Med surg test 3 practice questions

A nurse cares for a client who states, "My husband is repulsed by my colostomy and refuses to be intimate with me." How should the nurse respond? a. "Let's talk to the ostomy nurse to help you and your husband work through this." b. "You could try to wear longer lingerie that will better hide the ostomy appliance." c. "You should empty the pouch first so it will be less noticeable for your husband." d. "If you are not careful, you can hurt the stoma if you engage in sexual activity."

ANS: A The nurse should collaborate with the ostomy nurse to help the client and her husband work through intimacy issues. The nurse should not minimize the client's concern about her husband with ways to hide the ostomy. The client will not hurt the stoma by engaging in sexual activity.

A nurse plans care for a client who is recovering from an inguinal hernia repair. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Encouraging ambulation three times a day b. Encouraging normal urination c. Encouraging deep breathing and coughing d. Providing ice bags and scrotal support e. Forcibly reducing the hernia

ANS: A, B, D Postoperative care for clients with an inguinal hernia includes all general postoperative care except coughing. The nurse should promote lung expansion by encouraging deep breathing and ambulation. The nurse should encourage normal urination, including allowing the client to stand, and should provide scrotal support and ice bags to prevent swelling. A hernia should never be forcibly reduced, and this procedure is not part of postoperative care.

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching? a. Ham sandwich on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice c. Grilled cheese sandwich, small banana, cup of hot tea with lemon d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

ANS: B Clients with IBS are advised to eat a high-fiber diet (30 to 40 g/day), with 8 to 10 cups of liquid daily. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. They should avoid alcohol, caffeine, and other gastric irritants.

A nurse cares for an older adult client who has Salmonella food poisoning. The client's vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first? a. Apply oxygen via nasal cannula. b. Administer intravenous fluids. c. Provide perineal care with a premedicated wipe. d. Teach proper food preparation to prevent contamination.

ANS: B Dehydration caused by diarrhea can occur quickly in older clients with Salmonella food poisoning, so maintenance of fluid balance is a high priority. Monitoring vital signs and providing perineal care are important nursing actions but are of lower priority than fluid replacement. The nurse should teach the client about proper hand hygiene to prevent the spread of infection, and preparation of food and beverages to prevent contamination.

A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? a. "Eat low-fiber and low-residual foods." b. "White rice and bread are easier to digest." c. "Add vegetables such as broccoli and cauliflower to your new diet." d. "Foods high in animal fat help to protect the intestinal mucosa."

ANS: C The client should be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.

The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) Acupuncture Decreasing physical activities Herbs (moxibustion) Meditation Peppermint oil capsules Yoga

Acupuncture is recommended as a complementary therapy for IBS. Moxibustion is helpful for some clients with IBS. Meditation, yoga, and other relaxation techniques help many clients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.

The nurse is teaching a client who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the client to report to the health care provider? (Select all that apply.) Anorexia Depression Drowsiness Frequent urination Headache Vomiting

Anorexia, headache, and nausea/vomiting are side effects of sulfasalazine that should be reported to the health care provider. Depression, drowsiness, and urinary problems are not side effects of sulfasalazine.

A client with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to the treatment regimen. What does the nurse tell the client about the diarrhea and mouth ulcers? "A combination of chemotherapeutic agents has caused them." "GI problems are symptoms of the advanced stage of your disease." "5-FU cannot discriminate between your cancer and your healthy cells." "You have these as a result of the radiation treatment."

5-FU cannot discriminate between cancer and healthy cells; therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the client's GI problems.

The nurse case manager is discussing community resources with a client who has colorectal cancer and is scheduled for a colostomy. Which referral is of greatest value to this client initially? a Certified Wound, Ostomy, and Continence Nurse (CWOCN) b Home health nursing agency c Hospice d Hospital chaplain

A CWOCN (or an enterostomal therapist) will be of greatest value to the client because the client is scheduled to receive a colostomy. The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates a correct understanding of the nurse's instructions? "I should take Ex-Lax after the surgery to 'keep things moving'." "I will need to eat a diet high in fiber." "Limiting my fluids will help me with constipation." "To help with the pain, I'll apply ice to the surgical area."

A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements. Stimulant laxatives are discouraged because they are habit-forming. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications; cold therapy is sometimes recommended and useful before surgery for inflamed hemorrhoids.

A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. "I will plan to limit fiber in my diet." B. "I will eat my meals and plan fluid intake between meals." C. "I will switch to black tea instead of drinking coffee." D. "I will try to eat three moderate to large meals a day."

A. CORRECT: A low-fiber diet is recommended for the client who has ulcerative colitis to reduce inflammation. B. INCORRECT: A client who has dumping syndrome should avoid fluids with meals. C. INCORRECT: Caffeinated beverages, such as black tea, should be avoided by the client who has ulcerative colitis. D. INCORRECT: Small frequent meals are recommended for the client who has ulcerative colitis.

A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis? (Select all that apply.) A. Emesis greater than 500 mL with a fecal odor B. Report of spasmodic abdominal pain C. Pain relieved with vomiting D. Abdomen flat with rebound tenderness to palpation E. Laboratory findings indicating metabolic acidosis

A. CORRECT: Large emesis with a fecal odor is a finding in a client who has a small bowel obstruction. B. CORRECT: Report of abdominal pain is a finding in a client who has a small bowel obstruction. C. CORRECT: Relief of pain after vomiting is a finding in a client who has a small bowel obstruction. D. INCORRECT: Abdominal distention is a finding in a client who has a small bowel obstruction. E. INCORRECT: Metabolic alkalosis due to the loss of gastric acid is a finding in a client who has a small bowel obstruction.

A nurse is completing discharge teaching to a client who has Crohn's disease. Which of the following should be included in the teaching? A. Decrease intake of calorie-dense foods. B. Drink canned protein supplements. C. Take calcium supplements daily. D. Take a bulk-forming laxative daily.

A. INCORRECT: A high-protein diet is recommended for the client who has Crohn's disease. B. CORRECT: A high-protein diet is recommended for the client who has Crohn's disease, and canned protein supplements are encouraged. C. INCORRECT: Vitamin supplements, not calcium, are recommended for the client who has Crohn's disease. D. INCORRECT: Bulk-forming laxatives are recommended for the client who has diverticulitis.

A nurse is caring for an older adult client in an extended care facility. Which of the following indicates the client has a stool impaction causing a large intestine obstruction? A. The client reports he had a bowel movement yesterday. B. The client is having small, frequent liquid stools. C. The client is flatulent. D. The client indicates he vomited once this morning.

