholelithiasis itself.

The nurse evaluates a client's understanding of discharge teaching following a laparoscopic cholecystectomy. Which client statement indicates teaching has been effective? (Select all that apply.) A. "I will take my pain medicine on an empty stomach to get the maximum benefit." B. "I will be sure to get up and walk every hour." C. "I can have some hot chocolate with my breakfast." D. "I will increase the protein in my diet by drinking whole milk."

Answer: A, B, D Rationale: Clients from a laparoscopic cholecystectomy are often treated in day surgery, but discharge instructions should be similar to those for other clients who have had abdominal surgery. Therefore, they should be informed to be sure to increase their activity level when they return home. Clients should take pain medications with food to diminish irritation to the stomach lining. The client should follow a diet low in fat and high in fat-soluble vitamins. Therefore, including hot chocolate and whole milk would not be appropriate food choices.

A client with right upper quadrant abdominal pain asks why so many tests are being scheduled. Which is the reason that the nurse should give to this client? (Select all that apply.) A. To identify possible complications B. To determine if gallstones are present C. To prevent recurrence D. To determine the location of gallstones E. To diagnose the disorder

Answer: A, B, D, E Rationale: Diagnostic tests are used to identify the presence and location of gallstones, identify possible complications of the gallstones, and help differentiate gallbladder disorders from other disease processes. Diagnostic tests do not prevent the formation of gallstones but can give information necessary for treatments that prevent recurrence.

A middle-aged female client who is obese has been experiencing right upper quadrant abdominal pain for the past several hours. For which risk factors of gallstone development should the nurse assess this client during the health history? (Select all that apply.) A. Excess cholesterol B. Inflammation of the gallbladder C. Biliary colic D. Biliary stasis E. Abnormal bile composition

Answer: A, B, D, E Rationale: The formation of gallstones occurs when several factors are present, including abnormal bile composition, biliary stasis, inflammation of the gallbladder, and excess cholesterol. Excess cholesterol in bile is associated with obesity, a high-calorie and high-cholesterol diet, and drugs that lower serum cholesterol levels. Biliary colic is the pain described in cholelithiasis. This pain is localized to the epigastrium and the right upper quadrant of the abdomen. Biliary colic does not lead to the formation of gallstones.

The nurse is providing dietary teaching to a client with a history of gallstones. Which diet should the nurse recommend? (Select all that apply.) A. High protein B. Low sodium C. Low fat D. High vitamin C E. High carbohydrate

Answer: A, C Rationale: A low-carbohydrate, low-fat, high-protein diet reduces symptoms of cholecystitis. While fasting and very low-calorie diets are contraindicated, a moderate reduction in caloric intake and increased activity levels promote weight loss.

The nurse is preparing health promotion teaching for a client with gallbladder disease. Which topic should the nurse include in the teaching session? (Select all that apply.) A. Role of a high-cholesterol diet on gallstone formation B. Role of hypolipidemia on gallstone formation C. Importance of a low-cholesterol diet D. Dangers of rapid weight loss E. Importance of a high-fiber diet

Answer: A, C, D, E Rationale: Clients should be taught about the role of obesity, hyperlipidemia, and a high-cholesterol diet on gallstone formation; the importance of a high-fiber, low-fat, and low-cholesterol diet to reduce the incidence of gallbladder disorders; and the dangers of rapid weight loss. Hypolipidemia does not promote gallstone formation.

A client scheduled for a cholecystectomy asks what caused the gallstones to develop. Which risk factor should the nurse list when responding to this client? (Select all that apply.) A. American Indian ethnicity B. Male sex C. Family history of gallstones D. Obesity E. Hyperlipidemia

Answer: A, C, D, E Rationale: The risk factors for developing gallbladder disorders include age, family history of gallstones, American Indian ethnicity, obesity, hyperlipidemia, female sex, pregnancy, diabetes mellitus, cirrhosis, ileal disease, and sickle cell disease. Men have a lower risk of developing gallbladder disorders.

A pregnant client of American Indian heritage experiences mild gastric distress and nausea after eating large meals and constant sharp abdominal pain. Which additional information should the nurse collect during the interview? (Select all that apply.) A. History of chronic diseases B. Expected due date C. Length of time the symptoms last and when they occur D. Smoking history E. Other symptoms F. Current diet

Answer: A, C, E, F Rationale: The nurse should note current manifestations, including right upper quadrant (RUQ) abdominal pain, and its character and relationship to meals, duration, and radiation; nausea and vomiting; other symptoms; duration of symptoms; risk factors or previous history of symptoms; chronic diseases such as diabetes, cirrhosis, or IBD; current diet; and use of oral contraceptives or possibility of pregnancy.

Which of the following complications is thought to be the most common cause of appendicitis? a. A fecalith b. Internal bowel occlusion c. Bowel kinking d. Abdominal wall swelling"

Answer: A. A fecalith Rationale: A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction."

A client with acute cholecystitis is experiencing jaundice. Which should the nurse consider as the reason for the jaundice? A. Viral infection of the gallbladder B. Obstruction of the cystic duct by a gallstone C. Accumulation of bile in the hepatic duct D. Accumulation of fat in the wall of the gallbladder

Answer: B Rationale: When acute cholecystitis is accompanied by jaundice, partial common duct obstruction is likely, which is usually due to stones or inflammation.

Caffeinated beverages and smoking are risk factors to assess for in the development of what condition? A. Duodenal ulcers B. Peptic ulcers C. Helicobacter pylori D. Esophageal reflux

Answer: B PUD risk factors include family history, blood group O, smoking tobacco, and beverages containing caffeine

Caffeinated beverages and smoking are risk factors to assess for in the development of what condition? A. Duodenal ulcers B. Peptic ulcers C. Helicobacter pylori D. Esophageal reflux

Answer: B PUD risk factors include family history, blood group O, smoking tobacco, and beverages containing caffeine

Caffeinated beverages and smoking are risk factors to assess for in the development of what condition? A. Duodenal ulcers B. Peptic ulcers C. Helicobacter pylori D. Esophageal reflux

Answer: B PUD risk factors include family history, blood group O, smoking tobacco, and beverages containing caffeine

A client asks what causes gallstones to form. Which factor should the nurse explain as being present when these stones are formed? (Select all that apply.) A. Rapid weight gain B. Abnormal bile composition C. Excess cholesterol D. Inflammation of the gallbladder E. Biliary stasis

Answer: B, C, D, E Rationale: Gallstones are formed due to abnormal bile composition, an inflammation of the gallbladder, biliary stasis, and excess cholesterol. Rapid weight loss, not weight gain, is a factor that contributes to the formation of gallstones.

Which is a risk factor for gallbladder disease? A. Male gender B. Hypocalcemia C. Rapid weight loss D. Hypolipidemia

Answer: C Rationale: Rapid weight loss, hyperlipidemia (not hypolipidemia), and female (not male) gender are risk factors for gallbladder disease. Hypocalcemia is not a risk factor.

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

Answer: D "D) White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis."

Bobby, a 13 year old is being seen in the emergency room for possible appendicitis. An important nursing action to perform when preparing Bobby for an appendectomy is to:""a) administer saline enemas to cleanse the bowels b) apply heat to reduce pain c) measure abdominal girth d) continuously monitor pain

Answer: D Rationale: Pain is closely monitored in appendicitis. In most cases, pain medication is not given until prior to surgery or until the diagnosis is confirmed to be able to closely monitor the progression of the disease. A sudden change in the character of pain may indicate rupture or bowel perforation. Administering an enema or applying heat may cause perforation and abdominal girth may not change with appendicitis.

A client who is morbidly obese is diagnosed with acute cholelithiasis. Which nonpharmacologic therapy should the nurse expect to be prescribed for this client? A. Parenteral nutrition B. Fat-soluble vitamins C. Bile salts D. Withholding all oral intakes and inserting a nasogastric tube

Answer: D Rationale: During an acute attack of cholecystitis, food should be eliminated and a nasogastric tube inserted to relieve nausea and vomiting. Parenteral nutrition is not indicated at this time. Once the client is eating again, dietary fat intake may be limited, especially if the client is obese. If bile flow is obstructed, fat-soluble vitamins (A, D, E, and K) and bile salts may need to be administered but this would be considered a pharmacologic therapy.

The nurse is planning an educational program about development and prevention of gallstones for a community group. Which population should the nurse identify to be most at risk for developing gallstones? A. Young adult Asian American women B. Middle-aged Caucasian American men C. African American clients D. Women over the age of 40

Answer: D Rationale: Genetic considerations and risk factors vary depending on the nature of the inflammatory disorder. Female sex, being over the age of 40, American Indians, and Mexican Americans are most at risk for gallstones. Family history is also associated with increased risk.

The nurse is teaching a client with cholelithiasis about a new prescription for ursodiol. Which client statement indicates to the nurse that the teaching was successful? A. "If I take this for a long time it might damage my liver, so I will need checkups of my liver function." B. "There is a good chance I will experience diarrhea, so I might need my dosage reduced." C. "This medicine should take away the orange color from my skin." D. "I might have some slight diarrhea or constipation, but that is a normal side effect of the medicine."

Answer: D Rationale: Ursodiol is a bile acid. It is used to dissolve gallstones in clients who cannot have surgery to remove gallstones. Ursodiol is also used to prevent the formation of gallstones in clients who are overweight or who are losing weight very quickly. It works by decreasing the production of cholesterol and by dissolving the cholesterol in bile so that it cannot form stones. Ursodiol is generally well tolerated but can cause diarrhea or constipation.

Answer: D In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating foods. Other answers: the presence of blood does not specifically indicate diagnose of an ulcer. The client could have hemorrhoids or cancer. A waveline burning sensation is a symptom of GERD. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease

Answer: D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD

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

Answer: D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD

Which of these agents is a major contributing factor in the promotion of peptic ulcer disorder? A) Candida albicans. B) staphyloccus infection. C) streptococcus infection D) Helibacter pylori infection

Answer: Helobacter pylori infection. Rationale: Recurrence of peptic ulcers is related to Helicobacter pylori, use of NSAIDs, smoking, and continued acid hypersecretion.

Answer: Helobacter pylori infection. Rationale: Recurrence of peptic ulcers is related to Helicobacter pylori, use of NSAIDs, smoking, and continued acid hypersecretion

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

Ask the client to extend the arms.

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

Aspiration

A client with viral hepatitis states to the nurse, "I am so yellow." The nurse should take which action?

Assist the client in expressing feelings

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

Avoid coughing.

A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first? a. Inform the patient that laboratory testing of blood and stools will be necessary. b. Ask the patient to describe the character of the stools and any associated symptoms. c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. d. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.

A 54-year-old critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence? a. Apply incontinence briefs. b. Use a fecal management system c. Insert a rectal tube with a drainage bag. d. Assist the patient to a commode frequently.

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Assess the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system? A: Ileum B: Cecum C: Rectum D: Jejunum

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Insert a urinary catheter to drainage. b. Infuse metronidazole (Flagyl) 500 mg IV. c. Send the patient for a computerized tomography scan. d. Place a nasogastric (NG) tube to intermittent low suction.

A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing?* A. Obstruction of pylorus B. Upper gastrointestinal bleeding C. Perforation D. Peritonitis

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all these changes. I don't want to look at the stoma." What is the best action by the nurse? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Develop a detailed written list of ostomy care tasks for the patient. d. Postpone any teaching until the patient adjusts to the ileostomy.

Helicobacter pylori can live in the stomach's acidic conditions because it secretes ___________ which neutralizes the acid.* A. ammonia B. urease C. carbon dioxide D. bicarbonate

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about a. endoscopy. b. colonoscopy. c. computerized tomography screening. d. carcinoembryonic antigen (CEA) testing.

The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient a. inserts the irrigation tubing 4 to 6 inches into the stoma. b. hangs the irrigating container 18 inches above the stoma. c. stops the irrigation and removes the irrigating cone if cramping occurs. d. fills the irrigating container with 1000 to 2000 mL of lukewarm tap water.

Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the health care provider? a. The patient has a history of constipation. b. The patient has noticed blood in the stools. c. The patient had an appendectomy at age 27. d. The patient smokes a pack/day of cigarettes.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

Which information will the nurse teach a 23-year-old patient with lactose intolerance? a. Ice cream is relatively low in lactose. b. Live-culture yogurt is usually tolerated. c. Heating milk will break down the lactose. d. Nonfat milk is a better choice than whole milk.

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "The medication will be tapered if I need surgery." b. "I will need to use a sunscreen when I am outdoors." c. "I will need to avoid contact with people who are sick." d. "The medication will prevent infections that cause the diarrhea."

You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication?* A. "I will take this medication at the same time I take Ranitidine." B. "I will always take this medication on an empty stomach." C. "It is best to take this medication with antacids." D. "I will take this medication once a week."

You're educating a group of patients at an outpatient clinic about peptic ulcer formation. Which statement is correct about how peptic ulcers form?* A. "An increase in gastric acid is the sole cause of peptic ulcer formation." B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be released which signals to the parietal cells to release more pepsinogen which erodes the stomach lining further." D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form."

The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect? A) Hematochezia B) Left upper abdominal pain C) Ascites and peripheral edema D) Temperature over 102 F

B Rationale: Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following? A. "I can expect yellow-green drainage from the incision for a few days." B. "I can remove the bandages on my incisions tomorrow and take a shower." C. "I should plan to limit my activities and not return to work for 4 to 6 weeks." D. "I will always need to maintain a low-fat diet since I no longer have a gallbladder."

B Rationale: After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the incisions. Patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a life-long requirement.

The client diagnosed with acute pancreatitis is being discharged home. What statement by the client indicates the teaching has been effective? A. I should decrease my intake of coffee, tea, and cola B. I will eat a low fate diet and avoid spicy food C. I will check my amylase and lipase levels daily D. I will return to work tomorrow but take it easy

B Rationale: High fat and spicy foods stimulate pancreatic enzymes. Caffeinated beverages should be avoided not decreased. There are no daily tests the client can take at home. The client will be fatigued as a result as a lowered metabolic rate and will need to rest.

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A: 7:00 AM, 10:00 AM, and 1:00 PM B: 8:00 AM, 12:00 PM, and 4:00PM C: 9:00 AM, 3:00 PM D: 9:00 AM, 12:00 PM, and 3:00 PM

B *8AM, 12PM, 4PM* A nasogastric tube should be checked for patency routinely at 4-hour intervals.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? A: Osteoarthritis B: History of colorectal polyps C: History of lactose intolerance D: Use of herbs as a dietary supplement

B *History of colorectal polyps* A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for a colectomy? A: How to care for the wound B: How to cough and deep breathe C: The location and care of drains after surgery D: Which medications will be used during surgery

B *How to cough and deep breathe* Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

The nurse should administer an as-needed dose of magnesium hydroxide after noting what information when reviewing a patient's medical record? A: Abdominal pain and bloating B: No bowel movement for 3 days C: decrease in appetite by over 50% in 24 hours D: Muscle tremors and others signs of hypomagnesemia

B *No bowel movement for 3 days* Magnesium hydroxide is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

The nurse is assessing the client diagnosed with chronic gastritis. Which symptom(s) support this diagnosis? A. Rapid onset of midsternal discomfort B. Epigastric pain relieved by eating food C. Dyspnea and hematemesis D. Nausea and projectile vomiting

B Chronic pain in the epigastric area that is relieved by eating food is a sign of chronic gastritis

The nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a health care provider prescription for which type of suction? A: High and intermittent B: Low and intermittent C: High and continuous D: Low and continuous

B Gastric mucosa can be traumatized and pulled into the tube if the suction pressure is placed on high or if the suction is continuous. The suction should be set on low pressure and intermittent suction control.

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? A: Leukopenia with a shift to the left B: Leukocytosis with a shift to the left C: Leukopenia with a shift to the right D: Leukocytosis with a shift to the right

B Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white blood cells).

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective? A: "I should be sure to eat at least 1 cucumber every day." B: "Beet greens, parsley, or yogurt will help to control the colostomy odor." C: "I will need to increase my egg intake and try to eat ½ to 1 egg per day." D: "Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."

B The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley, buttermilk, and yogurt. Spinach also may reduce odor, but it is a gas-forming food and should be avoided. Cucumbers, eggs, and broccoli also are gas-forming foods and should be avoided or limited by the client.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hepatitis B? A. Explain the importance of good hand washing B. Recommend the client take the hepatitis B vaccine C. Tell the client not to ingest unsanitary food or water D. Discuss how to implement standard precautions

B The hepatitis B vaccine will prevent the client from contracting this disease

The nurse is caring for the client diagnosed with hepatic encephalopathy. What sign or symptom indicates the disease is progressing? A. The client has a decrease in serum ammonia level B. The client is not able to circle choices on the menu C. The client is able to take a deep breath as directed D. The client is able to eat previously restricted meal items

B The inability to circle menu items may indicate deterioration in the client's cognitive status. The client's neurological status is impaired with hepatic encephalopathy. The nurse should investigate this behavior.

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the health care provider for which type of diet for this client? A: A low-fat diet B: A low-fiber diet C: A high-protein diet D: A high-carbohydrate diet

B low-fiber diet places less strain on the intestines because this type of diet is easier to digest. Clients should avoid high-fiber foods when experiencing acute diverticulitis. As the attack resolves, fiber can be added gradually to the diet.

The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? 1. Ice tea 2. Dry toast 3. warm broth 4. plain hamburger

B) Dry toast (Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Extremely hot or cold liquids and fatty foods are generally not well tolerated

Thinking back to the patient in question 8, select ALL the correct statements on how to educate this patient about decreasing their symptoms:* A. "It is best to eat 3 large meals a day rather than small frequent meals." B. "After eating a meal lie down for 30 minutes." C. "Eat a diet high in protein, fiber, and low in carbs." D. "Be sure to drink at least 16 oz. of milk with meals."

B, C

A patient has developed a duodenal ulcer. As the nurse, you know that which of the following plays a role in peptic ulcer formation. Select ALL that apply:* A. Spicy foods B. Helicobacter pylori C. NSAIDs D. Milk E. Zollinger-Ellison Syndrome

B, C, E

When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant? Select all that apply. A. Assessing the client's bowel sounds B. Providing skin care following bowel movements C. Evaluating the client's response to antidiarrheal medications D. Maintaining intake and output records E. Obtaining the client's weight.

B, D, E and 5. The nurse can delegate the following basic care activities to the unlicensed assistant: providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight. Assessing the client's bowel sounds and evaluating the client's response to medication are registered nurse activities that cannot be delegated.

The nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply. A: Antidiarrheal B: Antimicrobial C: Corticosteroid D: Aminosalicylate E: Biological therapy F: Immunosuppressant

B,C,D,E,F Pharmacological treatment for IBD aims to decrease the inflammation to induce and then maintain a remission. Five major classes of medications used to treat IBD are antimicrobials, corticosteroids, aminosalicylates, biological and targeted therapy, and immunosuppressants. Medications are chosen based on the location and severity of inflammation. Depending on the severity of the disease, clients are treated with either a "step-up" or "step-down" approach. The step-up approach uses less toxic therapies (e.g., aminosalicylates and antimicrobials) first, and more toxic medications (e.g., biological and targeted therapy) are started when initial therapies do not work. The step-down approach uses biological and targeted therapy first. Option 1, antidiarrheals, is incorrect. Although an antidiarrheal may be used to treat the symptoms of IBD, it does not treat the disease (the inflammation) or induce remission. In addition, antidiarrheals should be used cautiously in IBD because of the danger of toxic megacolon (colonic dilation greater than 5 cm).

A client with a recent diagnosis of acute gastritis needs health teaching about nutrition therapy. Which foods and beverages should the nurse teach the client to avoid? Select all that apply. A. Potatoes B. Onions C. Apples D. Milk E. Orange juice F. Tomato juice

B,E,F (A balanced diet includes following the recommendations of the USDA and limiting the intake of foods and spices that can cause gastric distress. Acidic foods such as citrus fruits and juices and tomatoes should be avoided. Gas-forming foods such as onions should also be eliminated from the diet. Potatoes are relatively bland and often do not cause gastric upset. Apples are not acidic or irritating to the gastric mucosa and need not be avoided. Milk may actually have a beneficial coating effect on the gastric mucosa. Reference: p. 1225, Health Promotion and Maintenance

What client problem has a priority for the client diagnosed with acute pancreatitis? A. Risk for fluid volume deficient B. Alteration in comfort C. Imbalanced nutrition: less than the boy requires D. Knowledge deficient

B. Rationale: Autodigestion of the pancreas results in severe pain, accompanied by nausea, vomiting,m abdominal tenderness, and muscle guarding. The Maslow's hierarchy should be applied. After ABC's pain is the next priority

A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? A) Immediately start enteral feeding to prevent malnutrition. B) Insert an NG and maintain NPO status to allow pancreas to rest. C) Initiate early prophylactic antibiotic therapy to prevent infection. D) Administer acetaminophen (Tylenol) every 4 hours for pain relief.

B. Rationale: Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis? A. The patient's urine is bright yellow. B. The patient's stools are tan colored. C. The patient has increased pain after eating. D. The patient complains of chronic heartburn.

B. Rationale: Tan or grey stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse would also report the other assessment information to the health care provider.

Teaching in relation to home management after a laparoscopic cholecystectomy should include A. Keeping the bandages on the puncture sites for 48 hours. B. Reporting any bile-colored drainage or pus from any incision. C. Using over-the-counter antiemetics if nausea and vomiting occur. D. Emptying and measuring the contents of the bile bag from the T tube every day

B. Rationale: The following discharge instructions are taught to the patient and caregiver after a laparoscopic cholecystectomy: First, remove the bandages on the puncture site the day after surgery and shower. Second, notify the surgeon if any of the following signs and symptoms occur: redness, swelling, bile-colored drainage or pus from any incision; and severe abdominal pain, nausea, vomiting, fever, or chills. Third, gradually resume normal activities. Fourth, return to work within 1 week of surgery. Fifth, resume a usual diet, but a low-fat diet is usually better tolerated for several weeks after surgery.

The client with peptic ulcer disease (PUD) asks the nurse whether a maternal history of ovarian cancer will cause the client to develop gastric cancer. What is the nurse's best response? A. "Yes, it is known that a family history of ovarian cancer will cause someone to develop gastric cancer." B. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing." C. "Have you spoken to your physician about your concerns?" D. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."

B. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing." Genetic counseling will help the client determine whether he is at exceptionally high risk to develop gastric cancer.

A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen."

Which of the following tests should be administered to a client suspected of having diverticulosis? A. Abdominal ultrasound B. Barium enema C. Barium swallow D. Gastroscopy

B. A barium enema will cause diverticula to fill with barium and be easily seen on x-ray. An abdominal US can tell more about structures, such as the gallbladder, liver, and spleen, than the intestine. A barium swallow and gastroscopy view upper GI structures.

The nurse evaluates the client's stoma during the initial post-op period. Which of the following observations should be reported immediately to the physician? A. The stoma is slightly edematous B. The stoma is dark red to purple C. The stoma oozes a small amount of blood D. The stoma does not expel stool

B. A dark red to purple stoma indicates inadequate blood supply. Mild edema and slight oozing of blood are normal in the early post-op period. The colostomy would typically not begin functioning until 2-4 days after surgery.

The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate post-op period for which of the following most frequent complications of this type of surgery? A. Intestinal obstruction B. Fluid and electrolyte imbalance C. Malabsorption of fat D. Folate deficiency

B. A major complication that occurs most frequent following an ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from happening. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

Which of the following symptoms would a client in the early stages of peritonitis exhibit? A. Abdominal distention B. Abdominal pain and rigidity C. Hyperactive bowel sounds D. Right upper quadrant pain

B. Abdominal pain causing rigidity of the abdominal muscles is characteristic of peritonitis. Abdominal distention may occur as a late sign but not early on. Bowel sounds may be normal or decreased but not increased. Right upper quadrant pain is chatacteristic of cholecystitis or hepatitis.

Care for the postoperative client after gastric resection should focus on which of the following problems? A. Body image B. Nutritional needs C. Skin care D. Spiritual needs

B. After gastric resection, a client may require total parenteral nutrition or jejunostomy tube feedings to maintain adequate nutritional status.

During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care? A. Body image B. Ostomy care C. Sexual concerns D. Skin care

B. Although all of these are concerns the nurse should address, being able to safely manage the ostomy is crucial for the client before discharge.

. The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

B. Although these herbs may be helpful in managing PUD, the client should consult his or her physician before making a change in the treatment regimen.

Which is correct information about the treatment of Crohn's disease? A. Surgery is the preferred treatment. B. Aminosalicylates are frequently used first. C. Corticosteroids are given for long-term therapy. D. High-fiber foods are encouraged to add bulk to diarrheal stool.

B. Aminosalicylates are frequently used first. Aminosalicylates (5-ASAs) are used first because they are less toxic, although there is a movement to using biologic and targeted therapy as first-line therapy. Drugs with 5-ASA suppress the proinflammatory cytokines and inflammatory mediators.

A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention? A. Administer dilaudid B. Notify the physician C. Call and ask the operating room team to perform the surgery as soon as possible D. Reposition the client and apply a heating pad on a warm setting to the client's abdomen.

B. Based on the signs and symptoms presented in the question, the nurse should suspect peritonitis and should notify the physician. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis. Scheduling surgical time is not within the scope of nursing practice, although the physician probably would perform the surgery earlier than the prescheduled time.

A client with gastric cancer can expect to have surgery for resection. Which of the following should be the nursing management priority for the preoperative client with gastric cancer? A. Discharge planning B. Correction of nutritional deficits C. Prevention of DVT D. Instruction regarding radiation treatment

B. Client's with gastric cancer commonly have nutritional deficits and may be cachectic. Discharge planning before surgery is important, but correcting the nutrition deficit is a higher priority. At present, radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Prevention of DVT also isn't a high priority to surgery, though it assumes greater importance after surgery.

The patient with Crohn's disease has an ileostomy, with the terminal ileum removed. Absorption of what nutrient is a key concern? A. Carbohydrate B. Cobalamin C. Gluten D. Lactose

B. Cobalamin Patients who had the terminal ileum removed have reduced absorption of cobalamin (vitamin B12). Instrinsic factor is secreted in the stomach but absorbed in the small intestine.

The immunosuppressant azathioprine (Imuran) is given to maintain remission after corticosteroid induction therapy for an exacerbation of ulcerative colitis. What monitoring is required? A. Carcinogenic embryonic antigen (CEA) B. Complete blood cell count (CBC) C. Prostate-specific antigen (PSA) D. Potassium

B. Complete blood cell count (CBC) Regular CBC monitoring is required because the drug can suppress the bone marrow and lead to inflammation of the pancreas or gallbladder. CEA is used to monitor for recurrence of colorectal cancer. PSA is used to monitor for prostate cancer.

The nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to note documented on the client's record? A. Chronic constipation B. Diarrhea C. Constipation alternating with diarrhea D. Stool constantly oozing from the rectum

B. Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity. The other option are not associated with diarrhea.

Which goal of the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? A. Promoting self-care and independence B. Managing diarrhea C. Maintaining adequate nutrition D. Promoting rest and comfort

B. Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal medications, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs.

Which of the following definitions best describes diverticulosis? A. An inflamed outpouching of the intestine B. A noninflamed outpouching of the intestine C. The partial impairment of the forward flow of intestinal contents D. An abnormal protrusion of an organ through the structure that usually holds it.

B. Diverticulosis involves a noninflamed outpouching of the intestine. Diverticulitis involves an inflamed outpouching. The partial impairment of forward flow of the intestine is an obstruction; abnormal protrusion of an organ is a hernia.

Which of the following complications of gastric resection should the nurse teach the client to watch for? A. Constipation B. Dumping syndrome C. Gastric spasm D. Intestinal spasms

B. Dumping syndrome is a problem that occurs postprandially after gastric resection because ingested food rapidly enters the jejunum without proper mixing and without the normal duodenal digestive processing. Diarrhea, not constipation, may also be a symptom. Gastric or intestinal spasms don't occur, but antispasmidics may be given to slow gastric emptying.

An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take? A. Prepare 750 ml of irrigating solution warmed to 100*F B. Question the physician about the order C. Provide privacy and explain the procedure to the client D. Assist the client to left lateral Sim's position

B. Enemas are contraindicated in an acute abdominal condition of unknown origin as well as after recent colon or rectal surgery or myocardial infarction. The other answers are correct only when enema administration is appropriate.

Which preoperative teaching is the highest priority for a 68-year-old patient scheduled for a colectomy? A. How to care for the wound B. How to breathe deeply and cough C. The location and care of drains after surgery D. Which medications will be used during surgery

B. How to breathe deeply and cough Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is essential to teach the patient to cough and breathe deeply.

Which of the following symptoms is associated with ulcerative colitis? A. Dumping syndrome B. Rectal bleeding C. Soft stools D. Fistulas

B. In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn's disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn's disease.

. The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40, pulse 124, and respiratory rate 26. Which admission request will the nurse implement first A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and than daily. D. Insert nasogastric tube and connect to low intermittent suction.

B. Infuse lactated Ringer's solution at 200 mL/hr. The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia.

What is the main treatment for a patient with acute diverticulitis? A. Colon resection and ostomy B. Nasogastric tube and intravenous (IV) fluids C. Long-term course of oral corticosteroids D. Mechanical soft diet

B. Nasogastric tube and intravenous (IV) fluids In acute diverticulitis, the goal of treatment is to allow the colon to rest and inflammation to subside. Bowel rest can be accomplished with the use of a nasogastric tube and IV fluids.

Compared with a colostomy, which complication is a patient with an ileostomy at an increased risk for? A. Constipation B. Obstruction C. Flatus D. Polyps

B. Obstruction The ileostomy patient is susceptible to obstruction because the lumen is less than an inch in diameter and may narrow further at the point where the bowel passes through the fascia-muscle layer of the abdomen. Ileostomies have loose drainage because fluid is not absorbed in the large colon.

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request will the nurse implement first? A. Apply antiembolism stockings. B. Place nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.

B. Place nasogastric (NG) tube, and connect to suction. To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis.

A 68-year-old patient presents to the ED the day after Thanksgiving, stating that he has "eaten and drunk quite a bit." He states that about 1 hour ago he experienced a sudden onset of pain in the left upper quadrant that radiates to his left flank. He rates the pain as an 8 on a 0-to-10 scale. The patient is admitted with acute pancreatitis. Which laboratory finding corroborates the diagnosis of acute pancreatitis? A. Serum lipase, 150 U/L B. Serum amylase, 200 U/L C. White blood cells, 6000 mcL D. Serum glucose, 80 mg/dL

B. Serum amylase, 200 U/L A serum amylase of 200 U/L is elevated (normal range is approximately 23 to 85 U/L). Lipase normal range is 0-160 U/L; WBC normal range is 4800-10,800 ccm; and glucose normal range is 82-110 mg/dL. Amylase, lipase, WBC, and glucose are often higher than normal in patients with acute pancreatitis.

15. Which of the following factors is believed to cause ulcerative colitis? A. Acidic diet B. Altered immunity C. Chronic constipation D. Emotional stress

B. Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn't believed to be the primary cause.

How does the drug sulfasalazine (Azulfidine) work in the treatment of IBD? A. Destroys bacteria B. Suppresses inflammatory mediators C. Slows gastric motility D. Promotes electrolyte exchange across intestinal membrane

B. Suppresses inflammatory mediators Sulfasalazine contains sulfapyridine and 5-aminosalicylic acid (5-ASA). Although the exact action is unknown, it works by suppressing inflammatory mediators. IBD is an autoimmune inflammatory disease; no specific infectious agent has been identified, although antimicrobials (Flagyl, Cipro) occasionally are used.

After a right hemicolectomy for treatment of colon cancer, a 57-year old client is reluctant to turn while on bed rest. Which action by the nurse would be appropriate? A. Asking a co-worker to help turn the client B. Explaining to the client why turning is important. C. Allowing the client to turn when he's ready to do so D. Telling the client that the physician's order states he must turn every 2 hours

B. The appropriate action is to explain the importance of turning to avoid postoperative complications. Asking a coworker to help turn the client would infringe on his rights. Allowing him to turn when he's ready would increase his risk for postoperative complications. Telling him he must turn because of the physician's orders would put him on the defensive and exclude him from participating in care decision.

A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give the client? A. Low fiber, low-fat B. High fiber, low-fat C. Low fiber, high-fat D. High-fiber, high-fat

B. The client with irritable bowel syndrome needs to be on a diet that contains at least 25 grams of fiber per day. Fatty foods are to be avoided because they may precipitate symptoms.

Which of the following symptoms is a client with colon cancer most likely to exhibit? A. A change in appetite B. A change in bowel habits C. An increase in body weight D. An increase in body temperature

B. The most common complaint of the client with colon cancer is a change in bowel habits. The client may have anorexia, secondary abdominal distention, or weight loss. Fever isn't associated with colon cancer.

Which is the best understanding of colon irrigation? A. It is taught to patients with ascending colostomies. B. The tip should be inside a cone to prevent perforation. C. Use cold water to promote peristalsis. D. Administer 2000 mL of sterile saline.

B. The tip should be inside a cone to prevent perforation. The tip is inside a cone to control the depth of insertion, prevent water from leaking out, and prevent perforation. Irrigation is used only in the distal colon or rectum because the stool is solid there.

The client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease as well as gastritis has been reported. Have your other family members been tested for Crohn's disease?"

B. This is the only accurate statement. Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs.

Which is a complication in patients with ulcerative colitis? A. Hyperkalemia B. Toxic megacolon C. Pancreatitis D. Barrett's esophagus

B. Toxic megacolon Colonic dilation (toxic megacolon) can occur as a result of decreased tissue function, with lack of peristalsis and enlargement of the colon. The patient is at risk for perforation.

The client with a colostomy has an order for irrigation of the colostomy. The nurse used which solution for irrigation? A. Distilled water B. Tap water C. Sterile water D. Lactated Ringer's

B. Warm tap water or saline solution is used to irrigate a colostomy. If the tap water is not suitable for drinking, then bottled water should be used.

A 40 year old client is admitted to the hospital with cholecystitis. The nurse should contact the physician to question which of the following prescriptions? a. IV fluid therapy of normal saline solution to be infused at 100 mL/h until further prescriptions b. Administer morphine sulfate 10 mg IM every 4 hours as needed for sever abdominal pain c. Nothing by mouth (NPO) until further prescriptions d. Insert a nasogastric tube and connect to low intermittent suction

B: A nurse should question the prescription for morphine sulfate because it is believed to cause biliary spasm. The preferred opioid analgesic to treat cholecystitis is meperidine (Demerol).

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Ambulate four times daily. d. Increase dietary fiber intake.

B: Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to a. identify any metastasis of the cancer. b. monitor the tumor status after surgery. c. confirm the diagnosis of a specific type of cancer. d. determine the need for postoperative chemotherapy.

B: CEA is used to monitor for cancer recurrence after surgery

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? a. Bacteria in the perianal area can enter the urethra. b. Fistulas can form between the bowel and bladder. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

B: Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI

After change-of-shift report, which patient should the nurse assess first? a. 40-year-old male with celiac disease who has frequent frothy diarrhea b. 30-year-old female with a femoral hernia who has abdominal pain and vomiting c. 30-year-old male with ulcerative colitis who has severe perianal skin breakdown d. 40-year-old female with a colostomy bag that is pulling away from the adhesive wafer

B: Pain and vomiting with a femoral hernia suggest possible strangulation

Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question? a. Ferrous sulfate (Feosol) 325 mg daily b. Senna (Senokot) 1 tablet every day c. Psyllium (Metamucil) 2.1 grams 3 times daily d. Diphenoxylate with atropine (Lomotil) prn loose stools

B: Patients with short bowel syndrome have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patient's oral temperature. d. Obtain information about the accident.

B: Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery

The nurse is admitting a 67-year-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you usually drink?" b. "Have you noticed a recent weight loss?" c. "What time of day do your bowels move?" d. "Do you eat meat or other animal products?"

B: it is most important to determine if the patient has an imbalance in nutrition because of the steatorrhea.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery.

B:An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO

A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a. Teach about a low-residue diet. b. Monitor output from the stoma. c. Assess the perineal drainage and incision. d. Encourage acceptance of the colostomy stoma.

A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the last 6 hours.

A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? a. Administer bulk-forming laxatives. b. Assist the patient to sit on the toilet. c. Manually remove the impacted stool. d. Increase the patient's oral fluid intake.

A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing?* A. Gastroparesis B. Fascia dehiscence C. Dumping Syndrome D. Somogyi effect

During a home care visit, an adult client complains of chronic constipation. What should the nurse tell the client to do? A: Increase potassium in the diet. B: Include rice and bananas in the diet. C: Increase fluid and dietary fiber intake. D: Increase the intake of sugar-free products.

During discharge instructions for a patient following a laparoscopic cholecystectomy, the nurse advises the patient to A. keep the incision areas clean and dry for at least a week B. report the need to take pain medication for shoulder pain C. report any bile colored or purulent drainage from the incisions D. expect some postoperative nausea and vomiting for a few days

Following laparoscopic cholecystectomy, the nurse would expect the patient to A. return to work in 2 to 3 weeks B. be hospitalized for 3 to 5 days postoperatively C. have four small abdominal incisions covered with small dressings D. have a T tube placed in the common bile duct to provide bile drainage

Four hours after a bowel resection, a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to a. auscultate for hypotonic bowel sounds. b. notify the patient's health care provider. c. reposition the tube and check for placement. d. remove the tube and replace it with a new one.

