GASTRO QUIZ

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A client is admitted to the hospital with acute viral hepatitis. Which sign or symptom should the nurse expect to note based on this diagnosis? 1. Fatigue 2. Pale urine 3. Weight gain 4. Spider angiomas

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? 1. Assessment of vital signs 2. Completion of abdominal examination 3. Insertion of the prescribed nasogastric tube 4. Thorough investigation of precipitating events

A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing action? 1. Assist the client in expressing feelings. 2. Restrict visitors until the jaundice subsides. 3. Perform most of the activities of daily living for the client. 4. Provide information to the client only when he or she requests it

The clinic nurse is performing an abdominal assessment on a client and preparing to auscultate bowel sounds. The nurse should place the stethoscope in which quadrant first? Click on the image to indicate your answer. 1. RLQ 2. RUQ 3.LLQ 4. LUQ

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective? 1. "Baked foods such as chicken or fish are all right to eat." 2. "Citrus fruits and raw vegetables need to be included in my daily diet." 3. "I can drink beer as long as I consume only a moderate amount each day." 4. "I can drink coffee or tea as long as I limit the amount to 2 cups daily."

The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client on the signs and symptoms associated with dumping syndrome. Which client statement indicates that teaching was effective? 1. "It will cause diaphoresis and diarrhea." 2. "I have to monitor for hiccups and diarrhea." 3. "It will be associated with constipation and fever." 4. "I have to monitor for fatigue and abdominal pain.

The nurse has taught the client with chronic pancreatitis about risk factor modification to reduce the incidence of recurrences. The nurse determines that teaching was effective if the client states that it will be necessary to control which factor? 1. Alcohol intake 2. Duodenal ulcer 3. Crohn's disease 4. Diabetes mellitus

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the health care provider (HCP)? 1. Dark red drainage 2. Dark brown drainage 3. Green-tinged drainage 4. Light yellowish-brown drainage

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which assessment data would alert the nurse to this occurrence? 1. Inability to pass flatus 2. Loss of anal sphincter control 3. Severe, constant pain with rapid onset 4. Firm, nontender mass palpable at the lower right costal margin

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1.Notify the health care provider (HCP). 2.Administer the prescribed pain medication. 3.Call and ask the operating room team to perform surgery as soon as possible. 4.Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1. Sweating and pallor 2. Bradycardia and indigestion 3. Double vision and chest pain 4. Abdominal cramping and pain

The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which food should the nurse instruct the client to avoid? 1. Chili 2. Bagel 3. Lentil soup 4. Watermelon

The nurse is reviewing the health care provider's prescriptions written for a client admitted to the hospital with acute pancreatitis. Which prescription requires follow-up by the nurse? 1. Full liquid diet 2. Morphine sulfate for pain 3. Nasogastric tube insertion 4. An anticholinergic medicatio

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. 1. Administer stool softeners as prescribed. 2. Instruct the client to limit fluid intake to avoid urinary retention. 3. Encourage a high-fiber diet to promote bowel movements without straining. 4. Apply cold packs to the anal-rectal area over the dressing until the packing is removed. 5. Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

1,3,4

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply. 1. Nuts 2. Corn 3. Liver 4. Apples 5. Lentils 6. Bananas

1,3,5

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? 1. "I should increase the fiber in my diet." 2. "I will need to avoid caffeinated beverages." 3. "I'm going to learn some stress reduction techniques." 4. "I can have exacerbations and remissions with Crohn's disease."

1. "I should increase the fiber in my diet."

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical record? 1. Apply a cold pack to the abdomen. 2. Administer 30 mL of milk of magnesia (MOM). 3. Maintain nothing by mouth (nil per os [NPO]) status. 4. Initiate an intravenous (IV) line for the administration of IV fluids

A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? 1. Select foods high in fat. 2. Increase intake of fluids, including juices. 3. Eat a good supper when anorexia is not as severe. 4. Eat less often, preferably only 3 large meals daily

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse determines that education about positioning to reduce pain was effective if the client avoids which action? 1. Sitting up 2. Lying flat 3. Leaning forward 4. Drawing the legs to the chest

A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which source of complete proteins to maximize the availability of essential amino acids? 1. Nuts 2. Meats 3. Cereals 4. Vegetables

A sexually active young adult client has developed viral hepatitis. Which client statement indicates the need for further teaching? 1. "I should avoid drinking alcohol." 2. "I can go back to work right away." 3. "My partner should get the vaccine." 4. "A condom should be used for sexual intercourse."

Lactulose is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated? 1. Vomiting occurs. 2. The fecal pH is acidic. 3. The client experiences diarrhea. 4. The client is able to tolerate a full diet.

The health care provider has determined that a client has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis? 1. "I have had unprotected sex with multiple partners." 2. "I ate shellfish about 2 weeks ago at a local restaurant." 3. "I was an intravenous drug abuser in the past and shared needles." 4. "I had a blood transfusion 30 years ago after major abdominal surgery."

The nurse is caring for a client who had a subtotal gastrectomy. The nurse should assess the client for which signs and symptoms of dumping syndrome? 1. Diarrhea, chills, and hiccups 2. Weakness, diaphoresis, and diarrhea 3. Fever, constipation, and rectal bleeding 4. Abdominal pain, elevated temperature, and weakness

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a most common causative factor in this client's disorder? 1. Weight gain 2. Use of alcohol 3. Exposure to occupational chemicals 4. Abdominal pain relieved with food or antacids

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How should the nurse schedule the medications for administration? 1. Drink 8 ounces of water between taking each medication. 2. Administer the cimetidine and magnesium hydroxide at the same time twice daily. 3. Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide. 4. Collaborate with the health care provider (HCP), as the client should not be receiving both medications.

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response? 1. "I don't believe that." 2. "Everything will be all right." 3. "I'm not sure that I understand. Would you please explain?" 4. "I think you should talk more with the health care provider about this.

A client with viral hepatitis is having difficulty coping with the disorder. Which question by the nurse is the most appropriate in identifying the client's coping problem? 1. "Do you have a fever?" 2. "Are you losing weight?" 3. "Have you enjoyed having visitors?" 4. "Do you rest sometime during the day?"

The medication history of a client with peptic ulcer disease reveals intermittent use of several medications. The nurse would teach the client that which of these medications are not a part of the treatment plan because of its irritating effects on the lining of the gastrointestinal tract? 1. Nizatidine 2. Sucralfate 3. Ibuprofen 4. Omeprazole

The nurse has given instructions to a client with hepatitis about postdischarge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement? 1. "I need to avoid alcohol and aspirin." 2. "I should eat a high-carbohydrate, low-fat diet." 3. "I can resume a full activity level within 1 week." 4. "I need to take the prescribed amounts of vitamin K.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? 1. Clamp the T-tube. 2. Irrigate the T-tube. 3. Document the findings. 4. Notify the health care provider.

The nurse is assessing a client with a duodenal ulcer. The nurse interprets that which sign or symptom is most consistent with the typical presentation of duodenal ulcer? 1. Weight loss 2. Nausea and vomiting 3. Pain that is relieved by food intake 4. Pain that radiates down the right arm

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result? 1. The client reports some pain before meals. 2. The client frequently is awakened at 2 a.m. with heartburn. 3. The client has eliminated any irritating foods from the diet. 4. The client's pain is minimal with histamine H2-receptor antagonists.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? 1. Ambulate following a meal. 2. Eat high-carbohydrate foods. 3. Limit the fluids taken with meals. 4. Sit in a high Fowler's position during meals.

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client? 1. Maintain a high-carbohydrate diet. 2. Increase fluid intake, particularly at mealtime. 3. Maintain a low Fowler's position while eating. 4. Ambulate for at least 30 minutes following each meal

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the client? 1. Roast pork 2. Cheese omelet 3. Pasta with sauce 4. Tuna fish sandwich

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? 1. Dorsiflex the client's foot. 2. Measure the abdominal girth. 3. Ask the client to extend the arms. 4. Instruct the client to lean forward.

The nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primary characteristics of the preicteric phase? 1. Pruritus 2. Right upper quadrant pain 3. Fatigue, anorexia, and nausea 4. Jaundice, dark-colored urine, and clay-colored stools

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at this time? 1. "Do you want to stay here in this facility for a few more days?" 2. "Have you discussed your feelings with your health care provider?" 3. "You need to talk to your health care provider about these concerns." 4. "Tell me more about your concerns with your diet after going home."

