Med Surg I Quiz 2: GI Issues

A nurse is working in a busy clinic and must provide teaching to a client about caring for a new colostomy. The nurse has a nurse aide to help with some tasks. Which of the following tasks could the nurse delegate to the unlicensed assistive personnel while working with this client? a. Checking and measuring the output from the foley b. Instructing the client about which foods are least likely to cause odor c. Gathering informational materials to give to the client d. Teaching the client about how to change the colostomy bag

a. rationale: "Checking and measuring the output from the foley" is correct. In a specialized care setting, unlicensed assistive personnel can provide client care in the form of basic tasks that are not outside of their scope of practice. In this situation, the nurse may only delegate the measurement of urine output from the foley. All other practices of providing education and teaching should be done by the nurse.

The nurse is working with a client who has peptic ulcer disease. Which of the following labs is important to monitor with this condition? a. H/H (Hgb/hematocrit) b. Potassium c. Procalcitonin d. Lactic acid

a. rationale: In PUD, bleeding is a concern, so monitoring the H/H will alert the clinician of developing or worsening bleeding.

A client presents to the emergency department with chest pain. The EKG and troponin labs are all within normal limits. Upon reviewing the client's medication list, the nurse notes a medication for acid reflux. Which of the following medications is this? a. Cimetidine b. Clopidogrel c. Captopril d. Cephalexin

a. rationale: "Cimetidine" is correct. Cimetidine is an anti-ulcer H2 antagonist that treats GERD, ulcers and is used to prevent GI bleeding. When a client with chest pain has negative troponins and a normal EKG, acid reflux is sometimes found to be the cause of the chest pain.

The nurse is teaching a client who has been diagnosed with peptic ulcer disease about what foods to eat. Which of the following is a food that the client is allowed to eat with this diagnosis? Select all that apply. a. Citrus b. Purine containing foods c. Coffee d. Chocolate e. Tea

a., b. rationale: Citrus fruits are not contraindicated for a client with peptic ulcer disease.Purines are avoided for gout, but not peptic ulcer disease.

The nurse is discharging a client who is newly diagnosed with GERD. Which of the following medication prescriptions indicate the presence of this condition? a. Olanzapine b. Oxycodone c. Omeprazole d. Oxytocin

c. rationale: "Omeprazole" is correct. This medication is a proton pump inhibitor used to treat GERD and ulcers.

The nurse is giving a client an IV infusion of infliximab for Crohn's disease and notices the client has developed fever and chills during the infusion. What is a priority nursing intervention? a. Give diphenhydramine for the allergic reaction b. Report the findings to the provider c. Slow the infusion rate d. Give acetaminophen for the fever

c. rationale: The client is having an acute reaction to the infusion. The priority nursing action is to slow the infusion. Then the nurse should give the client acetaminophen for fever and notify the provider. The fever is not an allergic reaction, so diphenhydramine will not improve symptoms.

The nurse is reviewing orders for a client with peptic ulcer disease (PUD). Which of the following would the nurse question? a. 500 mg calcium carbonate PO QID b. 40 mg pantoprazole PO daily c. 325 mg aspirin PO daily d. 20 mg famotidine PO BID

c. rationale: Aspirin and NSAIDS are avoided with PUD because they exacerbate symptoms.

The client has a chronic peptic ulcer and wants to know the difference between an acute and chronic peptic ulcer. How does the nurse educate the client? a. An acute ulcer is a superficial erosion, while a chronic ulcer extends through the muscular wall of the stomach b. An acute ulcer is treated with H2 blockers while a chronic ulcer is treated with proton pump inhibitors c. H. pylori is present with a chronic ulcer but not with an acute ulcer d. An acute ulcer lasts only a month and a chronic ulcer lasts greater than one month

a. rationale: When the erosion in the lining of the GI tract extends through the mucosal wall and muscle in a portion of the GI tract accessible to gastric secretions, it is called a chronic ulcer. Locations include the stomach, pylorus, duodenum and esophagus. An acute ulcer is in the same locations, but is a superficial erosion through the mucosal wall only.