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? A: Blood in the stool B: Chalky gray stool C: Loose, watery stool D: Dry, hard, constipated stool

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include? a. Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. b. The patient will begin sitting in a chair at the bedside on the first postoperative day. c. The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively. d. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.

Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown.

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? a. Auscultation for bowel sounds b. Nasogastric (NG) tube irrigation c. Applying petroleum jelly to the lips d. Assessment of the nares for irritation

Your patient is diagnosed with peptic ulcer disease due to h.pylori. This bacterium has a unique shape which allows it to penetrate the stomach mucosa. You know this bacterium is:* A. Rod shaped B. Spherical shaped C. Spiral shaped D. Filamentous shaped

The client diagnosed with acute pancreatitis is in pain. Which position should the nurse assist the client to assume to help decrease the pain? A. Recommend lying in the prone position with legs extended B. Maintain a tripod position over the bedside table C. Plance in side-lying position with knees flexed D. Encourage a supine position with a pillow under the knees

C Rationale: The fetal position deceases pain caused by the stretching of the peritoneum as a result of edema. The pancreas is located abdomen. Anything that causes the abdomen to be stretched will increase pain.

The nurse has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement? A: Fleet enema B: Fecal disimpaction C: Glycerin suppository D: Soap solution enema (SSE)

C The least amount of invasiveness needed to produce a bowel movement is best. Use of glycerin suppositories is the least invasive method and usually stimulates bowel evacuation within a half-hour. Enemas may be needed on an every-other-day basis, but they are used cautiously (even if not contraindicated) because the Valsalva maneuver can increase intracranial pressure. Fecal disimpaction is done only when the client's rectum has become impacted from constipation as a result of inattention or failure of other measures. Stool softeners may be prescribed on a regular schedule for some clients to avoid hard, dry stools, but oral medication is not administered to an unconscious client.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? A: Clamp the T-tube. B: Irrigate the T-tube. C: Document the findings. D: Notify the health care provider.

C *Document* Following cholecystectomy, drainage from the T-tube is initially bloody and then turns a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? A: Return the patient to NPO status. B: Place a cool compress on the abdomen. C: Encourage the patient to ambulated as ordered D: Administer a PRN dose of IV morphine sulfate

C *Encourage the patient to ambulate* Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

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

C *Reposition the tube and check for placement* The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The physician does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

The client is being prepared for discharge after a laparoscopic cholecystectomy. Which intervention should the nurse implement? A. Discuss the need to change the abdominal dressing daily B. Tell the client to check the T-tube output every 8 hours C. Include the client's significant other in discharge teaching D. Instruct client to stay off clear liquids for 2 days

C A lap chole is outpatient surgery. The nurse must make sure the significant other taking care of the patient is knowledgeable about post-op care.

The nurse is preparing to administer an intermittent enteral feeding though a nasogastric (NG) tube. Which priority assessment should the nurse perform? A: Observe for digestion of formula. B: Assess fluid and electrolyte status. C: Evaluate absorption of the last feeding. D: Evaluate percussion tone of the stomach.

C All stomach contents are aspirated and measured before a tube feeding is administered. This procedure measures the gastric residual. The gastric residual is assessed to confirm whether undigested formula from a previous feeding remains, thereby evaluating absorption of the last feeding. It is important to assess gastric residual because administration of an enteral feeding to a full stomach could result in overdistention, predisposing the client to regurgitation and possible aspiration

The nurse is caring for a client with ascites secondary to hepatic cirrhosis. Which information should the nurse report to the healthcare provider? A. Decrease in the client's weight of one pound B. An increase of urine output after administration of a diuretic C. An increase of abdominal girth of two inches D. A decrease in the serum direct bilirubin to 0.6mg/dL

C An increase in abdominal girth means ascites is increasing, meaning the client's condition is becoming more serious and should be reported to the healthcare provider

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical record? A: Apply a cold pack to the abdomen. B: Administer 30 mL of milk of magnesia (MOM). C: Maintain nothing by mouth (nil per os [NPO]) status D: Initiate an intravenous (IV) line for the administration of IV fluids.

C Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain. Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible surgery.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the health care provider prescribing? A: Enteral feedings B: Fluid restrictions C: Oral corticosteroids D: Activity restrictions

C Crohn's disease is a form of inflammatory bowel disease that is a chronic inflammation of the gastrointestinal (GI) tract. It is characterized by periods of remission interspersed with periods of exacerbation. Oral corticosteroids are used to treat the inflammation of Crohn's disease, so option 3 is the correct one. In addition to treating the GI inflammation of Crohn's disease with medications, it is also treated by resting the bowel. Therefore, option 1 is incorrect. Option 2 is incorrect, as clients with Crohn's disease typically have diarrhea and would not be on fluid restrictions. Option 4, activity restrictions, is not indicated. The client can do activities as tolerated but should avoid stress and strain.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? A: Nausea and vomiting B: Hyperactive bowel sounds C: Firmly distended abdomen D: Abrasions on all extremities

C Firmly distended abdomen Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP). The nurse should contact the HCP to question which prescription if noted in the client's record? A: Maintain a semi Fowler's position. B: Maintain on NPO (nothing by mouth) status. C: Apply a heating pad to the lower abdomen for comfort. D: Initiate an intravenous (IV) line with the administration of IV fluids.

C Heat should never be applied to the abdomen because this may increase circulation to the appendix, potentially leading to increased inflammation and perforation

The nurse is caring for a client admitted to the hospital with suspected acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? A: White blood cell (WBC) count of 4000 mm3 (4 × 109/L) B: WBC count of 8000 mm3 (8 × 109/L) C: WBC count of 18,000 mm3 (18 × 109/L) D: WBC count of 26,000 mm3 (26 × 109/L)

C Laboratory findings do not establish the diagnosis of appendicitis, but there is often a moderate elevation of the WBC count (leukocytosis) to 10,000 to 18,000 mm3 (10 to 18 × 109/L) with an increased number of immature WBCs. An inflammatory process causes a rise in the WBC count. A rise to 26,000 mm3 (26 × 109/L) may indicate a perforated appendix (greater than 20,000 mm3 [20 × 109/L]).

Which complain is significant for the nurse to assess in the adolescent male who uses oral tobacco? A. The client complains of clear to white sputum B. The client has an episodic blister on the upper lip C. The client complains of a non-healing sore in the mouth D. The client has bilateral ducts at the second molars.

C Presence of any non-healing sore on the lips or mouth may be oral cancer. Oral cancer risk increases by using oral tobacco.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider? A: Hypotension B: Bloody diarrhea C: Rebound tenderness D: hemoglobin level of 12 mg/dL (120 mmol/L)

C Rebound tenderness may indicate peritonitis.

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication? A: On arising B: After meals C: On an empty stomach D: 30 minutes before meals

C Salicylate compounds, such as sulfasalazine, act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and increase fluid intake throughout the day. The medication needs to be taken after meals to reduce gastrointestinal irritation.

Which instruction should be discussed with the client diagnosed with GERD? A. Eat a low-carbohydrate, low-sodium diet B. Lie down for 30 minutes after eating C. Do not eat spicy or acidic foods D. Drink 2 glasses of water at bedtime

C The client should avoid spicy and acidic foods, as well as alcohol, caffeine, and tobacco, as they increase gastric secretions

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching? A: "It is normal to feel gassy or bloated after the procedure." B: "The abdominal muscles may be tender from the procedure." C: "It is all right to drive once I've been home for an hour or so." D: "Intake should be light at first and then progress to regular intake."

C The client should not drive for several hours after discharge because of the sedative medications used during the procedure. Important decisions also should be delayed for at least 12 to 24 hours for the same reason. The client may experience gas, bloating, or abdominal tenderness for a short while after the procedure, and this is normal. The client should resume intake slowly and progress as tolerated.

The nurse is caring for a client with pancreatitis. Which finding should the nurse expect to note when reviewing the client's laboratory results? A: Elevated level of pepsin B: Decreased level of lactase C: Elevated level of amylase D: Decreased level of enterokinase

C The serum level of amylase, an enzyme produced by the pancreas, increases with pancreatitis. Amylase normally is responsible for carbohydrate digestion. Pepsin is produced by the stomach and is used in protein digestion. Lactase and enterokinase are enzymes produced by the small intestine; lactase splits lactose into galactose and fructose, and enterokinase activates trypsin

an 18 yr old is admitted with an acute onset of right lower quadrant pain. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis A) urinary retention B) gastric hyperacidity C) rebound tenderness D) increased lower bowel motility

C) rebound tenderness is a classic subjective sign of appendicitis

Which clinical manifestations of inflammatory bowel disease does the nurse determine are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply.)? A: Restricted to rectum B: Strictures are common C: Bloody, diarrhea stools D: Cramping abdominal pain E: Lesions penetrate intestine

C,D *Bloody diarrhea, and cramping abdominal pain* Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign. A. Tap lightly at the costovertebral margin on the client's back B. Palpate the RLQ C. Inspect the skin around the umbilicus D. Auscultate the area below the scapula

C. Rationale: Cullen's sign is indicated by a bluish-gray discoloration in the periumbillical area

The client is admitted to the medical department with a diagnosis of R/O acute pancreatitis. What laboratory values should the nurse monitor to confirm this diagnosis? A. Creatinine and BUN B. Troponin and CK-MB C. Serum amylase and lipase D. Serum bilirubin and calcium

C. Rationale: Serum amylase levels increase within two to 12 hours of the onset of acute pancreatitis; lipase elevates and remains elevated for seven to 14 days

In a client with diarrhea, which outcome indicates that fluid resuscitation is successful? A. The client passes formed stools at regular intervals B. The client reports a decrease in stool frequency and liquidity C. The client exhibits firm skin turgor D. The client no longer experiences perianal burning.

C. A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to excessive fluid loss in the stool. Expected outcomes include firm skin turgor, moist mucous membranes, and urine output of at least 30 ml/hr. The client also has a nursing diagnosis of diarrhea, with expected outcomes of passage of formed stools at regular intervals and a decrease in stool frequency and liquidity. The client is at risk for impaired skin integrity related to irritation from diarrhea; expected outcomes for this diagnosis include absence of erythema in perianal skin and mucous membranes and absence of perianal tenderness or burning.

Which of the following treatments is used for rectal cancer but not for colon cancer? A. Chemotherapy B. Colonoscopy C. Radiation D. Surgical resection

C. A client with rectal cancer can expect to have radiation therapy in addition to chemotherapy and surgical resection of the tumor. A colonoscopy is performed to diagnose the disease. Radiation therapy isn't usually indicated in colon cancer.

In a client with Crohn's disease, which of the following symptoms should not be a direct result from antibiotic therapy? A. Decrease in bleeding B. Decrease in temperature C. Decrease in body weight D. Decrease in the number of stools

C. A decrease in body weight may occur during therapy due to inadequate dietary intake, but isn't related to antibiotic therapy. Effective antibiotic therapy will be noted by a decrease in temperature, number of stools, and bleeding.

Which of the following diagnostic tests may be performed to determine if a client has gastric cancer? A. Barium enema B. Colonoscopy C. Gastroscopy D. Serum chemistry levels

C. A gastroscopy will allow direct visualization of the tumor. A colonoscopy or a barium enema would help diagnose colon cancer. Serum chemistry levels don't contribute data useful to the assessment of gastric cancer.

The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? A. Administering an H2 antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

C. Administering intravenous (IV) fluids Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding.

Which of the following factors is believed to be linked to Crohn's disease? A. Constipation B. Diet C. Hereditary D. Lack of exercise

C. Although the definite cause of Crohn's disease is unknown, it's thought to be associated with infectious, immune, or psychological factors. Because it has a higher incidence in siblings, it may have a genetic cause.

Medical management of the client with diverticulitis should include which of the following treatments? A. Reduced fluid intake B. Increased fiber in diet C. Administration of antibiotics D. Exercises to increase intra-abdominal pressur

C. Antibiotics are used to reduce the inflammation. The client isn't typically isn't allowed anything orally until the acute episode subsides. Parenteral fluids are given until the client feels better; then it's recommended that the client drink eight 8-ounce glasses of water per day and gradually increase fiber in the diet to improve intestinal motility. During the acute phase, activities that increase intra-abdominal pressure should be avoided to decrease pain and the chance of intestinal obstruction.

Which of the following associated disorders may the client with Crohn's disease exhibit? A. Ankylosing spondylitis B. Colon cancer C. Malabsorption D. Lactase deficiency

C. Because of the transmural nature of Crohn's disease lesions, malaborption may occur with Crohn's disease. Ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an enzyme isn't present.

The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan? A. Restricting pain medication B. Maintaining bedrest C. Avoiding coughing D. Irrigating the drain

C. Bedrest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure, although the client may be instructed in simple dressing changes. Coughing is avoided to prevent disruption of the tissue integrity, which can occur because of the location of this surgical procedure.

A patient with metastatic colorectal cancer is scheduled for chemotherapy and radiation therapy. Patient teaching regarding these therapies should include which explanation? A. Chemotherapy can be used to cure colorectal cancer. B. Irradiation is routinely used as adjuvant therapy after surgery. C. Both chemotherapy and irradiation can be used as palliative treatments. D. The patient should expect few or no side effects from chemotherapeutic agents.

C. Both chemotherapy and irradiation can be used as palliative treatments. Chemotherapy can be used to shrink the tumor before surgery, as an adjuvant therapy after colon resection, and as palliative therapy for nonresectable colorectal cancer. Radiation therapy may be used postoperatively as an adjuvant to surgery and chemotherapy or as a palliative measure for patients with metastatic cancer.

The patient had an ileostomy 4 days earlier and has a daily drainage of 1800 mL. What action should you take? A. Notify the primary provider. B. Send a specimen to the laboratory. C. Document the findings. D. Test the stool for occult blood.

C. Document the findings. With an ileostomy, the volume of drainage is high (1000 to 1800 mL/day) after peristalsis returns because the adsorptive functions provided by the colon and the delay provided by the ileocecal valve have been altered.

The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom indicates this occurrence? A. Abdominal cramping and pain B. Bradycardia and indigestion C. Sweating and pallor D. Double vision and chest pain

C. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

A client's ulcerative colitis symptoms have been present for longer than 1 week. The nurse recognizes that the client should be assessed carefully for signs of which of the following complications? A. Heart failure B. DVT C. Hypokalemia D. Hypocalcemia

C. Excessive diarrhea causes significant depletion of the body's stores of sodium and potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia. Ulcerative colitis does not place the client at risk for heart failure, DVT, or hypocalcemia.

Five days after undergoing surgery, a client develops a small-bowel obstruction. A Miller-Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority? A. Imbalanced nutrition: Less than body requirements B. Acute pain C. Deficient fluid volume D. Excess fluid volume

C. Fluid shifts to the site of the bowel obstruction, causing a fluid deficit in the intravascular spaces. If the obstruction isn't resolved immediately, the client may experience an imbalanced nutritional status (less than body requirements); however, deficient fluid volume takes priority. The client may also experience pain, but that nursing diagnosis is also of lower priority than deficient fluid volume.

A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs? A. Initiate continuous enteral feedings B. Encourage a high protein, high-calorie diet C. Implement total parenteral nutrition D. Provide six small meals a day.

C. Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional status, the client will be started on TPN. Enteral feedings or dividing the diet into 6 small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.

The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse determines that the client needs further instructions if the client stated to eat which of the following foods to make the stools less watery? A. Pasta B. Boiled rice C. Bran D. Low-fat cheese

C. Foods that help thicken the stool of the client with an ileostomy include pasta, boiled rice, and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool by increasing propulsion through the bowel. Ileostomy output is liquid. Addition or elimination of various foods can help thicken or loosen this liquid drainage.

Which of the following definitions best describes gastritis? A. Erosion of the gastric mucosa B. Inflammation of a diverticulum C. Inflammation of the gastric mucosa D. Reflux of stomach acid into the esophagus

C. Gastritis is an inflammation of the gastric mucosa that may be acute (often resulting from exposure to local irritants) or chronic (associated with autoimmune infections or atrophic disorders of the stomach). Erosion of the mucosa results in ulceration. Inflammation of a diverticulum is called diverticulitis; reflux of stomach acid is known as gastroesophageal disease.

The nurse is performing a colostomy irrigation on a client. During the irrigation, a client begins to complain of abdominal cramps. Which of the following is the most appropriate nursing action? A. Notify the physician B. Increase the height of the irrigation C. Stop the irrigation temporarily. D. Medicate with dilaudid and resume the irrigation

C. If cramping occurs during a colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. Increasing the height of the irrigation will cause further discomfort. The physician does not need to be notified. Medicating the client for pain is not the most appropriate action (damn).

The patient has nonresectable colorectal cancer. The primary provider has recommended chemotherapy. What is the best explanation of this treatment? A. It gives the patient a sense of hope that something is being done. B. It shrinks the tumor before surgery. C. It provides palliative treatment. D. It prevents metastasis to the liver.

C. It provides palliative treatment. Palliative treatment is done for nonresectable colorectal cancer to shrink the tumor and prevent obstruction.

A female college student goes to the university health clinic complaining of pain that started at the umbilicus and moved to the right lower quadrant over the last 12 hours. You notice muscle guarding on examination. What action should you take? A. Administer a PRN laxative per standing orders. B. Ask about the last menstrual period. C. Make the student NPO. D. Assess bowel sounds.

C. Make the student NPO. This is a classic description of appendicitis. At the very least, it is an acute abdomen, and the student should be kept NPO until a need for surgery is ruled out. The student should be referred to an emergency department.

Which of the following interventions should be included in the medical management of Crohn's disease? A. Increasing oral intake of fiber B. Administering laxatives C. Using long-term steroid therapy D. Increasing physical activity

C. Management of Crohn's disease may include long-term steroid therapy to reduce the inflammation associated with the deeper layers of the bowel wall. Other management focuses on bowel rest (not increasing oral intake) and reducing diarrhea with medications (not giving laxatives). The pain associated with Crohn's disease may require bed rest, not an increase in physical activity.

A client with rectal cancer may exhibit which of the following symptoms? A. Abdominal fullness B. Gastric fullness C. Rectal bleeding D. Right upper quadrant pain

C. Rectal bleeding is a common symptom of rectal cancer. Rectal cancer may be missed because other conditions such as hemorrhoids can cause rectal bleeding. Abdominal fullness may occur with colon cancer, gastric fullness may occur with gastric cancer, and right upper quadrant pain may occur with liver cancer.

A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication: A. 30 minutes before meals B. On an empty stomach C. After meals D. On arising

C. Salicylate compounds act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and to increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI irritation.

A client has surgery for a perforated appendix with localized peritonis. In which position should the nurse place the client? A) Sims position B) trendelenburg C) semi-fowlers D)dorsal recumbant

C. Semi-fowlers aids in drainage and prevents spread of infection throughout the abodominal cavity.

A client with gastric cancer may exhibit which of the following symptoms? A. Abdominal cramping B. Constant hunger C. Feeling of fullness D. Weight gain

C. The client with gastric cancer may report a feeling of fullness in the stomach, but not enough to cause him to seek medical attention. Abdominal cramping isn't associated with gastric cancer. Anorexia and weight loss (not increased hunger or weight gain) are common symptoms of gastric cancer.