A. INCORRECT: A report of a bowel movement yesterday is unlikely in a client who has a suspected impaction. B. CORRECT: Small, frequent liquid stools can be passed around an impaction. C. INCORRECT: The presence of flatus does not indicate an obstruction of the large intestine. D. INCORRECT: A report of a single episode of vomiting does not indicate an obstruction of the large intestine.

A nurse is completing discharge teaching to a client who has irritable bowel syndrome (IBS). Which of the following should be included in the teaching? A. Increase dietary intake of dairy products. B. Consume 15 to 20 g of fiber daily. C. Plan three moderate to large meals per day. D. Drink at least 2 L of fluids each day.

A. INCORRECT: Dairy products should be limited or avoided by a client who has IBS due to their higher fat content. B. INCORRECT: A client who has IBS should increase their daily fiber intake to 30 to 40 g. C. INCORRECT: A client who has IBS should eat small frequent meals. D. CORRECT: A client who has IBS should drink 2 to 3 L of fluids a day to promote a consistent bowel pattern.

A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease (IBD). Which of the following assessment findings is the highest priority? A. Client reports difficulty sleeping. B. Blood glucose at 0800 is 140 mg/dL. C. Client reports having a sore throat. D. Client reports gaining 4 lb in last 6 months.

A. INCORRECT: Difficulty sleeping is an important finding but not the priority finding. B. INCORRECT: A blood glucose slightly above the expected reference range is an important finding but not the priority finding. C. CORRECT: The greatest risk to the client who is taking prednisone is an infection due to immunosuppression. This is the priority finding. D. INCORRECT: Weight gain is an important finding but not the priority finding.

A nurse is reviewing the laboratory findings of a client who has an acute exacerbation of Crohn's disease. Which of the following laboratory findings is indicative of Crohn's disease? (Select all that apply.) A. Increased hematocrit B. Increased erythrocyte sedimentation rate (ESR) C. Increased WBC D. Increased folic acid E. Increased serum albumin

A. INCORRECT: Hematocrit is decreased as a result of chronic blood loss. B. CORRECT: Increased ESR is a clinical finding in a client who has Crohn's disease. C. CORRECT: Increased WBC is a clinical finding in a client who has Crohn's disease. D. INCORRECT: A decrease in folic acid level is indicative of malabsorption. E. INCORRECT: A decrease in serum albumin is indicative of malabsorption.

A nurse is planning care for a client who has a small bowel instruction and a nasogastric (NG) tube in place. Which of the following nursing interventions should be included in the plan of care? (Select all that apply.) A. Subtract the NG drainage from the client's output. B. Irrigate the NG tube every 8 hr. C. Assess bowel sounds. D. Provide oral hygiene every 2 hr. E. Clamp the NG tube during ambulation.

A. INCORRECT: NG drainage is included as output and must be considered when planning fluid replacement. B. INCORRECT: The NG tube is irrigated every 4 hr to maintain patency. C. CORRECT: Bowel sounds should be assessed to evaluate treatment and resolution of the obstruction. D. CORRECT: An NG tube promotes mouth breathing. Frequent oral hygiene should be included in the plan of care. E. CORRECT: The client can tolerate clamping of the NG tube for short periods, such as during ambulation. Scheduled clamping should be included in the plan of care prior to removal of the NG tube.

A nurse is completing an admission assessment of a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Profuse emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. Serum potassium 3.0mEq/L E. WBC 10,000/uL

A. INCORRECT: Profuse emesis is an expected finding in a client who has a small bowel obstruction. B. CORRECT: This finding indicates significant dehydration in the client, is outside the expected reference range, and should be reported to the provider. C. CORRECT: This finding indicates significant dehydration in the client, is outside the expected reference range, and should be reported to the provider. D. CORRECT: This finding indicates significant dehydration in the client, is outside the expected reference range, and should be reported to the provider. E. INCORRECT: This finding is within the expected reference range and does not need to be reported to the provider

A nurse is reinforcing teaching for a client who has a prescription for sulfasalazine (Azulfidine). Which of the following should the nurse include in the teaching? A. "Take the medication 1 or 2 hr after eating." B. "This medication may cause yellowing of the sclera." C. "Notify the provider if you experience a sore throat." D. "This medication may cause your stools to turn black."

A. INCORRECT: Sulfasalazine should be taken with food. B. INCORRECT: Sulfasalazine does not cause yellowing of the sclera. C. CORRECT: A client who is taking sulfasalazine may have a depressed immune system and be more vulnerable to infection. The provider should be notified of this finding. D. INCORRECT: Sulfasalazine does not change the color of stools.

A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number.) ____ mL

ANS: 25 mL 100 lb = 50 kg. 50 kg × 5 mg/kg = 250 mg.

A nurse prepares to administer 12 mg/kg of 5-fluorouracil chemotherapy intravenously to a client who has colon cancer. The client weights 132 lb. How many milligrams should the nurse administer? (Record your answer using a whole number.) _____ mg

ANS: 720 mg 132 lb = 60 kg. 60 kg × 12 mg/kg = 720 mg.

A nurse cares for a client with ulcerative colitis. The client states, "I feel like I am tied to the toilet. This disease is controlling my life." How should the nurse respond? a. "Let's discuss potential factors that increase your symptoms." b. "If you take the prescribed medications, you will no longer have diarrhea." c. "To decrease distress, do not eat anything before you go out." d. "You must retake control of your life. I will consult a therapist to help."

ANS: A Clients with ulcerative colitis often express that the disorder is disruptive to their lives. Stress factors can increase symptoms. These factors should be identified so that the client will have more control over his or her condition. Prescription medications and anorexia will not eliminate exacerbations. Although a therapist may assist the client, this is not an appropriate response.

A nurse reviews the chart of a client who has Crohn's disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions? a. Serum potassium of 2.6 mEq/L b. Client ate 20% of breakfast meal 3 c. White blood cell count of 8200/mm d. Client's weight decreased by 3 pounds

ANS: A Fistulas place the client with Crohn's disease at risk for hypokalemia which can lead to serious dysrhythmias. This potassium level is low and should cause the nurse to intervene. The white blood cell count is normal. The other two findings are abnormal and also warrant intervention, but the potassium level takes priority.

A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. "Have you been experiencing any constipation?" b. "Are you eating a diet high in fiber and fluids?" c. "Do you have a history of high blood pressure?" d. "What vitamins and supplements are you taking?"

