MED SURG GI review

A nurse is caring for a patient immediately following an appendectomy. The nurse should assign which nursing diagnosis the highest priority? a) Excess fluid volume b) Risk for constipation c) Acute pain d) Deficient knowledge (postoperative care)

c) Acute pain

A nurse is assessing a patient who underwent esophagogastroduodenoscopy (EGD) for postoperative complications. Which sign or symptom is a complication of this procedure? a) Drooling b) Sore throat c) Bloody secretions d) Absent gag reflex

c) Bloody secretions

What is a risk factor for squamous cell carcinoma of the esophagus? A) Chronic ingestion of hot liquids or foods B) Excessive dairy consumption C) Regular exercise D) Adequate vitamin C intake

A) Chronic ingestion of hot liquids or foods

A nurse is admitting a patient to the postsurgical unit following a gastrostomy. When planning assessments, the nurse should be aware of what potential postoperative complication of a gastrostomy? A) Premature removal of the G tube B) Bowel perforation C) Constipation D) Development of peptic ulcer disease (PUD)

A) Premature removal of the G tube A significant postoperative complication of a gastrostomy is premature removal of the G tube. Constipation is a less immediate threat and bowel perforation and PUD are not noted to be likely complications.

What is the most common presenting symptom of colorectal cancer? A) Headache B) Change in bowel habits C) Joint pain D) Increased appetite

B) Change in bowel habits

What is a significant risk factor for oral cancers according to page 1235? A) High salt intake B) Excessive use of alcohol C) Regular dental checkups D) Allergic reactions

B) Excessive use of alcohol

Why should medications not be mixed with feeding formula during tube feeding? A) Enhances drug absorption B) Prevents nutrient and drug interaction C) Improves taste D) Accelerates digestion

B) Prevents nutrient and drug interaction

What is the recommended age to start periodic screening for colorectal cancer? A) 30 years old B) 40 years old C) 50 years old D) 60 years old

C) 50 years old

Why is the injection of vitamin B12 required for patients who have undergone gastrectomy? A) Enhances wound healing B) Promotes weight loss C) Compensates for intrinsic factor loss D) Prevents infection

C) Compensates for intrinsic factor loss

A patient receiving tube feedings is experiencing diarrhea. The nurse and the physician suspect that the patient is experiencing dumping syndrome. What intervention is most appropriate? A) Stop the tube feed and aspirate stomach contents. B) Increase the hourly feed rate so it finishes earlier. C) Dilute the concentration of the feeding solution. D) Administer fluid replacement by IV.

C) Dilute the concentration of the feeding solution. Dumping syndrome can generally be alleviated by starting with a dilute solution and then increasing the concentration of the solution over several days. Fluid replacement may be necessary but does not prevent or treat dumping syndrome. There is no need to aspirate stomach contents. Increasing the rate will exacerbate the problem.

Which symptom is NOT associated with gastritis? A) Dyspepsia B) Hiccups C) Joint pain D) Nausea and vomiting

C) Joint pain

Which symptom is characteristic of IBS? A) Persistent cough B) Severe chest pain C) Recurrent abdominal pain D) Visual hallucinations

C) Recurrent abdominal pain

Which of the following is NOT listed as a risk factor for oral cancers on page 1235? A) HPV B) Excessive use of Alcohol C) Regular exercise D) History of head and neck cancers

C) Regular exercise

What is a common occurrence in the postoperative period following gastric surgery? A) Increased appetite B) Weight gain C) Weight loss D) Reduced pain sensitivity

C) Weight loss

What complication should the nurse monitor for if diarrhea occurs during tube feeding? A) Hypertension B) Respiratory distress C) Hyperglycemia D) Hypovolemia

D) Hypovolemia

What is a common symptom of bowel obstruction according to the notes? A) Constipation B) Clear bowel movements C) Frequent urination D) Passing of blood and mucus without fecal matter

D) Passing of blood and mucus without fecal matter

A patient is admitted with inflammatory bowel syndrome (Crohn's disease). Which therapies should the nurse expect to be part of the care plan? Select all that apply. a) Antidiarrheal medications b) Lactulose therapy c) Corticosteroid therapy d) High-protein milkshakese) High-fiber diet

a) Antidiarrheal medications c) Corticosteroid therapy

The patient asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse would be most accurate? a) "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." b) "Surgery is not performed for this type of hernia." c) "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned." d) "Surgery is usually required, although medical treatment is attempted first."

a) "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes."

