GI med surg, Chapter 22: PrepU - Nursing Management: Patients With Oral and Esophageal Disorders and Patients Receiving Gastrointestinal Intubation, Enteral, and Parenteral Nutrition, Ch. 22: Oral & Esophagus PREPU, Med Surg. Chapter 45 Digestive and...

The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is: a. loose, watery stools. b. increased urination. c. elevated blood pressure. d. decreased pulse rate.

*a. loose, watery stools. * When the client indicates that loose, watery stools are a sign/symptom of metabolic complications, the nurse evaluates that the client understands the teaching of metabolic complications. *Signs and symptoms of metabolic complications from PN* include: neuropathies, changes in mental activity, diarrhea, nausea, skin changes, and decreased urine output.

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? a. Peptic ulcer disease b. Esophageal cancer c. Gastroesophageal reflux disease d. Diverticulitis

*c. gastroesophageal reflux disease* Symptoms may include *pyrosis* (burning sensation in the esophagus), *dyspepsia* (indigestion), regurgitation, *dysphagia* or odynophagia (pain on swallowing), hypersalivation, and esophagitis.

The nurse confirms placement of a client's nasogastric (NG) tube using a combination of visual and pH assessment of the aspirate. The nurse determines that the NG tube remains properly placed when the pH of the aspirate is 1- alkaline 2- acidic 3- neutral 4- unmeasurable

2

The nurse is creating a plan of care for a client who is not able to tolerate brushing his teeth. The nurse includes which mouth irrigation in the plan of care? 1- Dextrose and water 2- Baking soda and water 3- Full-strength peroxide 4- Mouthwash and water

2

Which condition is caused by improper catheter placement and inadvertent puncture of the pleura? 1- air embolism 2- pneumothorax 3- sepsis 4- fluid overload

2

A client has been receiving radiation therapy to the lungs and now has erythema, edema, and pain of the mouth. What instruction will the nurse give to the client? 1- Use a hard-bristled toothbrush. 2- Rinse with an alcohol-based solution. 3- Brush and floss daily. 4- Continue with the usual diet.

3

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? 1- Dry skin 2- Slowed heart beat 3- Diarrhea 4- Hyperglycemia

3

Insertion of an NG tube for decompression

A client has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse's priority intervention?

Dizziness Sweating Tachycardia

A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply.

Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food.

A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client?

Diarrhea

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?

Daily weights and abdominal girth measurement

A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments?

A nurse is providing discharge teaching to a partner of a patient who has a new diagnosis of hepatitis A which of the following instruction should the nurse include in the teaching during this illness she may take acetaminophen for fevers or discomfort courage her to eat foods that are high in carbohydrates The provider will prescribe medication to help her liver heal faster have her perform moderate exercise to restore her strength more quickly

Encourage her to eat foods that are high in carbohydrates the patient's diet should be high in carbohydrates and calories with only moderate amounts of proteins and fat especially if nausea is present the patient should not take acetaminophen or any other over-the-counter medications without checking with the doctor acetaminophen and many OTC medications are metabolized by the liver there are no approved medications to treat hepatitis A While complete bed rest is usually unnecessary the client should alternate periods of rest with light activity patient should be encouraged increased activity gradually

Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube?

Enteric-coated tablets

A patient is starting therapy with psyllium (Metamucil). You explain to the patient that psyllium will have which of the following therapeutic effects? (Select all that apply.) Relieve constipation Increase gastric pH Reduce diarrhea Decrease gastric acid secretion Alleviate nausea

Relieve constipation Reduce diarrhea Psyllium, a bulk laxative, treats constipation and reduces diarrhea by increasing bulk to create soft, formed stools. It helps patients who have diverticulosis, irritable bowel syndrome, and fecal ostomies. Aluminum hydroxide (Amphojel), an antacid, increases gastric pH. Omeprazole (Prilosec), a proton pump inhibitor, decreases the secretion of gastric acid. Ondansetron (Zofran), a serotonin antagonist, helps relieve nausea and vomiting.

Smoking history of 20 years Male gender Previous treatment for gastroesophageal reflux disease

The nurse is reviewing the chart of a client with swallowing problems. Which factors would raise suspicion that the client has cancer of the esophagus? Select all that apply.

The client will change positions frequently throughout the procedure.

The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized?

myocutaneous flap

This flap involves the transfer of intact muscle, subcutaneous tissue and skin as a single unit rotated on a relatively narrow blood supply of the muscle.

A patient has a gastric sump tube inserted and attached to low intermittent suction. The physician has ordered the tube to be irrigated with 30 mL of normal saline every 6 hours. When reviewing the patient's intake and output record for the past 24 hours, the nurse would expect to note that the patient received how much fluid with the irrigation?

120

Promotion of adequate nutrition

A client has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this client's discharge education?

Potassium-rich foods

A client is being treated for prolonged diarrhea. Which foods should the nurse encourage the client to consume?

Keep the vent lumen above the client's waist

A client is concerned about leakage of gastric contents out of the gastric sump tube the nurse has just inserted. What would the nurse do to prevent reflux gastric contents from coming through the blue vent of a gastric sump tube?

Tube feedings are advised for a client who is recovering from oral surgery. The nurse manages the tube feedings to minimize the risk of aspiration. Which measures should the nurse include in the care plan to *reduce the risk of aspiration*? Select all that apply. a. Place client in semi-Fowler's position during and 30 to 60 minutes after an intermittent feeding. b. Check tube placement and gastric residual prior to feedings. c. Administer 15 to 30 mL of water before and after medications and feedings. d. Change the tube feeding container and tubing.

*a. Place client in semi-Fowler's position during and 30 to 60 minutes after an intermittent feeding. b. Check tube placement and gastric residual prior to feedings* Proper positioning prevents regurgitation. Checking tube placement and gastric residual prior to feedings is another important measure because it prevents improper infusion and vomiting.

A nurse is conducting morning assessments of several medical patients and has entered the room of a patient who has a nasogastric (NG) tube in situ. Immediately, the nurse observes that the tube has become unsecured from the patient's nose and the mark at the desired point of entry is now approximately 8 inches from the patient's nose. How should the nurse best respond to this assessment finding? a. Reinsert the NG tube and arrange for x-ray confirmation of placement. b. Remove the NG tube and obtain an order for reinsertion. c. Reinsert the NG tube and monitor the patient closely for signs of aspiration. d. Reinsert the NG tube and aspirate stomach contents to confirm correct placement.

*a. Reinsert the NG tube and arrange for x-ray confirmation of placement. * If the patient's NG tube becomes unsecured, placement should be reconfirmed; the most accurate form of confirmation is an x-ray.

A patient has been NPO for two days anticipating surgery which has been repeatedly delayed. In addition to risks of nutritional and fluid deficits, the nurse determines that this patient is at the greatest risk for: a. altered oral mucous membranes. b. physical injury. c. ineffective social interaction. d. confusion.

*a. altered oral mucous membranes.* Not drinking anything by mouth can result in drying of the oral mucous membranes, compromising their integrity. Being NPO is unrelated to physical injury or ineffective social interaction. Confusion is unlikely to result from the client's NPO status.

Semi-Fowler position is maintained for at least which timeframe following completion of an intermittent tube feeding? a. 30 minutes b. 1 hour c. 90 minutes d. 2 hours

*b. 1 hour* The semi-Fowler position is necessary for a a nasogastric (NG) feeding, with the client's head elevated at least 30 to 45 degrees to reduce the risk for reflux and pulmonary aspiration. This position is maintained for at least 1 hour after completion of an intermittent tube feeding and is maintained at all times for clients receiving continuous tube feedings.

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach? a. 6 b. 4 c. 10 d. 8

*b. 4* Gastric secretions are acidic and have a pH ranging from 1 to 5. Intestinal aspirate is typically 6 or higher; respiratory aspirate is more alkaline, usually 7 or greater

An older woman has been receiving enteral feeds by nasogastric (NG) tube for the past several days due to a decrease in her level of consciousness. How can the nurse best assess the patient's tolerance of the current formula and rate of delivery? a. Carefully document the number and consistency of bowel movements. b. Aspirate and measure the stomach contents on a regular basis. c. Monitor the patient's skin turgor and the color of her sclerae. d. Perform regular chest auscultation and monitor her oxygen saturation levels.

*b. Aspirate and measure the stomach contents on a regular basis. * Patient tolerance of liquid enteral nutrition is determined by residual measurement. The *volume of aspirate indicates the rate at which the patient is digesting the feedings and how quickly the chyme is passing into the small intestine*. Respiratory assessment is important because of the risk of aspiration, but doing so does not necessarily determine tolerance of the feeds. Skin turgor is not an accurate assessment in older adults. Bowel patterns are a significant assessment, but these do not necessarily indicate tolerance or a lack thereof.

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse? a. Reinsert the nasogastric tube to the stomach. b. Notify the surgeon about the tube's removal. c. Place the nasogastric tube to the level of the esophagus. d. Document the discontinuation of the nasogastric tube.

*b. Notify the surgeon about the tube's removal* If the nasogastric tube is removed accidently in a client who has undergone esophageal or gastric surgery, it is usually replaced by the health care provider. Care is taken to avoid trauma to the suture line. The nurse will not insert the tube to the esophagus or to the stomach in this situation. The nurse needs to do more than just document its removal. The nurse needs to notify the health care provider who will make a determination of leaving out or inserting a new nasogastric tube.

The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every: a. 12 hour b. shift c. 24 hours d. 1 hour

*b. shift* Each nurse caring for the client is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the client is extremely restless or there is basis for rechecking the tube due to other client activities. Checking for placement every 12 or 24 hours does not meet the standard of care for the client receiving continuous tube feedings.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a."Lie down after meals to promote digestion." b. "Avoid coffee and alcoholic beverages." c. "Take antacids with meals." d. "Limit fluid intake with meals."

*b.Avoid coffee and alcoholic beverages.* To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? a. Spray the oropharynx with an anesthetic spray. b. Have the patient maintain a backward tilt head position. c. Allow the patient to sip water as the tube is being inserted. d. Have the patient eat a cracker as the tube is being inserted.

*c. Allow the patient to sip water as the tube is being inserted.*

A 26-year-old man experienced severe burns in an industrial accident and has been admitted to the burn unit of a tertiary care hospital. In the days since the accident, the care team has been pleased with the trajectory of the man's recovery, and they estimate that he will require parenteral nutrition for 2 to 3 months. Which of the following access devices is most likely appropriate for this patient's nutritional needs? a. Implanted port b. Tunneled central catheter c. Peripherally inserted central catheter (PICC) d. Nontunneled central catheter

*c. Peripherally inserted central catheter (PICC) * PICCs are used for feedings of a few weeks to a few months. Implanted ports and tunneled central lines are for longer-term use, and nontunneled central catheters are used for short-term (<6 weeks) IV therapy.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? a. Dry skin b. Slowed heart beat c. Diarrhea d. Hyperglycemia

*c. diarrhea* Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces: - weakness, - dizziness, - sweating, - palpitations, - abdominal cramps, and - diarrhea, - hypotension which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

The most common symptom of esophageal disease is a. nausea. b. vomiting. c. dysphagia. d. odynophagia.

*c. dysphagia* This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

The nurse prepares to administer all of a client's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes which type of oral medication on the client's medication administration record? a. simple compressed tablets b. buccal or sublingual tablets c. enteric-coated tablets d. soft, gelatin capsules filled with liquid

*c. enteric-coated tablets * Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change in the form of medication is necessary for clients with tube feedings. Simple compressed tablets may be crushed and dissolved in water for clients receiving oral medications by feeding tube. Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended to the client undergoing tube feedings. The nurse may make an opening in the capsule and squeeze out contents for administration by feeding tube.

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? a. Remove the tape from the nose of the client. b. Withdraw the tube gently for 6 to 8 inches. c. Provide oral hygiene. d. Flush with 10 mL of water.

*d. Flush with 10 mL of water.* Before a nasogastric tube is removed, the nurse flushes the tube with 10 mL of water or normal saline to ensure that the tube is free of debris and away from the gastric tissue. The tape keeps the tube in the correct position while flushing is occurring and is then removed from the nose. The nurse then withdraws the tube gently for 6 to 8 inches until the tip reaches the esophagus, and then the remainder of the tube is withdrawn rapidly from the nostril. After the tube is removed, the nurse provides oral hygiene.

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

*d. Weakness, diaphoresis, diarrhea 90 minutes after eating* Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating. Elevated temperature and chills can be a significant finding for infection and should be reported. Constipation with rectal bleeding is not indicative of dumping syndrome.

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. What is the nurse's best intervention? 1- Instruct the client to swish prescribed nystatin solution for 1 minute. 2- Remove the plaque from the mouth by rubbing with gauze. 3- Provide saline rinses prior to meals. 4- Encourage the client to ingest a soft or bland diet.

1

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and would make a recommendation when noticing which circumstance? 1- No land line; cell phone available and taken by family member during working hours 2- Water of low pressure that can be obtained through all faucets 3- Little food in the working refrigerator 4- Electricity that loses power, usually for short duration, during storms

1

A nurse is conducting morning assessments of several medical patients and has entered the room of a patient who has a nasogastric (NG) tube in situ. Immediately, the nurse observes that the tube has become unsecured from the patient's nose and the mark at the desired point of entry is now approximately 8 inches from the patient's nose. How should the nurse best respond to this assessment finding? 1- Reinsert the NG tube and arrange for x-ray confirmation of placement. 2- Remove the NG tube and obtain an order for reinsertion. 3- Reinsert the NG tube and monitor the patient closely for signs of aspiration. 4- Reinsert the NG tube and aspirate stomach contents to confirm correct placement.

1

A patient has been NPO for two days anticipating surgery which has been repeatedly delayed. In addition to risks of nutritional and fluid deficits, the nurse determines that this patient is at the greatest risk for: 1- altered oral mucous membranes. 2- physical injury. 3- ineffective social interaction. 4- confusion.

