ATI_MED-SURG_Gastroinstestinal System

A nurse is reinforcing preoperative teaching with a client who will undergo surgery to create a temporary colostomy. The client asks the nurse about the difference between colostomies and ileostomies. Which of the following responses should the nurse offer? A. "A colostomy drains stool and an ileostomy drains urine." B. "A colostomy is temporary and an ileostomy is permanent." C. "A colostomy is from the large intestine and an ileostomy is from the small intestine." D. "An ileostomy requires dietary restrictions while a colostomy does not."

"A colostomy is from the large intestine and an ileostomy is from the small intestine." *The name of the ostomy reflects the region the surgeon brings to the surface of the abdominal wall. *colon+ostomy (large intestine) *ileum+ostomy (small intestine)

A nurse is reinforcing teaching with a group of community residents about hepatitis B. Which of the following statements should the nurse include in the teaching? A. "A hepatitis B immunization is recommended for those who travel, especially military personnel." B. "A hepatitis B immunization is given to infants and children." C. "Hepatitis B is acquired by eating foods that are contaminated during handling." D. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation."

"A hepatitis B immunization is given to infants and children." *Hepatitis B immune globulin is given as part of standard childhood immunizations. It can be administered as early as birth, especially in infants born to hepatitis B surface antigen (HBsAg) negative mothers. These infants should receive the second dose between 1 and 4 months of age

A nurse is reinforcing teaching with a client who takes phenytoin and has a new prescription for sucralfate tablets. Which of the following instructions should the nurse include? A. "Take an antacid with the sucralfate." B. "Take sucralfate with a glass of milk." C. "Allow a 2-hour interval between these medications." D. "Chew the sucralfate thoroughly before swallowing."

"Allow a 2-hour interval between these medications." *Antacids can interfere with the effects of sucralfate, so the client should allow a 30-min interval between the sucralfate and the antacid. Sucralfate should be taken on an empty stomach, 1 hr before meals. Sul

A nurse is reinforcing postoperative teaching with a client who had a partial gastrectomy about the management of dumping syndrome. Which of the following instructions should the nurse include? A. "Consume at least 4 ounces of fluid with meals." B. "Take a short walk after each meal." C. "Use honey to flavor foods such as cereal." D. "Eat protein with each meal."

"Eat protein with each meal." *The client should eat meals that are high in protein and fat with low to moderate carbohydrate content. Proteins should be included in every meal because it delays digestion, which helps reduce the manifestations of dumping syndrome

A nurse is reinforcing discharge techniques with a client who has a newly placed ileostomy about ostomy care while at home. Which of the following instructions should the nurse include in the teaching? A. "Empty your ostomy pouch when it gets half full." B. "Place an aspirin in the ostomy pouch to eliminate odor." C. "Change the ostomy appliance every week." D. "Cleanse the site around the stoma with hydrogen peroxide and water."

"Empty your ostomy pouch when it gets half full." *The nurse should instruct the client to empty the pouch when it is 1/3-1/2 full. This prevents the ostomy from becoming too full of stool or gas and exploding

A nurse is reinforcing discharge teaching with the partner of a client who has a new diagnosis of hepatitis A. Which of the following instructions should the nurse include? A. "During this illness, shemay take acetaminiphen for a fever or discomfort." B. "Encourage her to eat foods that are high in carbohydrates." C. "The provider will prescribe a medication to help her heal faster." D. "Have her perform moderate exercise to get her strength back quicker."

"Encourage her to eat foods that are high in carbohydrates." *The client's diet should be high in carbs and calories with only moderate amounts of protein and fat, especially if nausea is present.

A nurse is reinforcing discharge teaching with a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching? A. "When sitting in my lounge chair agter a meal, I will lower the back of it." B. "I will try to eat three large meals a day." C. "I will elevate the head of my bed on blocks." D. "I will avoid eating within 1 hour before bedtime."

"I will elevate the head of my bed on blocks." *The client is instructed to remain upright after eating following a fundoplication. The cliet is instructed to avoid large meals after a fundoplication. After a fundoplication, the client is instructed to elevate the head of the bed to limit reflux. The client should avoid eating 2 hr before bedtime to reduce the risk for reflux.

A nurse in a clinic is reinforcing teaching with a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the information provided? A. "I will plan to limit lactose in my diet." B. "I will restrict fluid intake during meals." C. "I will switch to black tea instead of drinking coffee." D. "I will try to eat cold foods rather than warm when my stomach feels upset."

"I will plan to limit lactose in my diet." *Lactose limitations are recommended for the client who has ulcerative colitis to reduce inflammation. A client who has dumping syndrome should avoid fluids with meals. Caffeine can increase diarrhea and cramping. The client should avoid caffeinated beverages, such as black tea. The client should avoid cold foods because these can increase intestinal motility and cause exacerbation of manifestations

A nurse is reinforcing discharge teaching for a client who has infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."

"I will take a combination of medications for treatment." *Corticosteroid use is a contributing factor to an infection caused by H. pylori. An esophagogastroduodenoscopy is done to evaluate for the presence of H. pylori and to evaluate effectiveness of treatment. A combination of antibiotics and a histamine 2 receptor antagonist is used to treat an infection caused H. pylori. H. pylori is evaluated by obtaining gastric samples, not a throat swab

A nurse is reinforcing teaching with a client who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the instruction? A. "The medicine coats the lining of my stomach." B. "The medication should stop the pain right away." C. "I will take my pill at bedtime." D. "I will monitor for bleeding from my nose."

"I will take my pill at bedtime." *Famotidine decreases gastric acid output. It does not have a protective coating action. The client might need to take famotidine coating action. The client might need to take famotidine for several days before pain relief occurs when starting this therapy. The client should take famotidine at bedtime, which suppresses nocturnal acid production. Instruct the client to monitor for GI bleeding when taking famotidine.

A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client asks why he has to stay in bed, how should the nurse respond to explain the most important reason for this prescription? A. "You need to conserve energy at this time." B. "Lying quietly in bed helps slow down the activity in your intestines." C. "Staying in bed helps promote the rest and comfort you need." D. "Staying in bed will help prevent injury and minimize your fall risk."

"Lying quietly in bed helps slow down the activity in your intestines." *the greatest risk to the client is complications from severe diarrhea such as dehydration, electrolyte imbalances, and GI bleeding and trauma. Activity restriction can help reduce intestinal peristalsis and diarrhea.

A nurse is reinforcing teaching with a client who is scheduled for a sigmoid colon resection with colostomy. Which of the following statements by the client indicates a need for further teaching? A. "Because most of my colon is still intact and functioning, my stool will be formed." B. "My stoma will appear large at first, but it will shrink over time." C. "My colostomy will begin to function 2 to 6 days after surgery." D. "My diet will have to change to a soft diet after surgery."

"My diet will have to change to a soft diet after surgery." *The nurse should identify that this statement requires further reinforcement of teaching. After surgery, the client's diet quickly returns to a regular diet, and there are no food restrictions unless the client chooses to decrease intake of food that increase gas or odor

A nurse is reinforcing teaching with a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include? A. "Take the medicine 2 hours after eating." B. "Discontinue this medication if your skin turns yellow-orange." C. "Notify the provider if you experience a sore throat." D. "Expect your stools to turn black."

"Notify the provider if you experience a sore throat." *Sulfasalazine should be taken right after meals and with a full glass of water to reduce gastric upset and prevent crystalluria. Yellow-orange coloring of skin and urine is a harmless effect of sulfasalazine. Sulfasalazine can cause blood dyscrasias. The client should monitor and report any manifestations of infection, such as a sore throat. Sulfasalazine can cause thrombocytopenia and bleeding. Black stools are a manifestation of gastrointestinal bleeding, and the client should report this to the provider

A nurse is reinforcing teaching with a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? A. "I can take my medications with soda." B. "Peppermint tea will increase my indigestion." C. "Wearing an abdominal binder will limit my manifestations." D. "I will drink hot chocolate at bedtime to help me sleep." E. "I can lift weights as a way to exercise."

"Peppermint tea will increase my indigestion." *Carbonated beverage decrease LES pressure and should be avoided by the client who has a hiatal hernia. Peppermint decreases LES pressure and should be avoided by the client who has a hiatal hernia. Tight restrictive clothing or abdominal binders should eb avoided by the client who hasa hiatal hernia, as this increases intra-abdominal pressure and causes the protrusion of the stomach into the thoracic cavity. The client should avoid consuming anything immediately prior to bedtime. Additionally, chocolate relaxes the lower esophageal sphincter and should be avoided by a client who has a hiatal hernia. Heavy lifting and vigorous activities are to be avoided in the client who has a hiatal hernia

A nurse is caring for a client with colitis who states that the stress at work increases exacerbations. Which of the following responses should the nurse offer? A. "I will contact the social worker so you can discuss career alternatives." B. "Have you thought about discussing the possibility of a part-time assignment with your employer?" C. "Why don't you ask your employer to relieve you of some work until you are stronger?" D. "Perhaps we should review your coping mechanisms and talk about alternatives."

"Perhaps we should review your coping mechanisms and talk about alternatives." *Reviewing coping mechanisms and alternative coping patterns will promote coping skills that can assist the client in reducing stress.

A nurse is reinforcing teaching with a client regarding nutrition, which of the following statement should the nurse include about nutrients? A. "Carbohydrates transport nutrients throughout the body." B. "Fats prevents ketosis." C. "Protein builds and repairs body tissue." D. "Carbohydrates help regulate body temperature."