The nurse suspects that a client has a duodenal ulcer. Which of the following signs would indicate this condition? a. Pain 1.5-3 hours after eating, relieved by eating b. Hematemesis c. Gnawing, sharp pain 30-60 min after eating d. Pain immediately after eating

a. rationale: Pain 1.5-3 hours after eating that is relieved by eating is indicative of a duodenal ulcer. Remember, pain 30-60 min after eating is indicative of a gastric ulcer, rather than a duodenal ulcer.

A nurse answers a clients call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.

c. rationale: All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid contamination with blood or body fluids.

The dietary plan for a client with diverticulitis includes which of the following? a. Low carb, high fiber b. High protein, restrict fluids c. Low protein, high fat d. High fiber, increased fluids

d. rationale: Clients with diverticulitis have pouches of fecal matter stuck in their diverticula. High fiber, increased fluids, and low fat consumption promote movement in the GI tract.

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

d. rationale: Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the clients willingness and ability to follow the regimen. The other assessment findings are not as critical.

The nurse is caring for a client with an intestinal ulcer who takes lansoprazole. The nurse knows to monitor the client for which of the following adverse reactions? Select all that apply. a. Oliguria b. Severe constipation c. Nausea d. Headache e. Diarrhea

c., d., e. rationale: Lansoprazole is a proton pump inhibitor (PPI) that carries the risk of adverse reactions. These include abdominal pain, headache, nausea, and diarrhea.

The client with diverticular disease is scheduled for a sigmoidoscopy and suddenly reports severe abdominal pain. On examination the nurse notes a rigid abdomen with guarding. Which action should the nurse take next? a. Notify the healthcare provider b. Place the client in a more comfortable position c. Keep the client distracted untill the procedure begins d. Tell the client that the test will show what is causing his problem

a. rationale: perforation of an obstructed diverticulum can cause abcess formation or generalized peritonitis. The manifestations of peritonitis are abdominal guarding and rigidity and pain. Because treatment of this complication is beyond the scope of independent nursing practice, the healthcare provider must be notified. Placing the client in a position of comfort could be attempted after notifying the HCP of the complication.

The nurse has received report on 4 clients. All clients have pantoprazole ordered. Which client will need this medication first? a. A client with a GI bleed b. A client with a gallstone c. A client with hypovolemia d. A client with a DVT

a. rationale: Pantoprazole is a proton pump inhibitor that decreases the amount of acid in the GI tract and is used for GERD, GI bleeding and esophageal varicies. The client with a GI bleed will need the medication first, as active bleeding is the priority out of the clients listed.

The nurse is caring for a client who is recovering from a gastric resection. The nurse provides teaching about how to prevent dumping syndrome. Which of the following statements are correct? Select all that apply. a. Do not consume fluids with meals b. Avoid consuming sugar, salt and milk c. Lie down after each meal d. Eat two large meals each day e. Increase carbohydrate intake

a., b., c. rationale: Fluids cause the intestines to rapidly push food through, causing an episode of dumping. One measure to prevent dumping syndrome is to avoid sugar, salt, and milk. When these elements move too quickly into the small intestine, dumping occurs.Dumping syndrome can occur after gastric resections when the contents of the stomach are rapidly moved into the small intestine. Symptoms of dumping syndrome include nausea, vomiting, cramping, sweating, and diarrhea. Measures to prevent dumping syndrome include consuming a low carb, high fat, high protein diet, avoiding fluid consumption with meals, avoiding sugar, salt and milk, and lying down after each meal. The patient may also take antispasmodic drugs to delay gastric emptying, if prescribed.

The nurse is caring for a client with peptic ulcer disease due to H. pylori. Which drug combinations should be given along with a macrolide antibiotic? a. Penicillin and Axid b. Amoxicillin and Prilosec c. Flagyl and Amphogel d. Tetracycline and sodium bicarbonate

b. rationale: H. pylori can be complicated to treat, because the bacteria quickly becomes resistant to antibiotics. Therefore, "triple therapy" is used. (When triple therapy fails, "quadruple therapy" is recommended.) Triple therapy consists of a macrolide antibiotic, a proton pump inhibitor, and a penicillin-related antibiotic.