ANS: A Ischemic colitis is a life-threatening complication of alosetron. The nurse should assess the client for constipation. The other questions do not identify complications related to alosetron.

A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Sulfasalazine (Azulfidine) d. Ceftriaxone (Rocephin)

ANS: A Metronidazole is the drug of choice for a Giardia infection. Ciprofloxacin and ceftriaxone are antibiotics used for bacterial infections. Sulfasalazine is used for ulcerative colitis and Crohn's disease.

A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion

ANS: A Right lower quadrant pain, specifically at McBurney's point, is characteristic of appendicitis. Usually if nausea and vomiting begin first, the client has gastroenteritis. Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis. Abdominal pain due to appendicitis decreases with knee flexion.

After teaching a client who has a femoral hernia, the nurse assesses the client's understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss? a. "I will put on the truss before I go to bed each night." b. "I'll put some powder under the truss to avoid skin irritation." c. "The truss will help my hernia because I can't have surgery." d. "If I have abdominal pain, I'll let my health care provider know right away."

ANS: A The client should be instructed to apply the truss before arising, not before going to bed at night. The other statements show an accurate understanding of using a truss.

A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Pale and bluish stoma b. Liquid stool c. Ostomy pouch intact d. Blood-smeared output

ANS: A The nurse should assess the stoma for color and contact the health care provider if the stoma is pale, bluish, or dark. The nurse should expect the client to have an intact ostomy pouch with dark green liquid stool that may contain some blood.

A nurse cares for a client who has a new colostomy. Which action should the nurse take? a. Empty the pouch frequently to remove excess gas collection. b. Change the ostomy pouch and wafer every morning. c. Allow the pouch to completely fill with stool prior to emptying it. d. Use surgical tape to secure the pouch and prevent leakage.

ANS: A The nurse should empty the new ostomy pouch frequently because of excess gas collection, and empty the pouch when it is one-third to one-half full of stool. The ostomy pouch does not need to be changed every morning. Ostomy wafers with paste should be used to secure and seal the ostomy appliance; surgical tape should not be used.

A nurse assesses a client with Crohn's disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Distended abdomen b. Temperature of 100.0° F (37.8° C) c. Loose and bloody stool d. Lower abdominal cramps

ANS: A The presence of strictures predisposes the client to intestinal obstruction. Abdominal distention may indicate that the client has developed an obstruction of the large bowel, and the client's provider should be notified right away. Low-grade fever, bloody diarrhea, and abdominal cramps are common symptoms of Crohn's disease.

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, "The stool in my pouch is still liquid." How should the nurse respond? a. "The stool will always be liquid with this type of colostomy." b. "Eating additional fiber will bulk up your stool and decrease diarrhea." c. "Your stool will become firmer over the next couple of weeks." d. "This is abnormal. I will contact your health care provider."

ANS: A The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool. This finding is not abnormal. Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client's diet or with the passage of time.

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

ANS: A, B, D 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.

A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this client's plan of care? (Select all that apply.) a. Using premoistened disposable wipes for perineal care b. Turning the client from right to left every 2 hours c. Using an antibacterial soap to clean after each stool d. Applying a barrier cream to the skin after cleaning e. Keeping broken skin areas open to air to promote healing

ANS: A, B, D The nurse should use premoistened disposable wipes instead of toilet paper for perineal care, or mild soap and warm water after each stool. Antibacterial soap would be too abrasive and damage good bacteria on the skin. The nurse should apply a thin layer of a medicated protective barrier after cleaning the skin. The client should be re-positioned frequently so that he or she is kept off the affected area, and open skin areas should be covered with DuoDerm or Tegaderm occlusive dressing to promote rapid healing.

A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Distended abdomen b. Inability to pass flatus c. Bradycardia d. Hyperactive bowel sounds e. Decreased urine output

ANS: A, B, E A client with peritonitis may present with a distended abdomen, diminished bowel sounds, inability to pass flatus or feces, tachycardia, and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associated with peritonitis.

After teaching a client with an anal fissure, a nurse assesses the client's understanding. Which client actions indicate that the client correctly understands the teaching? (Select all that apply.) a. Taking a warm sitz bath several times each day b. Utilizing a daily enema to prevent constipation c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories e. Taking a laxative each morning

ANS: A, C, D Taking warm sitz baths each day, using bulk-producing agents, and administering anti-inflammatory suppositories are all appropriate actions for the client with an anal fissure. The client should not use enemas or laxatives to promote elimination, but rather should rely on bulk-producing agents such as psyllium hydrophilic mucilloid (Metamucil).

A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Wash leafy vegetables carefully before eating or cooking them." b. "Do not ingest water from the garden hose or the pool." c. "Wash your hands before and after using the bathroom." d. "Be sure meat is cooked to the proper temperature." e. "Avoid eating eggs that are sunny side up or undercooked."

ANS: A, C, D, E Salmonella is usually contracted via contaminated eggs, beef, poultry, and green leafy vegetables. It is not transmitted through water in garden hoses or pools. Clients should wash leafy vegetables well, wash hands before and after using the restroom, make sure meat and eggs are cooked properly, and, because it can be transmitted by flies, keep flies off of food.

A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this group's teaching? (Select all that apply.) a. "Rotavirus is more common among infants and younger children." b. "Escherichia coli diarrhea is transmitted by contact with infected animals." c. "To prevent E. coli infection, don't drink water when swimming." d. "Clients who have botulism should be quarantined within their home." e. "Parasitic diseases may not show up for 1 to 2 weeks after infection."

ANS: A, C, E Rotavirus is more common among the youngest of clients. Not drinking water while swimming can help prevent E. coli infection. Parasitic diseases may take up to 2 weeks to become symptomatic. People with botulism need to be hospitalized to monitor for respiratory failure and paralysis. Escherichia coli is not transmitted by contact with infected animals.

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L b. Loss of 15 pounds without dieting c. Abdominal pain in upper quadrants d. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L

ANS: A, C, E Small bowel obstructions often lead to severe fluid and electrolyte imbalances. The client is hypokalemic (normal range is 3.5 to 5.0 mEq/L) and hyponatremic (normal range is 136 to 145 mEq/L). Abdominal pain across the upper quadrants is associated with small bowel obstruction. Dramatic weight loss without dieting followed by bowel obstruction leads to the probable development of colon cancer. High-pitched sounds may be noted with small bowel obstructions.