"Protein build and repairs body tissue." *Protein is responsible for building and repairing body tissues such as muscles, tendons, and collagen. The skin, hair, nails are also made up of protein structures. A diet that is low in protein can impair wound healing.

A nurse is reinforcing teaching with a client who will begin taking aluminum hydroxide. Which of the following information should the nurse include? A. "If constipation develops, switch to a calcium-based antacid." B. "Take this medication 2 hours before or after other medications." C. "This medication increases the risk for pneumonia." D. "Have your magnesium level monitored while taking this medication."

"Take this medication 2 hours before or after other medications." *Alternate the aluminum antacid with a magnesium-based one to achieve a normal bowel pattern if constipation occurs. Aluminum hydroxide alters the absorption of many medications. The client should ensure no other medications ae taken within 1 to 2 hr of taking cimetidine. Omeprazole can increase the risk for pneumonia. Aluminum hydroxide can cause hypophosphatemia.

A nurse in a clinic is instructing a client about a fecal blood test, which requires mailing three speciments. Which of the following statements by the client indicates understanding? A. "I will continue taking my warfarin while I complete these tests." B. "I'm glad I don't have to follow any special diet at this time." C. "This test determines if I have parasites in my bowel." D. "This is a test I can do at home."

"This is a test I can do at home." *Clients are instructed to stop taking anticoagulants prior to obtaining stoll speciments for fecal occult blood testing because they can interfere with the results. Clients are instructed to avoid consuming red meat, chicken, and fish prior to obtaining stool speciments for fecal occult blood tesing because this can interfere with the results. Fecal occult blood testing does not identify parasites present in stool. Fecal occult blood testing is a screening procedure the client can perform at home. The testing cards can be mailed to the provider

A nurse is reinforcing teaching with a client who has a new prescription for omeprazole. Which of the following information should the nurse include? A. "Take this medication at bedtime." B. "This medication decreases the production of gastric acid." C. "Take this medication 2 hours after eating." D. "This medication can cause hyperkalemia."

"This medication decreases the production of gastric acid." *Omeprazole is administered in the morning for treatment of heartburn. Omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid. Omeprazole is administered before meals with a glass of water. Omeprazole can cause hypomagnesemia.

A nurse is reinforcing teaching with a client who has Barrett's esophagus and is scheduled to undergo an esophagagastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? A. "This procedure is performed to measure the presence of acid in your esophagus." B. "This procedure can determine how well the lower part of your esophagus works." C. "This procedure is performed while you are under general anesthesia." D. "This procedure can determine if you have colon cancer."

"This procedure can determine how well the lower part of your esophagus works."

A nurse is reinforcing preoperative teaching with a client who is scheduled for a laparoscopic cholecystectomy. Which of the following information should the nurse include? A. "The scope will be passed through your rectum." B. "You might have shoulder pain after surgery." C. "You will have a drain in place after surgery." D. "You should limit how often you walk for 1 to 2 weeks."

"You might have shoulder pain after surgery." *Surgery is possibly performed through the rectum during the natural orifice transluminal endoscopic surgery (NOTES) approach. Shoulder pain is expected postoperatively due to free air that is introduced into the abdomen during laparoscopic surgery. A drain or T-tube can be placed during the open surgery approach. The client is instructed to ambulate frequently following a laparoscopic surgical approach to minimize the free air that has been introduced.

A nurse is reinforcing teaching with a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements should the nurse include about the purpose of the procedure? A. "You will have increased duodenal gastric emptying." B. "You will have a reduction of gastric acid secretions." C. "You will have a increase of gastric mucus secretion." D. "You will have an increased secretion of hydrogen/potassium ATPase enzymes."

"You will have a reduction of gastric acid secretions." *Pyloroplasty will increase gastric emptying, which is performed to widen the opening from this stomach to the duodenum. Selective vagotomy will reduce gastric acid secretions. Prostaglandins analog medication will stimulate mucosal protection and decrease gastric acid secretions. A histamine 2 antagonist medication will inhibit gastric secretion by inhibiting the hydrogen/potassium ATPase enzyme system in the gastric parietal cells.

A nurse is reinforcing teaching with a client who has anemia and a new prescription for a liquid iron supplement. Which of the following information should the nurse include in the teaching? (Select all that apply) A. "Add foods that are high in fiber to your diet." B. "Rinse your mouth after taking the medication." C. "Expect stools to be green or black in color." D. "Take the medication with a glass of milk." E. "Add red meat to your diet."

1. "Add foods that are high in fiber to your diet." 2. "Rinse your mouth after taking the medication." 3. "Expect stools to be green or black in color." 4. "Add red meat to your diet." *Foods high in fiber can prevent constipation, which can occur when taking iron supplements. Iron supplements can stain teeth when taken in a liquid form. The client should rinse orally after taking the medication. Dark green or black stools can occur when taking iron supplements. The client should anticipate this effect. Dairy products and caffeine can decrease the absorption of iron supplements. Iron supplements are maximally absorbed when taken on an empty stomach or 1 hr before meals. Red meats are high in iron and recommended for a client to improve anemia when taken concurrently with iron supplements.

A nurse is reinforcing nutrition teaching with a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the instruction? (Select all that apply) 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 drinks per day."

1. "I plan to eat small, frequent meals." 2. "I will eat easy-to-digest foods with limited spice." 3. "I will use skim milk when cooking." *Small, frequent meals are recommended for the client who has pancreatitis. Bland, easy-to-digest foods are recommended for the client who has pancreatitis. Low-fat foods are recommended for the client who has pancreatitis. Caffeine-free beverages are recommended for the client who has pancreatitis. Regular cola contains caffeine. The client who has pancreatitis should avoid any alcohol intake

A nurse is reinforcing teaching with a client about probiotic supplements. Which of the following information should the nurse include? (select all that apply) A. "Probiotics are micro-organisms that are normally found in the GI tract." B. "Probiotics are used to treat Clostridium difficile." C. "Probiotics are used to treat benign prostatic hyperplasia." D. "You can experience bloating while taking probiotic supplements." E. "If you are prescribed an antibiotic, you should take it at the same time you take your probiotic supplement,"

1. "Probiotics are micro-organisms that are normally found in the GI tract." 2. "Probiotics are used to treat Clostridium difficile." 3. "You can experience bloating while taking probiotic supplements." *Probiotics consist of lactobacilli, bifidobacteria, and Saccharomyces boulardii, which normally are found in the digestive tract. Probiotics are used to treat a number of GI conditions, including irritable bowel syndrome, diarrhea associated with Clostridium difficile, and ulcerative colitis. Saw palmetto is a supplement that clients might use to treat benign prostatic hyperplasia. Flatulence and bloating are adverse effects of probiotic supplements. The client should take the probiotic supplement at least 2 hr after taking an antibiotic or antifungal medication. Antibiotics and antifungal medications destroy bacteria and yeast found in probiotic supplements.

A nurse is assisting with the evaluation of a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy? (Select all that apply) A. 12-year-old child who has iron deficiency anemia B. 24-year-old female who has no health problems C. 44-year-old male who has hypertension D. 55-year-old female who has alcohol use disorder E. 35-year-old male who has type 2 diabetes mellitus

1. 24-year-old female who has no health problems 2. 55-year-old female who has alcohol use disorder *The client who has iron deficiency anemia requires treatment with iron supplements. The client of childbearing age should take folic acid to prevent neural tube defects in the fetus. The client who has hypertension requires treatment with diet, exercise, and antihypertensive medication. The client who has alcohol use disorder can require folic acid therapy. Excess alcohol consumption leads to poor dietary intake of folic acid and injury to the liver. The client who has type 2 diabetes mellitus requires treatment with diet, exercise, and hyperglycemic medication.

A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should expect prescriptions for which of the following medications? (select all that apply) A. Antacids B. Histamine 2 receptor antagonists C. Opioid analgesics D. Fiber laxatives E. Proton pump inhibitors

1. Antacids 2. Histamine 2 receptor antagonists 3. Proton pump inhibitors *Antacids neutralize gastric acid which irritates the esophagus during reflux. Histamine 2 receptor antagonists decrease acid secretion, which contributes to reflux. Opioid analgesics and fiber are not effective in treating GERD. Proton pump inhibitors decrease gastric acid production, which contributes to reflux.

A nurse is collecting data from a client who has advanced cirrhosis. The nurse should identify which of the following findings indicators of hepatic encephalopathy? (select all that apply) A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus

1. Change in orientation 2. Asterixis 3. Fetor hepaticus *Anorexia is present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. A change in orientation indicates hepatic encephalopathy in a client who has advanced cirrhosis. Asterixis, a coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy. Ascites can be present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. Fetor hepaticus (a fruity, musty breath odor) is a finding of hepatic encephalopathy in the client who has advanced cirrhosis.

A nurse is collecting data from a client who has a gastric ulcer. Which of the following findings should the nurse expect? (select all that apply) A. Client reports pain relieved by eatin B. Client states that pain often occurs at night C. Client reports a sensation of bloating D. Client states that pain occurs 30 min to 1 hr after a meal E. Client experiences pain upon palpation of the epigastric region

1. Client reports a sensation of bloating 2. Client states that pain occurs 30 min to 1 hr after a meal 3. Client experiences pain upon palpation of the epigastric region *A client who has a duodenal ulcer will report that pain is relieved by eating. Pain that rarely occurs at night, a report of a bloating sensation, pain 30 to 60 min after a meal, and pain in the epigastric region upon palpation are expected findings.