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? 1. Carrots and ranch dip 2. Whole-grain cereal and milk 3. A cup of popcorn and a cola drink 4. Applesauce and a graham cracker

A client with cirrhosis complicated by ascites is admitted to the hospital. The client reports a 10-lb weight gain over the past 1½ weeks. The client has edema of the feet and ankles, and his abdomen is distended, taut, and shiny with striae. Which client problem is most appropriate at this time? 1. Difficulty with sleeping 2. Risk for skin breakdown 3. Difficulty with breathing 4. Excessive body fluid volume

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis? 1. "I have epigastric pain radiating to my neck." 2. "I have severe abdominal pain that is relieved after vomiting." 3. "My temperature has been running between 96°F (35.5°C) and 97°F (36.1°C)." 4. "I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis? 1. "It's due to insufficient production of vitamin B12 in the colon." 2. "Increased production of intrinsic factor in the stomach leads to this type of anemia." 3. "Overproduction of vitamin B12 in the large intestine can result in pernicious anemia." 4. "Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine.

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. 1.Diarrhea 2.Black, tarry stools 3.Hyperactive bowel sounds 4.Gray-blue color at the flank 5.Abdominal guarding and tenderness 6.Left upper quadrant pain with radiation to the back

4,5,6

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

4. A rigid, boardlike abdomen

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan? 1. Monitoring the temperature 2. Monitoring complaints of heartburn 3. Giving warm gargles for a sore throat 4. Assessing for the return of the gag reflex

4. Assessing for the return of the gag reflex

Which of the following is an appropriate nursing intervention for a pt. who has GERD? A. Advise pt. to remain upright after meals. B. Withhold fluids during meal time. C. Administer the appropriate immunoglobulin. D. Give the prescribed steroids with half a glass of milk.

A. Advise pt. to remain upright after meals.

A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? A. Brownie with nuts B. Bowl of mixed fruit C. Grilled turkey D. Baked potato

A. Brownie with nuts

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

A. Diuretic B. Beta-blocking agent D. Lactulose

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 hr after treatment begins? A. Aldolase B. Lipase C. Amylase D. Lactic dehydrogenase

A. Elevated aldolase levels are caused by inflammation of the muscles, also known as myositis. The levels of aldolase are not affected by pancreatic disorders. B. Lipase levels in clients who have pancreatitis increase after a rise in serum amylase and stay elevated for up to 14 days longer than amylase. C. CORRECT: Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3 to 6 hr following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hr and returns to the expected reference range within 2 to 3 days. D. Lactic dehydrogenase (LDH) increases are typically seen in clients who have anemia, leukemia, or liver damage.

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

A. Endoscopic sclerotherapy is the injection of a sclerotherapy agent during endoscopy to target esophageal varies that are actively bleeding. This promotes thrombosis, which eventually leads to sclerosis. B. A liver lobectomy is used for a client who has localized cancer of a lobe of the liver. This is not appropriate for a client experiencing rapidly progressive liver failure. C. CORRECT: 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. D. A transjugular intrahepatic portal-systemic shunt is placed to treat esophageal varies through placement of a stent into the portal vein. The stent serves as a shunt between the portal circulation and the hepatic vein, thereby reducing portal hypertension. It is not used for fulminant hepatic failure.

A nurse in the emergency dependent is caring for a client who has bleeding esophageal varies. The nurse should anticipate a prescription for which of the following medications? A. Famotidine B. Esomeprazole C. Vasopressin D. Omeprazole

A. Famotidine is an H2 receptor antagonist used to treat stress ulcers. B. Esomeprazole is a proton pump inhibitor used to treat gastrointestinal reflux disease. C. CORRECT: Vasopressin constricts the splanchnic bed and decreases portal pressure. Vasopressin also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varies. D. Omeprazole is a proton pump inhibitor used to treat duodenal and gastric ulcers.

A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? A. Fried chicken B. Mashed potatoes C. Dinner roll D. Tapioca pudding

A. Fried chicken

What should the nurse advise a pt. who has diverticulosis to eat? A. High fiber foods. B. Low fiber foods. C. Low carb foods. D. High carb foods

A. High fiber foods.

A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? (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

A. Limit physical activity B. Avoid alcohol E. Eat small frequent meals

A nurse is planning care for a client who has a new prescription for TPN. Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12-hour shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained.

A. Obtain a capillary blood glucose four times daily. C. Monitor vital signs three times during the 12-hour shift. D. Change the TPN IV tubing every 24 hr.

A nurse is caring for a client who is 2 days postoperative 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

A. Vanilla pudding contains sugar, which can cause diarrhea due to hyperosmolarity. Clear liquids should be given as the first oral feeding. B. The sugar content of apple juice can cause diarrhea due to hyperosmolarity. Clear liquids should be given as the first oral feeding. C. The client should avoid carbonated beverages because they can distend the stomach. causing pressure on the internal sutures or staples. Pressure can cause leaking into the peritoneum resulting in peritonitis. D. CORRECT: Clear liquids. such as water or broth. can be given for the first oral feedings. but should be limited to only 30 mL (1 oz) per feeding. Water does not contain sugar. which could cause diarrhea due to hyperosmolarity.

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

B. "You might have shoulder pain after surgery."

Which of the following is an appropriate nursing intervention for a pt. who has an inguinal hernia? A. Turn, cough, & deep breath every hour while awake to prevent pneumonia. B. Avoid prolonged standing. C. Decrease fiber intake to control diarrhea. D. Monitor your stools for occult blood.

B. Avoid prolonged standing.

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

B. Change in orientation C. Asterixis E. Fetor hepaticus

A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Take baths rather than showers. B. Clamps T-tube for 1 hr before and after meals. C. Keep the drainage system above the level of the abdomen. D. Expect to have the T-tube removed 3 days postoperatively. E. Report brown-green drainage to the provider.

B. Clamps T-tube for 1 hr before and after meals. C. Keep the drainage system above the level of the abdomen.

Which dietary modification is utilized for a patient diagnosed with acute pancreatitis? A. High-protein diet B. Elimination of Coffee C. Low carbohydrate diet D. High-fat diet

B. Elimination of Coffee

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 semi-Fowler's position. C. Cleanse the skin around the tube site. D. Aspirate the tube for residual contents.

B. Place the client in semi-Fowler's position.

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

B. Presence of enzyme immunoassay (EIA)

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. Serum amylase 80 units/L B. WBC 9,000/mm3 C. Direct bilirubin 2.1 mg/dL D. Alkaline phosphatase 25 units/L

C. Direct bilirubin 2.1 mg/dL

What is the cause of a 'non-mechanical' bowel obstruction? A. A tumor or twisting of the bowel B. Constipation. C. General anesthesia, narcotics, and handling of the bowel during surgery. D. Adhesions

C. General anesthesia, narcotics, and handling of the bowel during surgery.

A nurse is reviewing the health record of a client who has pancreatitis. The physical exam report by the provider indicates the presence of cullens sign. Which of the following is an appropriate action by the nurse to identify this finding? A. Tap lightly at the costovertebral margin on the clients back. B. Palpate the clients Right lower quadrant C. Inspect the skin around the umbilicus D. Auscultate the area below the clients scapula

C. Inspect the skin around the umbilicus

A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign? A. Tap lightly at the costovertebral margin on the client's back. B. Palpate the RLQ. C. Inspect the skin around the umbilicus. D. Auscultation the area below the scapula.

C. Inspect the skin around the umbilicus.

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? A. Maintain a high-fat diet and drink at least 3 L of fluid a day. B. Maintain a high sodium, high-calorie diet C. Maintain a high carbohydrate, low-fat diet D. Maintain a high-fat, high-carbohydrate diet

C. Maintain a high carbohydrate, low-fat diet

Which of the following is an appropriate nursing intervention for a patient who has had an EGD? A. Give food and water as soon as the test is completed. B. Enemas until clear. C. Monitor for hemorrhage r/t organ perforation. D. Administer a sedative.

C. Monitor for hemorrhage r/t organ perforation.

The nurse notes that the clients total bilirubin is 1.0 mg/dl. Which action by the nurse is correct? A. Access the clients sclerae for evidence of jaundice B. Check the clients stool for presence of occult blood C. Record the results as normal D. Test the clients urine for blood.

C. Record the results as normal

Which of the following should the nurse advise a pt who has ulcerative colitis to call the doctor for? A. Occasional abdominal cramping B. Nine mucous bloody stools per day. C. Signs of colon perforation and peritonitis. D. Diarrhea.

C. Signs of colon perforation and peritonitis.

Which of the following is a true statement regarding regional enteritis (Crohn's disease)? A. It has a progressive disease pattern B. It is characterized by lower left quadrant abdominal pain. C. The clusters of ulcers take on a cobble stone appearance. D. The lesions are in continuous contact with one another.

