Adv. Med Surg Exam 5 (Ch 41-50)

A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population? 1 "You should avoid pregnancy for at least 18 months after surgery." 2 "After surgery, your ability to conceive is decreased considerably." 3 "You should avoid pregnancy for at least 9 months after surgery" 4 "After surgery, contraceptives have much less efficacy."

1

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? 1 Diarrhea 2 Pain 3 Bloating 4 Abdominal distention

1 The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

Which of the following is the primary function of the small intestine? 1 Absorption 2 Digestion 3 Peristalsis 4 Secretion

1 Absorption is the primary function of the small intestine. Digestion occurs in the stomach. Peristalsis occurs in the colon. The duodenum secretes enzymes.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? 1 Shock 2 Pancreatic necrosis 3 MODS 4 Tetany

2 Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Shock and multiple organ failure may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in clients with acute pancreatitis.

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? 1 Vomiting 2 Hemorrhage 3 Awakening in pain 4 Constipation

3 The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds? 1 Mild 2 High-pitched 3 Hyperactive 4 Absent

4

A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has? 1 Osteoarthritis 2 Rheumatoid arthritis 3 Inflammatory arthritis 4 Necrotizing arthritis

1

A home care nurse is caring for a client with reports of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? 1 "I'll avoid eating or drinking anything 6 to 8 hours before the test." 2 "I'll drink full liquids the day before the test." 3 "There is no need for special preparation before the test." 4 "I'll take a laxative to clear my bowels before the test."

1

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? 1 Frequent changes of positions 2 Placing the patient in the prone position 3 Perform chest physiotherapy 4 Suction the patient every 4 hours

1

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible 1 hemorrhage? 1 Hematemesis 2 Bradycardia 3 Hypertension 4 Polyuria

1 The nurse interprets hematemesis (vomiting blood) as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? 1 "Apply ice packs for the first 12 to 18 hours." 2 "Apply heat packs for the first 24 to 48 hours." 3 "Apply ice packs for the first 24 to 48 hours, then apply heat packs." 4 "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

3

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? 1 Magnesium level 2 Potassium level 3 Alkaline phosphatase 4 Troponin levels

3

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: 1 caffeinated products. 2 spicy foods. 3 high-fiber diet. 4 fluids with meals.

3

If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first? 1 Call the physician. 2 Apply a dry sterile dressing to the site. 3 Clamp the catheter. 4 Tell the client to take and hold a deep breath.

3

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? 1 Comminuted 2 Compression 3 Impacted 4 Greenstick

3

The most common symptom of esophageal disease is 1 nausea. 2 vomiting. 3 dysphagia. 4 odynophagia.

3

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? 1 Compound 2 Depressed 3 Impacted 4 Comminuted

4

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? 1 Bone spurs 2 Diarrhea 3 Increased heel pain 4 Decreased height

4

A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose? 1 Stimulate GI peristalsis 2 Assess for intact swallowing 3 Assess for gastric perforation 4 Stimulate digestive hormones

1

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? 1 Bone fracture 2 Loss of estrogen 3 Negative calcium balance 4 Dowager's hump

1

When an infection is bloodborne, the manifestations include which symptom? 1 Chills 2 Bradycardia 3 Hypothermia 4 Hyperactivity

1 Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? 1 lack of free water intake 2 lack of solid food 3 lack of exercise 4 increased fiber

1 A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? 1 Constipation 2 Paralytic ileus 3 Peritonitis 4 Accumulation of gas

3 Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): 1 anorectal abscess. 2 anal fistula. 3 hemorrhoid. 4 anal fissure.