A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly? (Select all that apply.) a. Performs hand hygiene and positions the client in high-Fowler's position, with pillows behind the head and shoulders b. Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx c. Checks for correct placement by checking the pH of the fluid aspirated from the tube d. Secures the NG tube by taping it to the client's nose and pinning the end to the pillowcase e. Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

ANS: A, C, E The client's head should be flexed forward once the NG tube has reached the oropharynx. The NG tube should be secured to the client's gown, not to the pillowcase, because it could become dislodged easily. All the other actions are appropriate.

A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this group's teaching? (Select all that apply.) a. "Wash your hands after any contact with animals." b. "It is not necessary to buy a meat thermometer." c. "Stay away from people who are ill with diarrhea." d. "Use separate cutting boards for meat and vegetables." e. "Avoid swimming in backyard pools and using hot tubs."

ANS: A, D Washing hands after contact with animals and using separate cutting boards for meat and other foods will help prevent E. coli infection. The other statements are not related to preventing E. coli infection.

A nurse cares for a client who has a nasogastric (NG) tube. Which actions should the nurse take? (Select all that apply.) a. Assess for proper placement of the tube every 4 hours. b. Flush the tube with water every hour to ensure patency. c. Secure the NG tube to the client's upper lip. d. Disconnect suction when auscultating bowel peristalsis. e. Monitor the client's skin around the tube site for irritation.

ANS: A, D, E The nurse should assess for proper placement, tube patency, and output every 4 hours. The nurse should also monitor the skin around the tube for irritation and secure the tube to the client's nose. When auscultating bowel sounds for peristalsis, the nurse should disconnect suction.

A nurse assesses a client who is hospitalized for botulism. The client's vital signs are temperature: 99.8° F (37.6° C), heart rate: 100 beats/min, respiratory rate: 10 breaths/min, and blood pressure: 100/62 mm Hg. Which action should the nurse take? a. Decrease stimulation and allow the client to rest. b. Stay with the client while another nurse calls the provider. c. Increase the client's intravenous fluid replacement rate. d. Check the client's blood glucose and administer orange juice.

ANS: B A client with botulism is at risk for respiratory failure. This client's respiratory rate is slow, which could indicate impending respiratory distress or failure. The nurse should remain with the client while another nurse notifies the provider. The nurse should monitor and document the IV infusion per protocol, but this client does not require additional intravenous fluids. Allowing the client to rest or checking the client's blood glucose and administering orange juice are not appropriate actions.

The Norovirus causes acute viral gastroenteritis. What type of patient would be suspected of this infection? A. A person sunbathing on the beach. B. A person with a recent cold who ate at home. C. A person on a cruise ship. D. A person with peptic ulcers.

Answer: C- Remember the cruise ship enclosed with food at bay-Most likely place to get food poisoning.

After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I will avoid large crowds and people who are sick." b. "I will take this medication with my breakfast each morning." c. "Nausea and vomiting are common side effects of this drug." d. "I must wash my hands after I play with my dog."

ANS: B Adalimumab (Humira) is an immune modulator that must be given via subcutaneous injection. It does not need to be given with food or milk. Nausea and vomiting are two common side effects. Adalimumab can cause immune suppression, so clients receiving the medication should avoid large crowds and people who are sick, and should practice good handwashing.

An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the client's lower abdomen. Which action should the nurse take first? a. Measure the client's abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the client's hemoglobin and hematocrit. d. Obtain the client's complete health history.

ANS: B On noticing the ecchymotic areas, the nurse should check to see if abdominal guarding or rigidity is present, because this could indicate major organ injury. The nurse should then notify the provider. Measuring abdominal girth or obtaining a complete health history is not appropriate at this time. Laboratory test results can be checked after assessment for abdominal guarding or rigidity.

A nurse plans care for a client with Crohn's disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client's plan of care? a. Low-fiber diet b. Skin protection c. Antibiotic administration d. Intravenous glucocorticoids

ANS: B Protecting the client's skin is the priority action for a client who has a heavily draining fistula. Intestinal fluid enzymes are caustic and can cause skin breakdown or fungal infections if the skin is not protected. The plan of care for a client who has Crohn's disease includes adequate nutrition focused on high-calorie, high-protein, high-vitamin, and low-fiber meals, antibiotic administration, and glucocorticoids.

A nurse cares for a client with a new ileostomy. The client states, "I don't think my friends will accept me with this ostomy." How should the nurse respond? a. "Your friends will be happy that you are alive." b. "Tell me more about your concerns." c. "A therapist can help you resolve your concerns." d. "With time you will accept your new body."

ANS: B Social anxiety and apprehension are common in clients with a new ileostomy. The nurse should encourage the client to discuss concerns. The nurse should not minimize the client's concerns or provide false reassurance.

A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? a. Contact the provider and recommend a psychiatric consult for the client. b. Encourage the client to verbalize feelings about the diagnosis. c. Provide education about new treatment options with successful outcomes. d. Ask family and friends to visit the client and provide emotional support.

ANS: B The nurse recognizes that the client may be expressing feelings of grief. The nurse should encourage the client to verbalize feelings and identify fears to move the client through the phases of the grief process. A psychiatric consult is not appropriate for the client. The nurse should not brush aside the client's feelings with discussions related to cancer prognosis and treatment. The nurse should not assume that the client desires family or friends to visit or provide emotional support.

After teaching a client who has a new colostomy, the nurse provides feedback based on the client's ability to complete self-care activities. Which statement should the nurse include in this feedback? a. "I realize that you had a tough time today, but it will get easier with practice." b. "You cleaned the stoma well. Now you need to practice putting on the appliance." c. "You seem to understand what I taught you today. What else can I help you with?" d. "You seem uncomfortable. Do you want your daughter to care for your ostomy?"

ANS: B The nurse should provide both approval and room for improvement in feedback after a teaching session. Feedback should be objective and constructive, and not evaluative. Reassuring the client that things will improve does not offer anything concrete for the client to work on, nor does it let him or her know what was done well. The nurse should not make the client convey learning needs because the client may not know what else he or she needs to understand. The client needs to become the expert in self-management of the ostomy, and the nurse should not offer to teach the daughter instead of the client.

After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I'll rinse my rectal area with warm water after each stool and apply zinc oxide ointment." b. "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." c. "I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry." d. "I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."