C. The clusters of ulcers take on a cobble stone appearance.

A college student is diagnosed with Hepatitis A (HAV). Which of the following actions by the nurse best accomplishes the goal of reducing potential transmission of HAV? A. The nurse dons a mask and gown when providing direct care B. The nurse maintains the client in private room at all times C. The nurse preforms vigorous handwashing after leaving the room. D. The nurse wears gloves whenever entering the clients room

C. The nurse preforms vigorous handwashing after leaving the room.

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? A. Alterations in glucose metabolism B. Retention of bile salts C. Inadequate production of albumin by hepatocytes D. Inability of the liver to use vitamin K

D. Inability of the liver to use vitamin K

The nurse is providing care for a patient who has acute Hepatitis B. Which of the following findings should the nurse expect? A. Joint pain B. Obstipation C. Periumbilical discoloration D. Right upper quadrant tenderness

D. Right upper quadrant tenderness

A nurse is caring for a client who had 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

D. Temperature elevation

A nurse is reviewing a new prescription for ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? 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.

D. This medication dissolves gallstones gradually over a period of up to 2 years.

The use of metroclopramide:

GI stimulant to Treat GERD and Antiemetic

A nurse is caring for a client after having a splenectomy following a motor vehicle crash. Which of the following client care measures has the highest priority?

Promoting lung aeration

A patient is jaundiced and her stools are clay colored (gray). This is most likely related to a. decreased bile flow into the intestine. b. increased production of urobilinogen. c. increased production of cholecystokinin. d. increased bile and bilirubin in the blood

a Rationale: Bile is produced by the hepatocytes and is stored and concentrated in the gallbladder. When bile is released from the common bile duct, it enters the duodenum. In the intestines, bilirubin is reduced to stercobilinogen and urobilinogen by bacterial action. Stercobilinogen accounts for the brown color of stool. Stools may be clay-colored if bile is not released from the common bile duct into the duodenum. Jaundice may result if the bilirubin level in the blood is elevated.

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 for developing hepatitis A? a. Children b. Older adults c. Women who are pregnant d. Middle-aged men

a. Children

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

a. Prothrombin time

a nurse is acarin gfor a hospitalized client with acute pancreatitis. after treatment begins, the nurse anticipates that which serum laboratory value will return to normal within 72 hrs?

amylase - pancreatitis is the common reason for marked elevations in serum amylase. serum amylase begins to increase about 3 to 6 following onset of acute pancreatitis. the amylase level peaks in 20 tp 30 hr and returns to normal in 2 to 3 days.

The serious side effects associated with ondansetron (Zofran):

arrhythmias, hypotension, & extrapyramidal effects

An 80-year-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult a. should not experience changes in taste. b. has a loss of taste buds, especially for sweet and salt. c. has some loss of taste but no difficulty chewing food. d. loses the sense of taste because the ability to smell is decreased.

b Rationale: Older adults have decreased numbers of taste buds and a decreased sense of smell. These age-related changes diminish the sense of taste (especially of salty and sweet substances).

During an examination of the abdomen the nurse should a. position the patient in the supine position with the bed flat and knees straight. b. listen in the epigastrium and all four quadrants for 2 minutes for bowel sounds. c. use the following order of techniques: inspection, palpation, percussion, auscultation. d. describe bowel sounds as absent if no sound is heard in the lower right quadrant after 2 minutes.

b Rationale: The nurse should listen in the epigastrium and all four quadrants for bowel sounds for at least 2 minutes. The patient should be in the supine position and should slightly flex the knees; the head of the bed should be raised slightly. During examination of the abdomen, the nurse auscultates before performing percussion and palpation because the latter procedures may alter the bowel sounds. Bowel sounds cannot be described as absent until no sound is heard for 5 minutes in each quadrant.

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is used to do which of the following? a. To visualize polyps in the colon b. To detect an ulceration in the stomach c. To identify an obstruction in the biliary tract d. To determine the presence of free air in the abdomen

b. To detect an ulceration in the stomach

A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for this client? a. Endoscopic sclerotherapy b. Liver lobectomy c. Liver transplant d. Transjugular intrahepatic portal-systemic shunt placement

c. Liver transplant

A nurse in the emergency department is caring for 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

c. Vasopressin

a nurse is caring for a client who is placed on a low-bacteria diet in combination with oral selective bowel decontamination solution prior to a liver transplant. the nurse understands that the client should avoid consuming which of the following?

fresh grapes -

a client returns to the nursing unit 1 hr following physical therapy. the nurse notes that the infusion pump for the client's total parenteral nutririon (TPN) is turned off. after restarting the infusion pump, the nurse should monitor the client for which of the following?

shakiness and diaphoresis - the nurse should be aware that the client has the potential for the development of hypoglycemia due to the sudden withdrawal of the TPN solution. Other potential signs of hypoglycemia may include weakness, anxiety, confusion and hunger

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this client? 1. NPO (nothing by mouth) status 2. Ambulation at least 4 times daily 3. Cholinergic medications to reduce pain 4. Coughing and deep breathing every 2 hours

A client with chronic pancreatitis needs information on dietary modification to manage the health problem. Which item in the diet should the nurse teach the client to limit? 1. Fat 2. Protein 3. Carbohydrate 4. Water-soluble vitamins

A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse should plan a dietary consultation to limit the amount of which ingredient in the client's diet? 1. Protein 2. Calories 3. Minerals 4. Carbohydrates

A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that in this disorder because the stomach lining produces a decreased amount of a substance known as the intrinsic factor, the client will need which medication? 1. Vitamin B12 injections 2. Vitamin B6 injections 3. An antibiotic 4. An antacid

After performing an initial abdominal assessment on a client with nausea and vomiting, the nurse should expect to note which finding? 1. Waves of loud gurgles auscultated in all 4 quadrants 2. Low-pitched swishing auscultated in 1 or 2 quadrants 3. Relatively high-pitched clicks or gurgles auscultated in all 4 quadrants 4. Very high-pitched, loud rushes auscultated especially in 1 or 2 quadrants

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? 1. Decreased diarrhea 2. Decreased cramping 3. Improved intestinal tone 4. Elimination of peristalsis

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system? 1. Ileum 2. Cecum 3. Rectum 4. Jejunum

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication? 1. On arising 2. After meals 3. On an empty stomach 4. 30 minutes before meal

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention is appropriate? 1. Encourage foods that are high in protein. 2. Monitor for fluid and electrolyte imbalance. 3. Explain that high-fat diets usually are better tolerated. 4. Explain that most daily calories need to be consumed in the evening hours

A home care nurse visits a client who was recently diagnosed with cirrhosis. The nurse provides home care management instructions to the client. Which client statement indicates a need for further instruction? 1. "I will obtain adequate rest." 2. "I will take acetaminophen if I get a headache." 3. "I should monitor my weight on a regular basis." 4. "I need to include sufficient amounts of carbohydrates in my diet."

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication? 1. Stroke 2. Pernicious anemia 3. Bacterial meningitis 4. Peripheral arterial disease

The nurse is caring for a client with pancreatitis. Which finding should the nurse expect to note when reviewing the client's laboratory results? 1. Elevated level of pepsin 2. Decreased level of lactase 3. Elevated level of amylase 4. Decreased level of enterokinase

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider (HCP)? 1. Hypotension 2. Bloody diarrhea 3. Rebound tenderness 4. A hemoglobin level of 12 mg/dL (120 mmol/L

The nurse is developing a teaching plan for a client with viral hepatitis. The nurse should plan to include which information in the teaching session? 1. The diet should be low in calories. 2. Meals should be large to conserve energy. 3. Activity should be limited to prevent fatigue. 4. Alcohol intake should be limited to 2 ounces per day.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which sign(s)/symptom(s) of duodenal ulcer? 1. Weight loss 2. Nausea and vomiting 3. Pain relieved by food intake 4. Pain radiating down the right arm

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?

Wheat toast

Method ondansetron (Zofran) prevents nausea & Vomiting:

blocks 5-HT3 Serotonin receptors

A nurse is teaching a client with diverticulitis about preventing acute attacks. The nurse should advise the client to consume foods that are...

high in fiber.

normal pH level

7.35 - 7.45

The prototype drug for proton pump inhibitors:

Omeprazole (prilosec)

The drug that used to be the prototype for H2 receptor Antagonists:

cimetidine (Tagamet)

The prototype drug for H2 Receptor antagonists:

ranitidine (Zantac)

The reason omeprazole dose may need to be adjusted in Asians:

the duration Of action is lengthened

a nurse is assisting with the discharge teaching for a client with hepatitis A. which of the following client statements indicates am understanding of the teaching?

" I always donated blood regularly in the past, but I won't be able to anymore."

a nurse is assisting with the discharge of a client who had a bowel resection due to crohn's disease with placement of a colostomy. which of the following comments by the client indicates a need for further teaching?

" I will clean around the stoma with antimicrobial soap."

A nurse is preparing a community education program about hepatitis B. Which of the following statements should the nurse include in the teaching?

"A hepatitis B immunization is given to infants and children."