4 Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client? 1 Abdominal distention, elevated temperature, weakness before eating 2 Constipation, rectal bleeding following bowel movements 3 Persistent loose stools, chills, hiccups after eating 4 Weakness, diaphoresis, diarrhea 90 minutes after eating

4 Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating

The primary source of microorganisms for catheter-related infections are the skin and which of the following? 1 Catheter hub 2 Catheter tubing 3 IV fluid bag 4 IV tubing

1

What assessment findings of the leg are consistent with a fracture of the femoral neck? 1 Shortened, adducted, and externally rotated 2 Shortened, abducted, and internally rotated 3 Adducted and internally rotated 4 Abducted and externally rotated

1

Which ulcer is associated with extensive burn injury? 1 Cushing ulcer 2 Curling ulcer 3 Peptic ulcer 4 Duodenal ulcer

2 Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? 1 Hyperkalemia 2 Hypokalemia 3 Hyponatremia 4 Hypernatremia

2 The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? 1 Straw-colored urine 2 Reduced hematocrit 3 Clay-colored stools 4 Elevated urobilinogen in the urine

3

When completing a nutritional assessment of a patient who is admitted for a GI disorder, the nurse notes a recent history of dietary intake. This is based on the knowledge that a portion of digested waste products can remain in the rectum for how many days after a meal is digested? 1. 1 day 2. 2 days 3. 3 days 4. 4 days

3 days

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: 1 a sedentary lifestyle and smoking. 2 a history of hemorrhoids and smoking. 3 alcohol abuse and a history of acute renal failure. 4 alcohol abuse and smoking.

4

Which term refers to a disease of a nerve root? 1 Radiculopathy 2 Involucrum 3 Sequestrum 4 Contracture

1

The nurse is to insert a postpyloric feeding tube. How can the nurse aid in placement of the tube past the pylorus? 1 Administer prescribed metoclopramide. 2 Have the client lay on the left side. 3 Assist the client to drink 8 ounces of water. 4 Instruct the client to swallow several times.

1 Metoclopramide (Reglan) is administered to increase peristalsis of the feeding tube into the duodenum. Placing the client on the right side, not the left side, helps to facilitate movement and placement. Having the client swallow or even to drink water facilitates placement of the tube past the epiglottis, not into the duodenum.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? 1 Living a sedentary lifestyle to reduce the incidence of injury 2 Stopping estrogen therapy 3 Taking a 300-mg calcium supplement to meet dietary guidelines 4 Initiating weight-bearing exercise routines

3 Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient? 1 The patient requires more pain medication. 2 The patient is developing a paralytic ileus. 3 The patient has developed peritonitis. 4 The patient has developed renal failure.

3 Abdominal guarding is present. A rigid or boardlike abdomen may develop and is generally an ominous sign, usually indicating peritonitis (

The nurse determines one or two bowel sounds in 2 minutes should be documented as 1 normal. 2 hyperactive. 3 hypoactive. 4 absent.

3 Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Normal bowel sounds are heard every 5 to 20 seconds. Hyperactive bowel sounds occur when 5 or 6 sounds are heard in less than 30 seconds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? 1 "You will need to decrease the amount of dairy products you consume." 2 "You will need to avoid foods high in phosphorus and vitamin D." 3 "You may need to be evaluated for an underlying cause, such as renal failure." 4 "You will need to engage in vigorous exercise three times a week for 30 minutes."

3 The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.

Which of the following is an enzyme secreted by the gastric mucosa? 1 Pepsin 2 Trypsin 3 Ptyalin 4 Bile

1 Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile.

Postoperatively, a client with a radical neck dissection should be placed in which position? 1 Supine 2 Fowler 3 Prone 4 Side-lying

2 The client should be placed in the Fowler position to facilitate breathing and promote comfort. This position also promotes expansion of the lungs because the diaphragm is pulled downward and the abdominal viscera are pulled away from the lungs. The other positions are not the position of choice postoperatively.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description? 1 Coffee-ground-like 2 Clay-colored 3 Black and tarry 4 Bright red

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

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? 1 Creatinine 2 Urobilinogen 3 Chloride 4 Albumin

4 Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop? 1 Impingement syndrome 2 Metastatic bone disease 3 Bone abscess formation 4 Pathological fractures

3 Bone abscess formation is a potential complication of osteomyelitis. Impingement syndrome is related to repetitive shoulder activities. Metastatic bone disease and pathological fractures are related to caner

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as 1 Hammertoe 2 Pes cavus 3 Hallux valgus 4 Flatfoot

3 Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. The client with flatfoot demonstrates a diminished longitudinal arch of the foot.