ANS: B Toilet paper can irritate the sensitive perineal skin, so warm water rinses or soft cotton washcloths should be used instead. Although aloe vera may facilitate healing of superficial abrasions, it is not an effective skin barrier for diarrhea. Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools. Patting the skin is recommended instead of rubbing the skin dry.

Which menu selections by the client with irritable bowel syndrome indicates that teaching was understood? a. Tuna salad on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, tossed green salad, glass of apple juice c. Grilled cheese sandwich, small ripe banana, cup of hot tea with lemon d. Grilled steak, green beans, dinner roll with butter, cup of coffee with cream

ANS: B Clients with irritable bowel syndrome are advised to eat a high-fiber diet, with 8 to 10 cups of liquid daily. They should avoid alcohol, caffeine, and other gastric irritants. DIF: Cognitive Level: Application REF: N/A for Application and above OBJ: Learning Outcome 4 TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Teaching/Learning

A client has been taking naproxen (Naprosyn) for several months. Which assessment question is important for the nurse to ask? a. "Have you experienced any constipation?" b. "Have you had any stomach pain or indigestion?" c. "Have you had any difficulty swallowing?" d. "Have you noticed any weight loss lately?"

ANS: B Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic pain can precipitate peptic ulcer formation through the inhibition of prostaglandins. The client should be assessed for stomach pain or indigestion. This medication does not typically cause constipation or difficulty swallowing. Weight loss would not be related to this medication. DIF: Cognitive Level: Application REF: N/A for Application and above OBJ: Learning Outcome 3 TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening) MSC: Integrated Process: Nursing Process (Assessment)

A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, "I am having trouble swallowing this pill." Which action should the nurse take? a. Contact the clinical pharmacist and request the medication in suspension form. b. Empty the contents of the capsule into applesauce or pudding for administration. c. Ask the health care provider to prescribe the medication as an enema instead. d. Crush the pill carefully and administer it in applesauce or pudding.

ANS: C Asacol is the oral formula for mesalamine and is produced as an enteric-coated pill that should not be crushed, chewed, or broken. Asacol is not available as a suspension or elixir. If the client is unable to swallow the Asacol pill, a mesalamine enema (Rowasa) may be administered instead, with a provider's order.

The nurse is teaching the client how to use a truss for a femoral hernia. Which statement by the client indicates the need for further teaching? a. "I will put on the truss upon awakening." b. "I will wear the truss over a T shirt to avoid skin irritation." c. "I will assess the skin under the truss daily and protect it with a light layer of powder." d. "If truss is used it will be only after the surgeon has reduced the hernia and it is not incarcerated."

ANS: B The truss should be worn against the skin, not over the T shirt or underwear. The client is instructed to apply the truss before arising, not before going to bed at night. The truss should be cleaned with a damp cloth a few times a week. The physician should be notified immediately if abdominal pain develops, because the hernia may have become strangulated or incarcerated. DIF: Cognitive Level: Application REF: N/A for Application and above OBJ: Learning Outcome 9 TOP: Client Needs Category: Physiological Integrity (Basic Care and Comfort) MSC: Integrated Process: Teaching/Learning

After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the client's understanding. Which statements made by the client indicate that the client correctly understands the teaching? (Select all that apply.) a. "I'll have my housekeeper keep my toilet clean." b. "I must take a shower or bathe every day." c. "I should have my well water tested." d. "I will ask my sexual partner to have a stool test." e. "I must only eat raw vegetables from my own garden."

ANS: B, C, D Parasitic infections can be transmitted to other people. The client himself or herself should keep the toilet area clean instead of possibly exposing another person to the disease. Parasites are transmitted via unclean water sources and sexual practices with rectal contact. The client should test his or her well water and ask sexual partners to have their stool examined for parasites. Raw vegetables are not associated with parasitic gastrointestinal infections. The client can eat vegetables from the store or a home garden as long as the water source is clean.

A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this client's plan of care? a. "You may experience nausea and vomiting for the first few weeks." b. "Carbonated beverages can help decrease acid reflux from anastomosis sites." c. "Take a stool softener to promote softer stools for ease of defecation." d. "You may return to your normal workout schedule, including weight lifting."

ANS: C 1151 KEY: Ostomy care Clients recovering from a colon resection should take a stool softener as prescribed to keep stools a soft consistency for ease of passage. Nausea and vomiting are symptoms of intestinal obstruction and perforation and should be reported to the provider immediately. The client should be advised to avoid gas-producing foods and carbonated beverages, and avoid lifting heavy objects or straining on defecation.

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a. Inspection of oral mucosa b. Recent dietary intake c. Heart rate and rhythm d. Percussion of abdomen

ANS: C Although the client with severe diarrhea may experience skin irritation and hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea. The client should have her or his electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, recent dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this client than heart rate and rhythm.

After teaching a client who has diverticulitis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I'll ride my bike or take a long walk at least three times a week." b. "I must try to include at least 25 grams of fiber in my diet every day." c. "I will take a laxative nightly at bedtime to avoid becoming constipated." d. "I should use my legs rather than my back muscles when I lift heavy objects."

ANS: C Laxatives are not recommended for clients with diverticulitis because they can increase pressure in the bowel, causing additional outpouching of the lumen. Exercise and a high-fiber diet are recommended for clients with diverticulitis because they promote regular bowel function. Using the leg muscles rather than the back for lifting prevents abdominal straining.

A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find? a. Positive Murphy's 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

ANS: C The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohn's disease. A positive Murphy's 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 Crohn's disease. Nightly worsening of abdominal cramping is not consistent with Crohn's disease.

A nurse cares for a teenage girl with a new ileostomy. The client states, "I cannot go to prom with an ostomy." How should the nurse respond? a. "Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance." b. "The pouch won't be as noticeable if you avoid broccoli and carbonated drinks prior to the prom." c. "Let's talk to the enterostomal therapist about options for ostomy supplies and dress styles." d. "You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable."

ANS: C The ostomy nurse is a valuable resource for clients, providing suggestions for supplies and methods to manage the ostomy. A larger dress size will not necessarily help hide the ostomy appliance. Avoiding broccoli and carbonated drinks does not offer reassurance for the client. Ileostomies have an almost constant liquid effluent, so pouch removal during the prom is not feasible.

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

ANS: C The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. The nurse should contact the provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The registered nurse is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first? a. Send a blood sample for a type and crossmatch. b. Insert a large intravenous line for fluid resuscitation. c. Obtain the heart rate and blood pressure. d. Assess and maintain a patent airway.