A nurse is reinforcing teaching about hypoglycemia with a client who has diabetes mellitus. Which of the following manifestations should the nurse include? (select all that apply) A. Bradycardia B. Diaphoresis C. Deep, rapid respirations D. Palpitations E. Shakiness

1. Diaphoresis 2. Palpitations 3. Shakiness *Sympathetic nervous responses to hypoglycemia include: diaphoresis, palpitations and a bounding heart rate, and shakiness

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply) A. Diuretic B. Beta blocking agent C. Opioid analgesic D. Lactulose E. Sedative

1. Diuretic 2. Beta blocking agent 3. Lactulose *Diuretics facilitate exertion of excess fluid from the body in a client who has cirrhosis. Beta blocking agents are prescribed for a client who has cirrhosis to prevent bleeding from varices. Opioid analgesics are metabolized in the liver. They should not be administered to a client who has cirrhosis. Lactulose is prescribed for a client who has cirrhosis to aid in the elimination of ammonia in the stool. Sedatives are metabolized in the liver. They should not be administered to a client who has cirrhosis.

A nurse is contributing to the plan of care for a client who has a small bowel obstruction and a nasogastric (NG) tube in place. Which of the following interventions should the nurse include? (select all that apply) A. Document the NG drainage with the client's output B. Irrigate the NG tube every 8 hr C. Monitor bowel sounds D. Ensure the client is in semi-Fowler's position E. Monitor NG tube for placement

1. Document the NG drainage with the client's output 2. Monitor bowel sounds 3. Ensure the client is in semi-Fowler's position 4. Monitor NG tube for placement *Document the NG drainage as output. This helps determine the amount of fluid replacement needed. The NG tube is irrigated every 4 hr to maintain patency. Bowel sounds should be monitored to evaluate treatment and resolution of the obstruction. The client should be in semi-Fowler's position to prevent aspiration. If the client experiences hypotension, place the client on their left side. Check the placement of the NG tube prior to irrigation to prevent aspiration and periodically to prevent an increase in abdominal distention

A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis? (Select all that apply) A. Emesis greater than 500 mL with a fecal odor B. Report of spasmodic abdominal pain C. High-pitched bowel sounds D. Abdomen flat with rebound tenderness to palpation E. Laboratory findings indicating metabolic acidosis

1. Emesis greater than 500 mL with a fecal odor 2. Report of spasmodic abdominal pain 3. High-pitched bowel sounds *Large emesis with a fecal odor is a finding in a client who has a small bowel obstruction. Report of abdominal pain is a finding in a client who has a small bowel obstruction. High-pitched bowel sounds are a manifestation of a small or large bowel obstruction. Abdominal distention is a finding in a client who has a small bowel obstruction. Metabolic alkalosis due to the loss of gastric acid is a finding in a client who has a small bowel obstruction

A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse instruct the client to perform (select all that apply) A. Use antimicrobial ointment on the peristomal skin B. Empty the bag when it is one-third to one-half full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water E. Apply the skin barrier while the skin is slightly moist

1. Empty the bag when it is one-third to one-half full 2. Cut the skin barrier opening a little larger than the ostomy 3. Wash the peristomal skin with mild soap and water *Allowing the bag to become too full can cause leakage. *The client should cut an opening that is about 1/16 to 1/8 larger than the stoma to avoid applying any constricting pressure to the stoma. *The client should avoid moisturizing soaps because their lubricants can affect adhesion of the appliance

A nurse is reinforcing teaching with a client about cimetidine. The nurse should identify which of the following as adverse effects of cimetidine? (Select all that apply) A. Increased libido B. Insomnia C. Enlargement of breast tissue D. Confusion E. Decreased sperm count

1. Enlargement of breast tissue 2. Confusion 3. Decreased sperm count *Decreased libido and Gynecomastia (enlargement of breast tissue) are adverse effects of cimetidine. Lethargy, confusion, and impotence are adverse CNS effect of cimetidine.

A nurse is reviewing the laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following blood laboratory results should the nurse expect to be elevated? (select all that apply) A. Hematocrit B. Erythrocyte sedimentation rate C. WBC D. Folic acid E. Albumin

1. Erythrocyte sedimentation rate 2. WBC *Hematocrit is decreased as a result of chronic blood loss. Increased erythrocyte sedimentation rate is a finding in a client who has Crohn's disease. A decrease in folic acid level is indicative of malabsorption due to Crohn's disease. A decrease in sodium is indicative of malabsorption due to Crohn's disease. A decrease in sodium is indicative of malabsorption due to Crohn's disease

A nurse is contributing to the plan of care for a client who has acute gastritis. Which of the following nursing interventions should the nurse recomend for inclusion in the plan of care? (select all that apply) A. Evaluate intake and output B. Monitor laboratory reports of electrolytes C. Provide three large meals a day D. Administer ibuprofen for pain E. Observe stool characteristics

1. Evaluate intake and output 2. Monitor laboratory reports of electrolytes 3. Observe stool characteristics *Evaluate the client's intake and output to prevent electrolyte loss and dehydration. Monitor the client's electrolyte laboratory values to prevent fluid loss and dehydration. Instruct the client to eat small, frequent meals. Instruct the client to avoid taking ibuprofen, an NSAID, because of its erosive capabilities. Instruct the client to report to the provider any indication of the presence of blood in the stools, which can indicate gastrointestinal bleeding

A nurse is reviewing the health record of a client who has a suspected tumor of the jejunum. The nurse should expect a prescription for which of the following tests? (Select all that apply) A. Blood alpha-fetoprotein B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Gastrointestinal x-ray with contrast D. Small bowel capsule endoscopy (M2A) E. Colonscopy

1. Gastrointestinal x-ray with contrast 2. Small bowel capsule endoscopy (M2A) *Blood alpha-fetoprotein is a laboratory test used in cases of suspected liver cancer. An ERCP is used to visualize the duodenum, biliary ducts, gall bladder, liver, and pancreas. A gastrointestinal x-ray with contrast involves the client drinking barium, which is then traced through the small intestine to the junction with the colon. This would identify a tumor in the jejunum. Capsule endoscopy (M2A) is a procedure in which the client swallows a capsule with a glass of water for a video enteroscopy to visualize the entire small bowel over an 8-hr period. A colonoscopy is the use of a flexible fiberoptic colonoscope, which enters through the anus, to visualize the rectum and the sigmoid, descending, transverse, and ascending colon.

A nurse is preparing to administer ondansetron to a client. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply) A. Headache B. Diarrhea C. Shorted PR interval D. Hyperglycemia E. Prolonged QT interval

1. Headache 2. Diarrhea 3. Prolonged QT interval *Headache is a common adverse effect of ondansetron. Diarrhea or constipation are both adverse effects of ondansetron. Ondansetron does not affect blood glucose. A prolonged QT interval is a possible adverse effect of ondansetron that can lead to torsades de pointes, a serious dysrhythmia.

A nurse is reinforcing teaching with a client who will undergo a sigmoidoscopy. Which of the following information about the procedure should reinforce? (select all that apply) A. Increased flatulence can occur following the procedure. B. NPO status status should be maintained until after the procedure C. Procedure does not cause the client any discomfort D. Repositioning will occur throughout the procedure E. Fluid intake is limited the day after the procedure

1. Increased flatulence can occur following the procedure. 2. NPO status status should be maintained until after the procedure *Reinforce to the client that increased flatulence can occur due to the instillation of air during the procedure. Instruct the client to remain NPO until after the procedure is complete. Inform the client that sedation may cause cramping and to use deep breathing and relaxation techniques to assist with relief. Inform the client that the position to lie in for the procedure is on the left side. Instruct the client to increase, not limit, fluid intake following the procedure

A nurse is reinforcing teaching with a client who has hepatitis B about home care. Which of the following instructions should the nurse include? (select all that apply) A. Limit physical activity B. Avoid alcohol C. Take acetaminophen for comfort D. Wear a mask when in public places E. Eat small, frequent meals

1. Limit physical activity 2. Avoid alcohol 3. Eat small, frequent meals *Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B. Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B. Acetaminophen is metabolized in the liver and should be avoided by the client who has hepatitis B. Hepatitis B is a blood-borne disease. Wearing a mask is not necessary to prevent transmission to others. The client who has hepatitis B should eat small, frequent meals to promote improved nutrition due to the presence of anorexia.

A nurse is monitoring the IV site of a client after the charge nurse has started an IV bolus of potassium. While the potassium is infusing, which of the following conditions should the nurse monitor at the IV site? (select all that apply) A. Local irritation B. Phlebitis C. Infiltration D. Hematoma E. Skin warmth

1. Local irritation 2. Phlebitis 3. Infiltration *The nurse should monitor the IV site for local irritation, which can indicate infiltration of the IV or too rapid of infusion causing irritation to the vein. The nurse should monitor the IV site for phlebitis, which can indicate infiltration of the IV or too rapid of infusion causing irritation to the vein. The nurse should monitor the IV site for infiltration, which can cause tissue breakdown and necrosis at the IV site. A hematoma can develop at the IV site when IV fluids are infusing; however, the nurse is monitoring irritation, phlebitis, and infiltration. The nurse should monitor the skin for coolness not warmth around the IV site, which can indicate IV infiltration.