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? 1 Yellow-green 2 Black and tarry 3 Blood tinged 4 Clay-colored or whitish

4

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: 1 restrict fluid intake to 1 qt (1,000 ml)/day. 2 drink liquids only with meals. 3 don't drink liquids 2 hours before meals. 4 drink liquids only between meals.

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

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? 1 Strain 2 Contusion 3 Sprain 4 Fracture

3 A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? 1 Nearly two-thirds of clients with diabetes mellitus are older than age 60. 2 Diabetes mellitus is more common in Hispanics and Blacks than in Whites. 3 Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. 4 Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

3 Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.

Which is the primary symptom of achalasia? 1 Difficulty swallowing 2 Chest pain 3 Heartburn 4 Pulmonary symptoms

1

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? 1 Decreases in the physiologic function of major organs 2 Increases in the bicarbonate output by the kidneys 3 Increases in the rate of pancreatic secretion 4 Development of local complications

1 Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in physiologic function of major organs with increasing age.

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: 1 acute cholecystitis 2 hepatitis A 3 hepatitis B 4 pancreatitis

1 Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? 1 Colonoscopy 2 Barium enema 3 Flexible sigmoidoscopy CT scan

1 Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? 1 Slows gastric emptying 2 Provides much needed rest 3 Allows for better absorption of vitamin B12 4 Removes tension on internal suture line

1 Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? 1 30 mg/dL 2 50 mg/dL 3 70 mg/dL 4 90 mg/dL

1 Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulinlike material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding? 1 Rapid gastric dumping 2 Excessive fat intake 3 Decreased motility 4 Decreased gastric size

1 Rapid gastric dumping may lead to steatorrhea, excessive fat in the feces. The primary cause of this finding is rapid gastric dumping. Excessive fat intake can make the problem worse; however, this is not the primary cause of the symptoms. Steatorrhea results from increased motility, not decreased and the size of the stomach does not contribute to this finding.

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? 1 0.9% NS 2 D5W 3 D10W 4 0.45% of NS

1 The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

Which enzyme aids in the digestion of protein? 1 trypsin 2 lipase 3 pepsin 4 ptyalin

1 Trypsin, amylase, and lipase are digestive enzymes secreted by the pancreas. Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? 1 Compound 2 Greenstick 3 Oblique 4 Spiral

1 A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the: 1 Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. 2 Digestive process occurs more rapidly as a result of the feedings not having to pass through the esophagus. 3 Feedings can be administered with the patient in the recumbent position. 4 The patient cannot experience the deprivational stress of not swallowing.

1 Gastrostomy is preferred over NG feedings in the patient who is comatose because the gastroesophageal sphincter remains intact. Regurgitation and aspiration are less likely to occur with a gastrostomy than with NG feedings.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? 1 A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. 2 A sectioned portion of the stomach is joined to the jejunum. 3 The antral portion of the stomach is removed and a vagotomy is performed. 4 The vagus nerve is cut and gastric drainage is established.

1 A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.

The nurse is examining the mouth of a client who is HIV positive. On the inner side of the lip, the nurse sees a shallow ulcer with a yellow center and red border. The client says the area has been painful for about 5 days or so. Which condition is most consistent with these findings? 1 Aphthous stomatitis 2 Kaposi's sarcoma 3 Chancre 4 Hairy leukoplakia

1 Aphthous stomatitis is characterized by a shallow ulcer with a white or yellow center and red border, often on the inner lip and cheek or on the tongue. It begins with a burning or tingling sensation and slight swelling, and is painful, usually lasting 7 to 10 days. Aphthous ulcers are associated with HIV infection. Kaposi's sarcoma and hairy leukoplakia also are found in clients who are HIV positive. Kaposi's sarcoma is marked by red, purple, or blue lesions on the oral mucosa; hairy leukoplakia is characterized by white patches with rough hair-like projections typically on the lateral border of the tongue. A chancre is a reddened, circumscribed lesion that ulcerates and becomes crusted--it is a primary lesion of syphilis.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? 1 Increasing fluid intake to prevent dehydration 2 Wearing an appliance pouch only at bedtime 3 Consuming a low-protein, high-fiber diet 4 Taking only enteric-coated medications

1 Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

Following ingestion of carrots or beets, the nurse would expect which alteration in stool color? 1 Red 2 Black 3 Yellow 4 Milky white

1 Carrots or beets will tend to change the stool color to red. Black stools are associated with iron, licorice, and charcoal. Senna is associated with yellow stools. A milky white stool is associated with administration of barium.