Which of the following statements indicate that the patient with peptic ulcer disease understands how to effectively adjust the response to work-related stress? a) "I will have to improve my ability to cope with stress." b) "Well, I guess this ulcer means I won't be able to work toward a promotion." c) "I don't have any control over my stressors at work. My coworkers are difficult to work with." d) "My job is too stressful. I will have to find a different career."

a) "I will have to improve my ability to cope with stress."

A patient is learning about caring for an ileostomy. Which of the following statements would indicate that the patient understands how to care for the ileostomy pouch? a) "I'll empty my pouch when it's about one-third full." b) "I can take my pouch off at night." c) "I should change my pouch immediately after lunch." d) "I must apply a new pouch system every day."

a) "I'll empty my pouch when it's about one-third full."

A patient has had sucralfate prescribed as treatment for peptic ulcer disease. Which of the following statements indicates that the patient understands how to take the medication? a) "It is important that I take this drug on an empty stomach." b) "I should have my hemoglobin checked monthly while taking sucralfate." c) "I should take the sucralfate every evening at bedtime." d) "I should avoid milk products while taking this drug."

a) "It is important that I take this drug on an empty stomach."

The patient with gastroesophageal reflux disease (GERD) reports a chronic cough. The nurse understands that in a patient with GERD this symptom may be indicative of which of the following conditions? a) Aspiration of gastric contents. b) Development of laryngeal cancer. c) Esophageal scar tissue formation. d) Irritation of the esophagus.

a) Aspiration of gastric contents.

A nurse is reviewing the history and physical of a patient admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see? a) Constipation b) Hypoglycemia c) Hyperkalemia d) Lactic acidosis

a) Constipation

A patient's abdominal incision eviscerates. The nurse should: a) Cover the incision with a dressing moistened with sterile normal saline solution. b) Take the patient's vital signs and call the physician. c) Lower the patient's head and elevate the feet. d) Start an emergency infusion of I.V. fluids.

a) Cover the incision with a dressing moistened with sterile normal saline solution.

The patient with a peptic ulcer is prescribed antibiotics and bismuth salts. The nurse explains that this combination of medications will: a) Eradicate the Helicobacter pylori bacteria. b) Prevent future ulcers from forming. c) Prepare his bowel for surgery. d) Prevent bleeding from the ulcer.

a) Eradicate the Helicobacter pylori bacteria.

Which of the following diets would be most appropriate for the patient with ulcerative colitis? a) High-protein, low-residue. b) High-calorie, low-protein. c) Low-sodium, high-carbohydrate. d) Low-fat, high-fiber.

a) High-protein, low-residue.

The nurse would expect a patient with a hiatal hernia to report that the symptoms worsen when the patient is: a) Lying down. b) Physically active. c) Sitting. d) Upset or angry.

a) Lying down.

The nurse has been teaching the patient about maintaining a high-fiber diet. The patient's selection of which of the following breakfast menus indicates an understanding of the instructions? a) Oatmeal, milk, grapefruit wedges, and bran muffin. b) Danish pastry, prune juice, coffee, and milk. c) Corn flakes, milk, white toast, and orange juice. d) Scrambled eggs, bacon, English muffin, and apple juice.

a) Oatmeal, milk, grapefruit wedges, and bran muffin.

A patient who had an appendectomy for a perforated appendix returns from surgery with a drain inserted in the incisional site. The purpose of the drain is to: a) Promote drainage of wound exudates. b) Provide access for wound irrigation. c) Minimize development of scar tissue. d) Decrease postoperative discomfort.

a) Promote drainage of wound exudates.

The nurse assesses a patient with diverticulitis and suspects peritonitis when which of the following symptoms is noted? a) Rigid abdominal wall. b) Hyperactive bowel sounds. c) Explosive diarrhea. d) Excessive flatulence.

a) Rigid abdominal wall.

Which of the following interventions would be most appropriate for the nurse to recommend to a patient to decrease discomfort from hemorrhoids? a) Use warm sitz baths. b) Decrease fiber in the diet. c) Take laxatives to promote bowel movements. d) Decrease physical activity.

a) Use warm sitz baths.

A nurse is caring for a patient with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to prevent: a) aspiration. b) gastric ulcers. c) abdominal distention. d) diarrhea.

a) aspiration.