Which of the following conditions is most likely to directly cause peritonitis? A. Cholelithiasis B. Gastritis C. Perforated ulcer D. Incarcerated hernia

C. The most common cause of peritonitis is a perforated ulcer, which can pour contaminates into the peritoneal cavity, causing inflammation and infection within the cavity. The other conditions don't by themselves cause peritonitis. However, if cholelithiasis leads to rupture of the gallbladder, gastritis leads to erosion of the stomach wall, or an incarcerated hernia leads to rupture of the intestines, peritonitis may develop.

Which of the following medications is most effective for treating the pain associated with irritable bowel disease? A. Acetaminophen B. Opiates C. Steroids D. Stool softeners

C. The pain with irritable bowel disease is caused by inflammation, which steroids can reduce. Stool softeners aren't necessary. Acetaminophen has little effect on the pain, and opiate narcotics won't treat its underlying cause (I feel this is untrue—dilaudid will help anything!)

A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain, and intermittent diarrhea after birth of her 2nd child. Diagnostic tests reveal gluten-induced enteropathy. Which foods must she eliminate from her diet permanently? A. Milk and dairy products B. Protein-containing foods C. Cereal grains (except rice and corn) D. Carbohydrates

C. To manage gluten-induced enteropathy, the client must eliminate gluten, which means avoiding all cereal grains except for rice and corn. In initial disease management, clients eat a high calorie, high-protein diet with mineral and vitamin supplements to help normalize nutritional status.

What is the best indication that the intravenous (IV) fluid replacement is adequate during the treatment of a patient with intestinal obstruction? A. Serum sodium: 155 mEq/L B. Urine specific gravity: 1.050 C. Urine output: 0.5 ml/kg/ hour D. Bowel sounds: 4 times/minute

C. Urine output: 0.5 ml/kg/ hour Adequate fluid replacement results in urine output of 0.5 mL/kg/ hour. The first two options indicate dehydration. Bowel sounds (peristalsis) are not used to determine rehydration.

In planning care for the patient with Crohn's disease, you recognize that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease A. frequently results in toxic megacolon. B. causes fewer nutritional deficiencies than does ulcerative colitis. C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. D. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.

C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment.

A 62-year-old patient has had a hemorrhoidectomy at an outpatient surgical center. Which instructions will the nurse include in discharge teaching? a. Maintain a low-residue diet until the surgical area is healed. b. Use ice packs on the perianal area to relieve pain and swelling. c. Take prescribed pain medications before a bowel movement is expected. d. Delay having a bowel movement for several days until healing has occurred.

C: Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

C: During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains.

A 19-year-old female is brought to the emergency department with a knife handle protruding from the abdomen. During the initial assessment of the patient, the nurse should a. remove the knife and assess the wound. b. determine the presence of Rovsing sign. c. check for circulation and tissue perfusion. d. insert a urinary catheter and assess for hematuria.

C: The initial assessment is focused on determining whether the patient has hypovolemic shock.

A client is admitted to the hospital with a diagnosis of cholecystitis from cholelithiasis. The client has severe abdominal pain and nausea, and has vomited several times. Based on these data, which nursing action would have been the highest priority for intervention at this time? a. Manage anxiety b. Restore fluid loss c. Manage the pain d. Replace nutritional loss

C: The priority for nursing care at this time is to decrease the client's severe abdominal pain. The pain, which is frequently accompanied by nausea and vomiting, is caused by biliary spasm.

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient asks for antidiarrheal medication after each stool. c. The patient uses witch hazel compresses to decrease irritation. d. The patient cleans the perianal area with soap after each stool.

C: Witch hazel compresses are suggested to reduce anal irritation and discomfort

The nurse is monitoring a client diagnosed with appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begns to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the appropriate nursing intervention? "1. Notify the Physician 2. Administer the prescribed pain medication 3. Call and ask the operating room team to perform the surgery as soon as possible 4. Reposition the client and apply a heating pad on warm setting to the client's abdomen

CORRECT ANSWER: 1" "1. Based on the assessment information the nurse should suspect peritonitis, a complication that is associated with appendicitis, and notify the physician. 2. Administering pain medication is not an appropriate intervention 3. Scheduling surgical time is not within the scope of practice of an RN. 4. Heat should never be applied to the abdomen of a patient suspected of having peritonitis because of the risk of rupture."

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

CORRECT ANSWER: B Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing

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

A nurse provides feeding instructions to a mother of an infant diagnosed with gastroesophageal reflux disease. To assist in reducing the episodes of emesis, the nurse tells the mother to:1) Provide less frequent, larger feedings. 2) Burp the infant less frequently during feedings. 3) Thin the feedings by adding water to the formula. 4) Thicken the feedings by adding rice cereal to the formula

CORRECT: 4) Thicken the feedings by adding rice cereal to the formula. Rationale: GERD is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescibed in the treatment of GER. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required

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. The tube is secured properly and does not appear to have been dislodged. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse analyzes this problem as which?

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

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

Checking for return of a gag reflex

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

Cimetidine (Tagamet) results in decreased secretion of stomach acid

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

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

A client receiving a high cleansing enema complains of pain and cramping. The nurse should take which corrective action?

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

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the appropriate nursing intervention? Saunders Comprehensive Review for the NCLEX-RN Examination 5th ed. 1. Notify the physician 2. Administer the prescribed pain medication 3. Call and ask the operating room team to perform the surgery as soon as possible 4. Reposition the client and apply a heating pad on warm setting to the clien't abdomen

Correct 1 Based on the signs and symptoms presented in the question, the nurse shoudl suspect peritonitis and notify the physician. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client wiht suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the physician probably would perform the surgery earlier than the prescheduled time.

"A client is admitted with right lower quadrant pain, anorexia, nausea, low-grade fever, and an elevated white blood cell count. Which complication is most likely the cause? "1. A fecalith 2. Bowel kinking 3. Internal bowel occlusion 4. Abdominal wall swelling"

Correct 1 The client is experiencing appendicitis. A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis.

The client with sever abdominal pain is being evaluated for appendicitis. What is the most common cause of appendicistis? http://nursing.slcc.edu/nclexrn3500/ 1. Rupture of the appendix 2.Obstruction of the appendix 3 A high-fat diet 4. A duodenal ulcer

Correct 2 Appendicitis most commonly results from obstruction of the appendix, which may lead to rupture. A high-fat diet or duodenal ulcer doesn't cause appendicitis; however, a client may require dietary restrictions after an appendectomy

which statement made by the client who is postoperative abdominal surgery indicates the discharge teaching has been effective? 1. "i will take my temp each week and report any elevation." 2. "i will not need any pain meds when i go home." 3. i will take all of my antibiotics until they are gone." 4. i will not take a shower until my three month check up.

Correct 3 1. the client should check the temp twice a day. 2. it is not realistic to expect the client to experience no pain after surgery. 3 (CORRECT): this statement about taking all the antibiotics ordered indicates the teaching is effective. 4. clients may shower after surgery, but not taking a tub bath for three months after surgery is too long a time.

A client complains of severe pain in the right lower quadrant of the abdomen. To assist with pain relief, the nurse should take which of the following actions? "1. Encourage the client to change positions frequently in bed 2. Massage the right lower quadrant fo the abdomen 3. Apply warmth to the abdomen with a heating pad 4. Use comfort measures and pillows to position the client"

Correct 4 "1. ""Encourage the client..."" - unnecesary movement will increase pain and should be avoided 2. ""Massage the lower..."" - if appendicitis is suspected, massorge or palpation should never be performed as thes actions may cause the appendix to rupture 3. ""Apply warmth..."" - if pain is casused by appendicitis, increased circulation from the heat may cause appendix to rupture 4. ""Use comfort measures..."" - CORRECT: non-pharmacological methods of pain relief"

"A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these assessment findings, the nurse should further assess the client for which of the following complications?... "1. Deficient fluid volume. 2. Intestinal obstruction. 3. Bowel ischemia. 4. Peritonitis

Correct 4 "Complications of acute appendicitis are perforation, peritonitis, and abscess development. Signs of the development of peritonitis include abdominal pain and distention, tachycardia, tachypnea, nausea, vomiting, and fever. Because peritonitis can cause hypovolemic shock, hypotension can develop. Deficient fluid volume would not cause a fever. Intestinal obstruction would cause abdominal distention, diminished or absent bowel sounds, and abdominal pain. Bowel ischemia has signs and symptoms similar to those found with intestinal obstruction."

"A nurse is providing wound care to a client 1 day after the client underwent an appendectomy. A drain was inserted into the incisional site during surgery. Which action should the nurse perform when providing wound care? 1. Remove the dressing and leave the incision open to air. 2. Remove the drain if wound drainage is minimal. 3. Gently irrigate the drain to remove exudate. 4. Clean the area around the drain moving away from the drain.

Correct 4 The nurse should gently clean the area around the drain by moving in a circular motion away from the drain. Doing so prevents the introduction of microorganisms to the wound and drain site. The incision cannot be left open to air as long as the drain is intact. The nurse should note the amount and character of wound drainage, but the surgeon will determine when the drain should be removed. Surgical wound drains are not irrigated.

Which of the following would confirm a diagnosis of appendicitis? "a. The pain is localized at a position halfway between the umbilicus and the right iliac crest. b. Mr. Liu describes the pain as occurring 2 hours after eating c. The pain subsides after eating d. The pain is in the left lower quadrant"

Correct A "Pain over McBurney's point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative"

Correct Answer: (B), Blood supply to the stoma has been interrupted An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?"a) The ostomy bag should be adjusted. b) Blood supply to the stoma has been interrupted. c) An intestinal obstruction has occurred. d) This is a normal finding 1 day after surgery

"When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: "a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension."

Correct Answer: B Rationale: Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis."

Which of the following position should the client with appendicitis assume to relieve pain ? A. Prone B. Sitting C. Supine D. Lying with legs drawn up

Correct Answer: D Lying still with legs drawn up towards chest helps relive tension on the abdominal muscle, which helps to reduce the amount of discomfort felt. Lying flat or sitting may increase the amount of pain experienced

The nurse is planning to teach a client with GERD about substances that will increase the LES pressure.Which item shoud the nurse include on this list.1. Coffee 2. Chocolate 3. Fatty Foods 4. Nonfat MIlk

Correct Answer: Nonfat MIlkFoods that will increase LES pressure will decrease reflux and lessen the symptoms of GERD. The food that will increase LES pressure is nonfat milk. The other substances listed decrease LES pressure, thus increasing reflux symptoms. Aggravating substances include the others listed and alcohol

Correct B A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture."

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? "a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage."

A nurse is making a home health visit and finds the client experiencing right lower quadrant abdominal pain, which has decreased in intensity over the last day. The client also has a rigid abdomen and a temperature of 103.6 F. The nurse should intervene by: a) administer Tylenol (acetaminophen) for the elevated temperature b) advising the client to increase oral fluids c) asking the client when she last had a bowel movement d) notifying the physician

Correct D D. The client symptoms indicate appendicitis which requires immediate attention

"During the assessment of a patient with acute abdominal pain, the nurse should: a. perform deep palpation before auscultation b. obtain blood pressure and pulse rate to determine hypervolemic changes c. auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus d. measure body temperature because an elevated temperature may indicate an inflammatory or infectious process.

Correct D Rationale: for the patient complaining of acute abdominal pain, nurse should take vital signs immediately. Increased pulse and decreasing blood pressure are indicative of hypovolemia. An elevated temperature suggests an inflammatory infectious process. Intake and output measurements provide essential information about the adequate of vascular volume. Inspect abdomen first and then auscultate bowel sounds. Palpation is performed next and should be gentle.

Which of the following would indicate that Bobby's appendix has ruptured? " a) diaphoresis b) anorexia c) pain at Mc Burney's point d) relief from pain

Correct D all are normal signs of having appendicits and once you have relief from pain means you could have a rupture.

Correct answer is B,Most clients with GERD have been self medicating with over-the counter medications prior to seeking advice from a healthcare provider. It is important to know what the client has been using to treat the problem

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

Correct answer: #1. Auscultation should be used prior to palpa-tion or percussion when assessing the abdomen. If the nurse manipulates the abdomen, the bowel sounds can be altered and give false information

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

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

Correct answer: 1 (pyrosis, water brash, and flatulence)1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reﬂux, and ﬂatulence is gas—all symptoms of GERD 2. Gastroesophageal reﬂux disease does not cause weight loss 3. There is no change in abdominal fat, no proteinuria (the result of a ﬁltration problem inthe kidney), and no alteration in bowel elimination for the client diagnosed with GERD 4. Mid-epigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease

The client with a hiatal hernia chronically experiences heartburn following meals. The nurse planc to teach the client to avoid which action because it is contraindicated with hiatal hernia? 1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking H2-receptor antagonist medication

Correct answer: 1Laying recumbant following meals or at night will cause reflux and pain. Relief is usually achieved with the intake of small, bland meals, use of H2 receptor antagonists and antacids, and elevation of the thorax after meals and during sleep

The client with a hiatal hernia chronically experiences heartburn following meals. The nurse planc to teach the client to avoid which action because it is contraindicated with hiatal hernia?1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking H2-receptor antagonist medication

Which of the following types of gastritis ic associated with Helicobacter pylori and duodenal ulcers? 1. Erosive (hemorrhagic) gastritis 2. Fundic gland gastritis (type A) 3. Antral gland gastritis (type B) 4. Aspiring-induced gastric ulcer

Correct answer: Antral gland gastritis ( type B). Rationale: Antral gland gastritis is the most common form of gastritis and is associated with Helicobacter pylori and duodenal ulcers

The nurse would increase the comfort of the patient with appendicitis by: a. Having the patient lie prone b. Flexing the patient's right knee c. Sitting the patient upright in a chair d. Turning the patient onto his or her left side

Correct answer: B" The patient with appendicitis usually prefers to lie still, often with the right leg flexed to decrease pain.

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

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

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

Correct: 2 "1. A client who has not voided within four (4)hours after any surgery would not be priority. This is an acceptable occurrence, but if the client hasn't voided for eight (8) hours, then the nurse would assess further. 2.This could indicate a ruptured appendix, which could lead to peritonitis, a life-threatening complication; therefore, thenurse should assess this client ﬁrst. 3.Bowel sounds should return within 24 hoursafter abdominal surgery. Absent bowel soundsat four (4) hours postoperative would not beof great concern to the nurse 4.The client being discharged would be stableand not a priority for the nurse"

The nurse is admitting a client with acute appendicitis to the emergency department. The client has abdominal pain of 10 on a pain scale of 1 to 10. The client will be going to surgery as soon as possible. The nurse should: "1. Contact the surgeon to request an order for a narcotic for the pain. 2. Maintain the client in a recumbent position. 3. Place the client on nothing-by-mouth (NPO) status. 4. Apply heat to the abdomen in the area of the pain."

Correct: 3 The nurse should place the client on NPO status in anticipation of surgery. The nurse can initiate pain relief strategies, such as relaxation techniques, but the surgeon will likely not order narcotic medication prior to surgery. The nurse can place the client in a position that is most comfortable for the client. Heat is contraindicated because it may lead to perforation of the appendix

"The nurse is admitting a client with acute appendicitis to the emergency department. The client has abdominal pain of 10 on a pain scale of 1 to 10. The client will be going to surgery as soon as possible. The nurse should: "1. Contact the surgeon to request an order for a narcotic for the pain. 2. Maintain the client in a recumbent position. 3. Place the client on nothing-by-mouth (NPO) status. 4. Apply heat to the abdomen in the area of the pain."

Correct: 3 - no rationale

"A client has an appendectomy and develops peritonitis. The nurse should asses the client for an elevated temperature and which additional clinical indication commonly associated with peritonitis? "1. hyperactivity 2. extreme hunger 3. urinary retention 4. local muscular rigidity

Correct: 4 muscular rigidity over the affected area is a classic sign of peritonitis

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

Correct: 4 - no rationale

Correct: B - no rationale

A client has an appendectomy. This is an example of what kind of surgery? a. Diagnostic b. palliative c. ablative d. constructive

Correct: C Appendectomy is an example of ablative surgery. Diagnostic confirms or establishes a diagnosis, palliative relieves or reduces pain, and constructive restores function or appearance.

"The health care team is assessing a patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis? A. Gastric pH B. Blood glucose C. Serum amylase D. Serum potassium

Correct: C Serum amylase levels indicate pancreatic function, and they are used to diagnose acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction.

Which client requires immediate nursing intervention? "The client who: a) complains of epigastric pain after eating. b) complains of anorexia and periumbilical pain. c) presents with ribbonlike stools. d) presents with a rigid, boardlike abdomen.

Correct: D A rigid, boardlike abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.

A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? a. Soak in sitz baths several times each day. b. Cough 5 times each hour for the next 48 hours. c. Avoid use of acetaminophen (Tylenol) for pain. d. Apply a scrotal support and ice to reduce swelling.

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. place ice packs around the stoma. b. notify the surgeon about the stoma. c. monitor the stoma every 30 minutes. d. document stoma assessment findings.

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? a. Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives. b. Dietary sources of fiber should be eliminated to prevent excessive gas formation. c. Use of this type of laxative to prevent constipation does not cause adverse effects. d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for a. referred back pain. b. metabolic alkalosis. c. projectile vomiting. d. abdominal distention.

After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? a. Notify the health care provider. b. Obtain a stool specimen for analysis. c. Teach the patient about handwashing. d. Place the patient on contact precautions.

In the stomach lining, the parietal cells release _________ and the chief cells release __________ which both play a role in peptic ulcer disease.* A. pepsin, hydrochloric acid B. pepsinogen, pepsin C. pepsinogen, gastric acid D. hydrochloric acid, and pepsinogen

The client with a small bowel obstruction asks the nurse to explain the purpose of the nasogastric tube attached to continuous gastric suction. The nurse determines that teaching has been effective if the client makes which statement? A: "It will help to provide me with nourishment." B: "It will help to relieve the congestion from excess mucus." C: "It is used to remove gastric contents for laboratory testing." D: "It will help to remove gas and fluids from my stomach and intestine."

The nurse is caring for a client who has just returned from the operating room after the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment? A: Apply ice to the stoma site. B: Apply pressure to the stoma site. C: Notify the health care provider (HCP). D: Document the amount and characteristics of the drainage.

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for a. oral ferrous sulfate tablets. b. regular blood transfusions. c. iron dextran (Imferon) infusions. d. cobalamin (B12) spray or injections.