A nurse is caring for a client with severe GERD who is to undergo a esophagoscopy. While teaching the client about the procedure, the nurse should state.

"Esophagoscopy is useful in determining how well the lower part of your esophagus works."

a nurse reinforces teaching with a client who has a new diagnosis of peptic ulcer disease. Which statement made by the client indicates to the nurse that the client understands the diet modifications that are most important for this disease?

"I will eat normal foods that do not caused discomforts." - the client should be encouraged to eat as normally as possible, but avoid foods that cause pain or discomfort. the diet plan for clients with peptic ulcer diseas is individualized. diet instruction should include a list of foods that typically cause distress such as hot spicy foods and pepper, alcohol, carbonated drinks, coffee , tea and meat broth.

A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching?

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

a nurse is caring for a client who has returned to the unit following a laparoscopic cholecystectomy and reports severe pain in the left shoulder. The nurse understands that the client's pain is due to which of the following?

"is due to carbon dioxide instilled into the abdomen during surgery." - referred infraclavicular pain is common after a laparoscopic cholecystectomy.

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching? 1. "I eat at least 3 large meals each day." 2. "I eat while lying in a semirecumbent position." 3. "I have eliminated taking liquids with my meals." 4. "I eat a high-protein, low- to moderate-carbohydrate diet."

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? 1. Malaise 2. Dark stools 3. Weight gain 4. Left upper quadrant discomfort

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the health care provider? 1. Elevated serum bilirubin level 2. Below normal hemoglobin concentration 3. Elevated blood urea nitrogen (BUN) level 4. Elevated erythrocyte sedimentation rate (ESR)

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply. 1. Orthopnea and dyspnea 2. Petechiae and ecchymosis 3. Inguinal or umbilical hernia 4. Poor body posture and balance 5. Abdominal distention and tenderness

1,2,3,5

The nurse is creating a plan of care for a client with cirrhosis and ascites. Which nursing actions should be included in the care plan for this client? Select all that apply. 1. Monitor daily weight. 2. Measure abdominal girth. 3. Monitor respiratory status. 4. Place the client in a supine position. 5. Assist the client with care as needed.

1,2,3,5

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply. 1. Coffee 2. Chocolate 3. Peppermint 4. Nonfat milk 5. Fried chicken 6. Scrambled eggs

1,2,3,5

The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse should explain to the client that the second stage of this disease is characterized by which specific assessment findings? Select all that apply. 1. Jaundice 2. Flulike symptoms 3. Clay-colored stools 4. Elevated bilirubin levels 5. Dark or tea-colored urine

1,2,4,5

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy? 1. Restlessness 2. Presence of asterixis 3. Complaints of fatigue 4. Decreased serum ammonia levels

The nurse is providing discharge instructions for a client following a Roux-en-Y gastric bypass surgery 3 days ago. What will the nurse include in the instructions? Select all that apply. 1. Do not drink fluids with meals. 2. Avoid foods high in carbohydrates. 3. Take an extended-release multivitamin daily. 4. Maintain a clear liquid diet for about 6 weeks. 5. Eat 6 small meals a day that are high in protein

1,2,5

The nurse is caring for a hospitalized client with pancreatitis. Which findings should the nurse look for and expect to note when reviewing the laboratory results? Select all that apply. 1. Elevated lipase level 2. Elevated lactase level 3. Elevated trypsin level 4. Elevated amylase level 5. Elevated sucrase level

1,3,4

1. Administer stool softeners as prescribed. 3. Encourage a high-fiber diet to promote bowel movements without straining. 4. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

The nurse is performing discharge teaching for a client with chronic pancreatitis. Which information should the nurse include? 1. Alcohol should be consumed in moderation. 2. Avoid caffeine because it may aggravate symptoms. 3. Diet should be high in carbohydrates, fats, and proteins. 4. Frothy, fatty stools indicate that enzyme replacement is working

1. Coffee 2. Chocolate 3. Peppermint 5. Fried chicken

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply. 1. Fever 2. Positive Cullen's sign 3. Complaints of indigestion 4. Palpable mass in the left upper quadrant 5. Pain in the upper right quadrant after a fatty meal 6. Vague lower right quadrant abdominal discomfort

1. Fever 3. Complaints of indigestion 5. Pain in the upper right quadrant after a fatty meal

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals 2. Consuming small, frequent, bland meals 3. Taking H2-receptor antagonist medication 4. Raising the head of the bed on 6-inch (15 cm) blocks

1. Lying recumbent following meals

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. 1. Maintain NPO (nothing by mouth) status. 2. Encourage coughing and deep breathing. 3. Give small, frequent high-calorie feedings. 4. Maintain the client in a supine and flat position. 5. Give hydromorphone intravenously as prescribed for pain. 6. Maintain intravenous fluids at 10 mL/hour to keep the vein open.

1. Maintain NPO (nothing by mouth) status. 2. Encourage coughing and deep breathing. 5. Give hydromorphone intravenously as prescribed for pain.

1. Malaise

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1. Notify the health care provider (HCP). 2. Administer the prescribed pain medication. 3. Call and ask the operating room team to perform surgery as soon as possible. 4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

1. Notify the health care provider (HCP).

1. Nuts 3. Liver 5. Lentils

1. Sweating and pallor

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

A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which would the nurse expect the client to report about the pain? 1. Eating helps to decrease the pain. 2. The pain usually increases after vomiting. 3. The pain is mostly around the umbilicus and comes and goes. 4. The pain increases when the client sits up and bends forward

The nurse is teaching an older client about measures to prevent constipation. Which statement by the client indicates a need for further teaching? 1. "I walk 1 to 2 miles every day." 2. "I need to decrease fiber in my diet." 3. "I have a bowel movement every other day." 4. "I drink 6 to 8 glasses of water every day.

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching? 1. "I need to lie down after eating." 2. "I need to drink liquids with meals." 3. "I need to avoid concentrated sweets." 4. "I need to eat small meals 6 times daily."

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which finding should the nurse interpret as a sign or symptom of portal hypertension? 1. Flat neck veins 2. Abdominal distention 3. Hemoglobin of 14.2 g/dL (142 mmol/L) 4. Platelet count of 600,000 mm3 (600 × 109/L)

The nurse is caring for a client with acute pancreatitis. Which medications should the nurse expect to be prescribed for treatment of this problem? Select all that apply. 1. Insulin 2. Morphine 3. Dicyclomine 4. Pancrelipase 5. Pantoprazole 6. Acetazolamide

2,3,5,6

The nurse should incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply. 1. Select foods high in protein content. 2. Consume multiple small meals throughout the day. 3. Select foods low in carbohydrates to prevent nausea. 4. Allow the client to select foods that are most appealing. 5. Eliminate fatty foods from the meal trays until nausea subsides. 6. Eat a nutritious dinner because it is typically the best tolerated meal of the day.

2,4,5

2. "I ate shellfish about 2 weeks ago at a local restaurant."

A client with Crohn's disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

2. Checking the frequency and consistency of bowel movements

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

2. Heartburn

2. Increase intake of fluids, including juices.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the health care provider? 1. Stoma is beefy red and shiny 2. Purple discoloration of the stoma 3. Skin excoriation around the stoma 4. Semi-formed stool noted in the ostomy pouch

2. Purple discoloration of the stoma

A client who uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased white blood cell count

2. Relief of epigastric pain

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP). The nurse should contact the HCP to question which prescription if noted in the client's record? 1. Maintain a semi Fowler's position. 2. Maintain on NPO (nothing by mouth) status. 3. Apply a heating pad to the lower abdomen for comfort. 4. Initiate an intravenous (IV) line with the administration of IV fluids.

A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse should assess the client for a history of chronic use of which medication? 1. Ibuprofen 2. Ranitidine 3. Acetaminophen 4. Acetylsalicylic acid

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially? 1. Call the surgeon to report the problem. 2. Reposition the NG tube to the proper location. 3. Check the suction device to make sure it is working. 4. Irrigate the NG tube with saline to remove the obstruction

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement? 1. "I know I must sign the consent form." 2. "I hope the throat spray keeps me from gagging." 3. "I'm glad I don't have to lie still for this procedure." 4. "I'm glad some intravenous medication will be given to relax me."

3. "I'm glad I don't have to lie still for this procedure."

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production."

The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? 1. "I will continue taking vitamin supplements." 2. "This medication will help to lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water."