What is the primary nursing diagnosis for a client with a bowel obstruction? 1 Deficient fluid volume 2 Deficient knowledge 3 Acute pain 4 Ineffective tissue perfusion

1 Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation. Therefore, Deficient fluid volume is the primary diagnosis. Deficient knowledge, Acute pain, and Ineffective tissue perfusion are applicable but not the primary nursing diagnosis.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? 1 Lower lumbar 2 Upper lumbar 3 Thoracic 4 Cervical

1 The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate? Select all that apply. 1 Anorexia 2 Nausea and vomiting 3 Diarrhea 4 Weight loss 5 Epigastric fullness

1, 2, 5 Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The client may have nausea and vomiting, constipation, epigastric fullness, and anorexia. A later sign will be weight loss. The client will not have diarrhea with the obstruction.

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? 1 Less than 24 hours 2 Between 24 and 48 hours 3 About 72 hours 4 At least 1 week

2

The nurse is caring for a man who has experienced a spinal cord injury. Throughout his recovery, the client expects to gain control of his bowels. The nurse's best response to this client would be which of the following? 1 "It is not going to happen. Your nerve cells are too damaged." 2 "Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." 3 "Over time, the nerve fibers will regrow new tracts, and you can have bowel movements again." 4 "Wearing an undergarment will become more comfortable over time."

2

The nurse is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred? 1 The nurse has inserted a tube that is too large for the patient. 2 The nurse has inadvertently inserted the tube into the trachea. 3 This is a normal occurrence and the tube should be left in place. 4 The tube is most likely defective and should be immediately removed.

2

The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? 1 Gallbladder 2 Pancreas 3 Stomach 4 Liver

2

A client with calculi in the gallbladder is said to have 1 Cholecystitis 2 Cholelithiasis 3 Choledocholithiasis 4 Choledochotomy

2 Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.

Which client would be at greatest risk for the development of an anorectal fistula? 1 A 50-year-old male with diverticulosis 2 A 35-year-old female with Crohn's disease 3 A 42-year-old female with irritable bowel syndrome 4 A 60-year-old male with polyps of the colon

2 Clients with Crohn's disease have an increased risk for the development of anorectal abscesses and anorectal fistulae. Diverticulosis, irritable bowel syndrome, and colon polyps are not typically associated with anorectal fistulae.

The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior? 1 Complete blood count (CBC) 2 Prothrombin time (PT) 3 Blood chemistry 4 Erythrocyte sedimentation rate (ESR)

2 The client must have coagulation studies before the procedure such as a PT or PTT because a major complication after a liver biopsy is bleeding. Clients at risk for serious bleeding may receive precautionary vitamin K. A complete blood count and blood chemistry may be completed for baseline values. Typically, an ESR is not associated with the procedure.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: 1 A small bowel disorder. 2 Intestinal malabsorption. 3 Inflammatory colitis. 4 A disorder of the large bowel.

2 Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance? 1 Press the adhesive faceplate from the stomal edge inward 2 Ask the client to remain inactive for 5 minutes. 3 Ensure that no air is trapped in the pouch 4 Ensure that there are no holes in the pouch

2 After applying the ostomy appliance, the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? 1 Barium study of the upper gastrointestinal tract 2 Endoscopy 3 Gastric secretion study 4 Stool antigen test

2 Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? 1 Providing generous servings at mealtime 2 Reserving an antecubital site for a peripherally inserted central catheter (PICC) 3 Providing the client with plenty of P.O. fluids 4 Limiting I.V. fluid intake according to the physician's orders

2 Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid lo

A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement? 1 "I should feel better in about 24 to 36 hours." 2 "My appetite should come back tomorrow." 3 "I should limit alcohol intake, at least until symptoms subside." 4 "Once I can eat again, I should stick with bland foods."