A nurse is assisting with the plan of care for a client who has a prescription for total parenteral nutrition (TPN). Which of the following interventions should the nurse recommend? (select all that apply) A. Measure a capillary blood glucose four times daily B. Ensure prescribed medications are administered through a secondary port of the TPN IV tubing C. Monitor vital signs three times during the 12-hr shift D. Change the TPN IV tubing every 24 hr E. Ensure a daily aPTT is obtained

1. Measure a capillary blood glucose four times daily 2. Monitor vital signs three times during the 12-hr shift 3. Change the TPN IV tubing every 24 hr *The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin. No other medications or fluids should be administed through the IV tubing being used to administed TPN due to the increased risk of infection and disruption of the rate of TPN infusion. Vital signs are recommedned every 4 to 8 hr to monitor for fluid volume excess and infection. It is recommended to change the IV tubing that is used to administer TPN every 24 hr. aPTT measures the coagulability of the blood, which is unneccessary during the administration of TPN.

A nurse is assisting with the admission of a client who has cirrhosis. Whcih of the following prescriptions shoult the nurse anticipate? (select all that apply) A. Obtain the client's PT and INR measurements B. Administer lactulose 30 mL PO 4 times daily C. Obtain dailty weight and abdominal girth measurements D. Administer a daily multivitamin E. Place the client on a low-protein diet

1. Obtain the client's PT and INR measurements 2. Administer lactulose 30 mL PO 4 times daily 3. Obtain daily weight and abdominal girth measurements 4. Administer a daily multivitamin *Cirrhosis interferes with the ability of the liver to produce clotting factors, which places the client at risk of hemorrage. The PT & INR are usually prolonged due to decreased synthesis of prothrombin. *Additionally, a client who has cirrhosis is unable to eliminate ammonia from the body once protein is broken down. Therefore, lactulose should be administered to increase the client's production of stool, which will help eliminate ammonia from the client's body. *The nurse should anticipate a prescription to assess the client's weight daily as a measure of fluid status An increase of 1 kg (2.2 lbs) in the client's weight indicates 1 L of fluid retention. *The nurse should also expect to measure the client's abdominal girth to determine if ascites is increasing or decreasing

A nurse is caring for a client who reports feeling a pop after coughing without properly splinting an abdominal incision. The nurse finds the client's wound has eviscerated. Which of the following actions should the nurse take? (select all that apply) A. Carefully reinsert the intestine through the opening in the wound B. Place the client in a supine position with hips and knees flexed C. Leave the room to call the surgeon D. Cover the wound and intestine with a sterile, moistened dressing E. Monitor the client for manifestations of shock

1. Place the client in a supine position with hips and knees flexed 2. Leave the room to call the surgeon 3. Cover the wound and intestine with a sterile, moistened dressing 4. Monitor the client for manifestations of shock *The nurse should place the client in a supine position with hips and knees flexed to prevent further tearing of the incision and to avoid wound evisceration by lessening tension on the wound *The nurse should delegate another person to immediately notify the surgeon and should stay with the client to observe for further complications such as shock. *Additionally, the nurse should cover the protruding intestine with a sterile dressing that is moistened with 0.9% sodium chloride to prevent further contamination of the wound and to keep the intestine from drying out. *Finally, the nurse should monitor the client for a physiological stimulus such as bleeding from the tearing or opening of the wound or a psychological stimulus such as viewing the intestine protruding outside of the body can increase the risk for shock. *The nurse should monitor the client for increased heart and respiratory rate, changes in blood pressure or mentation, and cool, clammy skin.

A nurse is reinforcing discharge teaching with a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include? (select all that apply) A. Take baths rather than showers B. Resume a low-fat diet C. Report brown drainage from the puncture site D. Remove adhesive strips from the puncture site in 24 hr E. Report nausea and vomiting to the surgeon

1. Resume a low-fat diet 2. Report brown drainage from the puncture site 3. Report nausea and vomiting to the surgeon *The client can take a bath or shower within 1 to 2 days following surgery. The client should resume a low fat diet until a regular diet is tolerated after surgery. The client should report brown colored drainage which could be indicative of bile leakage. The adhesive strips covering the puncture site should remain in place until they fall off naturally. The client should report nausea, vomiting, or abdominal pain to the surgeon.

A nurse is collecting data from a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness

1. Rigid abdomen 2. Tachycardia 3. Rebound tenderness *Manifestations or perforation include a rigid, board-like abdomen, tachycardia, hypotension, and rebound tenderness. Circumoral cyanosis is not a manifestation of perforation

A nurse is reinforcing teaching with a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse reinforce in the teaching? (select all that apply) A. Take the medication 1 hr before a meal B. Limit NSAIDs when taking this medication C. Expect skin flushing when taking this medication D. Increase fiber intake when taking this medication E. Chew the medication thoroughly before swallowing

1. Take the medication 1 hr before a meal 2. Limit NSAIDs when taking this medication *Take the medication 1 hr before meals. Limit NSAIDs when taking this medication. Skin flushing is not an adverse effect of this medication. Fiber intake does not need to be increased when taking this medication. Swallow the capsule whole. It should not be crushed or chewed.

A nurse is reviewing the medical record of a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider (Select all that apply) A. Emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. High-pitched bowel sounds E. WBC 10,000/uL

1. Urine specific gravity 1.040 2. Hematocrit 60% 3. High-pitched bowel sounds *this urine specific gravity is greater than the expected reference range of 1.005-1.030. An increased urine specific gravity is an indication of dehydration. Report this to the provider. The Hct is greater than the expected reference range of 42% to 52% for males and 37% to 47% for females. An elevated Hct indicates hemoconcentration, which is due to dehydration. High-pitched bowel sounds can be heard above the point of the obstruction for a client who has a small bowel obstruction. Report this finding to the provider.

A nurse in a provider's office is collecting data from a client who has gastroesophageal reflux disease (GERD). The nurse should expect the client to report which of the following manifestations? (select all that apply) A. Regurgitation B. Nausea C. Belching D. Heartburn E Weight loss

1. regurgitation 2. Nausea 3. Belching D. Heartburn *All are manifestations of GERD

A nurse is caring for a client who is 2 days postoperative following gastric surgery and has an NG tube inserted. Which of the following findings should the nurse report to the provider? A. Dryness of the mucous membranes B. Hypoactive bowel sounds in all quadrants C. 200 mL of bright red drainage from the NG tube D. Continuous low suction

200 mL of bright red drainage from the NG tube *The nurse should notify the provider immediately regarding 200 mL of bright red drainage from the NG tube 2 days following gastric surgery. Drainage should be either a yellow-green or clear. Bright red drainage indicates blood loss and can be the result of a disrupted line or other form of internal bleeding. Volume loss from blood is a medical emergency, and the provider should be immediately notified

A nurse is assisting with the planning of an in-service session about nutrition. How many of the amino acids must be obtained from dietary intake? A. 6 B. 9 C. 11 D. 15

9 *9 amino acids are considered essential for the human body and must be obtained from the diet

A nurse is assisting with the care of four clients who have peptic ulcer disease. The nurse should identify that misoprostal is contraindicated for which of the following clients? A. A client who is pregnant B. A client who has osteoarthritis. C. A client who has a kidney stone D. A client who has a urinary tract infection

A client who is pregnant *Misoprostol can induce labor and is contraindicated in pregnancy. There are no contraindications for use in in clients who have osteoarthritis. There are no contraindications for use in clients who have kidney stones. There are no contraindications for use in clients who have urinary tract infections

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hours after treatment begins? A. Aldolase B. Lipase C. Amylase D. Lactic dehydrogenase

Amylase *Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3-6 hours following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hours and returns to the expected reference range within 2 to 3 days

A nurse is collecting data from a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect? A. Jaundice B. Anorexia C. Dark urine D. Pale feces

Anorexia *Anorexia is an early manifestation of hepatitis A and is often severe. It is thought to result from the release of a toxin by the damaged liver or by the failure of the damaged liver cells to detoxify an abnormal product.

A nurse is providing care to a client who is 1 day postoperative following a paracentesis. The nurse observes clear, pale-yellow fluid leaking from the operative site. Which of the following is an appropriate nursing intervention? A. Place a clean towel near the drainage site B. Apply a dry, sterile dressing C. Apply a direct pressure to the site D. Place the client in a supine position

Apply a dry, sterile dressing *Cover the operative site to prevent infection and allow for observation of drainage. Application of a sterile dressing will contain the drainage and allow continuous observation of clolr and quantity. Application of direct pressure can cause discomfort and potential harm to the client Place the client with the head of the bed elevated to promote lung expansion.

A nurse is assisting a provider with performing a paracentesis on a client. Which of the following actions should the nurse take? A. Ask the client to empty his bladder before the procedure B. Place the client leaning forward over the bedside table for the procedure C. Inform the client he will be sedated during the procedure D. Instruct the client to fast for 6 hours prior to the procedure

Ask the client to empty his bladder before the procedure *this will prevent injury to the bladder

A nurse is helping develop a plan of care for a client who has gastroesophageal reflux disease (GERD). The nurse should suggest monitoring the client for which of the following complications? A. Aspiration B. Infection C. Anemia D. Weight loss

Aspiration *Aspiration is a common complication of GERD, which results when the esophageal sphincter malfunctions, allowing gastric acid and undigested food to back up into the esophagus. This places the client at risk of aspiration, GERD causes effortless, uncontrolled regurgitation, whether the client is an upright position or reclining. The most common results of regurgitation are heartburn and indigestion, however, aspiration is also possible. Therefore, the nurse should monitor the client for crackles in the lung fields, which is an indication of aspiration.