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1. Constipation 2. Abdominal pain 3. An episode of diarrhea 4. Hematest-positive nasogastric tube drainage

3. An episode of diarrhea

3. Ask the client to extend the arms.

3. Document the findings.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? 1. Leg exercises 2. Early ambulation 3. Irrigating the nasogastric tube 4. Coughing and deep-breathing exercises

3. Irrigating the nasogastric tube

3. Limit the fluids taken with meals.

3. Pain relieved by food intake

3. Pasta with sauce

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3. Reduction of steatorrhea

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment? 1. Bradycardia 2. Nausea and vomiting 3. Numbness in the legs 4. A rigid, boardlike abdomen

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1. Folate deficiency 2. Malabsorption of fat 3. Intestinal obstruction 4. Fluid and electrolyte imbalance

A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body? 1. Bile 2. Parietal cells 3. Liver enzymes 4. Pancreatic juice

A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse determines that which item mentioned by the client is most likely to be responsible for the exacerbation? 1. Sleeping 8 to 10 hours a night 2. Ability to work at home periodically 3. Eating 5 or 6 small meals per day 4. Frequent need to work overtime on short notice

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? 1. Hypercalcemia 2. Hypernatremia 3. Frothy, fatty stools 4. Decreased hemoglobin

The nurse is performing an admission assessment on a client who has been admitted to the hospital with a diagnosis of suspected gastric ulcer. The nurse is asking the client questions about pain. Which client statement supports the diagnosis of gastric ulcer? 1. "The pain doesn't usually come right after I eat." 2. "The pain gets so bad that it wakes me up at night." 3. "The pain that I get is located on the right side of my chest." 4. "My pain comes shortly after I eat, maybe a half-hour or so later."

The nurse should anticipate that the health care provider (HCP) will prescribe which treatment for a client with pernicious anemia? 1. Oral iron tablets 2. Blood transfusions 3. Gastric tube feedings 4. Vitamin B12 injections

4. Fluid and electrolyte imbalance

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. 1. Diarrhea 2. Black, tarry stools 3. Hyperactive bowel sounds 4. Gray-blue color at the flank 5. Abdominal guarding and tenderness 6. Left upper quadrant pain with radiation to the back

4. Gray-blue color at the flank 5. Abdominal guarding and tenderness 6. Left upper quadrant pain with radiation to the back

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4. Nausea and vomiting

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4. One hour before meals and at bedtime

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.) A. "I plan to eat small, frequent meals." B. "I will eat easy-to-digest foods with limited space." 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."

A. "I plan to eat small, frequent meals." B. "I will eat easy-to-digest foods with limited space." C. "I will use skim milk when cooking."

A nurse is caring for a client who is receiving TPN solution. The current bag of solution 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.

A. Remove the current bag and hang a new bag.

Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis? A. Severe, radiating abdominal pain B. Black, tarry stools and dark urine C. Increased and painful urination D. Increased appetite and weight gain

A. Severe, radiating abdominal pain

A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patients stools will have what characteristics? A. Watery with blood and mucus B. Hard and black or tarry C. Dry and streaked with blood D. Loose with visible fatty streaks

A. Watery with blood and mucus

A nurse is completing an admission history and assessment on a client admitted with an exacerbation of chronic pancreatitis. The nurse recognizes that which of the following findings is likely to be the cause of chronic pancreatitis?

Alcohol usage

A nurses completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition?

Alcohol use

A nurse is assessing a client who is in the early stages of hepatitis A. Which of the following manifestations should the client report?

Anorexia

A nurse is assessing a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect?

Anorexia

The nurse is providing care for a patient who has peritonitis. The patient expresses anxiety about the impending surgery. Which of the following actions should the nurse take? A. "Why are you feeling so anxious?" B. "Tell me more about your concerns." C. "You should distract yourself by reading a magazine" D. "You have nothing to worry about. Your surgeon is excellent." E. "Others who have had this procedure have had great results."

B. "Tell me more about your concerns."

A nurse is providing care to a client who is 1 day post paracentesis. The nurse observes clear, pale-yellow fluid leaking from the puncture 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. Attach an ostomy back D. Place the client in a supine position

B. Apply a dry, sterile dressing

What should the nurse advise a pt. who has diverticulitis to eat? A. High fiber foods. B. Low fiber foods. C. Low carb foods. D. High carb foods

B. Low fiber foods.

Which of the following promotes rest and healing of the bowel in a pt. who has ulcerative colitis? A. High fiber diet B. Maintaining NPO status as ordered C. Low carb diet D. Avoiding licorice and caffeine

B. Maintaining NPO status as ordered

Which of the following is a priority for a pt. who is hemorrhaging from a perforated duodenal ulcer? A. Administer the sedative prior to the PY test. B. Monitor for shock. C. Position the pt. on his back with a pillow under his right ribs and his right hand under his head. D. Guiac his stool

B. Monitor for shock.

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.

B. Offer a glass of water following medication administration.

Melena:

Black, tarry stools.

A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect?

Boardlike abdomen

Which of the following is an appropriate nursing intervention for a pt. who has gastritis? A. Lavage the NG tube with iced saline. B. Give sucralfate with meals and follow it with antacids. C. Advise the pt. to avoid irritating foods such as spicy foods. D. Advise the pt. to drink milk every two hours.

C. Advise the pt. to avoid irritating foods such as spicy foods.

Children

A community health nurse is planning an educational program to prevent the transmission of Hep A in a community where the virus is becoming endemic. When preparing the materials, the nurse realizes the population group likely to become infected with the hep A virus is which of the following?

Children and young adults

Clear liquids

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to report? A. History of cholelithiasis B. Elevated serum amylase level C. Decrease in bowel sounds upon auscultation D. Hand spasms present when blood pressure is checked

D. Hand spasms present when blood pressure is checked

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy 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?

Diaphoresis

You are working in the paracentesis clinic. Which of the following clients is most likely to have an adverse reaction to the lidocaine local anesthetic? A. Asian (Chinese) B. African american C. Caucasian D. Hispanic (Puerto rican) E. Native american (Navajo)

E. Native american (Navajo)

Barium swallow:

Fluoroscopic observation of a client swallowing a flavored barium solution and its progress down the esophagus to detect structural abnormalities of the esophagus as well as swallowing discoordination and oral aspiration.

A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend?

Foods high in fiber

Gamma-glutamyl transferase (GGT)

A nurse is preparing a community education program about Hep B. Which of the following statements should be included in the nurses discussion?

Hep B immunization is given to infants and children.

a nurse is preparing a community education program about hepatitis B. Which of the following statements should be included in the nurse's discussion?

Hepatitis B immunization is given to infants and children - Hepatitis B immune globulin is given as part of the standard childhood immunizations. It may be administered as early as birth, especially in infants born to He[atitis B surface antigen (HBsAg)- negative mothers. The infants should then receive the second dose between 1 and4 months of age

The potential electrolyte imbalances w/use of aluminum hydroxide w/magnesium hydroxide:

Hypophosphatemia & hypermagnesiemia

A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for this client?

Liver transplant

A nurse is caring for a client who is diagnosed with fulminant hepatic failure. Which of the following procedures should the nurse expect the client to be prepared for?

Liver transplant

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following should the nurse monitor prior to the procedure?

A nurse is caring for an unconscious client recovering from a closed-head injury following placement of PEG tube. Which of the following actions has the highest priority?

Place the client in high-Fowler's position during PEG tube feedings.

Place the client in semi-Fowler's position

Percutaneous liver biopsy:

Procedure in which a small core of liver tissue is obtained by placing a needle directly into the liver through the lateral abdominal wall.

Endoscopic retrograde cholangio-pancreatography:

Procedure in which an endoscope is used to visualize the common bile duct and the pancreatic and hepatic ducts through the ampulla of Vater in the duodenum.

Barium enema:

Radiographic study used to identify polyps, tumors, inflammation, strictures, and other abnormalities of the colon after instilling barium solution rectally.

A nurse is caring for a client who is 4 hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect?

Right shoulder pain

Rigid abdomen

A nurse is caring for a client admitted with a bowel obstruction who develops severe abdominal pain. Which of the following assessment findings should indicate to the nurse that a possible bowel perforation has occurred?

Rigid abdomen

A nurse is caring for a client who is scheduled to have an EGD. The nurse should recognize that this procedure is used to do which of the following?

Sclerose esophageal varices

Ultrasonography:

Technique that uses high-frequency sound waves to show the size and location of organs and to outline structures and abnormalities.

Radionuclide imaging:

Technique used to detect lesions in organs using a radioactive natural or synthetic element that is injected intravenously or ingested orally.

PY test:

Test in which a client's breath is analyzed after consuming 14 C-urea capsules to detect Helicobacter pylori, the bacteria associated with peptic ulcer disease.

A client is receiving a tube feeding via a continuous enteral pump at 75 ml/hr. When the nurse assesses the client at 0800, which of the following nursing observations requires intervention?

The head of the bed is elevated 20 degree

The head of the bed is elevated 20 degrees

The action of H2 Receptor Antagonists :

They block histamine and reduce gastric acid production

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is used to do which of the following?