2 The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? 1 Small-bowel disease 2 Ulcerative colitis 3 Disorders of the colon 4 Intestinal malabsorption

2 The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

A patient is receiving a continuous tube feeding. The nurse notes that the feeding tube was last irrigated at 2 p.m. The nurse would plan to irrigate the tube again at which time? 1 4 p.m. to 6 p.m. 2 6 p.m. to 8 p.m. 3 8 p.m. to 10 p.m. 4 10 p.m. to 12 a.m.

2 The recommendation is to irrigate the feeding tube of patients receiving continuous tube feedings every 4 to 6 hours. For this patient, the nurse would irrigate the tube next at 6 p.m. to 8 p.m.

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as? 1 Volkmann's contracture 2 Subluxation 3 Compartment syndrome 4 Sprain

2 A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? 1 Appendicitis 2 Rectal fissures 3 Bowel perforation 4 Diverticulitis

3 Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? 1 tenderness and pain in the right upper abdominal quadrant 2 jaundice and vomiting 3 severe abdominal pain with direct palpation or rebound tenderness 4 rectal bleeding and a change in bowel habits

3 Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis? 1 Calcium of 9.2 mg/dL (2.3 mmol/L) 2 Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) 3 Alkaline phosphate of 165 IU/L (2750 mmol/L) 4 Magnesium level of 2 mg/dL (0.82 mmol/L)

3 The normal range for alkaline phosphate level is 20 to 140 IU/L. An elevated serum concentration of alkaline phosphate reflects increased osteoblastic activity and is seen in clients with Paget's disease. A calcium level of 9.2 (2.3 mmol/L) is normal. A urinary creatinine level of 0.95 mg/dL (83.98 mmol/L) is normal. A magnesium level of 2 mg/dL (0.82 mmol/L) is normal.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: 1 Complex regional pain sydrome 2 Delayed union 3 Compartment syndrome 4 Fat embolism syndrome

4

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed? 1 When the residual is about 50 mL 2 When the residual is between 50 and 80 mL 3 When the residual is about 100 mL 4 When the residual is greater than 200 mL

4

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? 1 Wound packing 2 Wound irrigation 3 Vitamin supplements 4 Surgical debridement

4 In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the intial appropriate action by the nurse? 1 Notify the health care provider. 2 Irrigate the client's NG tube. 3 Place the client in the high-Fowler's position. 4 Assess the client's abdomen and vital signs.

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

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? 1 Colonoscopy 2 Abdominal x-ray 3 Cholecystectomy 4 Endoscopic retrograde cholangiopancreatography (ERCP)

4 ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? 1 Callus 2 Hammertoe 3 Hallux valgus 4 Dupuytren contracture

4 Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use? 1 5-mL 2 10-mL 3 20-mL 4 30-mL

4 When small-bore feeding tubes for continuous tube feedings are used and irrigated after administration of medications, a 30-mL or larger syringe is necessary, because the pressure generated by smaller syringes could rupture the tube.

Pulselessness, a very late sign of compartment syndrome, may signify 1 Venous congestion 2 Nerve involvement 3 Diminished arterial perfusion 4 Lack of distal tissue perfusion

4

_________________- occurs when inflamed and swollen tendons are caught in the narrow space between the bones within the shoulder joint

impingement syndrome

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? 1 Disseminated intravascular coagulation (DIC) 2 Avascular necrosis (AVN) 3 Complex regional pain syndrome (CRPS) 4 Fat embolism syndrome (FES)

4

Signs of hypokalemia?

*6 L's* *L*ethargy *L*ethal cardiac arrhythmia *L*eg cramps *L*imp muscles *L*ow, shallow respirations *L*ess stool (constipation)

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk? 1 Infection 2 Malunion 3 Complex regional pain syndrome 4 Depression

1

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should the nurse administer to the client before surgery? 1 Packed red blood cells 2 Vitamin C 3 Potassium 4 Oral bile acids

1

Dupuytren contracture causes flexion of which area(s)? 1 Thumb 2 Index and middle fingers 3 Fourth and fifth fingers 4 Ring finger

3

normal bowel sounds (borborygmus) ?

