Med-Surg: Gastrointestinal

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 30 mL PO 4x daily C. Obtain daily weight and abdominal girth measurements D. Administer a daily multivitamin E. Place the client on a low-protein diet

A, B, C, D A. Obtain the client's PT and INR measurements B. Administer lactulose 30 mL PO 4x daily C. Obtain daily weight and abdominal girth measurements D. Administer a daily multivitamin - Cirrhosis interferes with the liver's ability to produce clotting factors, which places the client at risk of hemorrhage. The PT and INR are usually prolonged due to decreased synthesis of prothrombin - A client who has cirrhosis is unable to eliminate ammonia from the body once protein is broken down. Therefore, lactulose should be administered to increase the client's production of stool, which will help eliminate ammonia from the client's body - The nurse should anticipate a prescription to assess the client's daily weight and fluid status. An increase of 1kg (2.2 lb) in the client's weight indicates 1 L of fluid retention. The nurse should also measure the client's abdominal girth daily to determine if ascites is increasing or decreasing - Cirrhosis also leads to deficiencies in many daily vitamins; therefore, the nurse should anticipate a prescription to administer a daily multivitamin to the client - Option E: Client who has cirrhosis needs a diet that is rich in protein, especially vegetable proteins

A nurse in a provider's office is assessing a client who has 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, B, C, D A. Regurgitation B. Nausea C. Belching D. Heartburn Regurgitation and heartburn are primary manifestations of GERD. Nausea and belching are also common manifestations - E: Clients who have GERD rarely experience unplanned weight loss

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 The nurse should ask the client to empty his bladder before the procedure to prevent injury to the bladder. - B: The client should lean forward over the bedside table for a thoracentesis to be performed - C: The client will be fully awake during the procedure; sedation is not required - D: The client can eat or drink up until the procedure; fasting is not required

A nurse is developing a plan of care for a client who has gastroesophageal reflux disease (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 Aspiration is a common complication of GERD, which results when the esophageal sphincter malfunctions and allows gastric acid and undigested food back up into the esophagus. This places the client at risk of aspiration. - GERD causes effortless, uncontrolled regurgitation whether the client is in an upright position or reclining. The most common results of regurgitation are heartburn and indigestion; however, aspiration is also possible. - The nurse should monitor the client for crackles in the lung fields, which are an indication of aspiration - B: Infection is not a common complication of GERD - C: Anemia is not a common complication of GERD - D: Nausea, vomiting, and resulting weight loss are rare in clients who have GERD

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 The nurse should expect to find rebound tenderness (Blumberg's sign) in a client who has cholecystitis. This response can be an indication of peritoneal inflammation. - B: The nurse should expect to find ascites in a client who has chronic pancreatitis or pancreatic cancer - C: The nurse should expect to find GI bleeding in a client who has pancreatic cancer - D: The nurse should expect to find a positive Kehr's sign in a client who has liver trauma

A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify 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 Hepatitis A is most commonly transmitted through the fecal-oral route. Children and young adults are most often affected by the hepatitis A virus. Typically, a child or young adult acquires the infection at school, through poor hygiene, through hand-to-mouth contact, or via another form of close contact.

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 The greatest risk to this client is an injury from infection due to wound exposure. Therefore, the first action the nurse should take is to cover the wound with a sterile, moist dressing.

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 Crackers, toast, and yogurt can help reduce flatus, which contributes to odor. - B: Chewing any flavor of gum can increase flatus, which contributes to odor - C: Cranberry juice and buttermilk can help prevent odor, not orange juice - D: Aspirin in the pouch can cause ulceration of the stoma

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 blood pressure C. Decreased heart rate D. Bright green stools

A. Emesis with a coffee-ground appearance The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee-grounds or is bright red in color. Hematemesis indicates upper gastrointestinal bleeding, occurring at or above the duodenojejunal junction. - B: A client with a bleeding duodenal ulcer will have a decreased blood pressure due to bleeding and fluid loss. - C: A client with a bleeding duodenal ulcer will have a decreased heart rate due to bleeding and fluid loss - D: A client with a bleeding duodenal ulcer will have melena stools, which are tarry or dark in color and are sticky.