The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present?* A. Ammonia B. Urea C. Hydrochloric acid D. Carbon dioxide

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? A: White bread, cheese, and green beans B: Fresh tomatoes, pears, and corn flakes C: Oranges, baked potatoes, and raw carrots D: Dried beans, All Bran (100%)cereal, and raspberries

D *Dried beans, all Bran cereal, and raspberries* A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A: Low-pitched and rumbling above the area of obstruction B: High-pitched and hypoactive below the area of obstruction C: Low-pitched and hyperactive below the area of obstruction D: High-pitched and hyperactive able the area of obstruction

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

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the health care provider? A: Stoma is beefy red and shiny D: Purple discoloration of the stoma C: Skin excoriation around the stoma D: Semi-formed stool noted in the ostomy pouch

D *purple stoma* Ischemia of the stoma would be associated with a dusky or bluish or purple color. A beefy red and shiny stoma is normal and expected. Skin excoriation needs to be addressed and treated but does not require as immediate attention as purple discoloration of the stoma. Semi-formed stool is a normal finding.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? A: Folate deficiency B: Malabsorption of fat C: Intestinal obstruction D: Fluid and electrolyte imbalance

D A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

The nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present? A: A sunken and hidden stoma B: A narrow and flattened stoma C: A stoma that is dusky or bluish D: A stoma that is elongated with a swollen appearance

D A prolapsed stoma is one in which the bowel protrudes, causing an elongated and swollen appearance of the stoma. A retracted stoma is characterized by sinking of the stoma. A stoma with a narrow opening is described as being stenosed. Ischemia of the stoma would be associated with a dusky or bluish color.

The nurse identifies the problem of "fluid volume deficit" for a client diagnosed with gastritis. Which intervention should be included in the plan of care? A. Obtain permission for a blood transfusion B. Prepare the client for total parenteral nutrition C. Monitor the client's lung sounds every shift D. Assess the client's intravenous site

D Fluid administration is the medical treatment for dehydration so the nurse must monitor and ensure the IV site is patent

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis? A: "It's due to insufficient production of vitamin B12 in the colon." B: "Increased production of intrinsic factor in the stomach leads to this type of anemia." C: "Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." D: "Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

D Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the small intestine. This vitamin is not produced or absorbed in the large intestine.

The client is complaining of painful swallowing, secondary to mouth ulcers. Which statement indicates the nurse's teaching has been effective? A. "I will brush my teeth with a soft-bristled toothbrush." B. "I will rinse my mouth with Listerine mouthwash." C. "I will swish with an antifungal solution, then swallow." D. "I will avoid spicy foods, tobacco, and alcohol."

D Irritating substances should be avoided during outbreaks of ulcers in the mouth. Spicy foods, alcohol, and tobacco are common irritants the client should avoid

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching? A: "I know I can massage my abdomen." B: "I will continue using antispasmodic medication." C: "One of the best things I can do is use relaxation techniques." D: "The best position for me is to lie supine with my legs straight."

D Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate inflamed intestinal tissues as the abdominal muscles are stretched.

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period? A: "When I can tolerate food without vomiting." B: "When my gastrointestinal system is healed enough." C: "When my health care provider says the tube can come out." D: "When my bowels begin to function again, and I begin to pass gas."

D NG tubes are discontinued when normal function returns to the gastrointestinal (GI) tract. Food would not be administered unless bowel function returns. The tube will be removed before GI healing. Although the health care provider (HCP) determines when the NG tube will be removed, it does not determine effectiveness of teaching and the need for the NG tube.

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis? A: "I have epigastric pain radiating to my neck." B: "I have severe abdominal pain that is relieved after vomiting." C: "My temperature has been running between 96°F (35.5°C) and 97°F (36.1°C)." D: "I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

D Nausea and vomiting are common presenting manifestations of acute pancreatitis. A hallmark symptom is severe abdominal pain that is not relieved by vomiting. The vomitus characteristically consists of gastric and duodenal contents. Fever also is a common sign. Epigastric pain radiating to the neck area is not a characteristic symptom.

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? A: Carrots and ranch dip B: Whole-grain cereal and milk C: A cup of popcorn and a cola drink D: Applesauce and a graham cracker

D The diet for the client with ulcerative colitis should be low fiber (low residue). The nurse should avoid providing foods such as whole-wheat grains, nuts, and fresh fruits or vegetables. Typically, lactose-containing foods also are poorly tolerated. The client also should avoid caffeine, pepper, and alcohol.

The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients? A: Colectomy B: Appendectomy C: Ascending colostomy D: Small bowel resection

D The small intestine is responsible for the absorption of most nutrients. The client who has undergone removal of a segment of the small bowel is the one who has a decreased area with which to absorb nutrients. Decreased absorption is not a likely complication with the surgical procedures identified in the remaining options.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? A: Hypercalcemia B: Hypernatremia C: Frothy, fatty stools D: Decreased hemoglobin

D Ulcerative colitis is an inflammatory disease of the large colon. Findings associated with ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia (not hypercalcemia). Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).

The client is diagnosed with acute pancreatitis. What health-care provider's admitting order should the nurse question? A. Bedrest with bathroom privileges B. Initiate IV therapy of D5W at 125 mL/hr C. Weight client daily D. Low fat, low car diet

D Rationale: Bedrest decreases the metabolic rate. The client should be NPO to rest the pancreas to decrease the auto digestion of the pancreas. Since the client is NPO IV therapy is appropriate. Weight changes will happen as a result of diet and IV fluids therefore daily weights is appropriate.

In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention? A) Heart rate of 105 beats/min B) Serum glucose of 136 mg/dL C) Blood pressure of 102/76 mm Hg D) Respiratory rate of 28 breaths/min

D) Respiratory rate of 28 breaths/min The patient with pancreatitis may develop pulmonary complications, pleural effusions, pulmonary infiltrates, and acute respiratory failure or ARDS.

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. A: Diarrhea B: Black, tarry stools C: Hyperactive bowel sounds D: Gray-blue color at the flank E: Abdominal guarding and tenderness F: Left upper quadrant pain with radiation to the back

D, E,F Grayish-blue discoloration at the flank is known as Grey-Turner's sign and occurs as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The client may demonstrate abdominal guarding and may complain of tenderness with palpation. The pain associated with acute pancreatitis is often sudden in onset and is located in the epigastric region or left upper quadrant with radiation to the back. The other options are incorrect.

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in the UQ rating to the shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation D. Epigastric pain radiating to the left shoulder

D. Rationale: A client with pancreatitis will report pain being worse when lying down in the fetal position, and pain that radiates to the back. left flank, or left, shoulder.

The nurse is completing discharge teaching to the client diagnosed with acute pancreatitis. What instruction should the nurse discuss with the client? A. Instruct the importance to avoid all stress B. Explain the correct way to take pancreatic enzymes C. Instruct the client to decrease alcohol intake D. Discuss the importance of stopping smoking

D. Rationale: Alcohol must be avoided completely due to its destruction of the pancreas. Stress stimulates the liver, but it is unrational to avoid all stress. Pancreatic enzymes are only needed for chronic pancreatitis. Smoking stimulates the pancreas to release pancreatic enzymes.

The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that A. Shock-wave therapy should be tried initially. B. Once gallstones are removed, they tend not to recur. C. The disorder can be successfully treated with oral bile salts that dissolve gallstones. D. Laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

D. Rationale: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis.

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which finding is the first priority? A) History of cholelithiasis B) Elevated serum amylase levels C) Decrease in bowel sounds upon auscultation D) Hand spasms present when blood pressure is checked

D. Rationale: the greatest risk to the client is ECG changes and hypotension from hypocalcemia. Hand spasms when taking blood pressure is a manifestation of hypocalcemia

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "Ibuprophen should be taken" D. "I should eat small meals about six times a day."

D. "I should eat small meals about six times a day."

The nurse is teaching the client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "Ibuprofen (Advil, Motrin, others) can be taken for my headaches instead of aspirin." D. "Small meals should be eaten about six times a day."

D. "Small meals should be eaten about six times a day The client with chronic gastritis should eat six small meals daily to avoid symptoms.

If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? A. Abdominal computed tomography (CT) scan B. Abdominal x-ray C. Barium swallow D. Colonoscopy with biopsy

D. A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn't provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn't involve the intestine.

The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would observe which of the following if stoma prolapse occurred? A. Sunken and hidden stoma B. Dark- and bluish-colored stoma C. Narrowed and flattened stoma D. Protruding stoma

D. A prolapsed stoma is one which the bowel protruded through the stoma. A stoma retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with dusky or bluish color. A stoma with a narrowed opening at the level of the skin or fascia is said to be stenosed.

Which of the following laboratory results would be expected in a client with peritonitis? A. Partial thromboplastin time above 100 seconds B. Hemoglobin level below 10 mg/dL C. Potassium level above 5.5 mEq/L D. White blood cell count above 15,000

D. Because of infection, the client's WBC count will be elevated. A hemoglobin level below 10 mg/dl may occur from hemorrhage. A PT time longer than 100 seconds may suggest disseminated intravascular coagulation, a serious complication of septic shock. A potassium level above 5.5 mEq/L may indicate renal failure.

The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

D. Blood pressure from 140/90 to 110/70 mm H A decrease in blood pressure is the most indicative sign of bleeding.

Colon cancer is most closely associated with which of the following conditions? A. Appendicitis B. Hemorrhoids C. Hiatal hernia D. Ulcerative colitis

D. Chronic ulcerative colitis, granulomas, and familial polposis seem to increase a person's chance of developing colon cancer. The other conditions listed have no known effect on colon cancer risk.

Which is the best method for evaluation and treatment of large intestine polyps? A. Sigmoidoscopy B. Barium enema C. Digital examination D. Colonoscopy

D. Colonoscopy Colonoscopy is preferred because it allows evaluation of the total colon and polyps can be immediately removed. Only polyps in the distal colon and rectum can be detected and removed during sigmoidoscopy.

Crohn's disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? A. The entire length of the large colon B. Only the sigmoid area C. The entire large colon through the layers of mucosa and submucosa D. The small intestine and colon; affecting the entire thickness of the bowel

D. Crohn's disease can involve any segment of the small intestine, the colon, or both, affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is too specific and therefore, not likely.

When teaching an elderly client how to prevent constipation, which of the following instructions should the nurse include? A. "Drink 6 glasses of fluid each day." B. "Avoid grain products and nuts." C. "Add at least 4 grams of brain to your cereal each morning." D. "Be sure to get regular exercise."

D. Exercise helps prevent constipation. Fluids and dietary fiber promote normal bowel function. The client should drink eight to ten glasses of fluid each day. Although adding bran to cereal helps prevent constipation by increasing dietary fiber, the client should start with a small amount and gradually increase the amount as tolerated to a maximum of 2 grams a day.

A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? A. Metabolic acidosis with hyperkalemia B. Metabolic acidosis with hypokalemia C. Metabolic alkalosis with hyperkalemia D. Metabolic alkalosis with hypokalemia

D. Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and hypokalemia.

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

D. High pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to push past the area of obstruction.

The nurse is reviewing the physician's orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client's chart? A. NPO status B. Insert a nasogastric tube C. An anticholinergic medication D. Morphine for pain

D. Meperidine (Demerol) rather than morphine is the medication of choice because morphine can cause spasm in the sphincter of Oddi.

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil, Motrin, others) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox, Mylanta) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

D. Misoprostol (Cytotec) Misoprostol (Cytotec) is a prostaglandin analogue that protects against NSAID-induced ulcers.

Which of the following substances is most likely to cause gastritis? A. Milk B. Bicarbonate of soda, or baking soda C. Enteric coated aspirin D. Nonsteriodal anti-imflammatory drugs

D. NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis. Milk, once thought to help gastritis, has little effect on the stomach mucosa. Bicarbonate of soda, or baking soda, may be used to neutralize stomach acid, but it should be used cautiously because it may lead to metabolic acidosis. ASA with enteric coating shouldn't contribute significantly to gastritis because the coating limits the aspirin's effect on the gastric mucosa.

Surgical management of ulcerative colitis may be performed to treat which of the following complications? A. Gastritis B. Bowel herniation C. Bowel outpouching D. Bowel perforation

D. Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery. Herniation and gastritis aren't associated with irritable bowel diseases, and outpouching of the bowel is diverticulosis.

For a patient with Crohn's disease which assessment finding is most important for you to follow-up? A. Bloody diarrheal stool: 4 times/day B. Abdominal cramping C. Temperature: 100.4° F (38° C) D. Positive rebound tenderness

D. Positive rebound tenderness Positive rebound tenderness is a classic sign of peritonitis and requires emergency follow-up. The other options are expected signs or symptoms with ulcerative colitis, which has intermittent exacerbations.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? A. Bloody diarrhea B. Hypotension C. A hemoglobin of 12 mg/dL D. Rebound tenderness

D. Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

Which of the following symptoms may be exhibited by a client with Crohn's disease? A. Bloody diarrhea B. Narrow stools C. N/V D. Steatorrhea

D. Steatorrhea from malaborption can occur with Crohn's disease. N/V, and bloody diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.

Which area of the alimentary canal is the most common location for Crohn's disease? A. Ascending colon B. Descending colon C. Sigmoid colon D. Terminal ileum

D. Studies have shown that the terminal ileum is the most common site for recurrence in clients with Crohn's disease. The other areas may be involved but aren't as common.

Which of the following diagnostic tests should be performed annually over age 50 to screen for colon cancer? A. Abdominal CT scan B. Abdominal x-ray C. Colonoscopy D. Fecal occult blood test

D. Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of stools. Abdominal x-ray and CT scan can help establish tumor size and metastasis. A colonoscopy can help locate a tumor as well as polyps, which can be removed before they become malignant.

The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client: A. Watches the nurse empty the colostomy bag B. Looks at the ostomy site C. Reads the ostomy product literature D. Practices cutting the ostomy appliance

D. The client is expected to have a body image disturbance after colostomy. The client progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest deal of acceptance when the client participates in the actual colostomy care. Each of the incorrect options represents an interest in colostomy care but is a passive activity. The correct option shows the client is participating in self-care.

Which of the following therapies is not included in the medical management of a client with peritonitis? A. Broad-spectrum antibiotics B. Electrolyte replacement C. I.V. fluids D. Regular diet

D. The client with peritonitis usually isn't allowed anything orally until the source of peritonitis is confirmed and treated. The client also requires broad-spectrum antibiotics to combat the infection. I.V. fluids are given to maintain hydration and hemodynamic stability and to replace electrolytes.

Which of the following nursing interventions should be implemented to manage a client with appendicitis? A. Assessing for pain B. Encouraging oral intake of clear fluids C. Providing discharge teaching D. Assessing for symptoms of peritonitis

D. The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity. Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which could be lethal. The client with appendicitis will have pain that should be controlled with analgesia. The nurse should discourage oral intake in preparation of surgery. Discharge teaching is important; however, in the acute phase, management should focus on minimizing preoperative complications and recognizing when such may be occurring.

During the assessment of a client's mouth, the nurse notes the absence of saliva. The client is also complaining of pain near the area of the ear. The client has been NPO for several days because of the insertion of a NG tube. Based on these findings, the nurse suspects that the client is developing which of the following mouth conditions? A. Stomatitis B. Oral candidiasis C. Parotitis D. Gingivitis

D. The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the client should lead the nurse to suspect the development of parotitis, or inflammation of the parotid gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or when clients have been NPO for an extended period. Preventative measures include the use of sugarless hard candy or gum to stimulate saliva production, adequate hydration, and frequent mouth care. Stomatitis (inflammation of the mouth) produces excessive salivation and a sore mouth.

Which of the following terms best describes the pain associated with appendicitis? A. Aching B. Fleeting C. Intermittent D. Steady

D. The pain begins in the epigastrium or periumbilical region, then shifts to the right lower quadrant and becomes steady. The pain may be moderate to severe.

Which of the following associated disorders may a client with ulcerative colitis exhibit? A. Gallstones B. Hydronephrosis C. Nephrolithiasis D. Toxic megacolon

D. Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn's disease and ulcerative colitis. The other disorders are more commonly associated with Crohn's disease.

The client is exhibiting symptoms of gastritis. The nurse is assessing the client to determine whether the form of gastritis being experienced is acute or chronic. Which data are correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C. Hematemesis and anorexia D. Treatment with radiation therapy

D. Treatment with radiation therapy

Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis? A. Treating constipation with chronic laxative use, leading to dependence on laxatives B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents C. Herniation of the intestinal mucosa, rupturing the wall of the intestine D. Undigested food blocking the diverticulum, predisposing the area to bacteria invasion.

D. Undigested food can block the diverticulum, decreasing blood supply to the area and predisposing the area to invasion of bacteria. Chronic laxative use is a common problem in elderly clients, but it doesn't cause diverticulitis. Chronic constipation can cause an obstruction—not diverticulitis. Herniation of the intestinal mucosa causes an intestinal perforation.

The patient has an obstruction high in the small intestine. What patient assessment do you anticipate finding? A. No bowel sounds B. Metabolic acidosis C. Flank pain D. Vomiting

D. Vomiting A patient with a high small intestinal obstruction is likely to have vomiting, which can be profuse. Lower intestinal obstruction is associated with a greater risk of metabolic acidosis. In small intestinal obstructions bowel sounds can still be heard in the large intestine.

When taking a history of a client diagnosed with a duodenal ulcer, which assessment finding does the nurse expect? A. Severe weight loss B. Pain while eating C. Hematemesis after eating D. Waking at night with pain

D. Waking at night with pain The pain associated with duodenal ulcers is often described as occurring 90 minutes to 3 hours after a meal and at night and often awakens the client between 1 and 2 AM. Reference:

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? a. Oatmeal with nonfat milk b. Whole wheat toast with butter c. Bagel with low-fat cream cheese d. Corn tortilla with scrambled eggs

D: Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not contain gluten, while oatmeal and wheat do.

After a cholecystectomy, the client is to follow a low-fat diet. Which of the following foods would be most appropriate to include a low-fat diet? a. Cheese omlet b. Peanut butter c. Ham salad sandwich d.Roast Beef

D: Lean meats, such as beef, lamb, veal, and well trimmed lean ham and pork, are low in fat. Cheese omlet, peanut butter, and ham salad are high in fat.

Which patient should the nurse assess first after receiving change-of-shift report? a. 60-year-old patient whose new ileostomy has drained 800 mL over the previous 8 hours b. 50-year-old patient with familial adenomatous polyposis who has occult blood in the stool c. 40-year-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours d. 30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

D: The patient's abdominal distention and tachycardia suggest hypovolemic shock

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? a. Encourage the patient to sip clear liquids. b. Assess the abdomen for rebound tenderness. c. Assist the patient to cough and deep breathe. d. Apply an ice pack to the right lower quadrant.

D: The patient's clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area.

A 45-year-old patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120, respirations 32, and blood pressure (BP) 82/54. Which prescribed intervention should the nurse implement first? a. Administer IV ketorolac (Toradol) 15 mg. b. Draw blood for a complete blood count (CBC). c. Obtain a computed tomography (CT) scan of the abdomen. d. Infuse 1 liter of lactated Ringer's solution over 30 minutes.