5-30 per minute or a sound every 5-20 seconds

abnormal outpouchings in the intestinal wall of the colon

Diverticulosis

ERCP (endoscopic retrograde cholangiopancreatography) is for? Cholecystectomy is for?

ERCP- locates stones in the bile duct Removal of gallbladder.

--A bony bump that forms on the joint at the base of the big toe. --It is formed when the big toe pushes against the next toe. Tight shoes, foot stress, and arthritis are causes

Hallux Valgus (bunion)

inflammation of the nerve typically between the 3rd and 4th metatarsals is called?

Mortons Neuroma

______________ include pulses, capillary refill, skin color, temperature, sensation, and motor funct

Neurovascular assessment

complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction what causes this usually?

Paralytic ileus ileus results from muscle or nerve problems that stop peristalsis

digestive enzymes secreted by the pancreas includes: _________ aids in digesting protein; ____________ aids in digesting starch; _______________ aids in digesting fats.

Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats.

puncture in the wall of the GI tract, contents within the stomach or intestine may then spill into abdominal cavity with potential to cause infection known as peritonitis

bowel perforation. stomach may be rigid.

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? 1 Vitamin A 2 Thiamine 3 Riboflavin 4 Vitamin K

1 associated with night blindness

A client has Paget's disease. An appropriate nursing diagnosis for this client is: 1 Risk for infection 2 Delayed wound healing 3 Risk for falls 4 Fatigue

3 The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

Cystic fibrosis, a genetic disorder characterized by pulmonary and pancreatic dysfunction, usually appears in young children but can also affect adults. If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system? 1 duodenum 2 jejunum 3 ileum 4 cecum

1

A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? 1 Curling's ulcer 2 Peptic ulcer 3 Esophageal ulcer 4 Meckel's ulcer

1 Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.

A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply. 1 Dizziness 2 Sweating 3 Fever 4 Hypertension 5 Tachycardia

1, 2, 5 Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that is common among clients who have had bariatric surgery. Symptoms of dumping syndrome include (but are not limited to): sweating, tachycardia, nausea, vomiting, dizziness, and diarrhea. Fever and hypertension are not symptoms of dumping syndrome.

A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"? 1 4 weeks 2 3 months 3 6 months 4 1 year

2

Which may occur if a client experiences compartment syndrome in an upper extremity? 1 Whiplash injury 2 Volkmann's contracture 3 Callus 4 Subluxation

2 If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation

A classic indicator of edema and alveolar hemorrhage associated with FES is: 1 Tachycardia. 2 Hyperventilation. 3 Crackles and wheezes. 4 Tachypnea.

2 Occlusion of the small vessels in the alveoli leads to a PaO2 of less than 80 mm Hg with an early respiratory alkalosis. The patient experiences hyperventilation in an attempt to get oxygen into the lungs

A client is recovering from a neck dissection. What volume of serosanguineous secretions would the nurse expect to drain over the first 24 hours? 1 20 to 40 mL 2 50 to 75 mL 3 80 to 120 mL 4 160 to 200 mL

3

A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document? 1 Aphthous stomatitis 2 Nicotine stomatitis 3 Erythroplakia 4 Hairy leukoplakia

4

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen. A. hepatic artery, low, high B. hepatic portal vein, high, low C. hepatic lobule, high, low D. hepatic vein, low, high

B The liver receives a blood supply from two sources. The first is the hepatic artery which delivers oxygenated blood from the general circulation. The second is the hepatic portal vein delivering deoxygenated blood from the small intestine containing nutrients. ... The blood drains out of the liver via the hepatic vein.

peritonitis means

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)

For people without diabetes, the normal range for the hemoglobin A1c level is between __% and ____%. Hemoglobin A1c levels between ____% and ____% mean you have a higher chance of getting diabetes. Levels of _____% or higher mean you have diabetes

normal= between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes

most common cause of esophageal varices

portal hypertension

Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much calcium in your blood can _________ your bones, create kidney stones, and interfere with how your heart and brain work. Hypercalcemia is usually a result of overactive parathyroid glands

weaken

Which of the following is a true statement regarding gastric cancer? 1 Most patients are asymptomatic during the early stage of the disease. 2 Women have a higher incidence of gastric cancer than men. 3 The prognosis for gastric cancer is generally considered good. 4 Most cases of gastric cancer are discovered prior to metastasis.