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) The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring drug toxicity and excessive alcohol use.

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 When a client with an NG tube develops nausea, the nurse should first attempt to irrigate the tube to determine potency. If the tube is not patent, gastric pressure cannot decrease, and the steady or increasing pressure can cause nausea. - B: Although oral hygiene is an appropriate comfort measure for a client who is NPO, it will not eliminate the client's nausea - C: Clamping the NG tube will likely worsen the client's nausea - D: Increasing the suction can either be ineffective or increase the risk of tissue injury

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

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 The NG tube remins in place after surgery to prevent excessive pressure on suture lines postoperatively. It drains the air and fluid that can cause pressure from inside the GI tract. In doing so, it also prevents vomiting and GI distention. - B: Gastric lavage is a therapy for upper GI bleeding, it isn't necessary after a gastric resection - C: Unless specific problems prevent oral nutrition, the client will begin taking clear liquids by mouth and progress accordingly - D: Before administering an enteral feeding via an NG tube, the nurse should aspirate gastric contest to test pH; however, the client will not receive enteral feedings following gastric resection

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 major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk of bleeding. In addition to prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count should be monitored. - Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to an increased incidence of bruising, nosebleeds, bleeding from wounds, and GI bleeding. This is due to a deficient absorption of vitamin K from the GI tract, caused by the inability of liver cells to use vitamin K to make prothrombin

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

A. Right shoulder pain The client can experience pain in the right upper shoulder due to gas (carbon dioxide) injected into the abdominal cavity during the laparoscopic procedure, which can irritate the diaphragm and cause referred pain in the shoulder area. The pain disappears in 1-2 days. Mild analgesics and a recumbent position can promote client comfort. - B: Urine output following surgery should be at least 30 mL/hr. A lower urine output can indicate hypovolemia or renal complications and should be reported to the provider immediately. - C: A temperature of >38.4c (101.1f) can indicate infection and should be reported to the provider immediately - D: An oxygen saturation of <95% can indicate an impaired gas exchange following surgery and should be reported to the provider immediately

A nurse is teaching a newly licensed nurse about caring for a client who is scheduled for an esophagogastric balloon tamponade tube to treat bleeding 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 The client will require intubation and mechanical ventilation prior to this procedure to protect the airway

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 Celiac disease is an autoimmune disorder characterized by permanent intolerance to wheat, barely, and rye. Wheat toast contains gluten and should be removed from the client's tray. - Tapioca pudding, hard-boiled eggs, and mashed potatoes do not contain gluten.

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 Because of the acute inflammation of diverticulitis, the client should maintain a diet very low in fiber. The client can consume low-fiber foods like white bread, low-fat milk, yogurt with active cultures, poached eggs, and canned soft fruit

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 one-third to one-half full C. Cut the 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, C, D B. Empty the bag when it is one-third to one-half full C. Cut the barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water - Allowing the bag to become too full can cause leakage - The client should cut an opening that is about 1/16 to 1/8 inch larger than the stoma to avoid applying any constricting pressure to the stoma - The client should use mild soap and water to wash the skin because moisturizing soaps can affect adhesion of the appliance - A: Oil-based ointments on the skin disrupt adhesion, and antimicrobials are not necessary unless presided by the provider to treat an infection - E: The skin must be dry before applying the skin barrier since the pouch will not adhere to moist skin

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, D, E B. Diaphoresis D. Palpitations E. Shakiness

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 hepatits B immunization is given to infants and children Hepatitis B immune globulin is given as part of the standard childhood immunizations. It can be administered as early as birth, especially in infants born to mothers that are negative for hepatitis B surface antigen. These infants should receive the second dose between 1 and 4 months of age. - A: This statement is correct, but there are other at-risk groups that the vaccination is recommended for as well - C: Hepatitis B is acquired by exposure to blood or body fluids from an infected person. Hepatitis A is acquired by eating fruits, vegetables, shellfish, or other foods that are contaminated during handling. - D: Good personal hygiene habits and proper sanitation can help prevent the spread of hepatitis A, not hepatitis B

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 Anorexia is an early manifestation of hepatitis A and is often severe. It is thought to result from the release of a toxin by the damaged liver or by the failure of the damaged liver cells to detoxify an abnormal product. - Jaundice, dark urine, and pale feces are late manifestations of hepatitis A

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. Microorganisms in the urine

B. Blood in stool A guaiac test detects the presence of blood in the stool. It is a commonly used point-of-care test for fecal occult blood.