1

An elderly patient comes into the emergency department complaining of an earache. The patient has an oral temperature of 100.2° F. Otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next? 1- Palpate the patient's parotid glands to detect swelling and tenderness. 2- Assess the temporomandibular joint for evidence of a malocclusion. 3- Test the integrity of the 12th cranial nerve by asking the patient to protrude his tongue. 4- Inspect the patient's gums for bleeding and hyperpigmentation.

1

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach? 1- 4 2- 6 3- 8 4- 10

1

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

1

The nurse cares for a client who receivies continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct? 1- Monitoring the feeding closely. 2- Increasing the feeding rate. 3- Lowering the head of the bed. 4- Flushing the feeding tube.

1

The nurse caring for a patient who is being discharged home after a radical neck dissection has worked with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection? 1- Indicates acceptance of altered appearance and demonstrates positive self-image 2- Freely expresses needs and concerns related to postoperative pain management 3- Compensates effectively for alteration in ability to communicate related to dysarthria 4- Demonstrates effective stress management techniques to promote muscle relaxation

1

The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is 1- loose, watery stools. 2- increased urination. 3- elevated blood pressure. 4- decreased pulse rate.

1

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. How is aphthous stomatitis best described by the nurse? 1- A canker sore of the oral soft tissues 2- An acute stomach infection 3- Acid indigestion 4- An early sign of peptic ulcer disease

1

Which of the following is one of the first clinical manifestations of esophageal cancer? 1- Increasing difficulty in swallowing 2- Sensation of a mass in throat 3- Foul breath 4- Hiccups

1

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply. 1- Daily weights 2- Intake and output monitoring 3- Calorie counts for oral nutrients 4- Daily transparent dressing changes 5- Strict bedrest

1,2,3

A 59-year-old woman with a recent history of heartburn, regurgitation, and occasional dysphagia has been diagnosed with a sliding hiatal hernia following an upper GI series. The nurse is providing patient education about the management of this health problem. What should the nurse suggest as a management strategy to this patient? 1- Minimizing her intake of highly spiced foods and dairy products 2- Remaining upright for at least 1 hour following each meal 3- Abstaining from alcohol 4- Drinking one to two glasses of water before and after each meal

2

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? 1- Slow the current infusion rate so that it will last until the new solution arrives. 2- Hang a solution of dextrose 10% and water until the new solution is available. 3- Have someone go to the pharmacy to obtain the new solution. 4- Begin an infusion of normal saline in another site to maintain hydration.

2

A patient with a recent diagnosis of esophageal cancer has undergone an esophagectomy and is currently receiving care in a step-down unit. The nurse in the step-down unit is aware of the specific complications associated with this surgical procedure and is consequently monitoring the patient closely for signs and symptoms of: 1- Increased intracranial pressure (ICP) 2- Aspiration pneumonia 3- Abdominal aortic aneurysm (AAA) 4- Dyspepsia

2

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? 1- Ensure adequate hydration with additional water. 2- Provide frequent mouth care. 3- Keep the feeding formula refrigerated. 4- Flush the tube with water before adding the feedings.

2

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? 1- "Lie down after meals to promote digestion." 2- "Avoid coffee and alcoholic beverages." 3- "Take antacids with meals." 4- "Limit fluid intake with meals."

2

A nurse is caring for a patient was two days postop following gastric surgery and has an injured NG tube inserted which of the following findings should the nurse report to the provider dryness of the mucous membranes hypo active bowel sounds in all quadrants 200 ML of bright red drainage from the NG tube suction set a continuous low suction

200 ML of right red drainage from the NG tube drainage should be either yellow green color or clear right red drainage indicates blood loss this could be the result of a disrupted suture line or other internal bleeding this is an emergency the nurse should expect hypo active bowel sounds following gastric surgery resumption of bowel sounds occurs slowly and indicates a return of peristalsis which promotes healing when it returns the NG tube can be removed the NG suction should be low continuous suction suction unless otherwise noted by provider the nurse can check the suction canister for drainage and the patient stomach for bloating and dissension to determine if decompression is effective

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, what should the nurse assign highest priority to? 1- Helping the client cope with body image changes 2- Ensuring adequate nutrition 3- Maintaining a patent airway 4- Preventing injury

3

Rebound hypoglycemia is a complication of parenteral nutrition caused by 1- glucose intolerance. 2- fluid infusing rapidly. 3- feedings stopped too abruptly. 4- a cap missing from the port.

3

Select the assessment finding that the nurse should immediately report, post radical neck dissection. 1- Temperature of 99°F 2- Pain 3- Stridor 4- Localized wound tenderness

3

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. The client has the following oral medications prescribed: furosemide, digoxin, enteric coated aspirin, and vitamin E. The nurse would withhold which medication? 1- furosemide 2- digoxin 3- enteric coated aspirin 4- vitamin E

3

The nurse is checking placement of a nasogastric (NG) tube that has been in place for 2 days. The tube is draining green aspirate. What does this color of aspirate indicate? 1- The tube is in the pleural space. 2- The tube is the intestine. 3- The tube is in the stomach. 4- The tube is in the esophagus.

3

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length? 1- A length of 50 cm (20 in) 2- A point that equals the distance from the nose to the xiphoid process 3- The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process 4- The distance determined by measuring from the tragus of the ear to the xiphoid process

3

The nurse prepares to administer all of a client's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes which type of oral medication on the client's medication administration record? 1- simple compressed tablets 2- buccal or sublingual tablets 3- enteric-coated tablets 4- soft, gelatin capsules filled with liquid

3

The nurse working in the recovery room is caring for a client who had a radical neck dissection. The nurse notices that the client makes a coarse, high-pitched sound upon inspiration. Which intervention by the nurse is appropriate? 1- Document the presence of stridor 2- Administer a breathing treatment 3- Notify the physician 4- Lower the head of the bed

3

Total parenteral nutrition (TPN) has been ordered for a male patient who has been experiencing a severe and protracted exacerbation of Crohn's disease. Before TPN can be initiated, the patient requires: 1- A random blood glucose level of ≤160 mg/dL 2- Angiography to determine the patency of his vascular system 3- The insertion of a central venous access device 4- A fluid challenge to assess his renal function

3

A client has a radical neck dissection to treat cancer of the neck. The nurse develops the care plan and includes all the following diagnoses. The nurse identifies the highest priority diagnosis as 1- Impaired tissue integrity related to surgical intervention 2- Imbalanced nutrition: less than body requirements, related to treatment 3- Risk for infection related to surgical intervention 4- Ineffective airway clearance related to obstruction by mucus

4

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention? 1- Serosanguineous drainage on the dressing 2- Foley catheter bag containing 500 ml of amber urine 3- A piggyback infusion of levofloxacin 4- The client lying in a lateral position, with the head of bed flat

4

A patient who is HIV positive comes to the clinic and is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are? 1- Aphthous stomatitis 2- Nicotine stomatitis 3- Erythroplakia 4- Hairy leukoplakia

4

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom? 1- Hiatal hernia 2- Gastroesophageal reflux disease 3- Gastritis 4- Esophageal tumor

4

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach?

4

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? 1- Remove the tape from the nose of the client. 2- Withdraw the tube gently for 6 to 8 inches. 3- Provide oral hygiene. 4- Flush with 10 mL of water.

4

The nurse provides health teaching to inform the client with oral cancer that 1- most oral cancers are painful at the outset. 2- blood testing is used to diagnose oral cancer. 3- a typical lesion is soft and craterlike. 4- many oral cancers produce no symptoms in the early stages.

4

Which is an accurate statement regarding cancer of the esophagus? 1- It is three times more common in women than men in the United States. 2- It is seen more frequently in Caucasian Americans than in African Americans. 3- It usually occurs in the fourth decade of life. 4- Chronic irritation of the esophagus is a known risk factor.

4

Encourage the client to connect with a community-based support group.

A client has been treated in the hospital for an episode of acute pancreatitis. The client has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes. What is the nurse's most appropriate response?

Reduced or absent bile as a result of obstruction impacts digestion

A client is treated for gastrointestinal problems related to chronic cholecystitis. What pathophysiological process related to cholecystitis does the nurse understand is the reason behind the client's GI problems?

An effective means of communicating with the nurse

A client who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the client is alert. What is the client's priority need at this time?

Apply a heating pad to your shoulder for 15 minutes hourly as needed."

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms?

phytonadione (Mephyton).

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:

A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A. Emesis with a coffee-ground appearance B. Increased BP C. Decreased HR D. Bright green stools

A. Emesis with a coffee-ground appearance

When teaching the parents of a toddler about feeding and eating, the nurse should include which of the following safety measures? A. Do not give the child peanut butter B. Have the child drink 28 to 32 oz. of milk daily C. Give the child 8 to 12 oz. of fruit juice daily D. Do not offer the child raw vegetables

D. Do not offer the child raw vegetables

A nurse enters a client's room and notes smoke coming from a wastebasket in the adjacent bathroom. Which of the following actions should the nurse take first? A. Close the door to the client's room B. Attempt to extinguish the fire C. Activate the facility's fire alarm system D. Transport the client to an area away from the smoke

D. Transport the client to an area away from the smoke

You are about to administer ondansetron (Zofran) to a patient to prevent anesthesia-induced nausea and vomiting. You prepare to monitor the patient for which of the following adverse effects of this drug? Bronchospasm Dizziness HTN Anxiety

Dizziness Ondansetron, a serotonin antagonist, can cause dizziness, lightheadedness, and sedation. It is unlikely to cause bronchospasm, hypertension, or anxiety. However, it can cause a headache, so recommend an over-the-counter analgesic for headache pain. This drug can also cause tachycardia and angina in patients who have a history of coronary artery disease.

Bowel perforation

During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring?

A nurse is providing postop teaching about management of dumping syndrome to a patient who has a partial gastrectomy which of the following instructions should the nurse include in the teaching consume at least 4 ounces of fluid with each meal take a short walk after each meal use honey to flavor food such as cereal eat protein with each meal

Eat protein with each meal the nurse instruct the patient to eat meals that are high in protein and fat with a low to moderate carbohydrate content protein should be included in every meal because it delays digestion which helps to reduce the manifestations of dumping syndrome

A nurse is providing teaching to a patient who has constipation which of the following instruction should the nurse include use bismuth subsalicylate regularly consume a low fiber diet eat yogurt with live cultures use suppositories bisacodyl regularly

Eat yogurt with live cultures they contain dietary probiotics would help maintain and promote bottle function

Pancakes with butter and honey, and orange juice

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu?

A nurse is teaching a patient with Barretts esophagus who is scheduled to undergo an 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 an EGD is useful in determining the function of the esophogeal lining and the extent of information potential scarring and structures

Compares exposed tube length with original measurement Visually assesses the color of the aspirate Checks the pH of the gastric contents

A client has a nasogastric tube for continuous tube feeding. The nurse does all the following every shift to verify placement (select all options that apply):

Intrinsic factor

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The health care provider begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption

Enlarged liver size Ascites Hemorrhoids

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.

floor of the mouth

A client is in the initial stages of oral cancer diagnosis and is frightened about the side effects of treatment and subsequent prognosis. The client has many questions regarding this type of cancer and asks where oral cancer typically occurs. What is the nurse's response?

Metoclopramide

A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug?

diuretics albumin

A client with acute pancreatitis has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, lab results indicate hypovolemia. What will the physician order to treat the large amount of protein-rich fluid that has been released into the client's tissues and peritoneal cavity? Select all that apply.

Administering diuretics Implementing fluid restrictions Enhancing client positioning

A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client's fluid volume excess? Select all that apply.

Hairy leukoplakia

A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document?

2 in.

The nurse is assisting a client to drain his continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve?

Fecal incontinence

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

A client has a new order for metoclorpramide. What potential side effects should the nurse educate the client about? 1- Extrapyramidal 2- Peptic ulcer disease 3- Gastric slowing 4- Nausea

1

A patient has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube?

10% glucose and tap water

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is: 1- H2-receptor antagonists. 2- Antispasmodics 3- Proton pump inhibitors. 4- Antacids

3

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate?

*Hang a solution of dextrose 10% and water until the new solution is available* The infusion rate of the solution should not be increased or decreased; if the solution is to run out, a solution of 10% dextrose and water is used until the next solution is available. Having someone go to the pharmacy would be appropriate, but there is no way to determine if the person will arrive back before the solution runs out. Starting another infusion would be inappropriate. Additionally, the infusion needs to be maintained through the central venous access device to maintain patency.

Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? Metoclopramide (Reglan) Famotidine (Pepcid) Nizatidine (Axid) Esomeprazole (Nexium)

*Metoclopramide (Reglan)* Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.

The client has just had a central line inserted for parenteral nutrition. The client is awaiting transport to the Radiology Department for catheter placement verification. The client reports feeling anxious. Respirations are 28 breaths/minute. The first action of the nurse is.. a. Auscultate lung sounds. b. Position client flat in bed. c. Elevate the head of the bed. d. Consult with the healthcare provider.

*a. Auscultate lung sounds. * Following placement of a central line, the *client is at risk for a pneumothorax*. The client's report of *anxiety* and *increased respiratory rate* may be the *first signs and symptoms of a pneumothorax*. The nurse first assesses the client by auscultating lung sounds. Other actions include placing the client in Fowler's position and consulting with the healthcare provider about findings.

A nurse inspects the Stensen duct of the parotid gland to determine inflammation and possible obstruction. What area in the oral cavity would the nurse examine? a. Buccal mucosa next to the upper molars b. Dorsum of the tongue c. Roof of the mouth next to the incisors d. Posterior segment of the tongue near the uvula

*a. Buccal mucosa next to the upper molars* The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

A client experienced surgical resection of a tumor of the esophagus. After recovery from the anesthesia, what will the nurse include in the postoperative care plans? Select all that apply. 1- Assess lung sounds every 4 hours and prn. 2- Replace the nasogastric tube if the tube becomes dislodged. 3- Monitor drainage in the closed chest drainage system. 4- Verify rhythm on the cardiac monitoring system. 5- Maintain the client in a side-lying position.