To detect an ulceration in the stomach

A nurse in the emergency department is caring for a client who has bleeding esophageal varies. The nurse should anticipate a prescription for which of the following medications?

Vasopressin

A nurse assesses a client's bowel sounds 3 days following a gastroplasty for obesity and notes that they have returned. A 1 oz serving of which of the following is appropriate as an initial feeding?

Water

A normal physical assessment finding of the GI system is/are (select all that apply) a. nonpalpable liver and spleen. b. borborygmi in upper right quadrant. c. tympany on percussion of the abdomen. d. liver edge 2 to 4 cm below the costal margin. e. finding of a firm, nodular edge on the rectal examination.

a, c Rationale: Normal assessment findings for the gastrointestinal system include a nonpalpable liver and spleen and generalized tympany on percussion. Normally, bowel sounds are high pitched and gurgling; loud gurgles indicate hyperperistalsis and are called borborygmi (stomach growling). If the patient has chronic obstructive pulmonary disease, large lungs, or a low-set diaphragm, the liver may be palpated 0.4 to 0.8 inch (1 to 2 cm) below the right costal margin. On palpation, the rectal wall should be soft and smooth and should have no nodules.

a nurse is assisting in the completion of an admission history and assessment on a client admitted with an exacerbation of chronic pancreatitis. the nurse recognizes that which of the following findings is likely to be the cause of chronic pancreatitis.

alcohol usage - alcohol consumption is the major cause of chronic pancreatitis in the United States. Long-term alcohol consumption produces hypersecretion of protein inpancreatis secretions. the result is protein plugs and calculi within the pancreatic ducts. alcohol also has a diets are poor in protein content and either very high or very low in fat.

a nurse is collecting data from a client who is in the early stage of hepatitis A. which of the following manifestations should the client report?

anorexia - jaundice appear later in the course of the disease

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that a. the gallbladder is unable to contract to release stored bile. b. bilirubin is not being conjugated and excreted into the bile by the liver. c. the Kupffer cells in the liver are unable to remove bilirubin from the blood. d. there is an obstruction in the biliary tract preventing flow of bile into the small intestine.

b Rationale: Bilirubin is a pigment derived from the breakdown of hemoglobin and is insoluble in water. Bilirubin is bound to albumin for transport to the liver and is referred to as unconjugated. An indirect bilirubin determination is a measurement of unconjugated bilirubin, and the level may be elevated in hepatocellular and hemolytic conditions.

A nurse is preparing a community education program 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."

b. "A hepatitis B immunization is given to infants and children."

A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (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."

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

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply) a. limiting alcohol intake to one serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking only drugs prescribed by the health care provider e. taking all drugs 1 hour before mealtime to prevent further bleeding

c, d Rationale: Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease and drug or alcohol abuse can cause upper GI bleeding. Help make the patient and caregiver aware of the consequences of noncompliance with drug therapy. Emphasize that no drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the HCP should be taken. Alcohol should be eliminated because it is a source of irritation and interfere with tissue repair.

when caring for a client recently admitted with vomiting, the nurse should do which of the following?

complete a health history regarding gastrointestinal alterations - data collection is the first phase of the nursing process. It is ipmportant to determine the underlying cause of the vomiting prior to implementing treatment. test taking strategy, whenever you are confronted with a priority setting question where all four choices appear right, but it includes various stages of the nursing process (data collection, interventions, evaluations) you can frequently rely on your nursing process to help set the priorities. remember that data collection always comes first, followed by planning, intervening and finally evaluating.

prohibited foods for clients with diverticulitis

corn - food that contains seeds and husks should be avoided strawberry - foods that contain seeds and husks should be avoided whole grain bread - foods that contain seeds and husks should be avoided

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

d Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients taking corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors are at increased risk for ulcers. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion.

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognized that increased peristalsis resulting in diarrhea can be related to a. sympathetic inhibition b. mixing and propulsion c. sympathetic stimulation d. parasympathetic stimulation

d Rationale: Peristalsis is increased by parasympathetic stimulation.

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources.

d Rationale: Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.

The nurse explains to the patient with Vincent's infection that treatment will include a. tetanus vaccinations. b. viscous lidocaine rinses. c. amphotericin B suspension. d. topical application of antibiotics.

d Rationale: Vincent's infection is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoidance of tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.

A nurse is completing a history and physical assessment for 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

d. Alcohol use

A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? a. Increased blood pressure b. Decreased heart rate c. Yellowing of the skin d. Boardlike abdomen

d. Boardlike abdomen

A nurse is caring for a client who has returned to the unit following a laparoscopic cholecystectomy and reports severe pain in the left shoulder. The nurse should recognize that the client's pain is

due to carbon dioxide instilled into the abdomen during surgery

Reason omeprazole should not be crushed or chewed:

enteric Coated granules & Acid labile

A nurse is caring for a client who is placed on a low-bacteria diet in combination with an oral selective bowel decontamination solution prior to a liver transplant. The nurse understands that the client should avoid consuming which of the following?

fresh grapes

a nurse is preparing a client who will be receiving a tap water enema. Which position should the nurse place the client for the procedure?

left lateral - the bowel is best visualized in this position

Serious Side effects of ranitidine (Zantac):

neutropenia, Agranulocytosis, Thrombocytopenia Aplastic anemia

a nurse is caring for a client who is scheduled to have an esophagastroduodenoscopy (EGD). the nurse should recognize that this procedure is used to do which of the following?

obtain gastric mucosal biopsies -

a nurse is caring for an unconscious client recovering from a closed-head injury following placement of a percutaneous endoscopic gastrostomy (PEG) tube. Which of the following actions has the highest priority?

place the client in high-fowler's position during PEG tube feeding -

a nurse is caring for a client after having a splenectomy following a motor vehicle crash. which of the following client care measures has the highest priority?

promoting lung aeration

a nurse is acaring for a client admitted with a bowel obstruction who develops severe abdominal pain. Which of the following assessment findings should indicate to the nurse that a possible bowel perforation has occurred?

rigid abdomen - abdominal tenderness and rigidity occur with a perforated bowel as peritonitis begins to develop

a client is receiving a tube feeding via a continuous enteral pump at 75 mL/hr. when the nurse assesses the client at 0800, which of the following nursing observation requires intervention.

the bed is flat and in the low position - the head of the bed should be elevated at 30 degrees ( semi-fowler position) while the tube feeding is administered. this position uses gravity to help the feeding go down and lessens the possibility of regurgitation.

A nurse is caring for a client with bleeding esophageal varices who was treated with a double balloon tamponade. Several hours after the gastric and esophageal balloons were inflated, the nurse notes that the client has become increasingly agitated, and respiration are 36/min and shallow. Which of the following is an appropriate nursing action?

use scissors to cut the tubing in front of the nose guard or sponge

three days after a gastroplasty for obesity, a nurse is told by the provider that the client's bowelsounds have returned. which food selection should the nurse anticipate to be appropriate to be appropriate as an initial feeding? A 1oz serving of

water - clear liquids should be given as the first oral feeding but are limited to 1 oz

Home History Help Calculator Study ModeQuestion 74 of 171QN: 1544 | ID: 2201 | file: Adult_Health_GI Previous Go Next Stop Bookmark Rationale Strategy Reference(s) Submit A client who has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome? 1. Remove fluids from the meal tray. 2. Give the client 2 large meals per day. 3. Ask the client to sit up for 1 hour after eating. 4. Provide concentrated, high-carbohydrate foods

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? 1. "The medication will cause constipation." 2. "I need to take the medication with meals." 3. "I may have increased sensitivity to sunlight." 4. "This medication should be taken as prescribed."

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The health care provider (HCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and should be reported to the HCP immediately? 1. Hematemesis 2. Bloody diarrhea 3. Swelling of the abdomen 4. An elevated temperature and a rise in blood pressure

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data should alert the nurse to this occurrence? 1. Inability to pass flatus 2. Loss of anal sphincter control 3. Severe, constant pain with rapid onset 4. Firm, nontender mass palpable at the lower right costal margin

The nurse is caring for a client with acute pancreatitis. Which finding should the nurse expect to note when reviewing the laboratory results? 1. Elevated serum lipase level 2. Elevated serum bilirubin level 3. Decreased serum trypsin level 4. Decreased serum amylase level

The nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which food? 1. Pork 2. Milk 3. Chicken 4. Broccoli

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis? 1. "Does the pain in your stomach radiate to your back?" 2. "Does the pain in your lower abdomen radiate to your hip?" 3. "Does the pain in your lower abdomen radiate to your groin?" 4. "Does the pain in your stomach radiate to your lower middle abdomen?"

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laënnec's cirrhosis. Which question related to the client's history would be most important to ask? 1. "Do you abuse alcohol?" 2. "Do you have any known cardiac disease?" 3. "Does your type of employment cause you to have exposure to chemicals?" 4. "Have you ever been told that you have had obstruction to your biliary ducts?"