D: The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion

A client has undergone a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the discharge teaching? a. Empty the bile bag daily b. Breathe deeply into a paper bag when nauseated c. Keep adhesive dressings in place for 6 weeks d. Report bile-colored drainage from any incision

D: There should be no bile colored drainage coming from any of the incisions postoperatively. A laparoscopic cholecystectomy does not involve a bile bag. Breathing into a paper bag will prevent a person from passing out due to hyperventilation; it does not alleviate nausea. If the adhesives have not already fallen off, they are removed by the surgeon in 7-10 days, not 6 weeks.

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?"

D: irritable bowel syndrome (IBS) is the presence of abdominal discomfort or pain for at least 3 months.

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

Diarrhea

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

Difficulty swallowing

A health care provider places a Miller-Abbott tube in a client who has a 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 should the nurse take next?

Document the finding in the client's record.

A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse should tell the client to avoid which practice?

Drinking liquids with meals

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

Drowsiness

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

Early in intestinal obstruction, the patient's bowel sounds are hyperactive adn high pitched. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent

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

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

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

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

Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? a. Decrease daily intake of vegetables and water, and ambulate frequently. b. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. c. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating. d. Avoid over-the-counter drugs that have antacids in them.

Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating. Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus

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

Eating low-fat or nonfat foods

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

Elevate the scrotum

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?

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

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? Nausea Belching Epigastric pain Difficulty swallowing

Epigastric pain Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain.

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 should suspect that the client has which diagnosis?

Esophageal varices

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?

Evaluate absorption of the last feeding.

A client is admitted to the hospital with acute viral hepatitis. Which sign/symptom should the nurse expect to note based on this diagnosis?

Fatigue

A client is admitted to the hospital with severe jaundice and 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. Which problem most likely is the reason for the client's reluctance to walk in the hall?

Feeling self-conscious about appearance

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

Fowler's

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?

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

A client with a possible hiatal hernia complains of difficulty swallowing. Which other sign/symptom is associated with a hiatal hernia?

Heartburn and regurgitation

The nurse has been caring for a client with a Sengstaken-Blakemore tube. The health care provider arrives on the nursing unit and deflates the esophageal balloon. Following deflation of the balloon, the nurse should monitor the client closely for which?

Hematemesis

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

Hemigastrectomy

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

Hemoglobin 10.2 g/dL

The nurse is interpreting the laboratory results of a client who has a history of chronic ulcerative colitis. Which result indicates a complication of ulcerative colitis?

Hemoglobin 10.2 g/dL

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

Hemorrhage

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?

Hepatitis A

Which infection control method should 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?

Hepatitis B vaccine

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

High-Fowler's position

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

High-fiber diet

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, and a gastric ulcer is suspected. The nurse should gather which additional supportive data from the client for this diagnosis?

History of alcohol use, smoking, and weight loss

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. Which data would further support this diagnosis?

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 is least likely associated with this disease?

History of the use of acetaminophen (Tylenol) for pain and discomfort

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

Hydromorphone (Dilaudid)

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

I will eat a bland diet only.

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

Ibuprofen (Motrin)

The nurse is working with a client diagnosed with anorexia nervosa. The nurse plans care, focusing on which as the primary problem?

Impaired nutritional status

The nurse is caring for a client with acute pancreatitis and a history of alcoholism and is monitoring the client for complications. Which data should be indicative of paralytic ileus?

Inability to pass flatus

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

Increase intake of fluids.

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

Irrigating the nasogastric (NG) tube

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

Irrigating the nasogastric (NG) tube

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

Learn measures such as biofeedback or progressive relaxation

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

Learn to use stress reduction techniques

The nurse should include which instruction in a teaching plan for a client who has peptic ulcer disease?

Learn to use stress reduction techniques.

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

Left sims

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

Limit the fluids taken with meals.

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

Low and intermittent

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

Low fiber

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

Lying flat

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

Lying recumbent after meals

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

Lying recumbent after meals Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm, where the esophagus usually is positioned.

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

Maintaining a patent nasogastric (NG) tube

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 should question which prescription?

Milk of magnesia

The nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). The nurse should plan to do which action first?

Monitor for return of the gag reflex.

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

Monitoring prothrombin and partial thromboplastin values

Treatment measures have been implemented for a client with bleeding esophageal varices and have been unsuccessful. The health care provider states that a Sengstaken-Blakemore tube will be used to control the resulting hemorrhage. The nurse prepares for insertion via which route?

Nasogastric

The nurse is caring for a client suspected of having appendicitis. Which should the nurse anticipate will be prescribed for this client?

No oral intake of liquids or food

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention should be appropriate?

Offer small, frequent meals.

"The client diagnosed with appendicitis has undergone an appendectomy. At two hours postoperative, the nurse takes the vital signs and notes T 102.6 F, P 132, R 26, and BP 92/46. Which interventions should the nurse implement? List in order of priority. 1. Increase the IV rate. 2. Notify the health care provider. 3. Elevate the foot of the bed. 4. Check the abdominal dressing. 5. Determine if the IV antibiotics have been administered.

Order of priority: 1, 3, 4, 5, 2." "1. The nurse should increase the IV rate to maintain the circulatory system function until further orders can be obtained. 3. The foot of the bed should be elevated to help treat shock, the symptoms of which include elevated pulse and decreased BP. Those signs and an elevated temperature indicate an infection may be present and the client could be developing septicemia. 4. The dressing should be assessed to determine if bleeding is occurring. 5. The nurse should administer any IV antibiotics ordered after addressing hypovolemia. The nurse will need this information when reporting to the HCP. 2. The HCP should be notified when the nurse has the needed information."

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

Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back-diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, resulting in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (i.e., certain infections, medications, and lifestyle factors) can damage the mucosal barrier

The nurse is teaching the patient and family about possible causative factors for peptic ulcers. The nurse explains that ulcer formation is: (Source: Medical-Surgical Nursing, LDH p. 1004) a) caused by stressful lifestyle and other acid producing factors such as H. pylori. b) inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c) promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylor. d) promoted by a combination of possible factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol

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

Personal history of ulcerative colitis or gastrointestinal (GI) polyps

The nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The nurse notes that the pH is 5. Which information does this indicate?

Placement of the NG tube is accurate.

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

Position the client supine and flat

A postgastrectomy client 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 plans to monitor which data?

Postprandial blood glucose readings

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

Presence of bowel sounds in all four quadrants

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

Protruding and swollen

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

Provide frequent oral and nasal care on a regular basis

The nurse is collecting data on a client admitted to the hospital with hepatitis. Which data indicate that the client may have liver damage?

Pruritus

The nurse is performing an abdominal assessment on a client. The nurse interprets that which finding is abnormal and should be reported to the registered nurse (RN) or health care provider?

Pulsation between the umbilicus and pubis

A client with a peptic ulcer is scheduled for a vagotomy, and the client asks the nurse about the purpose of this procedure. The nurse tells the client that a vagotomy serves which purpose?

Reduces the stimulation of acid secretions

A postgastrectomy client who is 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'm really behind. If I don't get my act together, I may lose my job." Based on the client's statement, the nurse determines that at this time, it is appropriate to discuss which topic?

Reducing stressors in life

The nurse reinforces instructions to a client following a gastrectomy about the signs and symptoms of pernicious anemia, knowing what information?

Regular monthly injections of vitamin B12 will prevent this complication.

A client is admitted to the hospital with a bowel obstruction secondary to a recurrent malignancy, and the 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 is the nurse's best action?

Remain with the client and be silent

A 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 should include which instruction in this discussion?

Remove all metal and jewelry before the test.

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

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

The nurse is assisting in caring for a client with a Sengstaken-Blakemore tube. Which article should the nurse place at the bedside?

Scissors

The nurse assigned to care for a client 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?

Semi-Fowler's

The nurse is admitting a client to the hospital for the treatment of dehydration. The client reports nausea, vomiting, diarrhea, and cramping for the past week. The nurse asks the client about medications he is taking. The client denies taking prescription medications but states he has been taking some herbs given to him by his cousin. The nurse alerts the health care provider when the client states he has been taking which herb?

Senna

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

Smaller, more frequent meals should be eaten

The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Administering intravenous (IV) pain medication B. Starting a large-bore intravenous (IV) C. Monitoring the client's anxiety level D. Preparing equipment for intubation

Starting a large-bore intravenous (IV) A large-bore IV should be placed as requested, so that blood products can be administered.

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

Steatorrhea

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

Stop the irrigation temporarily

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

Supine with the head raised slightly and the knees slightly flexed

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

Sweating and pallor

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

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

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

Take actions to prevent dumping syndrome.

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. The LPN should reinforce instructing the client to perform which action?

Take and hold a deep breath.

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

Takes the client's vital signs.

The nurse teaches the client about an anti-ulcer diet. Which of the following statements by the client indicates to the nurse that dietary teaching was successful? 1. "I must eat bland foods to help my stomach heal." 2. "I can eat most foods, as long as they don't bother my stomach." 3. "I cannot eat fruits and vegetables because they cause too much gas." 4. "I should eat a low-fiber diet to delay gastric emptying -

The answer is 2.

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 finding would indicate adequate location of the tube?

The aspirate from the tube has a pH of 7.45.

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

The pH of the aspirate is 5.

The nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to absorb food. While carrying out this function, the nurse recalls that absorption is defined as which?

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

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

The tube will be inserted through my nose to my stomach

A health care provider asks the nurse to obtain a Salem Sump tube for gastric intubation. The nurse selects which tube from the unit storage area?

Tube with a lumen and an air vent

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

Turkey and lettuce sandwich

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

Upright

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. In planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?

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

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

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?

Vitamin B12

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

Vitamin B12 and folic acid studies

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

Vitamin B12 injections

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

What have you done to alleviate the heartburn? Most clients with GERD have been self medicating with over-the counter medications prior to seeking advice from a healthcare provider. It is important to know what the client has been using to treat the problem

For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel (select all that apply)? a. NPO d. Sedatives b. IV fluids e. Nasogastric suction c. Bed rest f. Parenteral nutrition

a, b, e, f. With an acute exacerbation of inflammatory bowel disease (IBD), to rest the bowel the patient will be NPO, receive IV fluids and parenteral nutrition, and have nasogastric suction. Sedatives would be used to alleviate stress. Enteral nutrition will be used as soon as possible

A 20-year old patient with a history of Crohn's disease comes to the clinic with persistent diarrhea. What are characteristics of Crohn's disease (select all that apply)? a. Weight loss d. Toxic megacolon b. Rectal bleeding e. Has segmented distribution c. Abdominal pain f. Involves the entire thickness of the bowel wall

a, c, e, f. Crohn's disease may have severe weight loss, segmented distribution through the entire wall of the bowel, and crampy abdominal pain. Rectal bleeding and toxic megacolon are more often seen with ulcerative colitis.

The patient calls the clinic and describes a bump at the site of a previous incision that disappears when he lies down. The nurse suspects that this is which type of hernia (select all that apply)? a. Ventral d. Reducible b. Inguinal e. Incarcerated c. Femoral f. Strangulated

a, d. The ventral or incisional hernia is due to a weakness of the abdominal wall at the site of a previous incision. It is reducible when it returns to the abdominal cavity. Inguinal hernias are at the weak area of the abdominal wall where the spermatic cord in men or the round ligament in women emerges. A femoral hernia is a protrusion through the femoral ring into the femoral canal. Incarcerated hernias do not reduce.

Nurse determines teaching needed when patient with dumping syndrome says a. "I should eat bread with every meal" b. "I should avoid drinking fluids with meals" c. "I should eat small meals about 6x day"

a. "I should eat bread with every meal"

When the patient is asked about pain, he says that it is intense and continuous. He states that sometimes when he curls up in a fetal position the pain eases. Which medication does the nurse recognize that will provide the most comprehensive pain relief at this time? a. PCA morphine sulfate b. IM fentanyl (Sublimaze) c. PCA meperidine (Demerol) d. Oral hydromorphone (Dilaudid)

a. . PCA morphine sulfate Meperidine is not a good choice because it can cause seizures, especially in older adults. While hydromorphone is a good choice with acute pancreatitis pain, IV is the best route. Fentanyl is a good alternative, but the route chosen should be IV or transdermal.

When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about a. dietary intake. b. sports involvement. c. environmental exposure to carcinogens. d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).

a. A diet high in red meat and low fruit and vegetable intake is associated with development of colorectal cancer (CRC), as are alcohol intake and smoking. Family and personal history of CRC also increases the risk. Other environmental agents are not known to be related to colorectal cancer. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with reduced CRC risk.

The client who has cholelithiasis is scheduled for extracorporeal shock wave. The nurse should tell the client about which of these symptoms that may occur after this procedure? a. Colic Type pain b. Headache c. Diarrhea d. hiccups

a. Colic Type pain Pain is experienced while gallstone pieces are passing

The nurse plans teaching for the patient with a colostomy but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient? a. Encourage the patient to share concerns and ask questions. b. Refer the patient to a chaplain to help cope with this situation. c. Explain that there is nothing the patient can do about it and must take care of it. d. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.

a. Encouraging the patient to share concerns and ask questions will help the patient to begin to adapt to living with the colostomy. The other options do not support the patient and do not portray the nurse's focus on helping the patient or treating the patient as an individual.

Which method is preferred for immediate treatment of an acute episode of constipation? a. An enema c. Stool softeners b. Increased fluid d. Bulk-forming medication

a. Enemas are fast acting and beneficial in the immediate treatment of acute constipation but should be limited in their use. Bulk-forming medication stimulates peristalsis but takes 24 hours to act. Stool softeners have a prolonged action, taking up to 72 hours for an effect, and fluids can help to decrease the incidence of constipation

Priority Decision: A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? a. Measure the ileostomy output to determine the status of the patient's fluid balance. b. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. c. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. d. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

a. Initial output from a newly formed ileostomy may be as high as 1500 to 2000 mL daily and intake and output must be accurately monitored for fluid and electrolyte imbalance. Ileostomy bags may need to be emptied every 3 to 4 hours but the appliance should not be changed for several days unless there is leakage onto the skin. A terminal ileum stoma is permanent and the entire colon has been removed. A return to a normal, presurgical diet is the goal for the patient with an ileostomy, with restrictions based only on the patient's individual tolerances.

Priority Decision: A patient with a gunshot wound to the abdomen complains of increasing abdominal pain several hours after surgery to repair the bowel. What action should the nurse take first? a. Take the patient's vital signs. b. Notify the health care provider. c. Position the patient with the knees flexed. d. Determine the patient's IV intake since the end of surgery.

a. It is likely that the patient could be developing a peritonitis, which could be life-threatening, and assessment of vital signs for hypovolemic shock should be done to report to the health care provider. If an IV line is not in place, it should be inserted and pain may be eased by flexing the knees.

Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.) a. Low hemoglobin (Hgb) b. Low white blood cell (WBC) level c. Low hematocrit (Hct) d. Positive for H. pylori bacteria e. Low potassium of 3.4 mEq/L

a. Low hemoglobin (Hgb) c. Low hematocrit (Hct) d. Positive for H. pylori bacteria

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric (NG) tube b. Administering oral bicarbonate and testing the patient's gastric pH level c. Performing a fecal occult blood test and administering IV calcium gluconate d. Starting parenteral nutrition and placing the patient in a high-Fowler's position

a. Providing IV fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube.

A patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis? a. Pallor and hair loss c. Anorectal excoriation and pain b. Frequent diarrhea stools d. Hypotension and urine output below 30 mL/hr

a. Signs of malnutrition include pallor from anemia, hair loss, bleeding, cracked gingivae, and muscle weakness, which support a nursing diagnosis that identifies impaired nutrition. Diarrhea may contribute to malnutrition but is not a defining characteristic. Anorectal excoriation and pain relate to problems with skin integrity. Hypotension relates to problems with fluid deficit.

As the patient prepares for discharge, the nurse provides education about behaviors that reduce symptoms and aggravate peptic ulcers. Which teaching does the nurse provide? (Select all that apply.) a. Sit upright 30 to 60 minutes after meals. b. Spices should be added to food to enhance flavor. c. A vagotomy will be needed in the future d. Extreme vomiting should be reported to your physician. e. H. pylori can be a concern in patients with peptic ulcers. f. The goal of initial intervention is to control symptoms and prevent further complications.

a. Sit upright 30 to 60 minutes after meals. d. Extreme vomiting should be reported to your physician. e. H. pylori can be a concern in patients with peptic ulcers. f. The goal of initial intervention is to control symptoms and prevent further complications.

The client diagnosed with chronic pancreatitis and pancrelipase is prescribed. Which of the following instructions should the nurse give to this client about the administration of this medication? a. Take the drug with meals b. take the drug with a large glass if milk c. tale the drug between meals d. take the drug after it is crushed and mixed with ice cream.

a. Take the drug with meals

Priority Decision: A postoperative patient has a nursing diagnosis of pain related to effects of medication and decreased GI motility as evidenced by abdominal pain and distention and inability to pass flatus. Which nursing intervention is most appropriate for this patient? a. Ambulate the patient more frequently. b. Assess the abdomen for bowel sounds. c. Place the patient in high Fowler's position. d. Withhold opioids because they decrease bowel motility.

a. The abdominal pain and distention that occur from the decreased motility of the bowel should be treated with increased ambulation and frequent position changes to increase peristalsis. If the pain is severe, cholinergic drugs, rectal tubes, or application of heat to the abdomen may be prescribed. Assessment of bowel sounds is not an intervention to relieve the pain and a high Fowler's position is not indicated. Opioids may still be necessary for pain control and motility can be increased by other means.

82-year-old man is admitted with an acute attack of diverticulitis. What should the nurse include in his care? a. Monitor for signs of peritonitis. b. Treat with daily medicated enemas. c. Prepare for surgery to resect the involved colon. d. Provide a heating pad to apply to the left lower quadrant.

a. The inflammation and infection of diverticula cause small perforations with spread of the inflammation to the surrounding area in the intestines. Abscesses may form or complete perforation with peritonitis may occur. Systemic antibiotic therapy is often used but medicated enemas would increase intestinal motility and increase the possibility of perforation, as would the application of heat. Surgery is only necessary to drain abscesses or to resect an obstructing inflammatory mass.

Priority Decision: A patient is admitted to the emergency department with acute abdominal pain. What nursing intervention should the nurse implement first? a. Measurement of vital signs b. Administration of prescribed analgesics c. Assessment of the onset, location, intensity, duration, and character of the pain d. Physical assessment of the abdomen for distention, bowel sounds, and pigmentation changes

a. The patient with an acute abdomen may have significant fluid or blood loss into the abdomen and evaluation of blood pressure (BP) and heart rate (HR) should be the first intervention, followed by assessment of the abdomen and the nature of the pain. Analgesics should be used cautiously until a diagnosis can be determined so that symptoms are not masked.