A nurse is 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 cart B. Empty the drainage bag when it is 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 it is half-full of urine The nurse should empty the drainage bag when half-full of urine. A drainage bag that is too full can place tension on the catheter tubing, resulting in trauma to the urethra and urinary meatus. - A: The nurse should always hang the drainage bag below the level of the client's bladder to prevent back flow of the urine from the drainage bag and to maintain adequate drainage of the bladder at all times. - C: The nurse should maintain the drainage bag in a hanging position and verify that the drainage spigot does not touch the floor when emptying to prevent contamination and maintain asepsis. - D: The nurse should obtain a urine specimen through the collection port in the drainage tubing of the indwelling urinary catheter to prevent contamination and maintain asepsis.

A nurse is providing discharge teaching to a 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 to 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 The client's diet should be high in carbohydrates and calories with only moderate amounts of protein and fat, especially if nausea is present - A: The client should not take acetaminophen or any other OTC medications without checking with the healthcare provider. Acetaminophen and many other OTC medications are metabolized by the liver. - C: There is no approved medication available to treat hepatitis A. - D: While complete bed rest is usually unnecessary, the client should alternate frequent periods of rest with light activity. The client should be encouraged to increase activity gradually.

A nurse is assessing a client who is 12 hr 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 25 mL/hr C. Heart rate of 96/min D. Serous drainage at the surgical incision site

B. Indwelling urinary catheter output of 25 mL/hr The nurse should report a urinary output of <30 mL/hr to the provider, as this can indicate hypovolemia or a renal complication - A: Hypoactive bowel sounds are an expected finding during the initial postoperative period due to decreased peristalsis from anesthesia and analgesic medications - C: A heart rate of 96/min is within the expected reference range of 60-100/min - D: A small to moderate amount of serous drainage at the surgical incision site is an expected finding during the immediate postoperative period. An increased amount of drainage can indicate the possibility of wound dehiscence.

A nurse is providing dietary 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 Clients who have ulcerative colitis are restricted to a low-fiber diet, which omits whole grains and raw fruits and vegetables.

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

B. This procedure can determine how well the lower part of your esophagus works An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures. - A: A pH probe study, which involves the insertion of a specifically designed probe into the distal esophagus, is performed to monitor for the presence of acid in the normally alkaline esophagus - C: An EGD is performed while the client receives moderate sedation - D: A colonoscopy is performed to detect colon cancer

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is 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 An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect a tumor, ulceration, or obstruction - A: A sigmoidoscopy or barium enema is used to visualize the lower GI tract, where polyps are found - C: Identifying an obstruction in the biliary tract occurs during endoscopic retrograde cholangiopancreatography (ERCP) - D: The measurement of free air (a gas) is obtained using fluoroscopy or an X-ray, not an EGD

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

C. 200 mL of bright red drainage from the NG tube Drainage should be either a yellow-green color or clear. Bright red drainage indicates blood loss and can be the result of a disrupted suture line or other internal bleeding. Volume loss from blood is a medical emergency, and the provider should be immediately notified. - A: The nurse can offer a lubricant for the nose and lips and provide ice chips, if they are approved by the provider. - B: The nurse should expect bowel sounds to be hypoactive following gastric surgery. Resumption of bowel sounds occurs slowly and indicates a return of peristalsis, which promotes healing. When peristalsis returns, the NG tube can be removed. - D: The nurse should expect the NG suction to be set at low continuous suction unless otherwise noted by the provider. The nurse can check the suction canister for drainage and the client's stomach for bloating and distention to determine if the decompression is effective.