1,3,4

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, what must the nurse remain alert for? 1- diaphoresis, vomiting, and diarrhea. 2- manifestations of electrolyte disturbances. 3- manifestations of hypoglycemia. 4- constipation, dehydration, and hypercapnia.

1

administered over a period of less than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome? 1- Administer the feeding at a warm temperature to decrease peristalsis. 2- Administer the feeding by bolus to prevent continuous intestinal distention. 3- Administer the feeding with about 100 mL of fluid to dilute the high carbohydrate concentration. 4- Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.

4

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

42

Hemorrhoids

A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse's assessment should focus on what potential cause?

Acute gastritis

A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems?

Excrete bile

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?

acute cholecystitis

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:

These are less likely to cause dumping syndrome.

A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage?

Early diagnosis and treatment of gastroesophageal reflux disease

A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action should the nurse recommend as having the greatest potential to prevent esophageal cancer?

Tachycardia Diarrhea Diaphoresis

A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply.

Change the dressing no more than weekly.

A nurse is aware of the high incidence of catheter-related bloodstream infections in clients receiving parenteral nutrition. What nursing action has the greatest potential to reduce catheter-related bloodstream infections?

Strategies for avoiding irritating foods and beverages

A nurse is caring for a client hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize?

Daily weights Intake and output monitoring Calorie counts for oral nutrients

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply.

Clotted or displaced catheter Pneumothorax Hyperglycemia Line sepsis

A nurse is creating a care plan for a client who is receiving parenteral nutrition. The client's care plan should include nursing actions relevant to what potential complications? Select all that apply.

Tachycardia Hypotension A rigid, board-like abdomen

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply.

IV administration of octreotide (Sandostatin)

A nurse is participating in the emergency care of a client who has just developed variceal bleeding. What intervention should the nurse anticipate?

Masks Skin antiseptic Alcohol wipes Sterile gauze pads

A nurse is preparing to perform a dressing change to the site of a client's central venous catheter used for parenteral nutrition. Which equipment and supplies would the nurse need to gather? Select all that apply.

Dumping syndrome

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect?

Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.

A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate?

Clay-colored feces Pruritus Jaundice

A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.)

Ultrasonography

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for?

An abnormal glucose tolerance Glucosuria Hyperglycemia

A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply).

Parotid

A patient reports an inflamed salivary gland below the right ear. The nurse documents probable inflammation of which gland?

Achalasia

A patient tells the nurse that it feels like food is "sticking" in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate?

Transjugular intrahepatic portosystemic shunting (TIPS

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?

A nurse is developing a plan of care for a client who has GERD. The nurse should plan to monitor the client for which of the following complications? A. Aspiration B. Infection C. Anemia D. Weight loss

A. Aspiration

low platelet count.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to:

Which of the following are appropriate choices for a patient prescribed a full liquid diet? Select all that apply. A. Plain yogurt B. Custard C. Ice cream D. Mashed potatoes E. Pureed meat F. Gelatin

A. Plain yogurt B. Custard C. Ice cream F. Gelatin

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

A. "Empty your ostomy pouch when it becomes full."

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

A. Ask the client to empty his bladder before the procedure.

To assess a stroke patient for complications secondary to inadequate swallowing, the nurse should do which of the following? A. Auscultate the patient's lungs B. Place the tip of a tongue depressor on the patients posterior tongue C. With a penlight, inspect the patient's uvula an the soft palate D. Place fingers on the patient's throat at the level of the larynx and ask him to swallow

A. Auscultate the patient's lungs

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

A. Blumberg's sign

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

A. Cover the client's wound with a sterile, moist dressing

A nurse is teaching a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? A. Digesting fats B. Producing chyme C. Stimulating gastric acid secretion D. Providing energy

A. Digesting fats

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

A. Eat crackers and yogurt regularly

A nurse is caring for a client with a history of cirrhosis who has been 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 teaching dietary modification strategies to a client who has been newly diagnosed with cirrhosis. Which of the following foods should the nurse recommend? A. Grilled chicken B. Potato soup C. Fish sticks D. Baked ham

A. Grilled chicken

A nurse is performing a nasogastric intubation. Which of the following actions should the nurse take immediately after inserting the tube to the predetermined length? A. Inspect the oropharnx with a penlight and a tongueblade B. Obtain an x-ray examination of the chest and abdomen C. Tape the tube securely in place with a tube holder device D. Aspirate gastric contents

A. Inspect the oropharynx with a penlight and a tongueblade

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

A. Irrigate the tube with normal saline solution

To prevent a common complication of continuous enteral feedings, a nurse should A. Limit the time the formula hangs to 4 hr. B. Chill the formula prior to administration C. Deliver the formula at a brisk rate D. Allow the feeding bag to empty before refilling it

A. Limit the time the formula hangs to 4 hr.

A nurse is admitting a client who has cirrhosis. Which of the following prescriptions should the nurse anticipate? Select all that apply. A. Obtain the client's PT and INR measurements B. Administer lactulose 30mL PO 4 times daily C. Obtain daily weight and abdominal girth measurements D. Administer a daily multivitamin E. Place the client on high protein diet

A. Obtain the client's PT and INR measurements B. Administer lactulose 30mL PO 4 times daily C. Obtain daily weight and abdominal girth measurements D. Administer a daily multivitamin

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

A. Oranges and tomatoes

A nurse is preparing to administer a cleansing enema to a patient who is prone to fecal incontinence due to poor sphincter control and is unlikely to retain the enema solution. Which of the following interventions is appropriate for this patient? A. Place the patient in the dorsal recumbent position B. Administer the enema while the patient sits on the toilet. C. Administer an antidiarrheal medication 3 hours prior to the enema D. Instill 200mL of fluid at 15-minute intervals times four

A. Place the patient in the dorsal recumbent position on a bed pain.

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

A. Prevents excessive pressure on suture lines

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 in a provider's office is assessing a client with GERD. The nurse should expect the client to report which of the following manifestations? Select all that apply. A. Regurgitation B. Nausea C. Belching D. Heartburn E. Weight loss

A. Regurgitation B. Nausea C. Belching D. Heartburn

Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach

After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. How would the nurse explain this procedure to the family?

Abdominal surgery

After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction?

Which of the following drugs has protocols that require patients to meet specific risk management criteria and sign treatment agreement before the HCP can administer the drug? Alosetron (Lotronex) Lubiprostone (Amitiza) Sulfasalazine (Azulfidine) Azathioprine (Imuran)

Alosetron (Lotronex) Patients who take alosetron, a serotonin 5-HT3 receptor antagonist, can develop severe constipation that can lead to impaction, bowel obstruction, perforation, and potentially fatal ischemic colitis. Because of these risks, health care professionals must inform patients of the benefits and risks of the drug therapy, and patients must sign a treatment agreement.

A nurse is caring for a patient who has acute pancreatitis which of the following serum laboratory values should return to the expected reference range within 72 hours of treatment beginning Aldolase Lipase Amylase lactic dehydrogenase

Amylase pancreatitis is the most common diagnosis for marked elevations and serum amylase serum amylase begins to increase about 3 to 6 hours following the onset of acute pancreatitis the amylase levels peek in 20 to 30 hours and returns to the expected reference range within 2 to 3 days

Increased fiber intake Reduced fat intake

An adult client has been diagnosed with diverticular disease after ongoing challenges with constipation. The client will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply.

Exhibiting hemoglobin A1C 8.2

An elderly client states, "I don't understand why I have so many caries in my teeth." What assessment made by the nurse places the client at risk for dental caries?

HCP should question the use of dimenhydrinate for patient who has which of the following disorders? Angle-closure glaucoma Hypertension Diabetes mellitus Hyperthyroidism

Angle-closure glaucoma Dimenhydrinate, an antihistamine, is inappropriate for patients who have angle-closure glaucoma because it has anticholinergic properties. Anticholinergic drugs can increase intraocular pressure, making angle-closure glaucoma a contraindication for the use of the drug.

HCP caring for patient about to being taking ranitidine (Zantac) for GERD. HCP should tell the patient to take certain precautions when taking which of the following OTC drugs? Antidiarrheals Ginkgo biloba St. John's wort Antacids

Antacids Antacids can decrease the absorption of ranitidine, a histamine2-receptor antagonist. The health care professional should tell the patient to allow at least 1 hr between taking ranitidine and taking an antacid.

Evaluate the client's understanding of the procedure.

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene?

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to

Auscultate lung sounds every 4 hours.

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

B. 9

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

When checking for nasogastric tube placement, the nurse should conduct which of the following procedures? A. Instill 20mL of air into the tube and listen for a whooshing sound B. Aspirate stomach contents and check the pH. C. Aspirate stomach contents and check their color D. Auscultate lung sounds

B. Aspirate stomach contents and check the pH.

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

B. Bending over

A nurse is obtaining a guaiac test from a client. This test is performed to detect which of the following? A. Fecal material in vomit B. Blood in stool C. Infestation of parasites D. Mircroorganisms in urine

B. Blood in stool

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

B. Cabbage and peaches

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

B. Diaphoresis D. Palpitations E. Shakiness

Which of the following dietary modifications should an adolescent engaging in sports implement? A. Increase fats to 30% to 40% of daily kilocalories B. Drink water before and after sports activities C. Keep protein intake at same level D. Decrease carbohydrates to 30% to 40% of daily kilocalories

B. Drink water before and after sports activities

A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse teach the client to perform? Select all that apply. A. Use antimicrobial ointment on the peristomal skin B. Empty the bag when it is 1/3-1/2 full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water E. Apply the skin barrier while the skin is slightly moist

B. Empty the bag when it is 1/3-1/2 full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water

A nurse is planning an in-service training session regarding nutrition. Which of the following minerals should the nurse identify as involved in oxygen transport? A. Zinc B. Iron C. Phosphorus D. Magnesium

B. Iron

A patient who is postoperative is experiencing abdominal distention and is having difficulty expelling flatus. The nurse should anticipate receiving an order from the provider for which of the following types of enemas? A. Cleansing B. Return-flow C. Medicated D. Oil-retention

B. Return-flow

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

B. Roast chicken and white rice

A nurse in a providers office is assessing a patient was GER de when documenting the patient's history the nurse should expect the client to report symptoms worsening with which of the following actions stair climbing bending over sitting walking

Bending over gastric reflux symptoms are most evident with activities that increase of intra-abdominal pressure example: bending over straining lifting lying down

A nurse is obtaining a guaiac test from a client the test is performed to detect which of the following fecal material in vomit blood in stool infestation of parasites micro organisms in the urine

Blood in stool

A nurse is assessing a patient who had a Cholecystitis which of the following findings should the nurse expect Blumbergs sign Ascites gastrointestinal bleeding Kehrs sign

Blumberg sign the nurse should expect to find a rebound tenderness in a patient has cholecystitis this response can be an indication of a peritoneal inflammation the kehrs sign is a sign that is present in a patient who has liver trauma

HCP caring for patient about to begin taking azathioprine (Imuran) to treat IBD. The HCP should tell the patient to report which of the following adverse effects? SATA Bruising Impotence Nausea Sore throat Jaundice

Brusing Jaundice Sore throat Nausea

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

C. "A colostomy is from the large intestine, and an ileostomy is from the small intestine."

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

C. Amylase

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

C. Coughing and deep-breathing exercises

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

C. Decrease the client's fat intake

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

C. Destroys old blood cells

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

C. Determine the client's dietary preferences

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

C. Eat yogurt with live cultures

A nurse is caring for a patient who has impaired swallowing due to a CVA. Which of the following interventions should the nurse use to assist the patient with feeding? A. Provide the patient with a straw. B. Offer the patient thin fluids C. Elevate the head of the bed 45 to 90 degrees D. Place food in the weaker side of the mouth

C. Elevate the head of the bed 45 to 90 degrees

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 has abdominal pain and possible pancreatitis. Which of the following laboratory results should the nurse identify as an indication of pancreatitis? A. Decreased WBC count B. Increased albumin level C. Increased serum lipase level D. Decreased blood glucose level

C. Increased serum lipase level

Nasogastric tube feedings are an appropriate choice for a patient who A. Has a paralytic ileus B. Has recently experienced facial trauma C. Is postoperative following laryngectomy D. Has pancreatitis

C. Is postoperative following laryngectomy.

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

Which of the following strategies for enhancing the intake of healthful foods is appropriate for an adolescent? A. Encouraging the adolescent to consume snack foods from the grains food group. B. Permitting the adolescent to skip breakfast to enhance appetite at later meals C. Making healthful food choices more convenient and available for the adolescent D. Allowing the adolescent complete autonomy in making food choices

C. Making healthful food choices more convenient and available for the adolescent

The most reliable method for verifying initial placement of a small-bore feeding tube is by A. Measuring the pH of gastric aspartate B. Auscultating the epigastric area while injecting air. C. Obtaining an abdominal x-ray D. Placing the open end of the tube in a cup of water

C. Obtaining an abdominal x-ray

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicates that a possible bowel perforation has occurred? A. Elevated BP B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

C. Rigid abdomen

When administering sulfazalazine (Azulfidine), HCP should check which of following to identify adverse effect? SATA CBC Urine output Skin integrity Level of consciousness Temperature

CBC Skin integrity Temperature

A nurse is caring for a patient was recovered from acute diverticulitis the nurse should instruct the patient to increase his intake of which of the following foods when the inflammation subsides Cucumbers and tomatoes cabbages and peaches strawberries and corn figs and nuts

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

The primary source of microorganisms for catheter-related infections include the skin and which of the following?

Catheter hub

When talking w/ patient taking metoclopramine (Reglan) to treat GERD, HCP should include which of the following instructions? Stop taking the drug if drowsiness develops. Chew gum or suck on hard candy. Take acetaminophen (Tylenol) for headaches. Take the drug once a day in the morning.

Chew gum or suck on hard candy. Metoclopramide, a prokinetic, can cause anticholinergic effects, including dry mouth. Chewing gum, sucking on hard candy, and sipping water can help minimize this effect.