1,2,5

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? 1. "I need to limit my intake of dietary fiber." 2. "I need to drink plenty, at least 8 to 10 cups daily." 3. "I need to eat regular meals and chew my food well." 4. "I will take the prescribed medications because they will regulate my bowel patterns."

1. "I need to limit my intake of dietary fiber."

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. 1. "I will take the cimetidine with my meals." 2. "I'll know the medication is working if my diarrhea stops." 3. "My episodes of heartburn will decrease if the medication is effective." 4. "Taking the cimetidine with an antacid will increase its effectiveness." 5. "I will notify my health care provider if I become depressed or anxious." 6. "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

1. "I will take the cimetidine with my meals." 2. "I'll know the medication is working if my diarrhea stops." 4. "Taking the cimetidine with an antacid will increase its effectiveness."

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? 1. This is a normal, expected event. 2. The client is experiencing early signs of ischemic bowel. 3. The client should not have the nasogastric tube removed. 4. This indicates inadequate preoperative bowel preparation.

1. This is a normal, expected event.

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching? 1. "I plan to eat 4 to 6 small meals a day." 2. "I should sleep in the right side-lying position." 3. "I plan to have a snack 1 hour before going to bed." 4. "I will stop having a glass of wine each evening with dinner."

The nurse is assigned to care for a client with a Sengstaken-Blakemore tube. Which laboratory result is most focused on evaluating the effectiveness of this tube? 1. Sodium 2. Creatinine 3. Hemoglobin 4. Ammonia

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3. Confusion

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD? 1. Recently retired from a job 2. Significant other has a gastric ulcer 3. Occasionally drinks 1 cup of coffee in the morning 4. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis

A. A client experiencing fluid volume overload will exhibit hypertension. B. A client experiencing hyperglycemia will exhibit excessive thirst. C. A client who has an infection will have an increased temperature. D. CORRECT: The nurse should recognize that the client has the potential for the development of hypoglycemia due to the 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 assessing 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. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

A. A client who has experienced a bowel perforation will not display an elevated blood pressure. However, hypotension or shock can be present. B. Intestinal peristalsis increases in frequency and intensity as the bowel attempts to move intestinal contents past the obstructed area. Bowel sounds are silent with a bowel perforation C. CORRECT: Abdominal tenderness and rigidity occur with a bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume and a lowered blood pressure. or hypotension, results. D. Vomiting is frequent and copious with a small bowel obstruction. This does not indicate a bowel perforation.

A nurse is completing a history and physical assessment for 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

A. A high-calorie diet can contribute to heart disease and obesity but it does not cause chronic pancreatitis. B. A prior gastrointestinal illness does not cause or contribute to chronic pancreatitis. C. tobacco use can contribute to heart disease and increases the risk of cancer development. but it does not cause chronic pancreatitis. D. CORRECT: Alcohol consumption is one of the major causes of chronic pancreatitis in the U.S. Long-term alcohol use disorder produces hyper secretion of protein in pancreatic secretions. The result is 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 in protein content and either very high or very low in fat.

A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (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."

A. A pH probe study, which involves the insertion of a specially designed probe into the distal esophagus. is performed to monitor for the presence of acid in the normally alkaline esophagus. B. CORRECT: An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures. C. An EGD is performed while the client receives moderate sedation. D. A colonoscopy is performed to detect colon cancer.

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

A. A sigmoidoscopy or barium enema is used to visualize the lower gastrointestinal tract, where polyps are found. B. CORRECT: An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect a tumor, ulceration, or obstruction. C. Identifying an obstruction in the biliary tract is performed during endoscopic retrograde cholangiopancreatography (ERCP). D. The measurement of free air, which is a gas, is obtained using fluoroscopy or an x-ray, not an EGD.

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

A. CORRECT: A major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk for bleeding. Along with the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and the platelet count should be monitored. Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to an increased incidence of bruising nosebleeds, bleeding from wounds, and gastrointestinal bleeding. This is due to a deficient absorption of vitamin K from the gastrointestinal tract caused by the inability of liver cells to use vitamin K to make prothrombin. B. Serum lipase is monitored to detect pancreatic disease and does not need to be monitored prior to this procedure. C. Bilirubin is monitored to detect biliary obstruction and does not need to be monitored prior to this procedure. D. Calcium is monitored to detect kidney failure or pancreatitis and does not need to be monitored prior to this procedure.

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

A. CORRECT: Celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Wheat toast contains gluten and should be removed from the clients tray. B. Tapioca pudding is rich in dairy and does not contain gluten. Therefore, it is an acceptable food to include in the clients diet. C. A hard-boiled egg does not contain gluten and is a good source of protein. Therefore, it is an acceptable food to include in the client's diet. D. Mashed potatoes do not contain gluten and are a good source of protein and potassium. Therefore mashed potatoes are an acceptable food to include in the clients diet.

A nurse is caring for a client who has a history of cirrhosis and is 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-gluramyl transferase (GGT) B. Alkaline phosphatase (ALP) C. Serum bilirubin D. Alanine aminotransferase (ALT]

A. CORRECT: The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring drug toxicity and excessive alcohol use. B. ALP is elevated in biliary obstruction and most forms of liver dysfunction. It does not differentiate between alcohol and other causative factors for liver disease. C. The serum bilirubin test is used to detect the function of the liver and its ability to excrete bilirubin. Elevated levels can determine liver disease or biliary tract disease. D. The largest concentration of the enzyme ALT is found in liver tissue. However. it is also present in kidney, heart. and skeletal muscle tissues. Because it is elevated in various toes of tissue damage. it is not helpful in identifying excessive alcohol use.

A nurse is caring for a client who is 4 hr 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 degrees C (101.1 degrees F) D. Oxygen saturation 92%

A. CORRECT: The client can experience pain in the right upper shoulder due to gas (carbon dioxide) injected into the abdominal cavity during the laparoscopic 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 with client comfort. B. Urine output following surgery should be at least 30 mL/hr. Less than this amount can indicate hypovolemia or renal complications and should be reported to the provider immediately. C. A temperature greater than 38.4. C (101.1 F) can indicate infection and should be reported to the provider immediately. D. An oxygen saturation of less than 95% can indicate an impaired gas exchange following surgery and should be reported to the provider immediately.

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 for developing hepatitis A? A. Children B. Older adults C. Women who are pregnant D. Middle-aged men

A. CORRECT: 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 the two groups most often affected by the hepatitis A virus. Typically, a child or young adult acquires the infection at school, through poor hygiene, hand-to-mouth contact, or another form of close contact. B. Older adults are not often affected by or at risk for developing hepatitis A. C. Women who are pregnant are not often affected by or at risk for developing hepatitis A. D. Middle-aged men are not often affected by or at risk for developing hepatitis A.

A nurse is assessing 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

A. Jaundice is a late manifestation of hepatitis A. B. CORRECT: 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. C. Dark urine is a late manifestation of hepatitis A. D. Pale feces is a late manifestation of hepatitis A.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the clients recent laboratory findings and recognizes that which of the following findings will place the client at risk for complications? A. Low platelet count B. Low sodium level C. Decreased prothrombin time D. Low hemoglobin

A. Low platelet count ?

A nurse is preparing a community education program 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 earring foods that are contaminated during handling." D. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation."

A. The hepatitis A vaccine is recommended for those who travel, especially military personnel It is also recommended for other at-risk groups. B. CORRECT: Hepatitis B immune globulin is given as part of the 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. C. Hepatitis A is acquired by eating fruits. vegetables, shellfish. or other foods that are contaminated during handling. Hepatitis B is acquired by exposure to blood or body fluids from an infected person. D. Good personal hygiene habits and proper sanitation can help prevent the spread of hepatitis A.

A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Increased blood pressure B. Decreased heart rate C. Yellowing of the skin D. Boardlike abdomen

A. The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of shock, including hypotension. B. The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of shock, including tachycardia. C. The nurse should expect a client who has liver disease to exhibit jaundice, or yellowing of the skin. D. CORRECT: The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a boardlike 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 causes hemorrhaging.

A nurse is providing dietary teaching to 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

A. Vitamin C functions as an antioxidant as well as a coenzyme. It can be associated with prevention of cancer of the stomach. esophagus and colon. However, it does not improve or prevent acute diverticulitis attacks. B. Low-fat foods do not improve or prevent acute diverticulitis attacks. C. CORRECT: The result 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 gastrointestinal tract. D. Low-calorie foods do not improve or prevent acute diverticulitis attacks.

A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention by the nurse? A. A full pitcher of water is sitting on the clients bedside table within the clients reach. B. The disposable feeding bag 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 20 degrees.