A nurse is updating the plan of care for a client who has celiac disease. Which of the following dietary selections should the nurse recommend for the client? A. Whole-wheat tortilla with black beans B. Baked chicken and rice C. Turkey and cheese sandwich D. Pasta with marinara sauce

Baked chicken and rice *The nurse should recommend baked chick and rice as a dietary selection for a client who has celiac disease. Clients who have celiac disease should avoid foods containing gluten.

A nurse in a provider's office is collecting data from a client who has GERD, when documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions? A. Stair climbing B. Bending over C. Sitting D. Walking

Bending over *Gastroeophageal reflux symptoms are most evident with activities that increase intraabdominal pressure such as bending over, straining, lifting, and lying down

A nurse is obtaining a guaic test from a client. The nurse should identify that the guaic test is performed to detect which of the following? A. Fecal material in vomit B. Blood in stool C. Infestation of parasites D. Microorganisms in the urine

Blood in stool *The guaic test detects the presence of blood in the stool. It is a commonly used point-of-care test for fecal occult blood.

A nurse is collecting date from a client who has cholecystitis. Which of the following findings should the nurse expect? A. Bumberg's sign B. Ascites C. Gastrointestinal bleeding D. Kehr's sign

Blumberg's sign *The nurse should expect to find rebound tenderness (Blumberg's sign) in a client who has cholecystitis. This response can be an indication of peritoneal inflammation

A nurse is collecting data from a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Decreased heart rate B. Yellowing of the skin C. Increased blood pressure D. Board-like abdomen

Board-like abdomen *The nurse should expect this client who is experiencing perforation of a peptic ulcer to exhibit a board-like abdomen and severe pain in the abdomen or back that radiates to the right shoulder. Vomiting of blood and shock can occur if the perforation also causes hemorrhaging

A nurse is caring for a client who has recovered from acute diverticulitis. The nurse should instruct the client to increase his intake of which of the following foods when the inflammation subsides? A. Cucumbers and tomatoes B. Cabbage and peaches C. Strawberries and corn D. Figs and nuts

Cabbage and Peaches *When the acute inflammation has subsided, the client should increase his intake of foods that are high in fiber such as wheat bran, whole-grain bread, and fresh fruits and vegetables that do not contain seeds

A nurse is monitoring a client who is receiving magnesium sulfate and notes the client has depressed deep tendon reflexes. The nurse should expect to administer which of the following medications? A. Potassium chloride B. Folic acid C. Calcium gluconate D. Cyanocobalamin

Calcium gluconate *Potassium chloride is given to a client who is experiencing hypokalemia. Folic acid is given to a client who is experiencing alcohol use disorder. Expect to assist with the administration of calcium gluconate to a client who is experiencing magnesium toxicity as evidenced by depressed or absent deep tendon reflexes. Cyanocobalamin is given to a client who is experiencing megaloblastic anemia.

A nurse is reviewing bowel prep using polythylene glycol with a client scheduled for a colonscopy. Which of the following instructions should the nurse review with the client? A. Check with the provider about taking current medicaitons when consuming bowel prep B. Consume a normal diet util starting the bowel prep C. Expect the bowel prep to not begin acting until the day after all the prep is consumed D. Discontine the bowel prep once feces start to be expelled

Check with the provider about taking current medicaitons when consuming bowel prep *Instruct the client to check with the provider about taking current medication, because some medications can be withheld when taking polyethylene glycol due to their lack of absorption. Instruct the client to consume a clear liquid diet prior to starting the bowel prep. Instruct the client that the actions of polyethylene glycol begin within 2 to 3 hr after consumption. Instruct the client to consume the full amount prescribed

A nurse is caring for a client who is 2 days posteroperative following a gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding? A. Vanilla pudding B. Apple juice C. Diet ginger ale D. Clear liquids

Clear liquids *Clear liquidss such as water or broth can be given for the first oral feedings but should be limited to 30 mL (1 oz) per feeding. Water does not contain sugarm which can cause diarrhea due to hyperosmolarity

A nurse is collecting data from a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. The nurse should recognize which of the following findings as the priority? A. Client reports difficult sleeping B. The client's urine is positive for glucose C. Client reports having an elevated body temperature D. Client reports gaining 4 lb in the last 6 months

Client reports having an elevated body temperature *The greatest risk to the client is infection because prednisone can cause immunosuppression. Therefore, identify manifestations of an infection, such as an elevated body temperature, as the priority finding

A nurse is caring for a client who has gastrointestinal bleeding. The provider suspects a bleeding lesion in the colon. The nurse should anticipate that the most likely initial approach to treatment will involve which of the following procedures. A. Exploratory laparotomy B. Double-contrast barium enema C. Magnetic resonance imaging D. Colonoscopy

Colonoscopy *A colonoscopy involves the insertion of a flexible scope into the rectum. The provider advances the scope carefully until it enters the colon. This procedure can provide direct visualization of the inside of the colon and helps the provider identify the exact cause and location of the bleeding.

A nurse is caring for a client who has an umbilical hernia. Which of the following should the nurse identify is a risk factor for this type of hernia? A. Congenital B. Impaired healing C. Age D. Sex

Congenital *Congenital, pregnancy or obesity can be risk factors for umbilical hernias. Impaired healing can be a risk factor for umbilical hernias. Older adults can be a risk factor for inguinal hernias due to weakness of the posterior-inguinal wall. Being of male sex can be a risk factor for inguinal hernias due to incomplete closure of the tract when the testes descend into the scrotum before birth

A nurse is planning discharge teaching for a client who is postoperative following a traditional open cholecystectomy. Which of the following learning needs of the client is the nurse's priority? A. Dietary recommendations B. Incision care C. Coughing and deep-breathing exercises D. Pain management

Coughing and deep-breathing exercises *The greatest risk to this client is respiratory compromise. Therefore, learning how to perform coughing and deep-breathing exercises to promote lung expansion and secretion removal is the client's priority learning need.

A nurse is caring for a client who is 3 days posteroperative following abdominal surgery. The client states, "Something just popped when I coughed." Which of the following actions should theh nurse take first? A. Cover the client's wound with a sterile, moist dressing B. Flex the client's knees C. Reassure the client D. Instruct the client to avoid coughing

Cover the client's wound with a sterile, moist dressing *The greatest risk to this client is an inury from infection due to wound exposure. Therefore, the nurse should cover the wound with a sterile, moist dressing

A nurse is assisting with the plan of care for a client who has cholelithiasis. Which of the following interventions should the nurse include in the plan? A. Restrict the client's fluid intake B. Restrict the client's calcium intake C. Decrease the client's fat intake D. Decrease the client's potassium intake

Decrease the client's fat intake *this reduces the occurance of biliary colic

A nurse is reinforcing teaching with a client who has cirrhosis of the liver and a history of alcohol consumption. The nurse should explain that alcohol can cause liver cirrhosis through which of the following actions? A. Increasing the workload of the liver by releasing stored glycogen B. Causing ulceration of liver tissue that can lead to bleeding C. Dilating the veins in the portal circulation D. Destroying liver cells that are replaced with scar tissue

Destroying liver cells that are replaced with scar tissue *The development of cirrhosis in a client who consumes alcohol is related to liver inflammation and cell destruction. Over time, nonfunctional scar tissue and fibrosis replace the necrotic liver cells

A nurse is assisting with the care of a child who has had her spleen removed following a bicycle accident. The child's parent asks the nurse about the role of the spleen in the body. The nurse should reply that the spleen performs which of the following functions? A. Maintains fluid balance B. Regulates calcium in the blood C. Destroys old blood cells D. produces prothrombin

Destroys old blood cells *A function of the spleen is to destroy old blood cells. The spleen also filters antigens and stores platelets. A client with the spleen removed is at an increased risk of infection and sepsis due to reduced immune function

A nurse is caring for a client from the Middle East who has celiac disease. Which of the following actions should the nurse take regarding the client's diet? A. Provide foods prepared according to kosher dietary law B. Ask the kitchen to prepare grits to meet the client's dietary need for grains C. Determine the client's dietary preferences D. Prepare a diet tray that includes vegetables and barley soup

Determine the client's dietary preferences *While generalizations are often made regarding traditional eating practices of clients based on their cultural background, individual food choices can deviate from these generalizations. The nurse assess the client's dietary habits before planning for dietary needs.

A nurse is assisting with the care of a client who is receiving total parenteral nutrition (TPN) and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis

Diaphoresis *The client has the potential to develop hypoglycemia due to sudden withdrawal of the TPN solution. IN addition to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusion, and hunger.

A nurse is reinforcing teaching with a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? A. Digest fats B. Produce chyme C. Stimulate gastric acid secretion D. Provide energy

Digest fats *Bile is a product of the liver and aids in the digestion of fats

A nurse is caring for a client who received prochlorperazine 4 hr ago. The client reports spasms of the face. The nurse should expect a prescription for which of the following medications? A. Fomepizole B. Naloxone C. Phytonadione D. Diphenhydramine

Diphenhydramine *Fomepizole is an antidote used to treat ethylene glycol poisoning. Naloxone is used to treat opioid toxicity. Vitamin K-1 (phytonadione) is used to treat warfarin toxicity. An adverse effect of prochlorperazine is acute dystonia, which is evidenced by spasms of the muscles in the face, neck, and tongue. Diphenhydramine is used to suppress extrapyramidal effects of prochlorperazine.