A patient is about to start taking aluminum hydroxide (Amphojel) to reduce gastric acid. Which of the following instructions should you include when talking with the patient about taking this drug? (Select all that apply.) Take it with a large meal. Chew the tablets thoroughly. Drink 4 oz of water after taking it. Increase fluid and fiber intake. Take it once daily.

Chew the tablets thoroughly. Drink 4 oz of water after taking it. Increase fluid and fiber intake. Instruct patients to chew aluminum hydroxide tablets thoroughly (not swallow them whole) and follow the tablets or the liquid suspension with water to make sure it gets to the stomach promptly. This type of antacid can cause constipation, so make sure patients increase fluid and fiber intake and exercise more. Patients can take this drug up to four times a day.

That's mean a community health nurse is planning an educational program about hepatitis A when preparing the materials and or should identify which of the following groups is most at risk for developing hepatitis A children older adults women who are pregnant middle age men

Children the nurse should apply the safety risk reduction priority setting framework which signs priority to the factor or situation proposing the greatest safety risk of the patient that hepatitis A virus can be contracted from feces bile and blood of infected clients the usual mode of transmission is a fecal oral route children and young adults are most often affected by hepatitis A typically a child or young adult acquires infection at school through poor hygiene through hand to mouth contact or via other form of close contact

HCP caring for older adult about to begin cimetidine (Tagamet) for duodenal ulcer. HCP should tell patient to report which of the following adverse reactions? Myalgia Dry mouth Lethargy Cellulitis

Cimetidine, a histamine2 receptor antagonist, can cause CNS effects, such as lethargy, depression, confusion, and seizures, especially in older adults. The health care professional should tell the patient to report these effects. If they persist, ranitidine (Zantac) might be a better alternative for the patient.

A nurse is caring for a patient who is two days postop following gastric bypass the nurse notes that the bowel sounds are present which of the following foods should the nurse provide at the initial feeding vanilla pudding apple juice diet Ginger ale clear liquids

Clear liquids such as water or broth can be given for the first oral feeding but should be limited to only 30 mls or 1 ounce per serving water does the does not contain sugar which could cause diarrhea due to hyperosmolality

A nurse is caring for a patient who has diverticulitis and a new prescription for a low fiber diet which of the following food items to the nurse removed from the patient's tray canned fruit white bread grilled hamburger coleslaw

Coleslaw this contains red cabbage which is high in fiber patients eating a low fiber diet should avoid most raw vegetables

A nurse is caring for a patient who has a G.I. bleed the provider suspects a bleeding lesion in the colon the initial approach to the treatment likely will involve which of the following procedures exploratory laparotomy double contrast barium enema MRI colonoscopy

Colonoscopy it requires insertion of a flexible scope into the rectum the provider advances the scope carefully until it enters the colon it can provide direct visualization of the inside of the colon and helps the provider identify the exact cause and location of bleeding

A nurse administered a full strength feeding with an increased osmolality through a jejunostomy tube to a client. Immediately following the feeding, the client expelled a large amount of liquid brown stool and exhibited a blood pressure of 86/58 and pulse rate of 112 beats/min. The nurse

Consults with the physician about decreasing the feeding to half-strength

A nurse providing care to a patient who is receiving nasogastric tube feedings finds that the tube is clogged. Which of the following would be least appropriate to use to unclog the tube?

Cranberry juice

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

D. "Eat protein with each meal."

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

D. "I'll have to consume a soft diet after surgery."

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 illness C. Tobacco use D. Alcohol use

D. Alcohol use

A nurse is preparing to administer an oil-retaining enema to a patient who has constipation. The nurse explains that the patient should try to retain the instilled for A. As long as it takes to complete the procedure B. About 10-15 minutes C. Until the next time he feels the urge to defecate D. At least 30 min, but preferably as long as he can.

D. At least 30 min, but preferably as long as he can.

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

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

D. Coleslaw

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

D. Importance of colonoscopy screening starting at age 50 years old

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

D. Increased prothrombin time

A nurse is preparing an older adult patient for an enema. The nurse should assist the patient to which of the following positions? A. Prone B. Dorsal recumbent C. Right lateral with both knees at chest D. Left lateral with the right leg flexed

D. Left lateral with the right leg flexed.

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

D. Maintain a supine position after meals

A nurse is caring for a patient who has a nasogastric tube connected to suction. Which of the following should indicate to the nurse that the tube has become occluded? A. Active bowel sounds B. Passing flatus C. Increase in gastric secretions D. Patient's report of nausea

D. Patient's report of nausea

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

D. Pepsin

The nurse on an evidence-based practice council is making recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which of the following situations?

Daily when not in use

A nurse is planning care for a patient who has cholelithiasis which of the following intervention should they include in the plan restrict the patient's fluid intake restrict the patient's calcium intake decrease the patient's fat intake decrease the patient's potassium intake

Decrease the patient's fat intake this reduces the occurrence of biliary colic

A nurse is caring for a patient who is receiving TPN therapy and has just returned to the room following physical therapy the nurse notes that the infusion pump for the TPN is turned off after restarting the fusion pump the nurse should monitor the client for which of the following findings hypertension extreme thirst fever diaphoresis

Diaphoresis the nurse should recognize that this patient has the potential to develop hypoglycemia due to the sudden withdrawal of TPN solution in addition to diaphoresis other potential manifestations of hypoglycemia can include weakness anxiety confusion and hunger

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?

Diarrhea

A nurse is taking care of patient who has a bleeding duodenal ulcer which of the following findings should the nurse expect emesis with a coffee ground appearance increase blood pressure decrease heart rate bright green stools

Emesis with a a coffee ground appearance hematemesis indicates upper G.I. bleeding occurring at or above the duodenojejunal junction

A nurse is demonstrating colostomy care to a patient who has a new colostomy which of the following actions should the nurse teach the patient to perform use anti-microbial ointment on the peristomal skin empty the bag when it is 1/3 to 1/2 full cut the skin barrier opening a little larger than the ostomy wash the peristomal skin with mild soap and water apply the skin barrier while the skin is slightly moist

Empty the bag one is 1/3 to 1/2 full cut the skin barrier opening a little larger than the ostomy (1/16-1/8 larger than stoma) and wash the peristomal skin with mild soap and water we don't want to use oil based ointment on the skin which will disrupt adhesion and anti-microbial's are not necessary unless prescribed by the doctor the skin must be dry before applying the skin barrier since the pouch will not adhere to my skin

A nurse is caring for a patient who has an indwelling urinary catheter which of the following actions should the nurse take place of drainage bag on the patient's abdomen when transferring from bed to the cart Empty when the drainage bag 1/2 full of urine rest the drainage bag on the floor when closing the drain a spigot during Emptying disconnect the drainage bag when obtaining a urine specimen

Empty the drainage bag 1/2 full of urine This helps to avoid trauma to the urethra and urinary meatus

A nurse is performing discharge teaching of ostomy care well at home for a client who has a newly pierced ileostomy which of the following instruction should the nurse include in the teaching empty the ostomy when it becomes half full place an aspirin in the ostomy pouch to eliminate odor change the ostomy appliance every week cleanse the site around the stoma with hydrogen peroxide and water

Empty your ostomy pouch when it becomes half full the nurse should instruct the patient to empty the Ostomy when it is 1/3 to 1/2 full this prevents it from being becoming too full of stool and gas and exploding

A nurse is caring for a patient who has an acute exasperation of Crohn's disease which of the following actions should the nurse take ensure bowel rest offer sparkling water frequently administer a stool softener offer plain warm tea frequently

Ensure bowel rest clients who have an exasperation of Crohn's disease usually require NPO status to ensure bowl rest and promote healing and recovery

The nurse is preparing to administer all of a patient's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes on the patient's medication administration record which of the following types of oral medication?

Enteric-coated tablets

The patient is on a continuous tube feeding. How often should the tube placement be checked?

Every shift

A client has been receiving intermittent tube feedings for several days at home. The nurse notes the findings as shown in the accompanying documentation. The nurse reports the following as an adverse reaction to the tube feeding:

Fasting blood glucose level

Rebound hypoglycemia is a complication of parenteral nutrition caused by which of the following?

Feedings stopped too abruptly

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication?

Fluid volume deficit

The nurse is to discontinue a nasogastric tube that had been used for decompression. The first thing the nurse does is

Flush with 10 mL of water.

Ask dad a nurse is providing dietary teaching to a patient with diverticulitis about preventing acute attacks which of the following foods to the nurse recommend foods high in vitamin C foods low in fat foods high in fiber foods low in calories

Foods high in fiber long-term low fiber eating habits increased Intraclonic pressure leads to straining during bowel movements causing development of diverticulitis high fiber foods help strengthen and maintain the active motility of the G.I. tract

Therapeutic use: Ranitidine (Zantac)

GERD

A nurse is assessing a patient who has a complete intestinal obstruction which of the following should the nurse expect absence of bowel sounds in all four quadrants passage of blood tinged liquid stool presence of flatus hyperactive bowel sounds above the obstruction

Hyperactive bowel sounds above the obstruction because intestinal peristalsis above the obstruction attempts to push the obstruction through the intestines with a complete intestinal obstruction there are no bowel sounds below the obstruction

A nurse is 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 recommended for those who travel especially military personnel hepatitis immunization is given to infants and children hepatitis B is acquired by eating foods that are contaminated during handling hepatitis B can be prevented by using good personal hygiene habits and proper sanitation

Immunization is given to infants and children it is given as part of standard childhood immunizations it can be administered as early as birth especially in infants born to mothers that are negative for hepatitis B surface antigens infants receive the second dose Between one and four months of age

HCP is about to administer ondansetron (Zofran) to a patient who is recieving chemo. Which of the following actions should the HCP take? SATA Infuse the drug 30 min prior to chemotherapy. Repeat the dose 4 hr after chemotherapy. Infuse the drug slowly over 15 min. Administer the drug immediately following chemotherapy. Administer the drug when the patient reports nausea.

Infuse the drug 30 min prior to chemotherapy. Repeat the dose 4 hr after chemotherapy. Infuse the drug slowly over 15 min.

A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is

Inserted into the lungs

A nurse is planning in-service training or session regarding nutrition which of the following minerals should the nurse identify as involved in oxygen transportation zinc iron phosphorus magnesium

Iron

A nurse is caring for a patient who is NPO and has an NG tube dissection when the patient reports nausea which of the following actions should the nurse take

Irrigate the tube with normal saline solution when a client with a NG tube develops nausea the nurse will first attempt to irrigate the tube to determine patency if the tube is not patent gastric pressure cannot decrease and the steady or increasing pressure can cause nausea

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration?

Keeping the client in a semi-Fowler's position at all times.

A nurse is providing dietary teaching to a patient who has dumping syndrome following gastric bypass surgery four days ago which of the following recommendations for the nurse include in the teaching avoid foods containing protein drink liquids during each meal eat foods that contain simple sugars maintain a supine position after meals

Maintain a supine position after meals the nurse should instruct the patient to lie supine after eating to help slow the rapid emptying of food into the small intestine A patient that has dumping syndrome should: decrease the amount of food eaten at once -eat small meals more frequently -eliminate fluids at mealtime fluid shift occurs in the upper G.I. tract when food contents and -simple sugars exit the stomach too fast attracting fluid into the upper intestine and decreasing blood volume which causes the patient to experience: nausea vomiting sweating syncope palpitations increased heart rate hypertension

Aldactone, an aldosterone-blocking agent would be used. Daily salt intake would be restricted to 2 grams or less. The diuretic will be held if the serum sodium level decreases to <134 m Eq/L.

Management of a patient with ascites includes nutritional modifications and diuretic therapy. Which of the following interventions would a nurse expect to be part of patient care? Select all that apply.

Therapeutic use: metoclopramide (Reglan)

N/V

You are about to administer diphenoxylate plus atropine (Lomotil) to a patient to reduce diarrhea. Which of the following drugs should you have available to treat an overdose of this drug combination? Mucomyst (Acetadote) Flumazenil (Mazicon) Naxolone Diphenhydramine

Naloxone With high doses, diphenoxylate plus atropine, an opioid agonist antidiarrheal drug combination, can cause CNS effects similar to morphine. Have naloxone ready in case of drug overdose. Monitor respirations and level of sedation. Mucomyst treats acetaminophen (Tylenol) overdose. Flumazenil reverses the effects of benzodiazepines. Diphenhydramine reduces extrapyramidal symptoms resulting from metoclopramide (Reglan) use.

A nurse is presenting an in-service training about nutrition how many of amino acids must be obtained from dietary intake 6 9 11 15

Nine proteins are made up of chains of amino acids which are composed of carbon hydrogen oxygen nitrogen nine of these amino acids are considered essential for human body and must be obtained from the diet these include histamine isoleucine leucine lysine methylene phenylalanine threonine tryptophan and valine

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and makes a recommendation when noting the following:

No land line; cell phone available and taken by family member during working hours

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to

Notify the surgeon about the tube's removal.

A nurse is recommending dietary modifications for a patient who is GRD the nurse should suggest eliminating which of the following foods from the patient's diet oranges and tomatoes carrots and bananas potatoes and squash whole wheat and beans

Oranges and tomatoes symptoms worsen following the oral intake of substances that decrease lower esophageal stricture pressure these include alcohol caffeine nicotine chocolate fatty food citrus fruits potatoes tomatoes and peppermint

The nurse is planning an in-service training session for a group of nurses regarding the role of enzymes in digestion which of the following enzymes plays a role in the digestion of proteins amylase pepsin Lipase Steapsin

Pepsin is an Enzyme excreted by the Gastric Mucosa that breaks down proteins into polypeptides other enzyme such as trypsin and aminopeptidase further breakdown the polypeptides into amino acids which can be used by the body

A nurse is caring for a patient who has colitis and reported increased exasperation due to stress at work which of the following responses should the nurse make I will contact a social worker so you can discuss career alternatives have you thought about discussing the possibility of part-time assignment with your employer why don't your employer to relieve you of some work until you're stronger perhaps we should review your coping mechanisms and talk about alternatives

Perhaps we should review your coping mechanisms and talk about other alternatives

Tube feedings are given to a patient after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which of the following measures should the nurse include in the care plan to reduce the risk of aspiration?