A patient is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the patient is at greatest risk for: a) rupture of the appendix. b) emotional distress related to the pain. c) ulceration of the appendix. d) inflammation of the gallbladder.

a) rupture of the appendix.

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

b) "Avoid coffee and alcoholic beverages."

To reduce the risk of dumping syndrome, the nurse should teach the client to do which of the following? a) Sit upright for 30 minutes after meals. b) Decrease the carbohydrate content of meals. c) Avoid milk and other dairy products. d) Drink liquids with meals, avoiding caffeine.

b) Decrease the carbohydrate content of meals.

The nurse is obtaining a health history from a patient who has a sliding hiatal hernia associated with reflux. The nurse should ask the patient about the presence of which of the following symptoms? a) Stomatitis. b) Heartburn. c) Jaundice. d) Anorexia.

b) Heartburn.

Metoclopramide is ordered as a premedication for a patient about to undergo a gastroduodenoscopy. Which of the following is the expected therapeutic effect?a) Reduced anxiety. b) Increased gastric emptying. c) Increased gastric pH. d) Inhibited respiratory secretions.

b) Increased gastric emptying.

A patient with peptic ulcer disease is taking ranitidine. What is the expected outcome of this drug? a) Reduce acid concentration. b) Limit gastric acid secretion. c) Heal the ulcer. d) Protect the ulcer surface from acids.

b) Limit gastric acid secretion.

The nurse is developing a plan of care for a patient with Crohn's disease who is receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include? Select all that apply. a) Monitoring vital signs once a shift. b) Monitoring the I.V. infusion rate hourly. c) Taping all I.V. tubing connections securely. d) Weighing the client daily. e) Changing the central venous line dressing daily.

b) Monitoring the I.V. infusion rate hourly. c) Taping all I.V. tubing connections securely. d) Weighing the client daily.

While changing the patient's colostomy bag and dressing, the nurse assesses that the patient is ready to participate in self-care by noting which of the following? a) The patient talks about the news on the television. b) The patient asks about the supplies used during the dressing change. c) The patient reports that he is unhappy about the way the night nurse changed the dressing. d) The patient asks what time the doctor will visit that day.

b) The patient asks about the supplies used during the dressing change.

Which of the following indicates the patient with ulcerative colitis has attained an expected outcome of nursing care? a) The patient accepts that an ileostomy will be necessary. b) The patient maintains an ideal body weight. c) The patient experiences decreased frequency of constipation. d) The patient verbalizes the importance of restricting fluids.

b) The patient maintains an ideal body weight.

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The patient reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. The nurse suspects the patient has: a) dehiscence of the surgical wound. b) dumping syndrome. c) a normal reaction to surgery. d) peritonitis.

b) dumping syndrome.

A patient is admitted to the hospital with an exacerbation of his chronic gastritis. When assessing his nutritional status, the nurse should expect a deficiency in: a) vitamin B6. b) vitamin B12. c) vitamin A. d) vitamin C.

b) vitamin B12.

In developing a teaching plan for the patient with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? a) Temperature in the work area. b) Number and length of breaks. c) Body mechanics used in lifting. d) Cleaning solvents used.

c) Body mechanics used in lifting.

Barium enema is not prescribed as a diagnostic test for a patient with diverticulitis because a barium enema: a) Would greatly increase the client's pain. b) Is of minimal diagnostic value in diverticulitis. c) Can perforate an intestinal abscess. d) Is too lengthy a procedure for the client to tolerate.

c) Can perforate an intestinal abscess.

When preparing a patient for a scheduled colonoscopy, which of the following should the nurse include? a) Placing the patient on a full-liquid diet 48 hours before the procedure. b) Administering meperidine I.M. to prevent pain during the procedure. c) Cleansing the bowel with laxatives or enemas. d) Administering an antibiotic to decrease the risk of infection.

c) Cleansing the bowel with laxatives or enemas.

Which of the following interventions is most appropriate for a patient who has stomatitis? a) Drinking hot tea at frequent intervals. b) Gargling with antiseptic mouthwash. c) Eating a soft, bland diet. d) Using an electric toothbrush.

c) Eating a soft, bland diet.

Which of the following dietary measures would be useful in preventing esophageal reflux? a) Avoiding air swallowing with meals. b) Adding a bedtime snack to the dietary plan. c) Eating small, frequent meals. d) Increasing fluid intake.

c) Eating small, frequent meals.