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Blood amylase 80 units/L B. WBC 9,000/mm3 C. Direct bilirubin 2.1 mg/dL D. Alkaline phosphatase 25 units/L

Direct bilirubin 2.1 mg/dL *Expect the client who has cholelithiasis to have an elevated blood amylase level if pancreatic involvement is present. A blood amylase of 80 units/L is within the expected reference range. Expect the client who has cholelithiasis to have an elevated WBC level due to inflammation. A WBC of 9,000/mm3 is within the expected reference range. Expect the client who has cholelithiasis to have an elevated direct bilirubin level if the bile duct is obstructed. A direct bilirubin level of 2.1 mg/dL is above the expected reference range. Expect the client who has cholelithiasis to have an elevated alkaline phosphatase (ALP)level if the common bile duct is obstructed. An ALP of 25 units/L is less than the expected reference range..

A nurse is reinforcing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include? A. Decrease intake of calorie-dense foods B. Drink canned protein supplements C. Increase intake of high fiber foods D. Eat high-residue foods

Drink canned protein supplements *A high-protein diet is recommended for the client who has Crohn's disease. A high-protein diet is recommended for the client who has Crohn's disease. Canned protein supplements are encouraged. A low-fiber diet is recommended for the client who has Crohn's disease to reduce inflammation. Instruct the client to eat low-residue foods to reduce inflammation

A nurse is contributing to the plan of care for a client who has dumping syndrome. Which of the following instructions should the nurse include? A. Consume beverage with meals B. Eat 3 large meals per day C. Include high-fiber foods in the diet D. Eat a source of protein with each meal

Eat a source of protein with each meal *recommended because protein delays gastric emptying

A nurse is reinforcing teaching with a client who has a colostomy about ways to reduce flatus and odor. Which of the following strategies should the nurse include? A. Eat crackers and yogurt regularly B. Chew minty gum throughout the day C. Drink orange juice every day D. Put an aspirin in the pouch

Eat crackers and yogurt regularly *Crackers, toast, and yogurt can help reduce flatus, which contributes to odor

A nurse is reinforcing teaching with a client who has constipation. Which of the following instructions should the nurse include in the teaching? A. Use bismuth subsalicylate regularly B. Consume a low-fiber diet C. Eat yogurt with live cultures D. Use bisacodyl suppositories regularly

Eat yogurt with live cultures *Yogurt that contains liver bacterial cultures provides dietary probiotics that can help maintain and promote bowel function.

A nurse is planning care for a client who is postoperative following a gastrectomy. Which of the following strategies should the nurse suggest to help prevent dumping syndrome? A. have the client drink plenty of water with meals B. Eliminate simple sugars and sugar alcohols from the client's diet C. Limit the client to 2 meals per day D. Offer the client meals that are low in protein or protein-free

Eliminate simple sugars and sugar alcohols from the client's diet *Sugar, honey, and sugar alcohols such as sorbitol and xylitol increase hypertonicity and propel food through the intestines faster than food without sweenteners

A nurse is collecting data from a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A. Emesis with a coffee-ground appearance B. Increased blood pressure C. Decreased heart rate D. Bright green stools

Emesis with a coffee-ground appearance *The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee grounds or is bright red in color. Hematemesis indicates upper GI bleeding, occurring at or above the duodenojejunal junction.

A nurse is caring for a client who has an indwelling urinary catheter. Which of the following actions should the nurse take? A. Place the drainage bag on the client's abdomen when transferring from the bed to a cart B. Empty the drainage bag when it is half full of urine C. Rest the drainage bad on the floor when closing the drainage spigot during emptying D. Disconnect the drainage bag when obtaining a urine specimen

Empty the drainage bag when it is half full of urine *a drainage bag that is too full can lace tension on the catheter tubing, resulting in trauma to the urethra and urinary meatus

A nurse is caring for a client who has an acute exacerbation of Crohn's disease. Which of the following actions should the nurse take? A. Ensure bowel rest B. Offer sparkling water frequently C. Administer a stool softener D. Offer plain, warm tea frequently

Ensure bowel rest *Clients who have an exacerbation of Crohn's disease usually require NPO status to ensure bowel rest and promote healing and recovery

A nurse is collecting data from a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in right upper quadrant radiating to right shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation. D. Epigastric pain radiating to the left shoulder

Epigastric pain radiating to the left shoulder *A client who has cholecystitis will report pain the right upper quadrant radiating to the right shoulder. A client who has pancreatitis will report pain being worse when lying down. A client who has pancreatitis will report that pain is relieved by assuming the fetal position. A client who has pancreatitis will report severe, boring epigastric pain that radiates to the back, left flank, or left shoulder

A nurse is reinforcing teaching with a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? A. Foods high in vitamin C B. Foods low in fat C. Foods high in fiber D. Foods low in calories

Foods high in fiber *The results of long-term, low fiber eating habits along with increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain active motility of the GI tract.

A nurse is assisting with the care of a client who has a history of cirrhosis and was recently admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? A. Gamma-glutamyl transferase (GGT) B. Alkaline phosphatase (ALP) C. Serum bilirubin D. Alanine aminotransferase (ALT)

Gamma-glutamyl transferase (GGT *The GGT lab test is specific to the heptaobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring for drug toxicity and excessive alcohol use

A nurse is collecting data from a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis? A. Generalized cyanosis B. Hyperactive bowel sounds C. Gray-blue discoloration of the skin around the umbilicus D. Wheezing in the lower lung fields

Gray-blue discoloration of the skin around the umbilicus *Expect to find generalized jaundice. Expect to find absent or decreased bowel sounds. A gray-blue discoloration in the periumbilical area is a manifestation of pancreatitis. Expect to find diminished breath sounds as well as dyspnea or orthopnea

A nurse is reinforcing teaching about dietary modifications for a client with newly diagnosed cirrhosis. Which of the following foods should the nurse recommend? A. Grilled chicken B. Potato soup C. Fish sticks D. Baked ham

Grilled chicken *A client who as cirrhosis requires protein to compensate for the weight loss as a result of the disease. Increasing protein intake from animal or plant sources will also provide more energy. They should avoid foods that are high in sodium

A nurse is collecting data from a client who has a complete intestinal obstruction. Which of the following findings should the nurse expect? A. Absence of bowel sounds in all four abdominal quadrants B. Passage of blood-tinged liquid stool C. Presence of flatus D. Hyperactive bowel sounds above the obstruction

Hyperactive bowel sounds above the obstruction *The nurse should expect the client to have hyperactive bowel sounds above the obstruction because the intestinal peristalsis above the obstruction attempts to push the obstruction through the intestines. With a complete intestinal obstruction, there are no bowel sounds below the obstruction

A nurse is assisting with preparing a teaching plan about secondary prevention actions for colorectal cancer for a community health fair for adults. Which of the following topics should the nurse recommend including? A. Smoking cessation B. Benefits of a diet that is high in cruciferous vegetables C. New types of ostomy appliances D. Importance of colonoscopy screening starting at 50 years of age

Importance of colonoscopy screening starting at 50 years of age *Screening examinations for colorectal cancer are secondary prevention

A nurse is reinforcing teaching with a client who has dumping syndrome following gastric surgery. Which of the following information should the nurse reinforce in the teaching? A. Eat three moderate-sized meals a day B. Drink at least one glass of water with each meal C. Eat a bedtime snack with each meal D. Increase protein in the diet

Increase protein in the diet *Consume small, frequent meals rather than moderate-sized meals. Elimiate liquids with meals and for 1 hr prior to and following meals. Avoid milk products. Eat a high-protein, high-fat, low-fiber, and moderate to low carbohydrate diet

A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. Decreased blood lipase level B. Decreased blood amylase level C. Increased blood calcium D. Increased blood glucose level

Increased blood glucose level *The client will experience an elevated blood lipase level due to pancreatic cell injury. The client will experience an elevated serum amylase level due to pancreatic cell injury. The client will experience a decreased blood calcium level due to fat necrosis. The client will experience an increased blood glucose level due to pancreatic cell injury, which results in impaired metabolism of carbohydrates due to a decrease in the release of insulin

A nurse is monitoring the laboratory results of a client who has end-stage liver failure. Which of the following results should the nurse expect? Decreased lactate dehydrogenase B. Increased serum albumin C. Decreased serum ammonia D. Increased prothrombin time

Increased prothrombin time *Clients with end-stage liver failure have an inadequate supply of clotting factors and, therefore, have a prolonged time

A nurse is caring for a client who has abdominal pain and possibly pancreatitis. Which of the following laboratory results should the nurse identify as an indication of pancreatitis? A. Decreased white blood cell count B. Increased albumin level C. Increased serum lipase level D. Decreased blood glucose level

Increased serum lipase level *Due to the release of lipase into the pancreas and autodigestion, pancreatitis causes an increased serum lipase level

A nurse is assisting with data collection from a client who is 12 hours postoperative following an open cholecystectomy. Which of the following findings should the nurse report to the charge nurse? A. Hypoactive bowel sounds B. Indwelling urinary catheter output of 25 mL/hr C. Heart rate of 96/min D. Serous drainage at the surgical incision site

Indwelling urinary catheter output of 25 mL/hr *The nurse should report a urinary output of less than 30 mL/hr to the charge nurse, as this can indicate hypovolemia or renal complication

A nurse is having difficulty arousing a client following a esophagogastroduodenoscopy (EGD). Which of the following is the priority action by the nurse? A. Inspect the client's airway B. Allow the client to sleep C. Prepare to assist with the administration of an antidote to the sedative D. Assist with the evaluation of preprocedure laboratory findings

Inspect the client's airway *When using the ABC priority-setting framework, monitoring and maintaining an open airway is the priority action the nurse should take

A nurse is assisting with the planning of an in-service training session regarding nutrition. Which of the following minerals should the nurse include as a factor in oxygen transportation? A. Zinc B. Iron C. Phosphorous D. Magnesium

Iron *Iron transports hemoglobin and myoglobin. It is also a component of enzyme systems

A nurse is caring for a client who is NPO and has an NG tube to suction. The client reports nausea. Which of the following actions should the nurse take? A. irrigate the tube with a normal saline solution B. Provide oral hygiene C. Clamp the tube for 30 minutes D. Increase the amount of suction

Irrigate the tube with a normal saline solution *When caring for a client with an NG tube who develops nausea, the nurse should first attempt to irrigate the tube to determine patency. If the tube is not patent, gastric pressure cannot decrease, and the stead or increasing pressure can cause nausea.