Place patient in semi-Fowler's position during and 60 minutes after an intermittent feeding

A nurse is caring for a patient who has a peg tube and is receiving intermittent feedings prior to initiating the feeding which of the following actions should the nurse take first flush water flush the tube with water place the patient in semi Fowler's position cleanse the skin around the tube site aspirate the tube for residual

Place the patient in semi Fowler's use the ABC priority setting for the framework which emphasize the basic core function of having an open airway and being able to breathe A client who is receiving peg tube feeding should we position with the head of bed elevated at least 30° during and after feedings to decrease risk of aspiration therefore this is the priority action

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura?

Pneumothorax

HPC should question the use of misoprostil (Cytotec) for patient who has which of the following? RA Seizure disorder Positive pregnancy Heart failure

Positive pregnancy test Misoprostol, a prostaglandin E analog, is a pregnancy risk category X drug. It can cause uterine contractions and induce abortion; therefore, primary care providers must confirm that patients are not pregnant before prescribing the drug. Patients taking it must use contraception.

A nurse is caring for a patient who had a gastric resection to treat our adenocarcinoma of the stomach the client tells the nurse in the PACU that he does not remember why the surgeon said he had to have a tube in his nose the nurse explained that the NG tube serves what purpose Prevents excessive pressure on the suture lines Allows gastric lavage after surgery allows early. Feeding facilitates obtaining gastric specimens for testing

Prevents excessive pressure on the suture lines it remains in place after surgery it drains the air and fluid that can cause pressure from inside the G.I. tract in doing so it also prevents vomiting and G.I. distention Gastric lavage is for G.I. bleeding but not necessarily after resection the patient will be taking clear liquids by mouth it will not need feedings the other NG tube

A nurse in a providers office is assessing a patient who has GERD the nurse should expect the patient to report which of the following manifestations regurgitation nausea belching heartburn weight loss

Regurgitation nausea belching heartburn

When a central venous catheter dressing becomes moist or loose, what should a nurse do first?

Remove the dressing, clean the site, and apply a new dressing.

A nurse is caring for a patient who is four hours postop following a laparoscopic cholecystectomy which of the following findings should the nurse expect right shoulder pain Urine output 20 mls per hour temperature 38.4°C 101.1 Fahrenheit oxygen saturation 92%

Right shoulder pain

A nurse is inserting a nasogastric tube for feeding a client. Place in order the steps from 1 to 6 for correctly inserting the tube.

Sit the client in an upright position Apply gloves to the nurse's hands Measure the length of the tube that will be inserted Apply water-soluble lubricant to the tip of the tube Tilt the client's nose upward Instruct the client to lower the head and swallow

Clay-colored stools Dark urine Jaundice Pruritis

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Choose all that apply.

A patient is about to start taking sulfasalazine (Azulfidine) to treat inflammatory bowel disease. You should instruct the patient to watch for and report which of the following adverse effects of this drug? (Select all that apply.) Sore throat Fever Joint pain Constipation Dry mouth

Sore throat Fever Joint pain Sulfasalazine, an anti-inflammatory drug, can cause blood dyscrasias, such as agranulocytosis and hemolytic and macrocytic anemia. Instruct patients to avoid crowds and people who have communicable infections and to report sore throat, fever, or other indications of infection. Sulfasalazine can cause arthralgia, so instruct patients to report joint pain. Sulfasalazine is more likely to cause diarrhea than constipation. It is unlikely to cause dry mouth. Loperamide (Imodium) is an example of an antidiarrheal drug that causes dry mouth.

When talking with a patient about taking omeprazole (Prilosec) to treat duodenal ulcer, HCP should include which of the following instructions? Take the drug with food. Take the drug at bedtime. Dissolve the tablets in water. Swallow the capsules whole.

Swallow the capsules whole. Omeprazole, a proton pump inhibitor, is unstable in stomach acid. The health care professional should tell the patient to swallow the capsules or tablets whole and not chew the delayed-release tablets.

When talking with a patient about taking psyllium (Metamucil) to treat constipation, HCP should include which of the following instructions? SATA Take the drug with at least 8 oz of fluid. Avoid activities that require alertness. Expect results in 6 to 12 hr. Increase fluid and fiber intake. Urinate every 4 hr.

Take the drug with at least 8 oz of fluid. Increase fluid and fiber intake.

A nurse is performing GIS estimate of a patient who has liver cirrhosis with abdominal distention Which of the following actions should the nurse take to assess for changes in the patient's abdominal distention Percuss the abdomen for Tympanic sound inspect the contour of the abdominal wall instruct the patient to report increased abdominal discomfort take serial measurements of the abdomen with tape measure

Text serial measurements of the abdomen with tape measure

Weigh the client every day. Check blood glucose level every 6 hours. Document intake and output.

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). What actions would the nurse perform while the client receives PN? Select all that apply. You Selected:

Place the client in the Fowler's position

The client has returned to the floor following a radical neck dissection. Anesthesia has worn off. What is the nurse's priority action?

Before inserting a gastric or enteric tube, the nurse determines the length of tubing that will be needed to reach the stomach or small intestine. The Levin tube, a commonly used nasogastric tube, has circular markings at specific points. This tube should be inserted to 6 to 10 cm beyond what length?

The distance measured from the tip of the nose (N) to the earlobe (E) and from the earlobe to the xiphoid (X) process

"Often the area of pain is referred from another area."

The nurse asks a client to point to where pain is felt. The client asks why this is important. What is the nurse's best response?

Place the client in semi-Fowler's position.

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms?

Splenic vein Inferior mesenteric vein Gastric vein

The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply.

Measure abdominal girth daily. Perform daily weights.

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.)

A nurse is teaching a newly licensed nurse about caring for a patient who is scheduled for an esophogastric balloon tamponade to treat the bleeding esophageal varices which of the following pieces of information should the nurse include in the teaching the patient will be placed on a mechanical ventilation prior to the procedure the tube will be inserted into the patient's trachea the patient will receive a bowel prep with cathartics prior to this procedure the tube allows the application of a ligation band to the bleeding varices

The patient will be placed on mechanical ventilation prior to this procedure they will require intubation to protect the airway The tube is inserted through the patient's nose or mouth into The patient's stomach to stop the bleeding the tube is used to provide pressure to the varices to stop the bleeding

Catheter hub

The primary source of microorganisms for catheter-related infections are the skin and which of the following?

A nurse in the ER is caring for a client who has a bleeding esophageal varices the nurse would anticipate a prescription for which of the following medications famotidine omeprazole vasopressin Eosmeprazole

Vasopressin constricts the splanchnic bed and decreases portal pressure Vasopressin also constricts the digital esophageal and proximal gastric veins which reduces in flow into the portal system and is used to treat bleeding varices

The nurse inserts a nasoduodenal tube for feeding of the client. To check best for placement, the nurse

Verifies location with an abdominal x-ray

Weight loss

What is a major concern for the nurse when caring for a patient with chronic pancreatitis?

sudden, sustained abdominal pain abdominal distention

What symptoms of perforation might the nurse observe in a client with an intestinal obstruction? Select all that apply.

A nurse is providing teaching to the guardian of a child with celiac disease which of the following foods should the nurse instruct the guardian to admit from the patient's diet Cornflakes reduced fat milk canned fruits wheat bread

Wheat bread Wheat rye and barley contain gluten and should be eliminated from the diet or child who has celiac disease

A nurse is caring for a patient who has celiac disease which of the following foods to the nurse removed from the patient tray wheat toast tapioca pudding hard-boiled eggs mashed potatoes

Wheat toast

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?

When the residual is greater than 200 mL

Pepsin

Which of the following is an enzyme secreted by the gastric mucosa?

Approximately 80 to 120 mL

While caring for a patient who has had radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What does the nurse know is an expected amount of drainage in the wound unit?

A nurse is caring for a patient who has acute diverticulitis well the patient is an active information the nurse should instruct the patient to include which of the following foods in her diet white bread and plain yogurt shredded wheat cereal and blueberries broccoli and kidney beans oatmeal and fresh pears

White bread and plain yogurt because of the acute inflammation of diverticulitis the client should maintain a diet very low in fiber the patient should consume low fiber foods like white bread low-fat milk yogurt with active cultures poached eggs and canned soft fruit foods like shredded wheat cereal and blueberries can worsen the inflammation of acute diverticulitis, broccoli and kidney beans can worsen also worsen the inflammation as well as foods like oatmeal and fresh pears

A graduate nurse is cleaning a central venous access device (CVAD) and is being evaluated by the preceptor nurse. The preceptor nurse makes a recommendation for relearning the skill when she notes the graduate nurse does the following action:

Wipes catheter ports from distal end to insertion site

Initially, which diagnostic should be completed following placement of a NG tube?

X-ray

PCP should use caution when Rx bisacodyl (Dulcolax) for a patient who has _______________ myelosuppression. anorexia nervosa. hypomagnesemia. diabetes mellitus.

anorexia nervosa. Bisacodyl, a stimulant laxative, requires caution with patients who have an eating disorder because of the risk of laxative abuse. Health care professionals should monitor intake and output carefully and discourage long-term use.

Therapeutic use: Bisacodyl (Dulcolax)

constipation

Therapeutic use: omeprazole (Prilosec)

duodenal ulcers

Therapeutic use: Azathioprine (Imuran)

inflammatory bowel disease

Therapeutic use: sulfasalazine (Azulfidine)

inflammatory bowel disease, ulcerative colitis

Therapeutic use: dimenhydrinate

motion sickness

The nurse is caring for a patient who is receiving parenteral nutrition through a central line. Which of the following complication is caused by improper catheter placement and inadvertent puncture of the pleura?

pneumothorax

The nurse prepares to give a bolus tube feeding to the patient and determines that the residual gastric content is 150 cc. The priority nursing action is to

reassess the residual gastric content in 1 hour.

Therapeutic use: Docusate (Colace)

stool softener

HCP caring for a patient who takes phenytoin (Dilantin) for seizure disorder and is about to begin sucralfate (Carafate) therapy to treat duodenal ulcer. HCP should tell the patient to take the drugs at least 2 hours apart because ________________. phenytoin increases the metabolism of sucralfate. phenytoin reduces the effectiveness of sucralfate. sucralfate increases the risk for phenytoin toxicity. sucralfate interferes with the absorption of phenytoin.

sucralfate interferes with the absorption of phenytoin. Sucralfate decreases the absorption of phenytoin. The health care professional should tell the patient to allow at least 2 hr between taking the two drugs and should monitor the patient's phenytoin levels.

The most significant complication related to continuous tube feedings is

the potential for aspiration,

Intervention for a person who has swallowed strong acid includes a number of interventions depending on the type and amount of corrosive agent involved. Select all the actions that apply.

• Aspirate secretions from the pharynx if respirations are affected. • Neutralize the chemical. • Wash the esophagus with large volumes of water.

A nurse is caring for a client with a long-term central venous catheter. Which care principle is correct?

Clean the port with an alcohol pad before administering I.V. fluid through the catheter.

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply a. Daily weights b. Intake and output monitoring c. Calorie counts for oral nutrients d. Daily transparent dressing changes e. Strict bedrest

*a. Daily weights b. Intake and output monitoring c. Calorie counts for oral nutrients* For the client receiving parenteral nutrition at home, the nurse would obtain daily weights initially, decreasing them to two to three times per week once the client is stable. Intake and output monitoring also is necessary to evaluate fluid status. Calorie counts of oral nutrients are used to provide additional information about the client's nutritional status. Transparent dressings are changed weekly. Activity is encouraged based on the client's ability to maintain muscle tone. Strict bedrest is not appropriate.

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? a. Dysphagia b. Malnutrition c. Pain d. Regurgitation of food

*a. Dysphagia * Dysphagia (difficulty swallowing), the most common symptom of esophageal disease, may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute odynophagia (pain on swallowing).

An older adult patient in a long term care facility is receiving intermittent enteral feedings in his room. His affect is flat, and the nurse suspects that he is feeling isolated. Which of the following interventions is appropriate for this patient? A. Encourage him to go to the dining room at meal times to talk with other patients. B. Suggest that he watch television while his feedings are being administered C. Remind him that he can have visitors after his feeding administration times D. Ask the facility chaplain to speak with the patient

A. Encourage him to go to the dining room at meal times to talk with other patients.

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

A. White bread and plain yogurt

A nurse is caring for a patient who has a newly inserted nasogastric tube. Which of the following methods is appropriate for verifying initial placement? A. X-ray examination of the chest and abdomen B. Auscultation of injected air C. pH measurement of gastric aspartate D. Color of gastric contents

A. X-ray examination of chest and abdomen

HCP caring for patient about to begin taking alosetron (Lotronex) to treat IBS. HCP should tell patient to report which of the following adverse effects? Headache Sore throat Drowsiness Abdominal pain

AP Alosetron, a serotonin 5-HT3 receptor antagonist, can cause ischemic colitis. The health care professional should tell the patient to report abdominal pain, bloody diarrhea, or rectal bleeding, and to stop taking the drug if these symptoms occur.

The nurse is confirming placement of a patient's nasogastric (NG) tube using a combination of visual and pH assessment of the aspirate. The nurse determines that the NG tube remains properly placed when the pH of the aspirate is which of the following?