A nurse is assessing a patient who complains of abdominal pain, nausea, and diarrhea. When examining the patient's abdomen, which sequence should the nurse use? a) Inspection, palpation, percussion, and auscultation b) Palpation, auscultation, percussion, and inspection c) Inspection, auscultation, percussion, and palpation d) Auscultation, inspection, percussion, and palpation

c) Inspection, auscultation, percussion, and palpation

A patient is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The patient develops a sudden, sharp pain in the mid-epigastric region along with a rigid, boardlike abdomen. The nurse should do which of the following first? a) Prepare to insert a nasogastric tube. b) Raise the head of the bed. c) Notify the physician. d) Administer pain medication as ordered.

c) Notify the physician.

A nurse is monitoring a patient recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention? a) Heart rate of 84 beats/minute b) Blood-tinged stools c) Oxygen saturation (SaO2) of 85% d) Decreased cough and gag reflexes

c) Oxygen saturation (SaO2) of 85%

Immediately following an endoscopy, the nurse should assess the patient for? a) Intake and output. b) Bowel sounds. c) Return of the gag reflex. d) Peripheral pulses.

c) Return of the gag reflex.

A patient who has ulcerative colitis has persistent diarrhea and has lost 12 lb (5.4 kg) since the exacerbation of the ulcerative colitis. Which of the following will be most effective in helping the patient meet nutritional needs?a) Following a high-calorie, high-protein diet. b) Continuous enteral feedings. c) Total parenteral nutrition (TPN). d) Eating six small meals a day.

c) Total parenteral nutrition (TPN).

The nurse instructs the patient on health maintenance activities to help control symptoms from a hiatal hernia. Which of the following statements would indicate that the patient has understood the instructions? a) "I can still enjoy my potato chips and cola at bedtime." b) "If I wear a girdle, I'll have more support for my stomach." c) "I wish I didn't have to give up swimming." d) "I'll avoid lying down after a meal."

d) "I'll avoid lying down after a meal."

A patient is admitted with a diagnosis of ulcerative colitis. The nurse should assess the patient for: a) Alternating periods of constipation and diarrhea. b) Steatorrhea. c) Constipation. d) Bloody, diarrheal stools.

d) Bloody, diarrheal stools.

Which nursing intervention should the nurse perform for a patient receiving enteral feedings through a gastrostomy tube? a) Maintain the patient on bed rest during the feedings. b) Check the gastrostomy tube for position every 2 days. c) Maintain the head of the bed at a 15-degree elevation continuously. d) Change the tube feeding administration set at least every 24 hours.

d) Change the tube feeding administration set at least every 24 hours.

A patient has an elective hemorrhoidectomy. Immediately after a hemorrhoidectomy, the priority goal of nursing care for the patient should be to: a) Prevent infection. b) Promote ambulation. c) Prevent venous stasis. d) Control pain.

d) Control pain.

Total parenteral nutrition (TPN) is prescribed for a patient who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should: a) Designate a peripheral intravenous (IV) site for TPN administration. b) Administer TPN through a nasogastric or gastrostomy tube. c) Auscultate for bowel sounds prior to administering TPN. d) Handle TPN using strict aseptic technique.

d) Handle TPN using strict aseptic technique.

The patient is to take nothing by mouth after 4 a.m. (0400). The nurse recognizes that the patient has deficient knowledge when he states that he: a) Ate a gelatin dessert at 3:30 a.m. (0330). b) Held a cold washcloth against his lips. c) Brushed his teeth at 4:00 a.m. (0400) but did not swallow. d) Smoked a cigarette at 6:00 a.m. (0600).

d) Smoked a cigarette at 6:00 a.m. (0600).

Which of the following best indicates that a patient's peristaltic activity is returning to normal after surgery? a) The patient says that she is hungry. b) Peristalsis can be felt on abdominal palpation. c) Bowel sounds are hypoactive on auscultation. d) The patient passes flatus.

d) The patient passes flatus.

A patient presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the patient's current health problem? a) Hypertension b) Appendicitis c) Gastroesophageal reflux disease d) Ulcerative colitis

d) Ulcerative colitis

A patient with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately? a) Serum potassium 4.2 mEq/L b) Hematocrit 42% c) Serum sodium 135 mEq/L d) White blood cell count(WBC) 22.8/mm3

d) White blood cell count(WBC) 22.8/mm3

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

d) alcohol abuse and smoking.