ANS: D All of the options are important nursing actions in the care of a trauma client. However, airway always comes first. The client must have a patent airway, or other interventions will not be helpful.

After teaching a client with diverticular disease, a nurse assesses the client's 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

ANS: D 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.

A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection. Which assessment should the nurse complete first? a. Heart rate and rhythm b. Bowel sounds c. Urinary output d. Respiratory rate

ANS: D Severe infection with C. botulinum can lead to respiratory failure, so assessments of oxygen saturation and respiratory rate are of high priority for clients with suspected C. botulinum infection. The other assessments may be completed after the respiratory system has been assessed.

Which symptom findings does the nurse anticipate with an exacerbation of ulcerative colitis? A. Constipation, nausea, vomiting and abdominal fullness. B. Tenesmus, mucousy stools, dehydration and fever. C. Pain, fever, brown soft stools and distention. D. Epigastric pain and Blumberg's sign

Answer B- The symptoms of an acute exacerbation of ulcerative colitis includes fever, tenesmus (unpleasant urge to defecate), anorexia, dehydration from frequent stools and mucousy stools (Iggy & Workman, p. 1174, 2016).

Your client in the medical unit has a small bowel obstruction and needs a nasogastric tube. What assessments are necessary for NGT placement every shift? Select all that apply. A. Assess for placement every 4 hours. B. Secure NGT to the upper nose with adhesive barrier. C. Flush NGT every hour to maintain patency. D. Disconnect or turn off suction when assessing the client's bowel sounds.

Answer: A, B and D- QSEN priorities for care of nasogastric tubes includes: Assess every 4 hours for suction and patency, secure to the nose with a securement device and turn off suction or disconnect when assessing the bowel sounds of a client (Nursing Alert, p. 1159).

A client is scheduled for discharge after surgery for inflammatory bowel disease. The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and the spouse with regard to the client's home care? Ability of the client and spouse to perform incision care and dressing changes Effective coping mechanisms for the client and spouse after the surgical experience Knowledge about the client's requested pain medications Understanding of the importance of keeping scheduled follow-up appointments

Assessing the client's and the spouse's ability to carry out incision care and dressing changes is essential for avoiding further development of the infectious process, as well as infection of the surgical incision itself. Assessing coping mechanisms and knowledge of the client's pain medication are important, but are not the priority. Understanding the importance of scheduled follow-up appointments is important, but is not the priority.

Which diagnostic test measures urinary excretion of vitamin B12 for the diagnosis of pernicious anemia? A. 24 hour urine collection B. Hydrogen breath test C. Bile acid test D. Schilling test

D is correct no rational

You are teaching a client about Ileosotomy care before gong home. Which statement alerts the nurse that additional teaching is needed? a. "I can't wait to go home and eat my favorite ."cabbage stew b." I will wash my hands before and after emptying my pouch." c. " I will carry extra supplies with me when I travel." d."I think I need to make changes in my life."

a is the correct answer Teach patients with Ileosotomies to avoid gaseous foods, high fiber foods, nuts, corn and cabbage, apples with skins (Iggy, 1180)

An older client reports delayed bowel movements leading to constipation. What nonpharmacologic intervention does the nurse teach the client to alleviate this problem? a. Perform physical activity as tolerated. b.Avoid caffeine and alcohol intake c. Consume a high-protein diet d. Perform range of motion exercises

a. The nurse should encourage the client to perform as much physical activity as tolerated. Physical activity helps to increase peristaltic movement and increase the sensation of needing to defecate. Excessive intake of caffeine and alcohol can lead to gastritis and peptic ulcers. A high-protein diet does not alter peristaltic movement. Range of motion exercises help to maintain flexibility of the extremities, neck, and shoulders, but it does not affect bowel movement.

What is a preventative measure for diverticular disease? A. Excluding whole grains breads from the diet B. Avoiding fresh apples, broccoli and lettuce C. Taking bulk agents like Metamucil D. Taking anticholinergics to reduce bowel spasms

c is correct no rational

A 21-year-old with a stab wound to the abdomen has come to the emergency department. Once stabilized, the client is admitted to the medical-surgical unit. What does the admitting nurse do first for this client? a Administer pain medication. b Assess skin temperature and color. c Check on the amount of urine output. d Take vital signs

Assessment of vital signs should be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the client's condition. The client should not be medicated for pain until his or her alertness level is determined. Skin temperature and color are not specifically indicative of the client's overall condition. If the client is in shock, urine output will be scant and will not be an accurate assessment variable.

A male client in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing the client's incision for signs of infection Assisting the client to stand to void Instructing the client in how to deep-breathe Monitoring the client's pain level

Assisting the client with activities is part of the UAP role. Assessment of the client's incision and pain level requires broader education and scope of practice and should be done by licensed nursing personnel. Client teaching—even about something as fundamental as taking "deep breaths"—likewise requires broader education and scope of practice and should be done by licensed nursing personnel.

A nurse assesses a client who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider? a. White blood cell (WBC) count of 1500/mm3 b. Fatigue c. Nausea and diarrhea d. Mucositis and oral ulcers

ANS: A Common side effects of 5-FU include fatigue, leukopenia, diarrhea, mucositis and mouth ulcers, and peripheral neuropathy. However, the client's WBC count is very low (normal range is 5000 to 10,000/mm3), so the provider should be notified. He or she may want to delay chemotherapy by a day or two. Certainly the client is at high risk for infection. The other assessment findings are consistent with common side effects of 5-FU that would not need to be reported immediately.

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? a. "Drink plenty of fluids to prevent dehydration." b. "You should only drink 1 liter of fluids daily." c. "Increase your protein intake by drinking more milk." d. "Sips of cola or tea may help to relieve your nausea."

ANS: A The client should drink plenty of fluids to prevent dehydration. Milk products may not be tolerated. Caffeinated beverages increase intestinal motility and should be avoided.

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this client's assessment? (Select all that apply.) a. "Which food types cause an exacerbation of symptoms?" b. "Where is your pain and what does it feel like?" c. "Have you lost a significant amount of weight lately?" d. "Are your stools soft, watery, and black in color?" e. "Do you experience nausea associated with defecation?"

ANS: A, B, E The nurse should ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse should also assess the location, intensity, and quality of the client's pain, and nausea associated with defecation or meals. Clients who have IBS do not usually lose weight and stools are not black in color.

A nurse assesses a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which action should the nurse take? a. Assess the client's heart rate and blood pressure. b. Determine when the client last voided. c. Ask if the client is experiencing flatus. d. Auscultate all quadrants of the client's abdomen.