Acidic

A nurse is assessing a patient who is in the early stages of hepatitis A which of the following manifestations should the nurse expect Jaundice anorexia dark urine pale feces

Anorexia it is an early manifestation of hepatitis a and is often severe it is thought to result from the release of toxins by the damaged liver or by failure of the damage liver cells to detoxify an abnormal product all the other signs and symptoms are late manifestations

A nurse is assisting a provider with performing a paracentesis on a patient which of the following actions should the nurse take ask the patient to empty his bladder before the procedure place the patient leaning forward over the bedside table for the procedure Inform the patient he will be sedated during the procedure instruct the patient to fast for six hours prior to the procedure

Ask the patient to empty his bladder before the procedure the nurse should ask the patient to empty their bladder before the procedure to prevent injury to the bladder

A nurse is developing a plan of care for a patient who has GERD the nurse should plan to monitor the patient for which of the following complications aspiration infection anemia weight loss

Aspiration it is a common common complication of Gerd which results when the esophageal sphincter malfunctions and allows gastric acid and undigested food to back up into the esophagus this place is a patient at risk of aspiration because effortless uncontrolled regurgitation occur whether the patient is an upright position or reclining most common results of regurgitation are heartburn and indigestion however aspiration is also possible therefore the nurse should monitor for crackles in lung fields which are the first indication of aspiration

A nurse is providing discharge teaching to the partner of a client who has a new diagnosis of hepatitis A. Which of the following instructions should the nurse include in the teaching? A. "During this illness, she may take acetaminophen for fevers or discomfort." B. "Encourage her to eat foods that are high in carbohydrates." C. "The provider will prescribe a medication that will help her liver heal faster." D. "Have her perform moderate exercise to restore her strength more quickly."

B. "Encourage her to eat foods that are high in carbohydrates."

Which of the following formulas is appropriate to administer to a patient who has a dysfunctional GI tract? A. Modular B. Elemental C. Polymeric D. Specialty

B. Elemental

A nurse is providing teaching to a patient who is receiving intermittent nasogastric feedings. Which of the following should the nurse instruct the patient to report immediately? A. A feeling of fullness B. Persistent coughing C. Discomfort in the naris D. Postfeeding belching

B. Persistent coughing

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

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

The nurse is assessing a patient who is experiencing perforation of a peptic ulcer which of the following manifestations should the nurse expect increase blood pressure decreased heart rate yellowing of the skin board like abdomen

Board like abdomen the nurse should expect this patient who is experiencing perforation of a peptic ulcer to experience manifestations of board like abdomen is 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 should recognize that nasogastric intubation is indicated to relieve gastric distention for which of the following patients? A. A 6-year old child who drank a toxic substance B. A 60-year old patient admitted with gastrointestinal hemorrhage C. A 40-year old patient with a postoperative bowel obstruction D. A 20-year old patient with malabsorption syndrome

C. A 40-year old patient with a postoperative bowel obstruction

While a nurse is administering a cleansing enema, the patient reports abdominal cramping. Which of the following is the appropriate intervention? A. Measure the patient's vital signs. B. Notify the PCP C. Lower the enema fluid container D. Stop the enema instillation

C. Lower the enema fluid container

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

D. Destroying liver cells that are later replaced with scar tissue

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? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis

D. Diaphoresis

A nurse is caring for a client who is postoperative following a laparotomy. The client has an indwelling catheter and a Jackson-Pratt drain in place. Which of the following findings indicates that the client is developing a postoperative complication? A. Pain scale score of 5 out of 10 B. Urine output of 65mL/hr C. 20 mL of bright red drainage from the drain D. Pulse oximetry of 85%

D. Pulse oximetry of 85%

A nurse is performing a gastrointestinal assessment of a client who has liver cirrhosis with abdominal distention. Which of the following actions should the nurse take to assess for changes in the client's abdominal distention? A. Percuss the abdomen for tympanic sounds B. Inspect the contour of the abdominal wall C. Instruct the client to report increased abdominal discomfort D. Take serial measurements of the abdomen with a tape measure

D. Take serial measurements of the abdomen with a tape measure

A nurse is caring for a patient from the Middle East to a celiac disease which of the following actions should the nurse perform regarding this patient's diet Provide foods prepared according according to kosher dietary law ask the kitchen to prepare grits to meet the patients dietary need for grains determine the patients dietary preferences prepare a diet tray that includes vegetable and barley soup

Determine the patient's dietary preferences

The nurse is teaching a patient with diabetes mellitus about hypoglycemia which of the following manifestations should the nurse include bradycardia diaphoresis rapid deep respirations palpitations shakiness

Diaphoresis palpitations shakiness tachycardia would be the response not bradycardia and deep rapid respirations are referred to as Kussmaul's respirations are a manifestation of hyperglycemia

When talking with patient about taking lubiprostone (Amitiza), HCP should tell patient not to take the drug if they have which of the following? Urinary retention Sore throat Diarrhea Nausea

Diarrhea Lubiprostone, a chloride channel activator, increases peristalsis and activates the chloride channels in the intestinal wall, which then increases the secretion of sodium and water. These actions treat constipation and can make diarrhea much worse.

A nurse is updating the plan of care for a patient who has dumping syndrome which of the following instruction should the nurse include consume beverages with meals eat three large meals a day Include high fiber foods in the diet eat a source of protein with each meal

Eat a source of protein with each meal because protein delayed gastric emptying

A nurse is teaching a patient who has a colostomy about ways to reduce flatulence and odor which of the following strategies should the nurse include Eat crackers and yogurt regularly Chew minty gum throughout the day drink orange juice every day put aspirin in the pouch

Eat crackers and yogurt regularly crackers toast and yogurt can help reduce flatulence which contributes to odor

A nurse is caring for a patient with a history of cirrhosis who has been admitted with a manifestations of hepatic and cephalopathy the nurse should anticipate a prescription for which of the following laboratory test to determine the possibility of extensive alcohol use

Gamma glutamyl transferase GGT this laboratory test is specific to the hepatobiliary biliary system in which levels can be raised by alcohol and hepatotoxic drugs therefore it is useful for monitoring drug toxicity and excessive alcohol use

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the:

Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration.

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following?

Gastrostomy tube

The following appears on the medical record of a male patient receiving parenteral nutrition: WBC: 6500/cu mm Potassium 4.3 mEq/L Magnesium 2.0 mg/dL Calcium 8.8 mg/dL Glucose 190 mg/dL

Glucose level

Avoid beer, especially in the evening. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows.

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply.

A nurse is teaching about secondary prevention actions for colorectal cancer for a health fair for adults in the community which of the following topic should the nurse include smoking cessation benefits of diet high in cruciferous vegetables new types of Ostomy appliances importance of colonoscopy screening starting at age 50 years old

Importance of colonoscopy screening starting at 50 years old smoking cessation is not a primary prevention providing dietary teaching is not a primary prevention information about Ostomy appliance care is a tertiary prevention

A nurse is assessing a patient who is 12 hours postop following an open cul-de-sac cholecystectomy which of the following findings should the nurse report to the provider hypo active bowel sounds indwelling catheter output of 25 mls per hour heart rate of 96 per minute Serous drainage at the surgical incision site

Indwelling catheter output of 25 mls per hour the nurse should report an output of less than 30 mils per hour to the provider as this could indicate hypovolemia or renal complication

HCP should question the use of diphenoxylate/atropine (Lomotil) for patient who has which of the following disorders? Agranulocytosis Inflammatory bowel disease Thrombophlebitis Immunization with a live virus

Inflammatory bowel disease Diphenoxylate is an opioid, which can cause the severe complication of toxic megacolon in patients who have inflammatory bowel disease. This disorder is a contraindication for the use of the drug.

HCP reviewing medical record of patient on ranitidine (Zantac). Which of the following interacts w/ ranitidine? Lisinopril (Prinivil) Ketoconazole Phenobarbital sodium (Luminal) Hydrochlorothiazide (HydroDIURIL)

Ketoconazole Ranitidine reduces the absorption of ketoconazole.

A nurse is caring for a patient with ulcerative colitis writer describes bed rest with bathroom privileges when the client asked the nurse why he has to stay in bed which of the following responses should the nurse provide we need to conserve energy at this time lying down quietly in bed helps to slow down your intestines staying in bed promotes the rest and comfort you need staying in bed will help prevent injury and minimize your fall risk

Lying quietly in bed help slow down the activity in your intestines

A nurse is admitting a patient with cirrhosis which of the following prescriptions should the nurse anticipate obtaining the patient's PT and INR measurements administer lactulose 30 ml PO four times daily obtain daily weight in abdominal girth measurements administer a daily multivitamin place the patient on a high protein diet

Obtain the patient's PT and INR administer lactulose 30 ml PO x4 daily obtain daily weight and Abdominal girth measurements administer a daily multivitamin

HCP should conclude that alosetron (Lotronex) therapy is effective when a patient who is taking it reports which of the following? Less GI reflux One formed stool per day No nausea or vomiting Urination without burning

One formed stool per day. Alosetron, a serotonin 5-HT3 receptor antagonist, treats the diarrhea and pain of severe irritable bowel syndrome. One formed stool per day indicates symptom relief.

HCP caring for a patient who has recently had a MI and is about to begin taking docusate sodium (Colace). HCP should explain that docusate Na will have which of the following therapeutic effects? Prevents diarrhea Prevents straining Reduces gastric acid Reduces inflammation

Prevents straining Docusate sodium, a stool softener, prevents straining during defecation and prevents the elevation in blood pressure that can result from straining. It also helps relieve constipation and reduce the painful elimination of hard stools.

A nurse is providing teaching about nutrients to a patient which of the following statements should they include carbohydrates transport nutrients throughout the body fat prevents ketosis protein builds and repairs body tissue Carbohydrates help regulate body temperature

Protein builds and repairs body tissue

The nurse is caring for a patient who is scheduled to undergo a liver biopsy for a suspected malignancy which of the following lab findings should the nurse manager prior to this procedure prothrombin time serum lipase Bilirubin calcium

Prothrombin time a major complication during a liver biopsy is hemorrhage many patients who have liver disease have clotting defects and are at a risk of bleeding in addition to PT and activated partial thrombin time and platelet count should be monitored liver dysfunction causes a production of blood clotting factors to be reduced which will lead to an increased incidence of bruising of nosebleeds bleeding from wounds G.I. bleeding this is due to deficient absorption of vitamin K from the G.I. tract caused by the inability of liver cells to use vitamin K to make prothrombin

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care?

Provide frequent mouth care.

A nurse is caring for a patient who is postop following a laparotomy patient has an indwelling urinary catheter in a Jackson-Pratt drain in place which of the following in indicates that the patient is developing postop complication pain scale score of five out of 10 Urine output of 65 mls per hour 20 mls of bright red drainage from the drain pulse ox reading of 85%

Pulse ox reading of 85% after abdominal surgery clients should have oxygen sat above 93% of patient whose actions as 85 has hypoxemia and requires immediate intervention

A nurse is assessing a patient who is admitted with a bow obstruction the patient reports of your abdominal pain which of the following findings indicates that a possible bowel perforation has occurred elevated blood pressure Bowel sounds increased in frequency and pitch rigid abdomen Emesis of undigested food

Rigid abdomen as food escapes into the peritoneal cavity a reduction in circulating blood volume occurs lowering blood pressure Hypertension or shock can be present all sounds are silent with a bowel perforation

A nurse is providing dietary teaching to a patient was all sort of "colitis which of the following food selections by the client indicates an understanding of the teaching raw vegetable salad with low-fat dressing roast chicken and white rice fresh fruit salad and milk peanut butter on whole wheat bread

Roast chicken and white rice clients who have ulcerative colitis are required to a low fiber diet which omits whole grains and raw fruits and vegetables roast chicken and white rice is the best choice

A nurse is caring for a patient who has cholelithiasis and will undergo cholecystectomy patient states that she does not understand how she will be all right without her gallbladder a nurse should explain to the patient that which of the following is a main function of the gallbladder producing bile adding digestive enzymes to bile storing bile eliminating bile

Storing bile the primary function of the gallbladder is to store bile because this organ is only for storage the clients liver will still produce bile needed for digestion small amounts of It will continuously enter the duodenum where it will perform various functions

Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis?

Alterations in mood Agitation Insomnia

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.

The client's hands flap back and forth when the arms are extended.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?

Until bowel sound is present Until flatus is passed Until peristalsis is resumed

The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.)

Serum antibodies for H. pylori

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?

Risk for injury related to altered clotting mechanisms Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Disturbed body image related to changes in appearance, sexual dysfunction, and role function

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply.

Sialadenitis

The nurse notes that a client has inflammation of the salivary glands. The nurse documents which finding?

A nurse is clearing for a patient who is scheduled to undergo a EGD the nurse should identify that this procedure is for which of the following reasons reasons to visualize polyps in the colon to detect an ulceration in the stomach to identify an obstruction in the biliary tract to determine the presence of free air in the abdomen

To detect an alteration in the stomach and EGD is used to visualize esophagus stomach and duodenum with elated tube detect tumor ulceration or obstruction

change in mental status signs of GI bleeding

When caring for a client with cirrhosis, which symptoms should a nurse report immediately? Select all that apply.

Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered

When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.)

The primary source of microorganisms for catheter-related infections are the skin and

catheter hub.

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:

diaphoresis, vomiting, and diarrhea.

Nursing students are reviewing information about parenteral nutrition and indications for use. They demonstrate understanding of the material when they identify which patients as appropriate candidates for parenteral nutrition? Select all that apply.

• Child with short bowel syndrome • Middle-aged man with acute pancreatitis • Man with two-thirds of his colon removed

A client with a nasogastric tube set to low intermittent suction is receiving D51/2NS at 100 mL/hr. The nurse has identified a nursing diagnosis of deficient fluid volume. Which of the following are data that support this diagnosis? Select all that apply.

• Urine output that decreased from 60 to 40 mL/hr • Heart rate that increased from 82 to 98 beats/min within 2 hours • Fluid output of 2150 mL and total fluid intake of 2000 mL for the past 24 hours

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone? a. Radiation b. Lithotripsy c. Chemotherapy d. Biopsy

*b. Lithotripsy* Lithotripsy uses shock waves to disintegrate stones. It may be used instead of surgical extraction for parotid stones and smaller submandibular stones. Radiation, chemotherapy, and biopsy do not use shock waves to disintegrate a stone.