A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)

c. rationale: Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.

A nurse assesses a client who is hospitalized with an exacerbation of Crohns disease. Which clinical manifestation should the nurse expect to find? a. Positive Murphys sign with rebound tenderness to palpitation b. Dull, hypoactive bowel sounds in the lower abdominal quadrants c. High-pitched, rushing bowel sounds in the right lower quadrant d. Reports of abdominal cramping that is worse at night

c. rationale: The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohns disease. A positive Murphys sign is indicative of gallbladder disease, and rebound tenderness often indicates peritonitis. Dullness in the lower abdominal quadrants and hypoactive bowel sounds are not commonly found with Crohns disease. Nightly worsening of abdominal cramping is not consistent with Crohns disease.

The nurse is conduction a dietary teaching with a client who has dumping syndrome. The nurse encourages the client to avoid which foods that the client usually enjoys? select all that apply. a. eggs b. cheese c. fruit d. pork e. cookies

c. , e. rationale: Dumping syndrome, in which gastric contents rapidly enter the bowel, can occur following gastrectomy. Fruits and cookies containing simple carbohydrates will attract fluid into the GI tract, leading to symptoms of dumping syndrome. Eggs are higher in protein and fat (cholesterol), which will slow GI transit time, avoiding dumping syndrome. Cheese has variable amounts of protein and fat, and these are less likely to trigger dumping syndrome. Pork is high in protein, which slows GI transit time to reduce episodes of dumping syndrome.

A nurse is planning medication administration for a client who has all of the following oral medications due at 0900: Calcium carbonate, Codeine, Levetiracetam, Metoclopramide. What is the most appropriate action by the nurse? a. Give Levetiracetam 30 minutes after the others b. Give Metoclopramide 1 hour before the others c. Give Codeine 30 minutes before the others d. Give Calcium carbonate 1 hour after the others

d. rationale: Calcium carbonate is an antacid, which should always be given 1 hour after other oral medications, otherwise it may impair absorption of those medications. In this case, it would be appropriate to give the other medications at 0830 and the calcium carbonate at 0930.

A client with diverticulosis had a colostomy placed yesterday. Which of the following assessment findings would be the MOST concerning to the nurse? a. Red stoma b. Pale-pink stoma c. Red skin around stoma d. Purple stoma

d. rationale: This is the most concerning finding as it indicates severe ischemia and possibly even strangulation of the stoma. This needs to be addressed immediately.

A client has total gastrectomy. The nurse explains the need for longterm injections of which vitamin? a. Thiamine b. Folic acid c. Cyanocobalamin d. Niacin

c. rationale: the loss of parietal cells that secrete intrinsic factor results in Vitamin B12(cyanocobalamin) deficiency post-gastrectomy because intrinsic factor is needed for the absorption of Vitamin B21.

A nurse is providing discharge teaching to a client who has had a colostomy surgically placed during the hospital stay. What information would the nurse most likely include about the stoma for this clent? Select all that apply. a. The stoma is typically round or oval in shape b. The stoma is usually red in color c. The stoma is painful when touched d. The stoma is usually flat or inverted e. The stoma may be slightly swollen just after surgery

a. , b., e. rationale A client with a new colostomy may be surprised at the appearance of the stoma and requires teaching about what to expect as well as how the stoma may change. The stoma site may be slightly swollen just after surgery, but this should resolve with time. The client should understand what a normal stoma looks like in order to detect potential complications if there is a change in appearance. A red or pink stoma indicates high vascularization, which is normal. If the stoma becomes pale pink, the client may have low hemoglobin and hematocrit levels.

The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections

a. , b. , c. , d. rationale: Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.