ANS: B Assessment findings indicate that the client may have an over-full bladder. In the immediate postoperative period, the client may experience difficulty voiding due to urinary retention. The nurse should assess when the client last voided. The client's vital signs may be checked after the nurse determines the client's last void. Asking about flatus and auscultating bowel sounds are not related to a hemorrhoidectomy.

After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I will let my husband do all of the cooking for my family." b. "I'll take the ciprofloxacin until the diarrhea has resolved." c. "I should wash my hands with antibacterial soap before each meal." d. "I must place my dishes into the dishwasher after each meal."

ANS: B Ciprofloxacin should be taken for 10 to 14 days to treat Salmonella infection, and should not be stopped once the diarrhea has cleared. Clients should be advised to take the entire course of medication. People with Salmonella should not prepare foods for others because the infection may be spread in this way. Hands should be washed with antibacterial soap before and after eating to prevent spread of the bacteria. Dishes and eating utensils should not be shared and should be cleaned thoroughly. Clients can be carriers for up to 1 year.

A nurse cares for a middle-aged male client who has irritable bowel syndrome (IBS). The client states, "I have changed my diet and take bulk-forming laxatives, but my symptoms have not gotten better. I heard about a drug called Amitiza. Do you think it might help?" How should the nurse respond? a. "This drug is still in the research phase and is not available for public use yet." b. "Unfortunately, lubiprostone is approved only for use in women." c. "Lubiprostone works well. I will recommend this prescription to your provider." d. "This drug should not be used with bulk-forming laxatives."

ANS: B Lubiprostone (Amitiza) is a new drug for IBS with constipation that works by simulating receptors in the intestines to increase fluid and promote bowel transit time. Lubiprostone is currently approved only for use in women. Trials with increased numbers of male participants are needed prior to Food and Drug Administration approval for men.

A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, "I need to have a bowel movement." Which action should the nurse take? a. Obtain a bedside commode for the client to use. b. Stay with the client while providing privacy. c. Make sure the call light is in reach to signal completion. d. Gather supplies to collect a stool sample for the laboratory.

ANS: B The first bowel movement after hemorrhoidectomy can be painful enough to induce syncope. The nurse should stay with the client. The nurse should instruct clients who are discharged the same day to have someone nearby when they have their first postoperative bowel movement. Making sure the call light is within reach is an important nursing action too, but it does not take priority over client safety. Obtaining a bedside commode and taking a stool sample are not needed in this situation.

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I must change the ostomy appliance daily and as needed." b. "I will use warm water and a soft washcloth to clean around the stoma." c. "I might start bicycling and swimming again once my incision has healed." d. "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." e. "I will check the stoma regularly to make sure that it stays a deep red color." f. "I must avoid dairy products to reduce gas and odor in the pouch."

ANS: B, C, D The ostomy appliance should be changed as needed when the adhesive begins to decrease, placing the appliance at risk of leaking. Changing the appliance daily can cause skin breakdown as the adhesive will still be secured to the client's skin. The client should avoid using soap to clean around the stoma because it might prevent effective adhesion of the ostomy appliance. The client should use warm water and a soft washcloth instead. The tissue of the stoma is very fragile, and scant bleeding may occur when the stoma is cleaned. The flange should be cut to fit snugly around the stoma to reduce contact between excretions and the client's skin. Exercise (other than some contact sports) is important for clients with an ostomy. The stoma should remain a soft pink color. A deep red or purple hue indicates ischemia and should be reported to the surgeon right away. Yogurt and buttermilk can help reduce gas in the pouch, so the client need not avoid dairy products.

A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, "My doctor told me that the fecal occult blood test was negative for colon cancer. I don't think I need the colonoscopy and would like to cancel it." How should the nurse respond? a. "Your doctor should not have given you that information prior to the colonoscopy." b. "The colonoscopy is required due to the high percentage of false negatives with the blood test." c. "A negative fecal occult blood test does not rule out the possibility of colon cancer." d. "I will contact your doctor so that you can discuss your concerns about the procedure."

ANS: C A negative result from a fecal occult blood test does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed so the entire colon can be visualized and a tissue sample taken for biopsy. The client may want to speak with the provider, but the nurse should address the client's concerns prior to contacting the provider.

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the client's bowel sounds.

ANS: D A change in the nature and timing of abdominal pain in a client with a bowel obstruction can signal peritonitis or perforation. The nurse should immediately check for rebound tenderness and the absence of bowel sounds. The nurse should not medicate the client until the provider has been notified of the change in his or her condition. The nurse may help the client to the knee-chest position for comfort, but this is not the priority action. The nurse need not insert a nasogastric tube for decompression.

A client has developed gastroenteritis while traveling outside the country. What is the likely cause of the client's symptoms? Bacteria on the client's hands Ingestion of parasites in the water Insufficient vaccinations Overcooked food

A main cause of gastroenteritis when traveling outside the country is ingestion of water that is infested with parasites. Bacteria on the client's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.

A client diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the client states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this client? Antidiarrheal agent Muscarinic receptor antagonist Serotonin antagonist Tricyclic antidepressant

A muscarinic (M3) receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this client. A tricyclic antidepressant is not going to be effective for this client's diarrhea.

A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? "A change in position may be what is needed for you to have intercourse with your wife." "Have you considered going to see a marriage counselor with your wife?" "What has your wife said about your pouch system?" "You must get clearance from your health care provider before you attempt to have intercourse."

A simple change in positioning during intercourse may alleviate the client's apprehension and facilitate sexual relations with his wife. Suggesting marriage counseling may address the client's concerns, but it focuses on the wrong issue; the client has not stated that he has relationship problems. Asking the client what his wife has said about the pouch may address the client's concerns, but it similarly focuses on the wrong issue. Telling the client that he needs to get clearance from his health care provider is an evasive response that does not address the client's primary concern.

A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? Cramping intermittently, metabolic acidosis, and minimal vomiting Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis Metabolic acidosis, upper abdominal distention, and intermittent cramping Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, metabolic acidosis, and minimal vomiting are all symptoms of a large bowel obstruction.

A nurse cares for a client with colon cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How should the nurse respond? a. "I have a good friend with a colostomy who would be willing to talk with you." b. "The enterostomal therapist will be able to answer all of your questions." c. "I will make a referral to the United Ostomy Associations of America." d. "You'll find that most people with colostomies don't want to talk about them."