*Rebound hypoglycemia* is a complication of parenteral nutrition caused by: a. glucose intolerance. b.fluid infusing rapidly. c.feedings stopped too abruptly. d. a cap missing from the port.

*c.feedings stopped too abruptly. * Rebound hypoglycemia occurs when the feedings are stopped too abruptly because body has to adjust to the ↓ amounts of glucose in the body. . Hyperglycemia is caused by glucose intolerance. Fluid overload is caused by fluids infusing too rapidly. An air embolism can occur from a cap missing on a port

A public health nurse is participating in a community health fair that is focused on health promotion and illness prevention. Which of the following older adults most likely faces the highest risk of developing oral cancer? 1- A man who describes himself as always having been a "heavy smoker and a heavy drinker." 2- A woman who is morbidly obese and has a longstanding diagnosis of systemic lupus erythematosus (SLE). 3- A woman who describes herself as a "proud breast cancer survivor for over 10 years." 4- A man who states that he enjoys good health, with the exception of "heartburn after nearly every meal."

1

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

1

A 54 year-old man is postoperative day 1 following neck dissection surgery. Which of the following nursing actions should the nurse prioritize in the care of this patient? 1- Teaching the patient about the signs and symptoms of major postoperative complications 2- Positioning the patient in a high Fowler's position to protect the airway 3- Ensuring that naloxone (Narcan) is available at the patient's bedside 4- Maintaining protective isolation for 24 to 36 hours after surgery

2

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse? 1- Reinsert the nasogastric tube to the stomach. 2- Notify the surgeon about the tube's removal. 3- Place the nasogastric tube to the level of the esophagus. 4- Document the discontinuation of the nasogastric tube.

2

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an): 1- Extension of the esophagus through an opening in the diaphragm. 2- Involution of the esophagus, which causes a severe stricture. 3- Protrusion of the upper stomach into the lower portion of the thorax. 4- Twisting of the duodenum through an opening in the diaphragm.

3

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis? 1- Methicillin-resistant Streptococcus aureus (MRSA) 2- Pneumococcus 3- Staphylococcus aureus 4- Streptococcus viridans

3

Cholelithiasis

A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?

Measure and record drainage.

A client has a gastrostomy tube that has been placed to drain stomach contents by low intermittent suction. What is the nurse's priority during this aspect of the client's care? You Selected:

Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt

A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply.

Regurgitation of undigested food

A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom?

Fever, increased heart rate and decreased blood pressure

A client is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

Make appropriate referrals to services that provide psychosocial support.

A client is recovering in the hospital following gastrectomy. The nurse notes that the client has become increasingly difficult to engage and has had several angry outbursts at staff members in recent days. The nurse's attempts at therapeutic dialogue have been rebuffed. What is the nurse's most appropriate action?

Hemorrhage

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed?

An absence of blood in stool

A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms?

Stage 2

A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy?

To remove gas from the stomach To remove toxins from the stomach To diagnose GI motility disorders

A nurse is caring for a client who has a gastrointestinal tube in place. Which of the following are indications for gastrointestinal intubation? Select all that apply.

Enhancement of verbal communication

A nurse is caring for a client who has had surgery for oral cancer. When addressing the client's long-term needs, the nurse should prioritize interventions and referrals with what goal?

Encourage the family to bring in the client's favorite foods

A nurse is caring for a client who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the client's appetite?

Vasomotor symptoms associated with dumping syndrome

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect?

Remove gas and fluids from the stomach Diagnose gastrointestinal motility disorders Flush ingested toxins from the stomach Administer nutritional substances

A nursing instructor is preparing a class about gastrointestinal intubation. Which of the following would the instructor include as reason for this procedure? Select all that apply.

Ingestion of strong acids Irritating foods Overuse of aspirin

A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply.

A nurse is completing a history and physical assessment for a patient who has chronic pancreatitis which of the following findings should the nurse identify as a likely cause of the patient's condition high calorie diet prior G.I. Issues tobacco use alcohol use

Alcohol consumption is a major cause of chronic pancreatitis in the US long-term use disorder produces hypersecretion of protein in the pancreatic secretions which results in the protein plugs and calculi within the pancreatic duct alcohol also has a direct toxic effect on the cells of the pancreas damage to these cells is more likely to occur and be more severe in patients whose diet are poor and protein content is either very high or very low in fat

A patient recovering from gastric surgery remains NPO and has a nasogastric tube connected to suction. Which of the following actions should the nurse take to prevent dry mucous membranes? A. Allow the patient to suck on ice chips B. Provide frequent mouth care C. Apply petroleum jelly to the patient's naris D. Offer throat lozenges

B. Provide frequent mouth care

A nurse is caring for a patient who has sustained a head injury and whose level of consciousness fluctuates. The provider prescribes full liquid diet progressing to pureed diet as tolerated. Before initial feedings, it is essential that this patient undergo which of the following? A. Chest x-ray B. Swallowing examination C. Nasogastric tube insertion D. Olfactory nerve evaluation

B. Swallowing examination

A nurse is caring for a client who is scheduled to undergo an EGD. The nurse should identify that this procedure is for which of the following reasons? 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 patient is about to start taking alosetron (Lotronex) to treat diarrhea. You should instruct the patient to watch for and report which of the following adverse effects of this drug? Constipation Difficulty swallowing Blurred vision Confusion

Constipation Alosetron, a serotonin 5-HT3 receptor antagonist, can cause constipation that can lead to impaction and perforation. Monitor bowel patterns and stop the drug for constipation. Alosetron is unlikely to cause difficulty swallowing. Psyllium, a fiber supplement, can cause esophageal obstruction and difficulty swallowing. Instruct patients to take psyllium with 8 oz of water. Alosetron is unlikely to cause blurred vision. Dimenhydrinate, an antihistamine, can cause blurred vision. Alosetron is unlikely to cause confusion, but it can cause anxiety.

A nurse is planning discharge teaching for a patient who is post op following a traditional open cholecystectomy which of the following learning needs of the patient is a nurse is top priority dietary recommendations incision care coughing and deep breathing exercises pain management

Coughing and deep breathing exercises the greatest risk to the patient is respiratory compromise therefore learning how to cough and deep breathing exercises to promote lung expansion and secretion removal is the top priority

A nurse is teaching a group of patients about the functions of the liver and gallbladder which of the following should the nurse include in the teaching is the purpose of bile digesting fats producing chime simulating gastric acid secretion providing energy

Digesting fats it is produced by the liver and aids in the digestion of fat

HCP assessing pt who was given ondansetron (Zofran) IV 1 hour ago. Which of the following findings is an adverse effect of this drug? Dizziness Tardive dyskinesia Abdominal cramping Rash

Dizziness Dizziness and lightheadedness are the most common adverse effects of ondansetron.

A nurse is teaching dietary modification strategies to a patient who is newly diagnosed with cirrhosis of the liver which of the following foods should the nurse recommend grilled chicken potato soup fish sticks baked ham

Grilled chicken the nurse should identify that the client with cirrhosis requires proteins to compensate for disease related weight loss increasing protein intake from animal or plant sources will also help provide the client with more energy

A nurse is caring for a patient who has fulmiant hepatic failure which of the following procedures should the nurse anticipate for the patient endoscopic sclerotherapy liver lobectomy liver transplant transjugular intrahepatic portal systemic Shunt placement

Liver transplant

The absorption into the bloodstream of nutrient molecules produced by digestion

The nurse is providing health education to a client with a gastrointestinal disorder. What should the nurse describe as a major function of the GI tract?

The client must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours).

The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply.

Rovsing sign

The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to?

Do not eat and drink at the same time. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Avoid fruit drinks and soda.

The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply.

Serum lipase

The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator?

The nurse is teaching an unlicensed caregiver about bathing patients who are receiving tube feedings. Which of the following is the most significant complication related to continuous tube feedings?

The potential for aspiration

A nurse enters a patient's room and notes smoke coming from a wastebasket an adjacent bathroom which of the following action should they take first

Transport the patient to an area away from the smoke

Inspection

When examining the abdomen of a client with reports of nausea and vomiting, what would the nurse do first?

A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely? a. Excess fluid volume b. Risk for imbalanced nutrition, more than body requirements c. Deficient fluid volume d. Impaired urinary elimination

*a. Excess fluid volume * The patient's intake and output record reflects a greater intake than output, suggesting excess fluid volume. No information suggests that the patient's nutritional balance is at risk, even with nasogastric tube feedings. Deficient fluid volume would be appropriate if the patient's output exceeded input. No information indicates that the patient is experiencing difficulty with urination.

A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus and has been admitted to a medical unit. The nurse is writing a care plan for this patient. What information is essential to include? a. He will need to undergo an upper endoscopy every 6 months to detect malignant changes. b. Liver enzymes must be checked regularly as H2 receptor antagonists may cause hepatic damage. c. Small amounts of blood are likely to be present in his stools and should not cause concern. d. Antacids may be discontinued when symptoms of heartburn subside

*a. He will need to undergo an upper endoscopy every 6 months to detect malignant changes.* In the patient with Barrett's esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. *The altered cells are considered precancerous and are a precursor to esophageal cancer.* To facilitate early detection of malignant cells, upper endoscopies may be performed every 6 to 12 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or which are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.

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

1

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

3

The most significant complication related to continuous tube feedings is a. the interruption of GI integrity. b. a disturbance of intestinal and hepatic metabolism. c. the increased potential for aspiration. d. an interruption in fat metabolism and lipoprotein synthesis.

*c. the increased potential for aspiration. * Because the *normal swallowing mechanism is bypassed*, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the client receiving continuous tube feedings. Tube feedings preserve GI integrity by intraluminal delivery of nutrients. Tube feedings preserve the normal sequence of intestinal and hepatic metabolism. Tube feedings maintain fat metabolism and lipoprotein synthesis.

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

2

Metastases are common and respond poorly to treatment.

A client has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?

Streaks of blood present in the stool

A client has returned to the medical unit after a barium enema. When assessing the client's subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider?

A nurse is caring for a client who is 4 hour 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 (101.1) 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

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

B. "Lying quietly in bed helps slow down the activity in your intestines."

A nurse is teaching a patient who has cirrhosis of the liver and a history of alcohol consumption the nurse should explain that alcohol can cause the liver cirrhosis through which of the following actions increasing the workload of the liver by releasing store glycogen causing ulceration of the liver tissue that can lead to bleeding dilating veins in the portal circulation destroying liver cells that are later replaced with scar tissue

Destroying liver cells that are later replaced with scar tissue development of cirrhosis in a patient who consumes alcohol is related to liver inflammation in self-destruction overtime nonfunctional scar tissue and fibrosis replace necrotic liver cells

A nurse is monitoring the laboratory results of a patient who has an end stage liver failure which of the following results should the nurse expect Decreased lactate dehydrogenase increased serum albumin decreased serum ammonia increased prothrombin time

Increase prothrombin time clients who have end-stage liver failure have an inadequate supply of clotting factors and an increased prothrombin time a.k.a. prolonged prothrombin time

A nurse is caring for a patient who has abdominal pain and possible pancreatitis which of the following lab results should the nurse identify as an indication of pancreatitis decreased white blood count increase albumin level increased serum lipase level Decreased blood glucose level

Increase serum lipase level due to the release Of lipase into the pancreas and auto digestion pancreatitis causes increased serum lipase level with pancreatitis the WBC would increase due to the inflammatory process the albumin level would decrease due to inflammation and blood glucose would elevate due to a drop in insulin production

The client is receiving a 25% dextrose solution of parenteral nutrition. The infusion machine is beeping, and the nurse determines the intravenous (IV) bag is empty. The nurse finds there is no available bag to administer. It is most important for the nurse to

Infuse a solution containing 10% dextrose and water.

A patient is starting therapy with misoprostol (Cytotec) to prevent a gastric ulcer. Since she is a 30-year-old woman, you should give her which of the following instructions? (Select all that apply.) Report mid-cycle bleeding. Take a pregnancy test prior to therapy. Report excessive menstrual pain. Use effective contraception. Avoid taking the drug at bedtime.

Report mid-cycle bleeding. Take a pregnancy test prior to therapy. Report excessive menstrual pain. Use effective contraception. Misoprostol, a prostaglandin E analog, is a drug in pregnancy risk category X. It can induce uterine contractions and abort a pregnancy. Instruct women of childbearing age to confirm that they are not pregnant before taking this drug and to use effective contraception throughout drug therapy. Provide oral and written information about the risks of taking misoprostol during pregnancy. This drug can cause dysmenorrhea, so be sure to monitor for excessive menstrual pain or bleeding. Patients take this drug four times a day, with meals and again at bedtime.

The nurse is preparing to assess the donor site of a client who underwent a myocutaneous flap after a radical neck dissection. The nurse prepares to assess the most commonly used muscle for this surgery. Which muscle should the nurse assess? 1- Trapezius 2- Biceps 3- Pectoralis major 4- Sternomastoid

3

Fluids must be increased to facilitate the evacuation of the stool.

An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the client has completed the test?

When talking with a patient about taking loeramide (Imodium), HCP should include which of the following instructions? Take 30 min before activities that trigger nausea. Avoid activities that require alertness. Dissolve the powder thoroughly in 8 oz of water. Have diphenhydramine available.

Avoid activities that require alertness. Loperamide, an opioid agonist, can cause sedation and dizziness. The health care professional should caution the patient about not taking it before activities that require alertness.

HCP is caring for a patient who is about to begin using dimenhydrinate to prevent motion sickness. Which of the following instructions should the HCP include when talking with the patient about taking the drug? Sit upright for 30 min after taking the drug. Avoid activities that require alertness. Take the drug 30 to 60 min before activities that trigger nausea. Increase fluid and fiber intake. Avoid antacids when taking the drug.

Avoid activities that require alertness. Take the drug 30 to 60 min before activities that trigger nausea. Increase fluid and fiber intake.