A nurse is reinforcing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include? A. Keep a food diary to identify triggers to exacerbation B. Consume 15 to 20 g of fiber daily C. Plan three moderate to large meals per day D. Limit fluid intake to 1 L each day

Keep a food diary to identify triggers to exacerbation *The client should keep a food diary to identify foods that trigger exacerbation of manifestations. The client should increase daily fiber intake to 30 to 40 g. The client should eat small frequent meals. The client should drink 2 to 3 L fluids per day to promote a consistent bowel pattern

A nurse is reinforcing teaching with a client who has a new prescription for an iron supplement. Which of the following should the nurse include in the teaching? A. Take with food to increase absorption of the iron B. Diarrhea is an adverse effect of iron supplements. C. Liquid iron supplements can stain teeth D. Iron supplements can cause bowel movements to appear orange

Liquid iron supplements can stain teeth *The nurse should tell the client to avoid taking iron supplements with food in order to have greater absorption. The nurse should tell the client to monitor for constipation not diarrhea, which is an adverse effect of iron supplements. The nurse should tell the client that taking iron supplements in a liquid form can stain teeth. The client should rinse their mouth with water after taking the supplement. The nurse should tell the client that iron supplements can cause bowel movements to appear green or black

A nurse is assisting with the admission of a client who has fulminant failure. Which of the following procedures should the nurse expect for this client? A. Endoscopic sclerotherapy B. Liver lobectomy C. Liver transplant D. Transjugular intrahepatic portal-systemic shunt placement

Liver transplant *Fulminant hepatic failure, most often caused by viral hepatitis, is characterized by the development of hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence of hepatic dysfunction. Mortality remains high, even with treatment modalities such as blood or plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, liver transplantation has become the treatment of choice for these clients

A nurse is reinforcing teaching about dietary therapy with a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following pieces of information should the nurse include in the teaching? A. Avoid foods containing protein B. Drink liquids during each meal C. Eat foods that contain simple sugars D. Maintain a supine position after meals

Maintain a supine position after meals *The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at a time, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper GI tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine. This makes blood volume decrease, causing the client to experience nausea , sweating, syncope, palpitations, increased heart rate, and hypotension.

A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should expect a prescription for which of the following medications? A. Lubiprostone B. Metoclopramide C. Bisacodyl D. Loperamide

Metoclopramide *Lubiprostone is a medication used to treat irritable bowel syndrome with constipation in females. Metoclopramide is a dopamine antagonist that is used to treat nausea and also increases gastric motility. It can relieve the bloating and nausea of diabetic gastroparesis. Bisacodyl is a stimulant laxative that is used for short-term treatment of constipation. Loperamide is an antidiarrheal agent that decreases gastrointestinal peristalsis

A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify which of the following as a risk factor for cholecystitis? A. Obesity B. Rapid weight gain C. Decreased blood triglyceride level D. Male sex

Obesity. *Obesity is considered a risk factor for the development of cholecystitis. Rapid weight loss is a risk factor for the development of cholecystitis. Increased blood cholesterol levels are a risk factor are a risk factor for developing cholecystitis. Female sex is a risk factor for the development of cholecystitis.

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? A. Instruct the client to chew the medication before swallowing. B. Offer a glass of water following medication administration C. Administer the medication 30 min before meals D. Sprinkle the contents on peanut butter

Offer a glass of water following medication administration *Pancrelipase should be swallowed without chewing to reduce irritation and slow the release of the medication. Drink a full glass of water following administration of pancrelipase. Pancrelipase should be administered with every meal and snack. The contents of the pancrelipase capsule can be sprinkled on nonprotein foods, and peanut bitter is a protein food.

A nurse is recommending dietary modifications for a client who has GERD. The nurse should suggest eliminating which of the following foods from the client's diet? A. Oranges and tomatoes B. Carrots and bananas C. Potatoes and squash D. Whole grains and beans

Oranges and tomatoes *Symptoms of GERD worsen following oral intake of substances that decrease lower esophageal structure (LES) pressure. These include alcohol, caffeine, nicotine, chocolate, fatty foods, citrus fruits, tomatoes, and peppermint

A nurse is colelcting data on a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Painful swallowing C. Sweet taste in mouth D. Absence of eructation

Painful swallowing *Hypersalivation is an expected finding in a client who has GERD. Painful swallowing is a manifestation of GERD due to esophageal stricture or inflammation. A client who has GERD would reports a bitter taste in the mouth. Increased burping is an expected finding in a client who has GERD

A nurse is assisting with the planning of an in-service session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes has a role in the digestion of protein? A. Amylase B. Lipase C. Steapsin D. Pepsin

Pepsin *Pepsin is an enzyme by the gastric mucosa that breaks down protein into polypeptides. Other enzymes such as trypsin and aminopeptidase further break down polypeptides in to amino acids, which can be used by the body.

A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? A. Flush the tube with water B. Place the client in a semi-Fowler's position C. Cleanse the skin around the tube site D. Aspirate the tube prior to each feeding

Place the client in a semi-Fowler's position *A client who is receiving PEG tube feeding should be positioned with the head of the bed elevated at least 30° during and after feedings to decrease the risk of aspiration.

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following findings should the nurse expect? A. Presence of immunoglobulin G antibodies (IgG) B. Positive EIA test C. Aspartate aminotransferase (AST) 35 units/L D. Alanine aminotransferase (ALT) 15IU/L

Positive EIA test *The presence of IgG is an expected laboratory finding in a client who has hepatitis A infection. A positive EIA test is an expected laboratory finding in a client who has a new diagnosis of hepatitis C. AST is elevated in clients who have hepatitis C infection; 35 units/: is within the expected reference range. ALT is elevated in clients who have hepatitis C infection;15 units/L is within the expected reference range

A nurse is caring for a client who had a gastric resection to treat adenocarcinoma of the stomach. The client tells the nurse in the PACU that he does not remember why the surgeon said he had to have a tube in his nose. The nurse should explain that the NG tube serves which of the following purposes? A. Preventing excessive pressure on suture lines B. Allowing gastric lavage after surgery C. Allowing early postoperative feeding D. Obtaining a gastric specimen for testing

Preventing excessive pressure on suture lines *The NG tube remains in place after surgery to prevent excessive pressure on suture lines postoperatively. It drains the air and fluid that can cause pressure from inside the G tract. In doing so, it also prevents vomiting and GI distention

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure? A. Prothrombin time B. Serum lipase C. Bilirubin D. Calcium

Prothrombin time *A major complication following a liver biopsy is hemorrage. Many clients who have liver disease have clotting defects and are at risk for bleeding. Along with the prothrombin time (PT), activated partial thromboplastin time (aPTT) and platetlet count should be monitored. Liver dysfunction reduces the production of blood clotting factors, which leads to increased incidence of bruising, nosebleeds, bleeding from wounds, and GI bleeding. This is due to a deficient absorption of Vitamin K from the GI tract caused by the inability of liver cells to use vitamin K to make prothrombin

A nurse is caring for a client who is postoperative following a laparotomy. The client has an indwelling urinary catheter and a Jackson-Pratt drain in place. Which of the following findings indicates that the client is developing a postoperative complication? A. Pain scale score of 5 out of 10 B. Urine output of 65 mL/hr C. 10 mL of bright red drainage from the drain D. Pulse oximetry of 85%

Pulse oximetry of 85% *Clients who have had abdominal surgery should have an oxygen saturation about 95%. A client whose oxygen saturation is 85% has hypoxemia and requires immediate intervention

A nurse is assisting with the care of a client who is receiving TPN solution. The current bag of soultion was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag B. Infuse the remaining solution at the current rate and then hang a new bag C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag. D. Remove the current bag and hang a bag of lactated Ringer's

Remove the current bag and hang a new bag *The current bag of TPN should not hang more than 24 hr due to the risk of infection. A bag od TPN should not infuse for more than 24 hr due to the risk of infection. The rate of TP infusion should never be increased abruptly due to the risk of hyperglycemia. Administration of TPN should never be discontinued abruptly. If the solution needs replacing and another bag is not availablem, use dextrose 10% in water to maintain blood glucose.

A nurse is caring for a client who is 4 hours postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? A. Right shoulder pain B. Urine output 20 mL/hr C. Temperature 38.4 C (101.1F) D. Oxygen saturation 92%

Right shoulder pain *The client can experience pain the right upper shoulder due to gas (carbon dioxide) injected into the abdominal cavity during the procedure, which can irritate the diaphragm and cause referred pain in the shoulder area. The pain disappears in 1-2 days. MIld analgesics and a recumbent position can help relieve the client's pain

A nurse is checking a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? A. Elevated blood pressure B. Increased frequency and pitch of bowel sounds C. Rigid abdomen D. Emesis of undigested food

Rigid abdomen *Abdominal tenderness and rigidity occur with a bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume. A lowered blood pressure (hypotension) results.