1

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? 1 Weight loss 2 Diarrhea 3 Fatigue 4 Hypertension

1 Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: 1 yellow sclerae. 2 light amber urine. 3 circumoral pallor. 4 black, tarry stools.

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

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? 1 Pancreatitis can elevate the diaphragm and alter the breathing pattern. 2 Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. 3 Pancreatitis can atrophy the diaphragm and alter the breathing pattern. 4 Pancreatitis causes alterations to hemoglobin, impairing oxygenation.

1 Aggressive pulmonary care is required for clients with acute pancreatitis. Pancreatitis can elevate the diaphragm and alter the breathing pattern of clients. Pancreatitis can cause retention of pulmonary secretions but does not thicken the secretions. Acute pancreatitis does not alter the hemoglobin.

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: 1 The digestion of dietary and blood proteins. 2 Excessive diuresis and dehydration. 3 Severe infections and high fevers. 4 Excess potassium loss subsequent to prolonged use of diuretics.

1 Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? 1 Carbohydrate digestion 2 Protein synthesis 3 Fat digestion 4 Protein digestion

1 Amylase is a pancreatic enzyme involved in the breakdown and digestion of carbohydrates. Trypsin aids in the digestion of proteins. Lipase aids in the digestion of fats

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. 1 Jaundice 2 Petechiae 3 Ecchymoses 4 Cyanosis of the lips 5 Aphthous stomatitis

1, 2, 3

Which dietary modification is used for a client diagnosed with acute pancreatitis? 1 High-protein diet 2 Elimination of coffee 3 Low-carbohydrate diet 4 High-fat diet

2 A high-carbohydrate, low-fat, and low-protein diet should be implemented. Alcohol, caffeine, and spicy foods should be avoided.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? 1 Increased serum calcium levels 2 Elevated urine amylase levels 3 Decreased liver enzyme levels 4 Decreased white blood cell count

2 Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: 1 A pelvic abscess. 2 Peritonitis 3 An ileus. 4 An abscess under the diaphragm.

2 Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? 1 Potassium 2 Vitamin K 3 Vitamin B 4 Oral bile acids

2 Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? 1 Appendicitis 2 Pancreatitis 3 Cholecystitis 4 Gastric ulcer

2 Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. Appendicitis, cholecystitis, and gastric ulcer are less likely to exhibit fluid volume deficit.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? 1 Serum calcium 2 Serum bilirubin 3 Serum amylase 4 Serum potassium

3 Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are: 1 whole blood and albumin. 2 platelets and packed red blood cells. 3 fresh frozen plasma and whole blood. 4 cryoprecipitate and fresh frozen plasma.

4 The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These products include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, these products aren't specifically used to treat hemostasis. Although platelets may be helpful, the best answer is cryoprecipitate and fresh frozen plasma.

During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring? 1 Infection 2 Bowel perforation 3 Colonic polyp 4 Rectal fissure

2 Immediately after the test, the patient is monitored for signs and symptoms of bowel perforation (e.g., rectal bleeding, abdominal pain or distention, fever, focal peritoneal signs).

A patient tells the nurse that it feels like food is "sticking" in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate? 1 Achalasia 2 Diffuse spasm 3 Gastroesophageal reflex disease 4 Hiatal hernia

1 Achalasia is absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing. Narrowing of the esophagus just above the stomach results in a gradually increasing dilation of the esophagus in the upper chest. The main symptom is difficulty in swallowing both liquids and solids. The patient has a sensation of food sticking in the lower portion of the esophagus.

Which of the following digestive enzymes aids in the digesting of starch? 1 Amylase 2 Lipase 3 Trypsin 4 Bile

1 Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Bile is secreted by the liver and is not considered a digestive enzyme.

Which factor inhibits fracture healing? 1 Vitamin D 2 Exercise 3 Local malignancy 4 Maximum bone fragment contact

3 Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.