The nurse is caring for a client who is scheduled to be evaluated for possible GERD. The nurse is aware that diagnostic tests for GERD include which of the following? Select all that apply. a. Esophageal impedance pH study b. Esophagram c. Esophageal manometry d. Sigmoid colonoscopy e. Upper endoscopy

a. , b., c., e. rationale: Esophageal impedance pH study tests to evaluate a client with gastroesophageal reflux disease (GERD) involve the esophagus. An esophageal impedance-pH evaluates the esophagus. Esophagram tests to evaluate a client with gastroesophageal reflux disease (GERD) involve the esophagus. An esophagus evaluates the esophagus. Esophageal manometry tests to evaluate a client with gastroesophageal reflux disease (GERD) involve the esophagus. An esophageal manometry evaluates the esophagus. Upper endoscopy tests to evaluate a client with gastroesophageal reflux disease (GERD) involve the esophagus. An upper endoscopy evaluates the esophagus.

A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) a. Lower gastrointestinal bleeding - Erosion of the bowel wall b. Abscess formation - Localized pockets of infection develop in the ulcerated bowel lining c. Toxic megacolon - Transmural inflammation resulting in pyuria and fecaluria d. Nonmechanical bowel obstruction - Paralysis of colon resulting from colorectal cancer e. Fistula Dilation and colonic ileus - caused by paralysis of the colon

a. , b., d. rationale: Lower GI bleeding can lead to erosion of the bowel wall. Abscesses are localized pockets of infection that develop in the ulcerated bowel lining. Nonmechanical bowel obstruction is paralysis of the colon that results from colorectal cancer. When the inflammation is transmural, fistulas can occur between the bowel and bladder resulting in pyuria and fecaluria. Paralysis of the colon causing dilation and subsequent colonic ileus is known as a toxic megacolon.

The nurse is educating the client with GERD about ways to minimize symptoms. Which info in the client's history should the RN address as indicators that need to be changed? Select all that apply. a. Lifting weights for exercise b. being vegetarian c. having a body mass index of 26 d. taking calcium carbonate tablets e. drinking 2-4 cups of coffee daily

a. , c., e. rationale: lifestyle modifications can minimize symptoms of GERD. Anything that increases intra-abdominal pressure should be avoided, such as lifting weights. Obesity or being overweight (BMI of 26) also aggravates symptoms. Coffee, cola, other sources of caffeine, and chocolate decrease lower esophageal sphincter tone and can increase symptoms of GERD. Being a vegetarian does not increase risk of GERD. Calcium carbonate tablets often aid in symptom relief.

A client with Crohn's disease has been using whey protein shakes for weight gain. What information should the nurse give to this client about the safety of using these types of shakes? Select all that apply. a. Whey protein has been known to lower blood pressure in some people b. Whey protein may cause changes in cholesterol levels c. Whey protein is usually safe for use in adults when used at recommended amounts d. Whey protein has been shown to increase the risk of blood clots e. Whey protein powder can significantly increase blood glucose levels

a., b., c. rationale: Whey protein is a type of supplement that may be used to assist with weight gain because of the protein provided. Whey protein shakes can be helpful but they should be used with caution in some clients, particularly those who are lactose intolerant. Whey protein has also been shown to lower blood pressure, moderate blood glucose levels, reduce C-reactive protein levels (inflammatory markers), and can lower cholesterol levels.Whey protein has been shown to lower cholesterol levels in some clients.Whey protein is safe for most adults, unless the client is known to have a lactose intolerance.

A client has GERD. What changes should the nurse recommend to improve symptoms? Select all that apply. a. Quit drinking alcohol b. Quit smoking c. Raise the foot of the bed 4-6 inches d. Lose weight e. Eat large meals

a., b., d. rationale: For the management of gastroesophageal reflux disease (GERD), the head of the bed should be raised 4-6 inches, the client should eat small meals, quit smoking, quit drinking, lose weight, and should not eat within four hours of bedtime. Alcohol can cause irritation and increase acid reflux.

A client with a peptic ulcer has been brought in to the healthcare clinic and is being assessed by the nurse for an upper GI bleed. Which of the following signs or symptoms would the nurse expect to see with this condition? Select all that apply. a. Melena b. Swelling in the lower legs c. Epigastric pain d. Hematemesis e. Abdominal fullness

a., c., d. rationale: "Epigastric pain", "Melena" and "Hematemesis" are correct. An upper GI bleed occurs in the upper portion of the gastrointestinal tract, including the area within the esophagus. Signs or symptoms associated with bleeding from this area include epigastric pain, vomiting blood, and dark blood in your stool, called melena.