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 The nurse should decrease the client's fat intake to reduce the occurrence of biliary colic. - A: The nurse should not restrict the client's fluid intake to reduce the risk of dehydration - B: The nurse might restrict the intake of calcium for a client who has calcium phosphate kidney stones, not cholelithiasis - D: The nurse should decrease potassium intake for a client who has chronic kidney disease to reduce the risk of hyperkalemia

A nurse is caring for a child 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. Produces prothrombin

C. Destroys old blood cells The nurse should tell the parent that the spleen destroys old blood cells, filters antigens, and stores platelets. A client without a spleen has an increased risk of infection and sepsis due to a reduced immune function. - A: Fluid balance is maintained by a variety of regulators, including the renal and endocrine systems. The spleen is not involved in maintaining fluid balance. - B: The parathyroid glands, which are located behind the thyroid gland, regulate calcium levels in the blood - D: Prothrombin is a clotting factor produced in the liver, not in the spleen

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 Long-term low-fiber eating habits and increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain the active motility of the gastrointestinal tract. - A: Vitamin C functions as an antioxidant as well as a coenzyme. It has been associated with the prevention of cancer of the stomach, esophagus, and colon. It does not improve or prevent acute diverticulitis. - B & D: Low-fat foods and low-calorie foods do not improve or prevent acute diverticulitis attacks

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 white blood cell (WBC) count B. Increased albumin level C. Increased serum lipase level D. Decreased blood glucose level

C. Increased serum lipase level Due to the release of lipase into the pancreas and auto-digestion, pancreatitis causes an increase serum lipase level - A: With pancreatitis, the WBC count increases because of the inflammatory process - B: Pancreatitis decreases the albumin level as a result of the inflammatory process - D: With pancreatitis, blood glucose is elevated due to a drop in insulin production

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 Fulminant hepatic failure, most often caused by viral hepatitis, is characterized by the development of hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence of hepatic dysfunction. - Mortality remains high, even with treatment modalities such as blood or plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, liver transplant has become the treatment of choice for these clients. - A: Endoscopic sclerotherapy is the injection of a sclerotherapy agent during an endoscopy to target esophageal varices that are actively bleeding. This promotes thrombosis, which eventually leads to sclerosis. - B: A liver lobectomy is used for localized cancer of a lobe of the liver. This is not appropriate for a client experiencing rapidly progressive liver failure. - D: A transjugular intrahepatic portal-systemic shunt is placed to treat esophageal varices through a stent into the portal vein. The stent serves as a shunt between the portal circulation and the hepatic vein, thereby reducing portal hypertension. It is not used for fulminant hepatic failure.

A nurse 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 blood pressure B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

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

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

A nurse is teaching a client who has cirrhosis of the liver and a history of alcohol consumption. The nurse should explain that alcohol can cause liver cirrhosis through which of the following? 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 replaces with scar tissue

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

A nurse is 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 The nurse should recognize that this client has the potential to develop hypoglycemia due to the sudden withdrawal of the TPN solution. In addition to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusion, and hunger.

A nurse is assessing a client who has a complete intestinal obstruction. Which of the following findings should the nurse expect? A. Absence of bowel sounds in all 4 abdominal 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 The nurse should expect the client to have hyperactive bowel sounds above the obstruction because the intestinal peristalsis above the obstruction attempts to push the obstruction through the intestines. With a complete intestinal obstruction, there are no bowel sounds below the obstruction. - A: The nurse should expect an absence of bowel sounds in all 4 quadrants in a client who has a paralytic ileus, not an intestinal obstruction - B: The nurse should expect diarrhea in a client who has a partial intestinal obstruction. A client who has a complete intestinal obstruction is unable to pass stool. - C: The nurse should not expect a client who has a complete intestinal obstruction to pass flatus.

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 it 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 The nurse should identify that this statement requires further teaching. After surgery, the client quickly returns to a regular diet, and there are no food restrictions unless the client chooses to decrease the intake of foods that increase gas or odor.

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 Screening examinations for colorectal cancer are secondary prevention (an action that promotes early detection of disease) - A: This is a primary prevention intervention - B: This is a primary prevention intervention - C: This is a tertiary prevention intervention

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 Clients who have end-stage liver failure have an inadequate supply of clotting factors and an increased/prolonged prothrombin time - A: Lactate dehydrogenase levels increase for a client who has end-stage liver failure, indicating liver cell destruction - B: Serum albumin levels decrease for a client who has end-stage liver failure - C: Serum ammonia levels increase for a client who has end-stage liver failure