Regardless of precipitating factor, the injury to mucosal cells in PUD is caused by: a. acid back-diffusion into the mucosa b. ammonia formation in the mucus wall c. breakdown of gastric mucosal barrier d. release of histamine for cells

a. acid back-diffusion into the mucosa

A patient with NG tube develops nausea and increased upper abominal bowel sounds. Appropriate action is to: a. check the patency of the NG tube b. place client in recumbant position c. assess vital signs d. ecourage deep breathing

a. check the patency of the NG tube

Management of patient with upper GI bleeding is effective the lab results reveal: a. decreasing BUN b. normal hematocrit c. urine output of 20 ml hr d. specific gravity of 1.03

a. decreasing BUN

Diagnostic testing is planned fr a patient with suspected peptic ulcer. Most reliable test is: a. endoscopy b. gastric analysis c. barium swallow d. serologic test for H pylori

a. endoscopy

A 22 yr old calls the clinic complaining of N&V and RLQ abdominal pain. The nurse advises the patient to: a. have the symptoms evaluated by a MD right away b. use a heating pad c. drink at least 2 qts of juice d. take a laxative to empty the bowel

a. have the symptoms evaluated by a MD right away

When assessing the client admitted for a laparscopic cholecstectomy, the nurse would expect to find: a. history of intermittent episodes of right upper quadrant pain b. significant jaundice of sclera and skin c. complaints of recurrent heartburn and acid reflux d. ascites and peripheral edema

a. history of intermittent episodes of right upper quadrant pain

Combined with clinical manifestations, the lab finding that is most commonly used to diagnose acute prancreatitis is: a. increased serum lipase b. severe midepigastric of LUQ pain c. increased urinary amylase d. decreased renal amylase creatine clearance

a. increased serum lipase

Nursing management of the patient with chronic gastritis includes teaching the patient to: a. maintain a bland diet with six small meals a day b. take antacids before meals c. use NSAIDS instead of aspirin for pain relief d. eliminate alcohol and caffein

a. maintain a bland diet with six small meals a day

During an acute attack of diverticulitis, the patient is: a. monitored for signs of peritonitis b. treated with daily med enemas c. prepared for surgery to resect the involved colon d. provided with heating pad to apply to LLQ

a. monitored for signs of peritonitis

Patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements r/t decreased nutritional intake and decreased intestinal absorption. Data to support this is: a. pallor and hair loss b. frequent diarrhea

a. pallor and hair loss

In preparing to care for the patient, which conditions does the nurse recognize as potential complications of acute pancreatitis ( select all that apply) a. pancreatic infection b. plural effusion c. diabetes mellitus d. acute kidney failure e. hemorrhage f. pneumonia

a. pancreatic infection b. plural effusion c. diabetes mellitus d. acute kidney failure e. hemorrhage f. pneumonia

The client with chronic pancreatitis is being discharged. the nurse should anticipate teaching the client about which of these medications a. pancrelipase b. morphine sulfate c. biotin d. lactulose

a. pancrelipase

Patient admitted to ER has profuse bright-red hematemesis. During intial care of the patient, the nurse's first priority is to: a. perform a nursing assessment of patient's status b. establish 2 IV sites c. obtain a thorough health history

a. perform a nursing assessment of patient's status

A client has been admitted with a diagnosis of acute pancreatitis. A nurse would assess this client for pain that is: a. severe and unrelenting, located in the epigastric area and radiating to the back. b. severe and unrelenting, located in the lower left quadrant and radiating to the groin. c. burning and aching, located in the epigastric area and radiating to the umbilicus d. burning and aching, located in the left lower quadrant and radiating to the hip

a. severe and unrelenting, located in the epigastric area and radiating to the back. The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back. The other options are incorrect.

A patient's vomitus is dark brown and has a coffee-ground appearance. the nurse recognizes that this emsis is charactristic of: a. stomach bleeding b. an intestinal obstruction c. bile reflux d. active bleeding of lower esophagus

a. stomach bleeding

A knowledge of factors associated with colorectal cancer guides the nurse when obtaining a nursing history to ask specifically about: a. usual diet b. history of smoking c. history of alcohol d. environmental exposure to carcinogens

a. usual diet

Which of the following vitamins or minerals should be administered to the client who is experiencing blockage of the bile duct? a. vit. e b. vit. c c. vit. b12 d. calcium

a. vit. e

Postop patient has nursing diagnosis of pain r/t to immobility, meds, and decreased motility as evidenced by abdominal pain and distention and inability to pass flatus. An appropriate nursing intervention for the patient is to:

ambulate patient more frequently

The nurse is admitting a client with the diagnosis of appendicitis to the surgical unit. Which question is essential to ask? A."When did you last eat?" B."Have you had surgery before?" C."Have you ever had this type of pain before?" D."What do you usually take to relieve your pain?"

answer A. When a person is admitted with possible appendicitis, the nurse should anticipate surgery. It will be important to know when she last ate when considering the type of anesthesia so that the chance of aspiration can be minimized. The other inoformation is "nice to know", but not essential.

Which of the nursing interventions should be implemented to manage appendicitis? a. Assess pain b. encourage oral intake of clear fluids. c. provide discharge teaching D. assess for symptoms of peritonitis.

answer D. Monitor for peritonitis because if the appendix ruptures, bacteria can enter the peritoneum. Pain will be managed with analgesics, and pt should be NPO for surgery. Discharge is not done at this time

When considering the following causes of acute abdomen, the nurse should know that surgery would be indicated for (select all that apply)? a. pancreatitis c. foreign-body perforation b. acute ischemic bowel d. pelvic inflammatory disease e. ruptured ectopic pregnancy f. ruptured abdominal aneurysm

b, c, e, f. An immediate surgical consult is needed for acute ischemic bowel, foreign-body perforation, ruptured ectopic pregnancy, or ruptured abdominal aneurysm. A diagnostic laparoscopy may be done or a laparotomy may be done to repair a ruptured abdominal aneurysm or remove the appendix. Surgery is not needed for pancreatitis or pelvic inflammatory disease, as these can be diagnosed and treated without surgery.

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? a. "You will need to remain on a bland diet." b. "Avoid foods that cause pain after you eat them." c. "High-protein foods are least likely to cause you pain." d. "You should avoid eating any raw fruits and vegetables."

b. "Avoid foods that cause pain after you eat them." The best information is that each individual should choose foods that are not associated with postprandial discomfort.

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

b. "It would likely be beneficial for you to eliminate drinking alcohol." Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing.

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

b. A normal new colostomy stoma should appear bright red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. The colostomy will not have any fecal drainage for 2 to 4 days but there may be some earlier mucus or serosanguineous drainage. Bowel sounds after extensive bowel surgery will be diminished or absent

The patient asks the nurse to explain what the physician meant when he said the patient had an anorectal abscess. Which description should the nurse use to explain this to the patient? a. Ulcer in anal wall c. Sacrococcygeal hairy tract b. Collection of perianal pus d. Tunnel leading from the anus or rectum

b. An anorectal abscess is a collection of perianal pus. An ulcer in the anal wall is an anal fissure. Sacrococcygeal hairy tract describes a pilonidal sinus. A tunnel leading from the anus or rectum is an anorectal fistula.

Priority Decision: When caring for a patient with irritable bowel syndrome (IBS), what is most important for the nurse to do? a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed. b. Develop a trusting relationship with the patient to provide support and symptomatic care. c. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation. d. Inform the patient that new medications for IBS are available and effective for treatment of IBS manifested by either diarrhea or constipation.

b. Because there is no definitive treatment for irritable bowel syndrome (IBS) and patients become frustrated and discouraged with uncontrolled symptoms, it is important to develop a trusting relationship that will support the patient as different treatments are implemented and evaluated. Diagnosis of IBS can be established by Rome criteria and by elimination of other problems. Although IBS can be precipitated and aggravated by stress and emotions, it is not a psychogenic illness. High-fiber diets may help but they might also increase the bloating and gas pains of IBS. Medications are available but usually used as a last resort because of side effects.

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? a. Prevent all oral intake. b. Control abdominal pain. c. Provide enteral feedings. d. Avoid dietary cholesterol

b. Control abdominal pain. Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis.

Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting? a. Glass of orange juice b. Dish of lemon gelatin c. Cup of coffee with cream d. Bowl of hot chicken broth

b. Dish of lemon gelatin- clear liquids Clear cool liquids are usually the first foods started after a patient has been nauseated.

What information should be included when the nurse teaches a patient about colostomy irrigation? a. Infuse 1500 to 2000 mL of warm tap water as irrigation fluid. b. Allow 30 to 45 minutes for the solution and feces to be expelled. c. Insert a firm plastic catheter 3 to 4 inches into the stoma opening. d. Hang the irrigation bag on a hook about 36 inches above the stoma.

b. Following infusion of the fluid into the stoma, the solution and feces will take about 30 to 45 minutes to return and the patient can plan to read or perform other quiet activities during the wait time. Between 500 and 1000 mL of warm tap water should be used. A cone tip on the end of the tubing prevents bowel damage that could occur if a stiff plastic catheter is used. Fluid should be elevated about 18 to 24 inches above the stoma, or to about shoulder level, to prevent too rapid infusion of the solution and cramping.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? a. Diarrhea b. Heartburn c. Constipation d. Lower abdominal pain

b. Heartburn

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care? a. Immediately start enteral feeding to prevent malnutrition. b. Insert an NG and maintain NPO status to allow pancreas to rest. c. Initiate early prophylactic antibiotic therapy to prevent infection. d. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

b. Insert an NG and maintain NPO status to allow pancreas to rest. Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status.

An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to a. offer ice chips to suck PRN. b. provide mouth care every 1 to 2 hours. c. irrigate the tube with normal saline every 8 hours. d. keep the patient supine with the head of the bed elevated 30 degrees.

b. Mouth care should be done frequently for the patient with a small intestinal obstruction who has an NG tube because of vomiting, fecal taste and odor, and mouth breathing. No ice chips are allowed when a patient is NPO because of a bowel obstruction. The NG tube should be checked for patency and irrigated as ordered. The position of the patient should be one of comfort.

Most effective means of suppressing pancreatic secretion during an episode of pancreatitis is the use of: a. antibiotics b. NPO status c. antispasmotics d. H2R blockers

b. NPO status

What is a nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy? a. Applying heat to the inguinal area c. Applying a truss to support the operative site b. Elevating the scrotum with a scrotal support d. Encouraging the patient to cough and deep breathe

b. Scrotal edema is a common and painful complication after an inguinal hernia repair and can be relieved in part by application of ice and elevation of the scrotum with a scrotal support. Heat would increase the edema and the discomfort and a truss is used to keep unrepaired hernias from protruding. Coughing is discouraged postoperatively because it increases intraabdominal pressure and stress on the repair site.

Which patient is most likely to be diagnosed with short bowel syndrome? a. History of ulcerative colitis c. Diagnosed with irritable bowel syndrome b. Had extensive resection of the ileum d. Had colectomy performed for cancer of the bowel

b. Short bowel syndrome results from extensive resection of portions of the small bowel and would occur if a patient had an extensive resection of the ileum. The other conditions primarily affect the large colon and result in fewer and less severe symptoms.

A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On postoperative assessment of the patient, what should the nurse expect to find? a. A rectal tube set to low continuous suction b. A loop ileostomy with a plastic rod to hold it in place c. A colostomy stoma with an NG tube in place to provide pouch irrigations d. A permanent ileostomy stoma in the right lower quadrant of the abdomen

b. The initial procedure for a total proctocolectomy with ileal pouch and anal anastomosis includes a colectomy, rectal mucosectomy, ileal reservoir construction, ileoanal anastomosis, and a temporary ileostomy. A loop ileostomy is the most common temporary ileostomy and it may be held in place with a plastic rod for the first week. A rectal tube to suction is not indicated in any of the surgical procedures for ulcerative colitis. A colostomy is not used and an NG tube would not be used to irrigate the pouch. A permanent ileostomy stoma would be expected following a total proctocolectomy with a permanent ileostomy.

How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics b. Avoidance of milk and milk products c. Supplementation with pancreatic enzymes d. Avoidance of gluten found in wheat, barley, oats, and rye

b. The most common type of malabsorption syndrome is lactose intolerance and it is managed by restricting the intake of milk and milk products. Antibiotics are used in cases of bacterial infections that cause malabsorption, pancreatic enzyme supplementation is used for pancreatic insufficiency, and restriction of gluten is necessary for control of adult celiac disease (celiac sprue, gluten-induced enteropathy).

The patient has persistent and continuous pain at McBurney's point. The nursing assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing interventions for this patient include? a. Laxatives to move the constipated bowel b. NPO status in preparation for possible appendectomy c. Parenteral fluids and antibiotic therapy for 6 hours before surgery d. NG tube inserted to decompress the stomach and prevent aspiration

b. The patient's manifestations are characteristic of appendicitis. After laboratory test and CT scan confirmation, the patient will have surgery. Laxatives are not used. The 6 hours of fluids and antibiotics preoperatively would be used only if the appendix was ruptured. The NG tube is more likely to be used with abdominal trauma.

A physician just told a patient that she has a volvulus. When the patient asks the nurse what this is, what is the best description for the nurse to give her? a. Bowel folding on itself c. Emboli of arterial supply to the bowel b. Twisting of bowel on itself d. Protrusion of bowel in weak or abnormal opening

b. Volvulus is the bowel twisting on itself. The bowel folding on itself is intussusception. Emboli of arterial blood supply to the bowel is vascular obstruction. Protrusion of bowel in a weak or abnormal opening is a hernia

The client is admitted to the hospital with acute pancreatitis. the nurse taking a history should question the client about which of these risks for developing pancreatitis? a. inflammatory bowel disease b. alcoholism c. diabetes mellitus d. high- fiber diet

b. alcoholism

Patient with an ulcer of the posterior portion of duodenum experiences: a. pain that occurs after not eating all day b. back pain that occurs 2-4 hrs after eating c. midepigastric pain unrelieved with antacids d. high epigastric burning relieved with food

b. back pain that occurs 2-4 hrs after eating

Upon examining a patient 8 hrs after formation of a colostomy the nurse would expect to find a. hypoactive, high pitched bowel sounds b. brickred, puffy stoma that oozes blood c. purplish stoma, shiny and moist d. small amt of liquid fecal drainage from colostomy

b. brickred, puffy stoma that oozes blood

A patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. During the patient's early postop course the nurse anticpates that the patient may need: a. oral nutritional supplements b. drug therapy to prevent substance withdrawal symptoms

b. drug therapy to prevent substance withdrawal symptoms

The patient who is recovering from an acute case of pancreatitis has been NPO but is now tolerating food. Which nutrition teaching point should the nurse be sure to include? a. Expect to experience nausea and vomiting as you begin to consume foods. b. small and frequent meals are best c. low- carbohydrate, high protein, and high- fat foods should be consumed. d. Use of alcohol and caffeine should be consumed in moderation

b. small and frequent meals are best

In teaching patients at risk for upper GI bleeding to prevent bleeding episodes, the nurse stresses that: a. all stools and vomit must be tested for blood b. the use of over the counter meds of any kind should be avoided

b. the use of over the counter meds of any kind should be avoided

A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed? a. "I take antacids between meals and at bedtime each night." b. "I sleep with the head of the bed elevated on 4-inch blocks." c. "I eat small meals during the day and have a bedtime snack." d. "I quit smoking several years ago, but I still chew a lot of gum."

c. "I eat small meals during the day and have a bedtime snack." GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

Teaching is effective when patient with PUD states: a. "I should stop all meds if i develop side effects" b. "I should continue treatment as long as i have pain" c. "I have learned some relaxation strategies that decrease my stress"

c. "I have learned some relaxation strategies that decrease my stress"

the nurse determines that further discharge instruction is needed when the patient with acute pancreatitis states: a. "I should observe for fat in my stools" b. "I must not use alcohol to prevent future attacks" c. "I shouldn't eat salty foods"

c. "I shouldn't eat salty foods" Diet includes restriction of fats b/c they stimulate the secretion of cholecystokinin, which then stimulates the pancreas. Carbohydrates are less stimulating the pancreas and are encouraged.

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a. 40-year-old with chronic pancreatitis who has gnawing abdominal pain b. 58-year-old who has compensated cirrhosis and is complaining of anorexia c. 55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) d. 36-year-old recovering from a laparoscopic cholecystectomy who has severe shoulder pain

c. 55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) This patient's history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

The patient asks the nurse why she needs to have surgery for a femoral, strangulated hernia. What is the best explanation the nurse can give the patient? a. The surgery will relieve her constipation. b. The abnormal hernia must be replaced into the abdomen. c. The surgery is needed to allow intestinal flow and prevent necrosis. d. The hernia is because the umbilical opening did not close after birth as it should have.

c. A strangulated femoral hernia obstructs intestinal flow and blood supply, thus requiring emergency surgery. The other options are incorrect.

The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? A. Initiating enteral nutrition B. Administering an H2 antagonist C. Administering intravenous (IV) fluids D. Administering antianxiety medication

c. Administering intravenous (IV) fluids Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings? a. Malnutrition b. Osteomyelitis c. Alcohol abuse d. Diabetes mellitus

c. Alcohol abuse The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase and serum lipase levels as shown.

During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? a. "It is very rare for polyps to become malignant but you should continue to have routine colonoscopies." b. "Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps." c. "All polyps are abnormal and should be removed but the risk for cancer depends on the type and if malignant changes are present." d. "All polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps."

c. Although all polyps are abnormal growths, the most common type of polyp (hyperplastic) is non-neoplastic, as are inflammatory, lipomas, and juvenile polyps. However, adenomatous polyps are characterized by neoplastic changes in the epithelium and most colorectal cancers appear to arise from these polyps. Only patients with a family history of familial adenomatous polyposis (FAP) have close to a 100% lifetime risk of developing colorectal cancer.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis? a. Calcium b. Bilirubin c. Amylase d. Potassium

c. Amylase Amylase is elevated in acute pancreatitis.

Priority Decision: A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction, IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four hours after admission, the patient experiences nausea and vomiting. What is a priority nursing intervention for the patient? a. Assess the abdomen for distention and bowel sounds. b. Inspect the surgical site and drainage in the Jackson-Pratt. c. Check the amount and character of gastric drainage and the patency of the NG tube. d. Administer prescribed prochlorperazine (Compazine) to control the nausea and vomiting.

c. An adequately functioning nasogastric (NG) tube should prevent nausea and vomiting because stomach contents are continuously being removed. The first intervention in this case is to check the amount and character of the recent drainage and check the tube for patency. Decreased or absent bowel sounds are expected after a laparotomy and the Jackson-Pratt drains only fluid from the tissue of the surgical site. Antiemetics may be given if the NG tube is patent because anesthetic agents may cause nausea.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? a. Antibiotic(s), antacid, and corticosteroid b. Antibiotic(s), aspirin, and antiulcer/protectant c. Antibiotic(s), proton pump inhibitor d. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

c. Antibiotic(s), proton pump inhibitor Two antibiotics and a proton pump inhibitor

The patient is receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease? a. Corticosteroids c. Antidiarrheal agents b. 6-Mercaptopurine d. Sulfasalazine (Azulfidine)

c. Antidiarrheal agents only relieve symptoms. Corticosteroids, 6-mercaptopurine, and sulfasalazine (Azulfidine) are used to treat and control inflammation with various diseases.