A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce

a., c., d., e. rationale: Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided.

A nurse is caring for a client who is suffering from a gastric ulcer. Which of the following is an appropriate nursing intervention? Select all that apply. a. Take a histamine blocker b. Drink caffeinated beverages c. Take a proton pump inhibitor d. Drink plenty of milk e. Eat small, frequent meals

a., c., e. rationale: Histamine blockers or proton pump inhibitors should be given to reduce stomach acid.Small, frequent meals are less likely to cause irritation to an ulcer than large meals.

The client has an acute flare up of diverticulitis. Nursing interventions to prevent complications include which of the following? Select all that apply. a. Give antibiotics by IV b. Give the client an enema c. Maintain NPO status d. Give antispasmodics e. Provide IV fluids

a., c., e. rationale: IV antibiotics are necessary to reduce infection during a flare-up.During an acute flare up of diverticulitis, the client should have IV fluids and be placed on bowel rest with IV antibiotics.IV fluids are necessary when the client is NPO to avoid dehydration.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

a., d. rationale: Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

A 57-year-old client with peptic ulcer disease is being seen for abdominal pain. Which of the following are assessments for hemorrhage in this client? Select all that apply. a. Monitoring the client's hemoglobin and hematocrit levels b. Recording hourly urinary output c. Administering stool softeners d. Speaking calmly to the client to reduce anxiety e. Assessing for symptoms of dizziness or nausea

a., e. rationale: "Assessing for symptoms of dizziness or nausea" and "Monitoring the client's hemoglobin and hematocrit levels" are correct. A client with peptic ulcer disease is at higher risk of bleeding because of the disease process. The nurse can assess for bleeding by monitoring hemoglobin and hematocrit levels and assessing for signs of low blood pressure such as dizziness or nausea.

The client returning from a colonoscopy has been given a dx of Crohn's disease. The oncoming shift nurse expects to note which manifestations in the client? Select all that apply. a. Steatorrhea b. Firm, rigid abdomen c. Constipation d. Enlarged hemorrhoids e. diarrhea

a., e. rationale: Steatorrhea is often present in the client with Crohn's disease. Diarrhea is also a key feature, but unlike ulcerative colitis, the loose stoll usually does not contain blood and is usually less frequent in number of episodes. A firm rigid abdomen is not a manifestation of Crohn's disease. Constipation is not a manifestation of Crohn's disease. Hemorrhoids are nota manifestation of Crohn's disease.

The nurse is caring for a client with poorly controlled GERD. The nurse is providing education regarding foods that can exacerbate the condition. Which of the following would be an appropriate food for this client to eliminate? a. Gluten-containing foods b. Chocolate c. Purine-containing foods like organ meats (liver, kidneys) d. Citrus fruits

b. rationale: Chocolate contributes to GERD symptoms, because it decreases the tone of the esophageal sphincter which worsens the reflux. Other foods that have this effect include coffee, soda, tea, peppermint, and fried or fatty foods.

A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best? a. Arrange an intensive care unit tour. b. Assess the clients psychosocial status. c. Document the teaching and response. d. Have the client begin nutritional supplements.

b. rationale: Clients facing this long, difficult procedure are often anxious and fearful. The nurse should now assess the clients psychosocial status and provide the care and teaching required based on this assessment. An intensive care unit tour may help decrease stress but is too limited in scope to be the best response. Documentation should be thorough, but the nurse needs to do more than document. The client should begin nutritional supplements prior to the operation, but again this response is too limited in scope.

A client with diverticulosis had a colostomy placed 5 days ago and is now being discharged. Which of the following would NOT be appropriate discharge teaching for this patient? a. Increase fluid intake b. Increase fiber intake to 25-30 g/day c. Masticate fully before swallowing d. Let any sealers dry before applying a new appliance

b. rationale: Fiber intake should be introduced slowly after a colostomy, and only after the first 2 months. Therefore, increasing the fiber intake to 25-30 g/day right away would be inappropriate.