A. the nurse should monitor the clients intake and output and should observe the client for manifestations of dehydration, such as dry mucous membranes, thirst, and decreased urinary output. A pitcher of water at the clients bedside does not require intervention by the nurse. B. The clients feeding bag should be changed every 24 hrs. The 200 mL remaining in the bag is sufficient to last until the bag needs to be changed. Because the rate is 75 mL/hr, the nurse will need 150 mL to cover the 2 hr until the bag needs to be changed. The 50 mL left in the bag will ensure that the bag does not run dry, causing air to enter the clients stomach. C. This observation does not require intervention because the feeding is not by gravity, but by a pump. and is set at a constant rate. The clients side-lying position will not affect the pump's rate of flow unless the client is lying on the tubing. D. CORRECT: The head of the bed should be elevated at least 30. (Semi-Fowler's position) while the tube feeding is administered. This position uses gravity to help the feeding move down through the digestive system and lessens the possibility of regurgitation.

Amylase

A nurse is caring for a hospitalized client with acute pancreatitis. After treatment begins, the nurse anticipates that which serum lab value will return to normal within 72h?

Amylase

Which of the following nursing diagnosis might be appropriate for a pt with ulcerative colitis? A. Pain R/T the passage of stones. B. Risk for injury from falling R/T dizziness and low BP immediately after meals. C. Fatigue R/T blood loss caused by frequent bloody stools. D. Risk of injury R/T auto digestion of the pancreas.

C. Fatigue R/T blood loss caused by frequent bloody stools.

You are assigned to a client who is recovering from abdominal surgery. She tells you that the client in the next room has chronic hepatitis and she is afraid she will catch it. Which answer would best help this client? A. "Don't worry. That kind of hepatitis can only be transmitted sexually" B. "There are many kinds of hepatitis. Do you know which one she has?" C. "Hospital staff always use precautions to prevent any possibility of transmission of infectious diseases to other clients" D. "There is no problem, that client is not a carrier of the disease"

C. "Hospital staff always use precautions to prevent any possibility of transmission of infectious diseases to other clients" ??

The physician orders cholestyramine (questran) for the client with cirrhosis. The nurse determines that the drug is effective when the client exhibits which of the following? A. Reduced serum ammonia levels B. Improved clotting ability C. Decreased complaints of pruritus D. Improved serum protein levels

C. Decreased complaints of pruritus

The nurse is providing care for a patient who just had a paracentesis to treat ascites. Which of the following findings indicate that the procedure was effective? A. Increased heart rate B. Presence of a fluid wave C. Decreased shortness of breath D. Post procedure weight unchanged from pre procedure weight

C. Decreased shortness of breath

The nurse is providing discharge teaching for a patient who has chronic hepatitis C. Which of the following statements by the patient indicates an understanding of the teaching? A. "I will decrease my intake of calories." B. "I will need treatment for 3 months" C. "I will avoid alcohol until i am no longer contagious" D. "I will avoid medications that contain acetaminophen"

D. "I will avoid medications that contain acetaminophen"

A client is diagnosed with Hepatitis A (HAV). Which of the following should the nurse include in client education? A. "This type of hepatitis can now be cured by using a new medication every day for 12 weeks." B. "You cannot transmit this type of Hepatitis to others unless you have unprotected sex." C. "It's just fine to continue working as a food handler as long as you wear gloves." D. "You and everyone in your household should preform good handwashing."

D. "You and everyone in your household should preform good handwashing."

A nurse is completing an admission assessment of a client who has pancreatitis. which of the following is an expected finding? 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 left shoulder

D. Epigastric pain radiating to left shoulder

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in 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

D. Epigastric pain radiating to the left shoulder

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to be reported to the provider? A. A history of cholelithiasis B. Serum amylase levels three times greater than the expected value C. Client report of severe pain radiating to the back that is rated at an "8" D. Hand spasms present when blood pressure is checked

D. Hand spasms present when blood pressure is checked "trouso's sign"

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. Initiate contact precautions. B. Weigh the client weekly. C. Measure abdominal girth 7.5 cm (3 in) above the umbilicus. D. Provide a high-calorie, high-carbohydrate diet.

D. Provide a high-calorie, high-carbohydrate diet.

Esophagogastro-duodenoscopy:

Examination of the esophagus, stomach, and duodenum through an endoscope to inspect, treat, or obtain specimens from any of the upper GI structures.

A nurse is caring for a client with a history of Laennecs cirrhosis who is admitted to the hospitl with manifestations of hepatic encephalopathy. The client denies consuming alcohol. The nurse anticipates that which of the following diagnostic enzymes tests will be ordered to investigate the possibility of alcohol abuse?

GGT

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?

Prothrombin time

A client returns to the nursing unit 1 hr following physical therapy. The nurse notes that the infusion pump for the client's total parenteral nutrition is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following?

Shakiness and diaphoresis

A nurse is assessing 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. Bowel sounds increased in frequency and pitch c. Rigid abdomen d. Emesis of undigested food

c. Rigid abdomen

The common adverse effects of magnesium hydroxide:

cramps, Diarrhea, and nausea Caused by overactive GI activity

Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."

a Rationale: Patients who use an as-needed antacid should do so 1 to 3 hours after eating. Teach patients that the increased saliva production associated with chewing gum will help with GERD symptoms. The patient should not eat meals within 3 hours of bedtime. Some foods, such as red wine, decrease lower esophageal sphincter pressure and aggravate symptoms. Milk increases gastric acid secretion. There is no need for the patient to limit protein intake.

A nurse is caring for a client who has a history of cirrhosis and is 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)

a. Gamma-glutamyl transferase (GGT)

A nurse is caring for a client who is 4 hr 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 (101.1° F) d. Oxygen saturation 92%

a. Right shoulder pain

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

a. Wheat toast

The diet restrictions that should be taught for treatment of peptic ulcers:

avoiding Highly acidic, Spicey foods, alcohol, & caffeine

A nurse is caring for a client who is 2 days postoperative 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

d. Clear liquids

d. Diaphoresis

M.J. calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to a. administer antiemetic drugs and observe skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs. d. offer her mother large quantities of Gatorade to decrease the risk of sodium depletion.

b Rationale: Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. The elderly are particularly susceptible to the central nervous system (CNS) side effects of antiemetic drugs; these drugs may produce confusion. Dosages should be reduced and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances. High-protein drinks and high-sodium liquids may be contraindicated.

In preparing a patient for a colonoscopy, the nurse explains that a. a signed permit is not necessary. b. sedation may be used during the procedure. c. only one cleansing enema is necessary for preparation. d. a light meal should be eaten the day before the procedure.

b Rationale: Sedation is induced during a colonoscopy. A signed consent form is necessary for a colonoscopy. A cathartic or enema is administered the night before the procedure, and more than one enema may be necessary. Patients may need to be kept on clear liquids 1 to 2 days before the procedure.

Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing a. beef. b. meat and milk. c. poultry and eggs. d. home-preserved vegetables.

b Rationale: Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the a. inhibition of secretin release. b. release of bicarbonate by the pancreas. c. release of pancreatic digestive enzymes. d. release of gastrin by the duodenal mucosa

b Rationale: The hormone secretin stimulates the pancreas to secrete fluid with a high concentration of bicarbonate. This alkaline secretion enters the duodenum and neutralizes acid in the chyme.

A nurse is assessing 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

b. Anorexia

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 semi-Fowler's position. c. Cleanse the skin around the tube site. d. Aspirate the tube for residual contents.

b. Place the client in semi-Fowler's position.

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings. b. extension of the tumor into the aorta. c. leakage of fluids into the mediastinum. d. esophageal perforation with fistula formation into the lung.

c Rationale: After esophageal surgery, the nurse should observe the patient for signs of leakage into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.

The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting cells of the gastric mucosa.

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

The nurse teaching young adults about behaviors that put them at risk for oral cancer includes a. discouraging use of chewing gum. b. avoiding use of perfumed lip glass. c. avoiding use of smokeless tobacco. d. discouraging drinking of carbonated beverages.

c Rationale: Oral cancer has several predisposing risks factors: • Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression • Tongue: tobacco, alcohol, chronic irritation, and syphilis • Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection)

When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is a. "What is your usual bowel elimination pattern?" b. "What percentage of your income is spent on food?" c. "Have you traveled to a foreign country in the last year?" d. "Do you have diarrhea when you are under a lot of stress?"

c Rationale: When assessing gastrointestinal function in relation to the health perception-health management pattern, the nurse should ask the patient about recent foreign travel with possible exposure to hepatitis, parasitic infestation, or bacterial infection.

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 hr after treatment begins? a. Aldolase b. Lipase c. Amylase d. Lactic dehydrogenase

c. Amylase

A nurse is providing dietary teaching to 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

c. Foods high in fiber

A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 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 20°.

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