A nurse is reinforcing dietary teaching with a client who has ulcerative colitis. Which of the following food selections by the client indicates an understanding of the teaching? A. Raw vegetable salad with low-fat dressing B. Roasted chicken and white rice C. Fresh fruit salad and milk D. Peanut butter on whole wheat bread

Roasted chicken and white rice *Clients with ulcerative colitis are restricted to a low-fiber diet, which omits whole grains and raw fruits and vegetables. Roasted chicken and white rice is the best choice

A nurse is reinforcing instructions about the use of laxatives with a client who has heart failure. The nurse should tell the client to avoid which of the following laxatives? A. Sodium phosphate B. Psyllium C. Bisacodyl D. Polyethylene glycol

Sodium phosphate *Absorption of sodium phosphate causes fluid retention causes fluid retention which can exacerbate heart failure. Psyllium is not absorbed by the intestine and is not contraindicated for clients who have heart failure. Bisacodyl does not appear to have systemic effects and is not contraindicated for clients who have heart failure. Polyethylene glycol is contraindicated in a number of GI conditions, but it is not contraindicated for clients who have heart failure.

A nurse is reinforcing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse reinforce in the teaching? A. Mucus will be present in stool for 5 to 7 days after surgery B. Expect 500 to 1000 mL of semi-liquid stool after 2 weeks C. Stoma should be moist and pink D. Change the ostomy bag when it is 3/4 full

Stoma should be moist and pink *Mucus and blood can be present for 2 to 3 days after surgery. Output should become stool-like, semi-formed, or formed within days to weeks. A pink, moist stoma is an expected finding for a colostomy. The ostomy bag should be changed when it is 1/4 to 1/2 full.

A nurse is caring for a client who has cholelithiasis and will undergo a cholecystectomy. The client says she does not understand how she will be alright without her gallbladder. The nurse should explain that which of the following is the main function of the gallbladder? A. Producing bile B. Adding digestive enzymes to bile C. Storing bile D. Eliminating bile

Storing bile *The primary function of the gallbladder is to store bile. Because this organ is only for storage, the client's liver will still produce the bile needed for digestion. Small amounts of bile will continuously enter the duodenum and perform various functions.

A nurse is collecting data on a client who has liver cirrhosis with abdominal distention. Which of the following actions is the most effective way for the nurse to note a change in the client's abdominal distention? A. Percuss the abdomen for tympanic sounds B. Inspect the contour of the abdominal wall C. Ask the client to report increased abdominal discomfort D. Take serial measurements of the abdomen with a tape measure

Take serial measurements of the abdomen with a tape measure *Measuring the abdomen is the most effective way to monitor for a change in abdominal distention. This provides concrete, objective data that can be compared at various points in time in order to monitor changes

A nurse is monitoring a client following a paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A. Client report of upper chest pain B. Decreased urine output C. Pallor D. Temperature elevation

Temperature elevation *A report of sharp, constant abdominal pain is associated with bowel perforation. Decreased urine output is associated with bladder perforation during a paracentesis. Pallow can indicate hypovolemia related to fluid removal of ascites fluid during the procedure. Fever can be an indication of bowel perforation following a paracentesis.

A nurse is caring for a client who is dehydrated and is receiving a continuous tube feeding through a pump at 75 mL/hr. When the nurse checks the client 0800, which of the following findings requires intervention by the nurse? A. A full pitcher of water is sitting on the client's bedside table within the client's reach. B. The disposable feeding bag is from the previous day at 1000 and contains 200 mL of feeding. C. The client is lying on the right side with a visible dependent loop in the feeding tube D. The head of the bed is elevated to 20°

The head of the bed is elevated to 20° *The head of the bed should be elevated to at least 30° (semi-Fowler's position) while the tube feeding is administered. This position uses gravity to help the heeding progress through the digestive system and reduces the possibility of regurgitation

A nurse is reinforcing teaching with a client who has cholelithiasis and a new prescription for chenodiol. Which of the following information should the nurse include? A. This medication is used to decrease acute biliary pain B. This medication requires thyroid function monitoring every 6 months C. This medication is not recommended for clients who have diabetes mellitus D. This medication dissolves gallstones gradually over a period of up to 2 years

This medication dissolves gallstones gradually over a period of up to 2 years *Opioid analgesics are preferred for the treatment of acute biliary pain. The client should have an ultrasound of the gallbladder every 6 months during the first year of treatment to determine effectiveness of the medication. Chenodiol is used cautiously in clients who have hepatic conditions or disorders with varices. Chenodiol is a bile acid that gradually dissolves cholesterol-based gallstones. The medication can be taken for up to 2 years.

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that the purpose of this procedure is which of the following? A. To visualize colon polyps B. To detect an ulceration in the stomach C. To identify an obstruction in the biliary duct D. To determine the presence of free air in the abdomen

To detect an ulceration in the stomach *An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect tumors, ulceration, or obstructions

A nurse is assiting with the care the care of a newly admitted client who has bleeding esphageal varices. The nurse should anticipate a prescription for which of the following medication? A. Propranolol B. Metoclopramide C. Ranitidine D. Vasopressin

Vasopressin *Propranolol is not used for clients who are actively bleeding. It can be given prophylactically to decrease portal hypertension. Metoclopramide decreases motility of the esophagus and stomach. Histamine 2 receptor antagonists are administered following surgical procedures for bleeding esophageal varices. Vasopressin constricts blood vessels and is used to treat bleeding esophageal varices.

A nurse is assisting with the admission of a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A. Famotidine B. Esomeprazole C. Vasopressin D. Omeprazole

Vasopressin *Vasopressin constricts the splanchnic bed and decreased portal pressure. Vasopressin also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system; thus, it is used to treat bleeding varices.

A nurse is reinforcing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include? A. Take the medication with food B. Monitor for diarrhea C. Wait 1 hr before taking other oral medications D. Maintain a low-fiber diet

Wait 1 hr before taking other oral medications *Advise the client to tale aluminum hydroxide on an empty stomach. Include in the instruction that aluminum hydroxide can cause constipation. Advise the client not to tale oral medications within 2 hr of an antacid. Include in the instruction for the client to increase dietary fiber due to the constipating effect of the medication

A nurse is contributing to the plan of care for a client who has hepatitis B with ascites. Which of the following actions should the nurse include? A. Initiate contact precautions B. Weigh the client daily C. Measure abdominal girth at the base of the rib cage D. Provide a low-calorie, low-carbohydrate diet.

Weight the client daily *Hepatitis B is transmitted via blood. Standard precautions are adequate. Daily weights are obtained to monitor fluid status. The client's abdominal girth is measured over the largest part of the abdomen, which will vary by client. The client who has hepatitis B should have a diet high in calories and carbohydrates.

A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet? A. White bread and plain yogurt B. Shredded wheat cereal and blueberries C. Broccoli and kidney beans D. Oatmeal and pears

White bread and plain yogurt *During the acute inflammation of diverticulitis, the client should maintain a diet that is low in fiber (e.g, white bread, low-fat milk, yogurt with active cultures, poached eggs, and canned, soft fruit.)

A nurse is reinforcing teaching with a client who is scheduled for an upper endoscopy. Which of the following instructions should the nurse include? A. You will receive general anesthesia for this procedure B. You should have nothing to eat or drink 8 hr before the procedure C. You will be intubated during the procedure D. You will be placed on your right side for the procedure

You should have nothing to eat or drink 8 hr before the procedure *The client will receive IV sedation, such as midazolam, and will be awake during the procedure. The client should have nothing to eat or to drink 6 to 8 hr prior to the procedure. The client does not receive general anesthesia and will be breathing on their own; therefore, intubation is not required. The client will be placed on their left side for the procedure.

A nurse is collecting date from a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High-calorie diet B. Prior gastrointestinal illnesses C. Tobacco use D. alcohol use

alcohol use *Alcohol consumptionis a major cause of chronic pancreatitis in the U.S. Long-term alcohol use disorder produces hypersecretion of protein in pancreatic secretions, resulting in protein plugs and calculi within the pancreatic ducts. Alcohol also has a direct toxic effect on the cells of the pancreas. Damage to these cells is more likely to occur and to be more severe in clients whose diets are poor inprotein content and either very high or very low in fat

A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk of developing hepatitis A? A. Children and young adults B. Older adults C. Women who are pregnant D. Middle-aged men

children and young adults *The hepatitis A virus can be contracted from the feces, bile, and blood of infected clients. The usual mode of transmission is the fecal-oral route. Children and young adults are most often affected by the hepatitis A virus. Typically, a child or young adult acquires the infection at school, through poor hygiene, through hand-to-mouth contact, or by another form of close contact.

A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw

coleslaw *Coleslaw contains cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables

A nurse is reinforcing teaching with the parents of a child who has celiac disease. Which of the following foods should the nurse instruct the parents to omit from the child's diet? A. Cornflakes B. Reduced fat milk C. Canned fruits D. Wheat bread

wheat bread *clients should eliminate as much gluten as possible from their diets. Wheat, rye, and barley

A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray? A. Wheat toast B. Tapioca Pudding C. Hard-boiled egg D. Mashed Potatoes

wheat toast *Celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Wheat toast contains gluten and should be removed the client's tray.