The nurse is reviewing a medication list for a client who reports they take a medication for gastroesophageal reflux. The client asks the nurse to confirm which medication is used for this condition. Which of the following medications is taken for reflux? a. Fluoxetine b. Famotidine c. Fentanyl d. Furosemide

b. rationale: "Famotidine" is correct. This is an anti-ulcer H2 histamine blocker, used to treat ulcers, gastroesophageal reflux (GERD), and over-production of acid in the GI system

A nurse is working with a client who had bowel surgery with placement of a colostomy one month ago. The client has not had any complications following colostomy surgery so far. Which nutritional recommendation should the nurse give that is appropriate for a client in this stage of recovery? a. Limit the amount of fluids consumed b. Thoroughly chew food c. Measure waist circumference once per week d. Try new foods frequently to further improve output

b. rationale: "Thoroughly chew food" is correct. A client who has had a colostomy placed and who is not having complications can eat a normal diet and enjoy food as before the surgery. Although this client is still in a relatively early stage of recovery, the nurse should reinforce with the client to chew food thoroughly while eating and drink plenty of fluids, because blockages and dehydration are a common problem related to colostomies.

The nurse is caring for a client diagnosed with Crohn's disease. Which statement indicates more teaching is needed? a. "I am at risk for anemia and electrolyte disturbances" b. "I will deal with chronic constipation" c. "A high-calorie, high-protein diet is best" d. "I will have periods of remission and periods of exacerbation"

b. rationale: A client with Crohn's disease will have frequent episodes of diarrhea, not constipation.

A nurse is helping a client with colostomy irrigation. Which best describes effluent, which is part of this process? a. The type of skin barrier that is used to cover the stoma b. The stool that comes out of the colostomy c. The fluid that is instilled into the stoma d. The name of the applicator used to instill the fluid

b. rationale: Colostomy irrigation involves instilling fluid into a client's stoma using a specialized piece of equipment. The stool and liquid that comes out of the stoma after the irrigation is called the effluent. The effluent should be collected in a container or passed into the toilet during the irrigation.

The client with a duodenal ulcer asks the RN why an abx is part of the tx regimen. Which info should the nurse include in the response? a. abx decrease the likelihood of a 2ndary infection b. many duodenal ulcers are caused by H. pylori c. Abx are used in an attempt to sterilize the stomach d. May people have C. difficile, which can lead to ulcer formation

b. rationale: H. pylori infection is a major cause of peptic ulcers so tx includes abx therapy to eradicate the microorganism. Abx do not reduce the likelihood of a secondary infection, they treat the primary infection. Abx are not used to sterilize the bowel, and would upset the normal flor of the GI tract. C. diff is a contagious microorganism that can lead to severe diarrhea.

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.

b. rationale: This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.

The pt who has ulcerative colitis is scheduled for an ileostomy. When the client asks the nurse what to expect r/t bowel function and care after surgery, which response should the nurse make? a. "You will be able to have some control over your bowel movement.s" b. "the stoma will require that you wear a collection device all the time." c. "After the stoma heals, you can irrigate your bowel so you will not have to wear a pouch." d. The drainage will gradually become semisolid and formed.

b. rationale: a client wiht an ileostomy must always wear a collection device. The client has no contorl over bowel movements. Bowel irrigation is not performed to eliminate the need to wear a drainage pouch.

A nurse is changing the colostomy bag for a patient with a new colostomy. Which elements of skin care should the nurse provide during this process? Select all that apply. a. Avoiding adhesive remover or water when removing the pouch from the skin b. Drying the skin thoroughly before reapplying the pouch c. Avoiding ripping the pouch off of the patient's skin d. Cleaning around the stoma with warm water and a washcloth e. Using sterile gauze to wipe the stoma and absorb exudate

b., c., d. rationale: -"Avoiding ripping the pouch off of the patient's skin", "Cleaning around the stoma with warm water and a washcloth" and "Drying the skin thoroughly before reapplying the pouch" are correct. A patient who uses a colostomy bag is at risk of skin breakdown around the ostomy site. The pouch should be removed by pushing gently down on the skin with one hand, while pulling up on the pouch with the other hand. Skin care includes inspecting the skin and stoma site carefully, washing the skin with soap and water and ensuring the skin is dry before applying a new pouch. If the skin is irritated, it is possible that the pouch opening is too large, excessively exposing the surrounding skin to feces which leads to skin irritation and breakdown.