A nurse is caring for a client who is 2 days postoperative following gastric surgery and has an NG tube inserted. Which of the following findings should the nurse report to the provider? A. Dryness of mucous membranes B. Hypoactive bowel sounds in all 4 quadrants C. 200 mL of bright red drainage from NG tube D. Suction set at a continuous low suction

C. 200mL of bright red drainage from NG tube

A nurse is administering an enema medicated with sodium polystyrene sulfonate (Kayexalate) to an older adult patient who has hyperkalemia. The nurse should insert the tip of the rectal tube A. 2.5-3.75 cm (1-1.5 in) B. 5-7.5 cm (2-3 in) C. 7.5-10 cm (3-4 in) D. 10-12.5 cm (4-5 in)

C. 7.5-10 cm (3-4 in)

A patient is about to start taking omeprazole (Prilosec) to treat a duodenal ulcer. Which of the following instructions should you include when talking with the patient about taking this drug? Take it with food. Avoid using aluminum-based antacids. Consume adequate vitamin D and calcium. Do not drink with grapefruit juice.

Consume adequate vitamin D and calcium. Omeprazole, a proton pump inhibitor, can cause bone loss with long-term use, so instruct patients to increase weight-bearing activities and consume sufficient amounts of calcium and vitamin D to help prevent osteoporosis. Food can reduce the absorption of omeprazole, so instruct patients to take this drug 1 hr before a meal. Antacids are unlikely to interfere with the absorption of omeprazole and might help reduce gastric distress. Grapefruit juice interacts with many different drugs, including cyclosporine (Sandimmune), midazolam (Versed), and lovastatin (Mevacor), but it is unlikely to affect the metabolism of omeprazole.

To prevent aspiration during the administration of an enteral tube feeding, a nurse should A. Flush the feeding tube with 30 mL of water B. Add blue food coloring to the enteral formula C. Ensure the formula is at room temperature D. Place the patient in Fowler's position

D. Place the patient in Fowler's position

To determine how much of the length of a nasoenteric tube to insert, a nurse should measure the distance from the tip of the patient's nose to the earlobe and from the earlobe to the A. Umbilicus B. Xiphoid process C. Manubrium plus 10-20 cm more. D. Xiphoid process plus 20-30 cm more

D. Xiphoid process plus 20-30 cm more

"It can evaluate the presence and location of ductal stones and aid in stone removal." "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."

A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply.

Atelectasis Pneumonia Hemorrhage

A nurse is providing care for a client who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply.

Proton pump inhibitors

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is

Shakiness Tachycardia Weakness Confusion

A nurse suspects that a client is developing rebound hypoglycemia secondary to parenteral nutrition being discontinued too rapidly. Which assessment support the nurse's suspicion? Select all that apply.

Restricts the client's ability to eat.

A nurse works in a bariatric clinic and cares for client with obesity who will or have undergone bariatric surgery. What is the nurse's understanding of how the procedure works?

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

A. Ensure bowel rest

The nurse is teaching a newly licensed nurse about caring for a client who is scheduled for an esophagogatric balloon tamponade tube to treat esophageal varices. Which of the following pieces of information should the nurse include in the teaching? A. The client will be placed on mechanical ventilation prior to this procedure. B. The tube will be inserted into the client's trachea C. The client will receive a bowel preparation with cathartics prior to this procedure. D. The tube allows the application of a ligation band to the bleeding varices.

A. The client will be placed on mechanical ventilation prior to this procedure.

A nurse is teaching a client with Barrett's esophagus who is scheduled to undergo an 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."

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

B. Empty the drainage bag when half-full of urine

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

B. Indwelling urinary catheter output of 25 mL/hr

A nurse who is administering a return flow enema to a patient should instill 100 mL of enema fluid and then A. Instruct the patient to retain the fluid. B. Lower the container to allow the solution to flow back out. C. Help the patient to the toilet or bedside commode D. Wait 5 min and instill another 100mL of fluid

B. Lower the container to allow the solution to flow back out

A patient with a gastric ileus postoperatively requires nutritional support for approximately 2 weeks. Which of the following types of feeding tubes is appropriate for this patient? A. Nasogastric tube B. Nasointestinal tube C. Percutaneous endoscopic gastrostomy tube D. Percutaneous endoscopic jejunostomy tube

B. Nasointestinal tube

A nurse is preparing to administer an oil-retention enema who has constipation. The nurse explains that the pt. should try to retain the instilled oil for A. As long as it takes to complete the procedure B. About 10-15 min C. Until the next time he feels he needs to defecate D. At least 30 min., but preferably as long as he can.

D. At least 30 min., but preferably as long as he can.

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 BP B. Decreased HR C. Yellowing of the skin D. Boardlike abdomen

D. Boardlike abdomen

The nurse is preparing to administer an IV fat emulsion simultaneously with parenteral nutrition (PN). What approach to the administration of a fat emulsion is appropriate? a. IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. b. The nurse should prepare for placement of another IV line, as IV fat emulsions may not be infused simultaneously through the line used for PN. c. IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site after running the emulsion through a filter. d. The IV fat emulsions can be piggy-backed into any existing IV solution that is infusing.

*a. IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered.* IV fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. The patient does not need another IV line for the fat emulsion. The IVFE cannot be piggy-backed into any existing IV solution that is infusing.

Surgical removal of the diverticulum

A client has been diagnosed with Zenker's diverticulum. What treatment does the nurse include in the client education?

A nurse caring for a client who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What is an expected, normal amount of drainage? 1- Between 40 and 80 mL 2- Approximately 80 to 120 mL 3- Between 120 and 160 mL 4- Greater than 160 mL

2

Report this finding promptly to the health care provider and remain with the client

A nurse is caring for a client who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the client and notes the presence of high-pitched adventitious sounds over the client's trachea on auscultation. The client's oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurse's most appropriate action?

peptic ulcer disease

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has?

Erosion of the lining of the stomach or intestine

A nurse is caring for a client who just has been diagnosed with a peptic ulcer. When teaching the client about his new diagnosis, how should the nurse best describe it?

The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process

A nurse is caring for a client who needs a nasogastric (NG) tube for a tube feeding. What is the safe method for the nurse to use to measure the appropriate length of the NG tube?

48-year-old female with BMI 36 k/m2 and uncontrolled type 2 diabetes. 34-year-old male with BMI 30 k/m2 and metabolic syndrome with hypertension.

A nurse working in a bariatric clinic assesses various clients with obesity. Which clients will the nurse recognize as meeting the selction criteria for bariatric surgery? Select all that apply.

A nurse is preparing to administer the first of two large-volume, cleansing enemas prescribed for a patient in preparation for a diagnostic procedure. Which of the following is an appropriate step in this procedure? A. Warm the enema solution prior to instillation B. Prepare 1,500 mL of enema fluid C. Use tap water as the enema fluid D. Hang the enema container 24 inches above the anus

A. Warm the enema solution prior to instillation.

PCP who is considering the various pharmacologic options for a patient with PUD should understand that which of the following drugs require monitoring of the patient's phosphorus levels? Ranitidine (Zantac) Omeprazole (Prilosec) Sucralfate (Carafate) Aluminum hydroxide (Amphojel)

Aluminum hydroxide (Amphojel) Antacids that contain aluminum, such as aluminum hydroxide, can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption. The drug requires monitoring of phosphorus levels.

A nurse is providing teaching about nutrients to a client. Which of the following statements should the nurse include? A. "Carbohydrates transport nutrients throughout the body." B. "Fats prevent ketosis." C. "Protein builds and repairs body tissue." D. "Carbohydrates help regulate body temperature."

C. "Protein builds and repairs body tissue."

During report, a nurse is informed that the patient has a nasogastric tube connected to continuous suction. The nurse should recognize that this patient must have which of the following types of tube? A. Levin B. Sengstaken-Blakemore C. Salem pump D. Ewald

C. Salem pump

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

C. Storing bile

A nurse is assessing a client receiving tube feedings and suspects *dumping syndrome*. What would lead the nurse to suspect this? Select all that apply a. Hypertension b. Diarrhea c. Decreased bowel sounds d. Tachycardia e. Diaphoresis

*b. diarrhea d. tachycardia e. diaphoresis* Dumping syndrome is manifested by hypotension, diarrhea, tachycardia, and diaphoresis. The client often reports a feeling of fullness, nausea, and vomiting. Because of the rapid movement of water to the stomach and intestines, bowel sounds would most likely be increased.

The client has the intake and output shown in the accompanying chart for an 8-hour shift. What is the positive fluid balance?

260

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

D. "Perhaps we should review your coping mechanisms and talk about other alternatives."

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

D. Colonoscopy

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

D. Hyperactive bowel sounds above the obstruction

A nurse is caring for a client who is dehydrated and receiving continuous tube feeding through a pump at 75mL/hr. When the nurse assess the client at 0800, which of the following findings requires intervention? A. A full pitcher 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 200mL 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.

D. The head of the bed is elevated 20 degree.

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. The best nursing intervention is to: a. Instruct the client to swish prescribed nystatin (Mycostatin) solution for 1 minute. b. Remove the plaque from the mouth by rubbing with gauze. c. Provide saline rinses prior to meals. d. Encourage the client to ingest a soft or bland diet.

*a. Instruct the client to swish prescribed nystatin (Mycostatin) solution for 1 minute.* A *cheesy white plaque in the mouth that looks like milk curds and can be rubbed off is candidiasis*. The most effective treatment is anitfungal medication such as nystatin (Mycostatin). When used as a suspension, the client is to swish vigorously for at least 1 minute and then swallow. Other measures such as providing saline rinses or ingesting a soft or bland diet are comfort measures. The nurse does not remove the plaques; doing so will cause erythema and potential bleeding.

A nurse is providing Pre-op teaching to a patient who will undergo surgery to create a temporary surgery to create a temporary colostomy the patient asked the nurse about the differences between colostomy and ileostomy as which of the following responses should the nurse make a class in my dream stool and ileostomy drains you're in class me is temporary ileostomy permanent cost me is from the large intestine and an ileostomy is from the small intestine and ileostomy requires dietary restrictions while a classmate is not

A colostomy is from the large intestine and an ileostomy is from the small intestine

Fear of eating

A nurse cares for a client who is postoperative bariatric surgery and has experienced frequent episodes of dumping syndrome. The client now reports anorexia. What is the primary reason for the client's report of anorexia?

Acute Pain Related to Increased Peristalsis and GI Inflammation Activity Intolerance Related to Generalized Weakness Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea

A nurse is caring for a client who has been admitted to the hospital with diverticulitis. What would be appropriate nursing diagnoses for this client? Select all that apply.

The use of moderate sedation

A nurse is caring for a client who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this client, the nurse should describe what aspect of this diagnostic procedure?

A nurse inserting a nasogastric tube asks the patient to flex her head toward her chest after the tube passes through the nasopharynx. This action facilitates proper insertion of the tube by A. Closing off the glottis B. Preventing curling of the tube in the mouth C. Allowing the patient to breathe through her mouth D. Opening the lower esophageal sphincter

A. Closing off the glottis

The client has just had a central line inserted for parenteral nutrition. The client is awaiting transport to the Radiology Department for catheter placement verification. The client reports feeling anxious. Respirations are 28 breaths/minute. The first action of the nurse is

Auscultate lung sounds.

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 Child who had her Spleen removed during a bicycle accident the child's parents asked nurse about the role of the screen in the body the nurse should explain that the spleen performs which of the following functions maintain fluid balance regulates calcium in the blood destroys old blood cells produces prothrombin

Destroys old blood cells

HCP should question use of metoclopramide (Reglan) for a patient who is taking which of the following drugs? Digoxin (Lanoxin) Fluvoxamine (Luvox) Allopurinol (Zyloprim) Warfarin (Coumadin)

Digoxin (Lanoxin) Metoclopramide, a prokinetic drug, can interfere with the absorption of many drugs, including digoxin, diazepam (Valium), tetracycline, and lithium (Lithobid). The patient should not take this drug.

A nurse is providing teaching to a patient who is scheduled for a sigmoid colon resection with Colostomy which of the following statements by the patient indicates a need for further teaching because most of my colon is still intact and functioning my stool be formed my stoma will appear large at first but it will shrink over the next few weeks My colostomy will begin to function in 2 to 6 days after surgery I'll have to consume a soft diet after surgery

I'll have to consume a soft diet after surgery the nurse should identify that the patient requires further teaching after surgery the patient quickly returns to a regular diet and there are no restrictions unless the client chooses to decreased intake of foods that increase gas or odor an ostomy placed at the sigmoid colon is still fairly solid the stoma is edematous at first but will start to shrink within 6 to 8 weeks after surgery because of lack of bowel peristalsis after surgery and the patient NPO status it is not unusual for mucus to drain from the ostomy until 2 to 6 days after surgery

A nurse is caring for a patient who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL per hour when the nurse assess the patient at 0800 which of the following findings require intervention a full picture of water is sitting on the patient's bedside within the patients reach The disposable feeding bag is from the previous day at 1000 and contains 200 mL of feeding the patient is lying in the right side with a visible dependent loop in the feeding tube the head of the bed is elevated to 20°

The head of the bed is elevated it's 20° the bed should be elevated to at least 30° semi Fowler's position while the tube feeding is being administered this position uses gravity to help the feeding move through the digestive system and lessens the possibility of regurgitation

Which of the following is the gold standard for assessing placement of a nasogastric (NG) tube for the patient receiving feedings?

X-ray

After teaching nursing students about methods to assess gastric tube placement, the instructor determines that the teaching was successful when the group identifies which of the following as the most accurate method?

X-ray visualization

HCP should use caution when Rx sulfasalazine (Azulfidine) for a patient who has _____________ pancreatitis. GERD. aspirin sensitivity. bronchitis.

aspirin sensitivity. Any sensitivity to salicylates, sulfonamides, or trimethoprim (Primsol) is a contraindication for the use of sulfasalazine, a 5-aminosalicylate. This is because intestinal bacteria metabolize the drug into 5-aminosalicylic acid, a salicylate. Aspirin is also a salicylate.