The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea makes which statement? a. "I can use A&D ointment or Vaseline jelly around the anal area to protect my skin." b. "Gatorade is a good liquid to drink because it replaces the fluid and salts I have lost." c. "I may use over-the-counter Imodium or Parepectolin when I need to control the diarrhea." d. "I must wash my hands after every bowel movement to prevent spreading the diarrhea to my family."

c. Antiperistaltic agents, such as loperamide (Imodium) and paregoric, should not be used in infectious diarrhea because of the potential of prolonging exposure to the infectious agent. Demulcent agents may be used to coat and protect mucous membranes in these cases. The other options are all appropriate measures to use in cases of infectious diarrhea.

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart. The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level.

The medications prescribed for the patient with inflammatory bowel disease include cobalamin and iron injections. What is the rationale for using these drugs? a. Alleviate stress c. Correct malnutrition b. Combat infection d. Improve quality of life

c. Cobalamin and iron injections will help to correct malnutrition. Correcting malnutrition will also indirectly help to improve quality of life and fight infections.

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating? a. Malnutrition b. Bile reflux gastritis c. Dumping syndrome d. Postprandial hypoglycemia

c. Dumping syndrome After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel.

A client with chronic pancreatitis need information on dietary modification to manage the health problems. A nurse should plan as priority instruction to teach the client to limit which of the following items in the diet? a. Carbohydrate b. Protein c. Fat d. Water- soluble vitamins

c. Fat

What should the nurse teach the patient with diverticulosis to do? a. Use anticholinergic drugs routinely to prevent bowel spasm. b. Have an annual colonoscopy to detect malignant changes in the lesions. c. Maintain a high-fiber diet and use bulk laxatives to increase fecal volume. d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel.

c. Formation of diverticula is common when decreased bulk of stool, combined with a more narrowed lumen in the sigmoid colon, causes high intraluminal pressures that result in saccular dilation or outpouching of the mucosa through the muscle of the intestinal wall. To prevent the high intraluminal pressure, fecal volume should be increased with use of high-fiber diets and bulk laxatives, such as psyllium (Metamucil). Anticholinergic drugs are used only during an acute episode of diverticulitis and the lesions are not premalignant.

A 53 yo woman admitted w/acute pancreatitis says, i don't understand how I got this disease. I thought alcoholics got pancreatitis. I never drink. what's the most appropriate response by the nurse... a. Was there a time in your life that you did drink heavily? b. It also is prevalent in smokers: do you smoke cigarettes c. Gallstones also are a risk factor. We'll evaluate for them d. Intravenous drug use is a risk factor. Do you use drugs by injection?

c. Gallstones also are a risk factor. We'll evaluate for them

A 60-year-old African American patient is afraid she might have anal cancer. What assessment finding puts her at high risk for anal cancer? a. Alcohol use c. Human papillomavirus (HPV) b. Only one sexual partner d. Use of a condom with sexual intercourse

c. Human papillomavirus (HPV) is associated with about 80% of anal cancer cases. Other risk factors include multiple sexual partners, smoking, receptive anal sex, and HIV infection, as well as being female, age 60, and African American. The other options are not considered risk factors for anal cancer.

The patient has peritonitis, which is a major complication of appendicitis. What treatment will the nurse plan to include? a. Peritoneal lavage c. IV fluid replacement b. Peritoneal dialysis d. Increased oral fluid intake

c. IV fluid replacement along with antibiotics, NG suction, analgesics, and surgery would be expected. Peritoneal lavage may be used to determine abdominal trauma. Peritoneal dialysis would not be performed. Oral fluids would be avoided with peritonitis.

What laboratory findings are expected in ulcerative colitis as a result of diarrhea and vomiting? a. Increased albumin c. Decreased Na+, K+, Mg+, Cl-, and HCO3 - b. Elevated white blood cells (WBCs) d. Decreased hemoglobin (Hgb) and hematocrit (Hct)

c. In the patient with ulcerative colitis, decreased Na+, K+, Mg+, Cl-, and HCO3 - are a result of diarrhea and vomiting. Hypoalbuminemia may be present. Elevated WBCs occur with toxic megacolon. Decreased hemoglobin (Hgb) and hematocrit (Hct) occur with bloody diarrhea.

The patient comes to the emergency department with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is obstructed? a. Large intestine c. Upper small intestine b. Esophageal sphincter d. Lower small intestine

c. Intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration are characteristics of mechanical upper small intestinal obstruction. With continued vomiting, metabolic alkalosis may occur. Large bowel obstruction is characterized by constipation, low-grade abdominal pain, and abdominal distention. Fecal vomiting is seen with lower small intestinal obstruction.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? a. Turn, deep breathe, cough, and use spirometer every 4 hours. b. Maintain an upright position for at least 2 hours after eating. c. NG will have bloody drainage, and it should not be repositioned. d. Keep in a supine position to prevent movement of the anastomosis.

c. NG will have bloody drainage, and it should not be repositioned. The patient will have bloody drainage from the nasogastric (NG) tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon

The nurse should teach the patient with chronic constipation that which food has the highest dietary fiber? a. Peach c. Dried beans b. Popcorn d. Shredded wheat

c. Of the foods listed, dried beans contain the highest amount of dietary fiber and are an excellent source of soluble fiber. Bran and berries also have large amounts of fiber.

A patient is diagnosed with celiac disease following a workup for iron-deficiency anemia and decreased bone density. The nurse identifies that additional teaching about disease management is needed when the patient makes which statement? a. "I should ask my close relatives to be screened for celiac disease." b. "If I do not follow the gluten-free diet, I might develop a lymphoma." c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms." d. "It is going to be difficult to follow a gluten-free diet because it is found in so many foods."

c. The autoimmune process associated with celiac disease continues as long as the body is exposed to gluten, regardless of the symptoms it produces, and a lifelong gluten-free diet is necessary. The other statements regarding celiac disease are all true

On 2nd postop day, patient who had exploratory laparotomy complains if abdominal distention and gas pains. Best response to this is: a. Abdominal distention occurs as a normal response to inflammation and healing b. Gas pains occur when NG tube is not used correctly c. This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery

c. This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery

Priority Decision: What is the most important thing the nurse should do when caring for a patient who has contracted Clostridium difficile? a. Clean the entire room with ammonia. b. Feed the patient yogurt with probiotics. c. Wear gloves and wash hands with soap and water. d. Teach the family to use alcohol-based hand cleaners.

c. Wearing gloves will avoid hand contamination and washing hands with soap and water will remove more Clostridium difficile spores than alcohol-based hand cleaners and ammonia-based disinfectants. The entire room will need to be disinfected with a 10% solution of household bleach. Probiotics may help to prevent diarrhea in the patient on antibiotics by replacing normal intestinal bacteria.

Patient asks nurse if his risks for colon cancer are increased due to a polyp. the best response is: a. it is very rare for polyps ot become malignant b. individuals with polyps have a 100% lifetime risk of developing colorectal cancer c. all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present

c. all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present

Nurse teaches a patient with newly diagnosed PUD to a. maintain bland diet b. use alcohol and caffeine in moderation c. eat as normally as possible, eliminating foods that cause pain d. avoid milk and milk products

c. eat as normally as possible, eliminating foods that cause pain

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to a. increase the amount of fluid with meals. b. eat foods that are higher in carbohydrates. c. lie down for about 30 minutes after eating. d. drink sugared fluids or eat candy after meals.

c. lie down for about 30 minutes after eating. The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating.

Nurse teaches patient with diverticulosis to a. use anticholinergic drugs routinely to prevent bowel spasm b. have an annual colonoscopy to detect malignant changes c. maintain a high fiber diet and use bulk laxatives to increase fecal volume

c. maintain a high fiber diet and use bulk laxatives to increase fecal volume

Patient with pancreatitis has nursing dx of pain r/t distention of pancreas and peritoneal irritation. In addition to effective use of analgesics the nurse should: a. provide diversional activities to distract patient b. provide small frequent meals c. position the patient on the side with the head of the bed elevated 45º

c. position the patient on the side with the head of the bed elevated 45º

When assessing a patient with pancreatitits, nurse would expect to find: a. hyperactive bowel sounds b. hypertension and tachycardia c. severe midepigastric of LUQ pain d. temp greater than 102º

c. severe midepigastric of LUQ pain

the nurse teaches the patient with a hiatal hernia or GERD to control symptoms by: a. drinking 10-12 oz of water with meals b. spacing six small meals a day c. sleeping with the head of the bed elevated 4-6 inches d. perfrming aily exercises of toe touch

c. sleeping with the head of the bed elevated 4-6 inches

7) A patient with a gun shot wound to the abdomen develops a bacterial peritonitis after surgery to repair the bowel. This problem is caused primarily by: a. immobility and loss of peristalsis of the bowel as a result of surgery b. the penetration of unsterile foreign bodies into the abdominal cavity c. spillage of bowel contents into the normally sterile abdominal cavity d. accumulation of blood and fluid in the abdominal cavity as a result of the trauma

c. spillage of bowel contents into the normally sterile abdominal cavity

Patient with history of PUD is hospitalized with symptoms of a perforation. During initial assessment nurse would expect to find: a. vomit of bright red blood b. projectile vomiting c. sudden, severe upper abdominal pain and shoulder pain d. hyperactive

c. sudden, severe upper abdominal pain and shoulder pain

Delegation Decision: The RN coordinating the care for a patient who is 2 days postoperative following an anterior- posterior resection with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)? a. Irrigate the colostomy. b. Teach ostomy and skin care. c. Assess and document stoma appearance. d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

d, e. The licensed practical nurse (LPN) can monitor and record observations related to the drainage and can measure and record the amount. The LPN could also monitor the skin around the stoma for breakdown. LPNs can irrigate a colostomy in a stable patient but this patient is only 2 days postoperative. The other actions are responsibilities of the RN (teaching, assessing stoma, and developing a care plan).

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

d. Abdominal pain is decreased. NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain.

A patient who has been vomiting for several days from an unknown cause is admitted to hospital. the nurse anticipates collaborative care to include: a. oral admin of broth and tea b. admin of parenteral antiemetics c. insertion of NG tube to suction d. IV replacement of fluid and electrolytes

d. IV replacement of fluid and electrolytes

A nurse is doing a nursing assessment on a patient with chronic constipation. What data obtained during the interview may be a factor contributing to the constipation? a. Taking methylcellulose (Citrucel) daily c. History of hemorrhoids and hypertension b. High dietary fiber with high fluid intake d. Suppressing the urge to defecate while at work

d. Ignoring the urge to defecate causes the muscles and mucosa in the rectal area to become insensitive to the presence of feces and drying of the stool occurs. The urge to defecate is decreased and stool becomes more difficult to expel. Taking a bulk-forming agent with fluids or highfiber diet with fluids prevent constipation. Hemorrhoids are the most common complication of chronic constipation, caused by straining to pass hardened stool. The straining may cause problems in patients with hypertension but these do not cause constipation. Other things that may cause constipation are a history of diverticulosis, which is seen in individuals with low fiber intake, small stool mass, and hard stools. Chronic laxative use and chronic dilation and loss of colonic tone may also cause chronic constipation.

The client has cholelithiasis. Which of the following assessment findings indicates to the nurse that the stone has probably obstructed the common bile duct a. nausea b. hypercholesterolemia c. RUQ pain d. Jaundice

d. Jaundice

Which assessment finding would the nurse need to report most quickly to the healthcare provider regarding a patient with acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

d. Muscle twitching and finger numbness Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a. Chest pain relieved with eating or drinking water b. Back pain 3 or 4 hours after eating a meal c. Burning epigastric pain 90 minutes after breakfast d. Rigid abdomen and vomiting following indigestion

d. Rigid abdomen and vomiting following indigestion A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly.

A male patient who has undergone an anterior-posterior repair is worried about his sexuality. What is an appropriate nursing intervention for this patient? a. Have the patient's sexual partner reassure the patient that he is still desirable. b. Reassure the patient that sexual function will return when healing is complete. c. Remind the patient that affection can be expressed in ways other than through sexual intercourse. d. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

d. Sexual dysfunction may result from an anterior-posterior repair but the nurse should discuss with the patient that different nerve pathways affect erection, ejaculation, and orgasm and that a dysfunction of one does not mean total sexual dysfunction and also that an alteration in sexual activity does not have to alter sexuality. Simple reassurance of desirability and ignoring concerns about sexual function do not help the patient to regain positive feelings of sexuality.

Priority Decision: In instituting a bowel training program for a patient with fecal incontinence, what should the nurse first plan to do? a. Teach the patient to use a perianal pouch. b. Insert a rectal suppository at the same time every morning. c. Place the patient on a bedpan 30 minutes before breakfast. d. Assist the patient to the bathroom at the time of the patient's normal defecation.

d. The first intervention to establish bowel regularity includes promoting bowel evacuation at a regular time each day, preferably by placing the patient on the bedpan, using a bedside commode, or walking the patient to the bathroom. To take advantage of the gastrocolic reflex, an appropriate time is 30 minutes after the first meal of the day or at the patient's usual individual time. Perianal pouches are used to protect the skin only when regularity cannot be established and evacuation suppositories are also used only if other techniques are not successful.

The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? a. The pouch can be worn for up to 2 weeks before changing it. b. Decrease the amount of fluid intake to decrease the amount of drainage. c. The pouch can be removed when bowel movements have been regulated. d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch

d. The ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4 to 7 days unless there is a leak. Because the initial drainage from the ileostomy is high, the fluid intake must not be decreased. The pouch must always be worn, as the liquid drainage, not formed bowel movements, is frequent.

A 22-year-old patient calls the outpatient clinic complaining of nausea and vomiting and right lower abdominal pain. What should the nurse advise the patient to do? a. Use a heating pad to relax the muscles at the site of the pain. b. Drink at least 2 quarts of juice to replace the fluid lost in vomiting. c. Take a laxative to empty the bowel before examination at the clinic. d. Have the symptoms evaluated by a health care provider right away.

d. The patient is having symptoms of an acute abdomen and should be evaluated by a health care provider immediately. The patient's age, location of pain, and other symptoms are characteristic of appendicitis. Heat application and laxatives should not be used in patients with undiagnosed abdominal pain because they may cause perforation of the appendix or other inflammations. Fluids should not be taken until vomiting is controlled, nor should they be taken in the event that surgery may be performed.

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

d. The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileostomy has liquid to semiliquid stools needing a pouch and increased fluid. The sigmoid colostomy has formed stools and may or may not need a pouch but will need irrigation.

What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease? a. Celiac disease and gallstones c. Conjunctivitis and colonic dilation b. Peptic ulcer disease and uveitis d. Erythema nodosum and osteoporosis

d. Ulcerative colitis and Crohn's disease have many of the same extraintestinal symptoms, including erythema nodosum and osteoporosis, as well as gallstones, uveitis, and conjunctivitis. Colonic dilation and celiac disease are not extraintestinal.

Following a hemorrhoidectomy, what should the nurse advise the patient to do? a. Use daily laxatives to facilitate bowel emptying. b. Use ice packs to the perineum to prevent swelling. c. Avoid having a bowel movement for several days until healing occurs. d. Take warm sitz baths several times a day to promote comfort and cleaning.

d. Warm sitz baths provide comfort, healing, and cleansing of the area following all anorectal surgery and may be done three or four times a day for 1 to 2 weeks. Stool softeners may be prescribed for several days postoperatively to help keep stools soft for passage but laxatives may cause irritation and trauma to the anorectal area and are not used postoperatively. Early passage of a bowel movement, although painful, is encouraged to prevent drying and hardening of stool, which would result in an even more painful bowel movement.

When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect? a. An abdominal dressing c. A temporary colostomy and drains b. An abdominal wound and drains d. A perineal wound, drains, and a stoma

d. With an abdominal perineal-resection (APR), an abdominal incision is made and the proximal sigmoid colon is brought through the abdominal wall and formed into a permanent colostomy. The patient is repositioned, a perineal incision is made, and the distal sigmoid colon, rectum, and anus are removed through the perineal incision, which may be left open, packed, and have drains.

The nurse will ask a 64-year-old patient being admitted with acute pancreatitis specifically about a history of a. diabetes mellitus. b. high-protein diet. c. cigarette smoking. d. alcohol consumption.

d. alcohol consumption. Alcohol use is one of the most common risk factors for pancreatitis in the United States.

Early screening for detection of cancers of the right side of colon in individuals over 50 yrs old should be done every year to include: a. serum CEA levels b. flexible sigmoidoscopy c. digital rectal exam d. fecal testing for occult blood

d. fecal testing for occult blood

Patient with cancer of stomach undergoes total gastrecotmy with esophagojejunostomy. Postop the nurse teaches the patient to expect: a. rapid healing b. ability to return to normal dietary habits c. close follow up for development of ulcers d. lifelong intramuscular or intranasal admin of cobalamin

d. lifelong intramuscular or intranasal admin of cobalamin

Following a Billroth 2 procedure, patient develops dumping syndrome. The nurse explains that the symptoms associated wti h this problem are caused by: a. distention of smaller stomach by too much food and fluid intake b. hyperglycemia caused by uncontrolled gastric emptying into the small intestine c. irritation of the stomach lining by reflux of bile salts d. movement of fluid into the bowel because concentrated foods and fluids move quickly into the intestine

d. movement of fluid into the bowel because concentrated foods and fluids move quickly into the intestine

The nurse will anticipate teaching a patient experiencing frequent heartburn about a. barium swallow. b. radionuclide tests. c. endoscopy procedures. d. proton pump inhibitors.

d. proton pump inhibitors. Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD.

Zofran is prescribed for a patient with cancer chemo induced vomiting. The nurse understands this drug: a. is a derivative of cannabis b. has a strong antihistamine effect that provides sedation and sleep c. is used only when other therapies are ineffective d. relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying

d. relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying

The preferred immediate treatment for acute episode of constipation is: a. soapsud enema b. stimulant cthartics c. stool sofenting cathartic d. tap water or hypertonic enemas

d. tap water or hypertonic enemas

A patient is returned to the surgical unit following a laparoscopic fundoplication for repair of hiatal hernia with an IV, NG tube to suction, and several small abdominal incisions. To prevent disruption of the surgical site, it is most important for the nurse to

maintain the patency of the NG tube

Patient with ulcerative colitis has a total colectomy with formation of a terminal ileum stoma. an important nursing intervention for this patient postop is to:

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