A nurse is caring for an 86-year-old client who is undergoing surgery for a bladder suspension. The nurse assesses the client's medical history prior to surgery and documents that the client also has arthritis. Which best describes why this information is important? a. The client will have problems transferring from the bed to the operating table b. The client's arthritis medications can interfere with the anesthesia used during surgery c. The client with arthritis has a higher risk for a cardiovascular event d. A client with arthritis will be less likely to have bladder stones

c. rationale: "The client with arthritis has a higher risk for a cardiovascular event" is correct. When assessing a client who is getting ready for surgery, the nurse must determine if the client has any medical history that could impact the surgery and surgical outcomes. A client with arthritis is at an increased risk for a cardiovascular event, including myocardial infarction. This is similar to a person with diabetes mellitus, or a person ten years older than the age of the surgical candidate. Additionally, the client with arthritis typically presents with fewer complaints of angina and a higher unrecognized cardiovascular disease state.

The nurse is caring for a client who has been admitted with an acute exacerbation of ulcerative colitis (UC). Which of the following orders would the nurse question? a. Hemoccult stools b. Labs: CMP, magnesium, phosphorus serum levels c. High protein diet d. 0.9 % normal saline continuous at 75 ml/hr

c. rationale: A client experiencing an acute exacerbation of UC should be NPO while receiving IV fluids and electrolytes (if needed). Initiating a high-protein diet during this phase would be inappropriate. Once the client is out of the acute phase, this diet is appropriate.

A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first? a. Client who underwent diverticula removal with a pulse of 106/min b. Client who had esophageal dilation and is attempting first postprocedure oral intake c. Client who had an esophagectomy with a respiratory rate of 32/min d. Client who underwent hernia repair, reporting incisional pain of 7/10

c. rationale: The client who had an esophagectomy has a respiratory rate of 32/min, which is an early sign of sepsis; this client needs to be assessed first. The client who underwent diverticula removal has a pulse that is out of the normal range (106/min), but not terribly so. The client reporting pain needs pain medication, but the client with the elevated respiratory rate needs investigation first. The nurse should see the client who had esophageal dilation prior to and during the first attempt at oral feedings, but this can wait until the other clients are cared for.

The nurse is caring for a client who has ulcerative colitis. The nurse knows to monitor for which of the following abnormal lab work? Select all that apply. a. Urine b. Folic acid c. Calcium d. Complete blood count e. Potassium

c. , d. , e. rationale: Potassium and Calcium - clients with ulcerative colitis are likely to have blood in their stool, decreased amounts of electrolytes due to decreased absorption, and frequent stools leading to elimination of electrolytes before they are absorbed. A CBC is checked for signs of infection and anemia.

An ostomy nurse is caring for a client who is scheduled for surgery for placement of a colostomy. The nurse explains that it is important to choose the most appropriate site for the stoma. Which of the following regarding stoma location is accurate for the nurse to include in teaching? a. Without proper placement, the stoma will be sunken below the skin level b. The stoma is more likely to become infected if it is not exactly placed in the proper location c. Placement of the stoma in the right location will affect how you feel about having it d. If the stoma is not in the right place, you may have trouble reaching it to take care of it

d. rationale: One of the most important aspects to consider for the client who will have a stoma is to determine the correct location of the site. A stoma that is poorly positioned may be difficult for the client to reach, which means the client may have a harder time taking care of it. This could lead to a greater risk of skin complications and infection.

After teaching a client with diverticular disease, a nurse assesses the clients understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice

d. rationale: Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup of bean soup) should be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.