ANS: C Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including Ostomates (specially trained visitors who also have ostomies). The nurse should not suggest that the client speak with a personal contact of the nurse. Although the enterostomal therapist is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse should not brush aside the client's request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.

A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes? (Select all that apply.) a. Indirect inguinal hernia - An enlarged plug of fat eventually pulls the peritoneum and often the bladder into a sac b. Femoral hernia - A peritoneum sac pushes downward and may descend into the scrotum c. Direct inguinal hernia - A peritoneum sac passes through a weak point in the abdominal wall d. Ventral hernia - Results from inadequate healing of an incision e. Incarcerated hernia - Contents of the hernia sac cannot be reduced back into the abdominal cavity

ANS: C, D, E A direct inguinal hernia occurs when a peritoneum sac passes through a weak point in the abdominal wall. A ventral hernia results from inadequate healing of an incision. An incarcerated hernia cannot be reduced or placed back into the abdominal cavity. An indirect inguinal hernia is a sac formed from the peritoneum that contains a portion of the intestine and pushes downward at an angle into the inguinal canal. An indirect inguinal hernia often descends into the scrotum. A femoral hernia protrudes through the femoral ring and, as the clot enlarges, pulls the peritoneum and often the urinary bladder into the sac.

A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily b. A 44-year-old with irritable bowel syndrome (IBS) c. A 60-year-old lawyer who works 65 hours per week d. A 72-year-old who eats fast food frequently

ANS: D Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

A nurse cares for a client who has a family history of colon cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer?" How should the nurse respond? a. "If you eat a low-fat and low-fiber diet, your chances decrease significantly." b. "You are safe. This is an autosomal dominant disorder that skips generations." c. "Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer." d. "You should have a colonoscopy more frequently to identify abnormal polyps early."

ANS: D The nurse should encourage the client to have frequent colonoscopies to identify abnormal polyps and cancerous cells early. The abnormal gene associated with colon cancer is an autosomal dominant gene mutation that does not skip a generation and places the client at high risk for cancer. Changing the client's diet, preemptive chemotherapy, and removal of polyps will decrease the client's risk but will not prevent cancer. However, a client at risk for colon cancer should eat a low-fat and high-fiber diet.

After an automobile crash, a client is admitted to the emergency department with possible abdominal trauma. Which health care provider request does the nurse implement first? Insert a nasogastric tube and connect it to intermittent suction. Obtain a complete blood count and coagulation panel. Start an IV line and infuse normal saline at 200 mL/hr. Arrange for a computed tomography (CT) scan of the abdomen.

After the initial airway, breathing, and circulation assessment is completed, the most immediate concerns are the high risks for hemorrhage and shock. To rapidly treat for these possible complications, IV access and infusion of fluids are necessary as the priority intervention. Inserting a nasogastric tube, laboratory studies, and arranging a CT scan are secondary to establishing IV access and instilling fluids.

A client diagnosed with ulcerative colitis is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? "Be aware of the symptoms of toxic megacolon that we discussed." "If diarrhea increases, you should let your health care provider know." "Pregnancy should be avoided." "You will need to decrease your dose of sulfasalazine (Azulfidine)."

Antidiarrheal drugs may precipitate colonic dilation and toxic megacolon. Toxic megacolon is characterized by an enlarged colon with fever, leukocytosis, and tachycardia. Loperamide will decrease diarrhea rather than increase it. Constipation is sometimes a problem. No contraindication for pregnancy is noted. Sulfasalazine therapy typically continues on a long-term basis.

A client with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client? "Are you afraid of what your spouse will think of the colostomy?" "Don't worry. You will get used to the colostomy eventually." "Tell me what worries you the most about this procedure." "Why are you so afraid of having this procedure done?"

Asking the client about what worries him or her is the only question that allows the client to express fears and anxieties about the diagnosis and treatment. Asking the client if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response); it closes the dialogue and is not therapeutic. Telling the client not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place clients on the defense and are not therapeutic because they close the conversation.

Which client does the medical-surgical unit charge nurse assign to an LPN/LVN? A 41-year-old who needs assistance with choosing a site for a colostomy stoma A 47-year-old who needs to receive "whole gut" lavage before a colon resection A 51-year-old who has recently arrived on the unit after having an open herniorrhaphy A 56-year-old who has obstipation and a recent emesis of foul-smelling liquid

Because administration of medications is within the LPN/LVN scope of practice, this preoperative client can be assigned to the LPN/LVN. Assistance with choosing a site for a colostomy stoma is an intervention that should be provided by an RN. The recent postoperative client and the critically ill client will need assessments and interventions that can only be done by an RN.

The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) Broccoli Buttermilk Mushrooms Onions Peas Yogurt

Broccoli, mushrooms, onions, and peas often cause flatus. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? Decrease in liver function test results Elevated carcinoembryonic antigen Elevated hemoglobin levels Negative test for occult blood

Carcinoembryonic antigen may be elevated in many clients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? It destroys the cancer's cell wall, which will kill the cell. It decreases blood flow to rapidly dividing cancer cells. It stimulates the body's immune system and stunts cancer growth. It blocks factors that promote cancer cell growth.

Cetuximab, a monoclonal antibody, may be given for advanced disease. This drug works by binding to a protein (epidermal growth factor receptor) to slow cell growth. The medication does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. The treatment does not decrease blood flow to rapidly dividing cancer cells.

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? Abdominal pain relieved by bending the knees Chronic diarrhea, abdominal pain, and fever Epigastric cramping Hypotension with vomiting

Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

A client who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the client to do in the meantime? "Avoid all solid foods to allow complete bowel rest." "Consume extra fluids to replace fluid losses." "Take an over-the-counter antidiarrheal medication." "Contact your provider for an antibiotic medication."

Clients should be taught to drink extra fluids to replace fluid lost through vomiting and diarrhea. It is not necessary to stop all solid food intake. Antidiarrheal medications are used if diarrhea is severe. Antibiotics are used if the infection is bacterial.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a client with advanced colorectal cancer for relief of symptoms? Analgesics and antiemetics Analgesics and benzodiazepines Steroids and analgesics Steroids and anti-inflammatory medications

Clients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these clients.

After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? LPN/LVN who has worked with many home health clients after colostomy surgeries LPN/LVN with 20 years of experience in the home health agency RN who is new to the agency with 5 years experience in the emergency department Social worker who is experienced with case management of older clients

Clients with medical or surgical diagnoses have complex physiologic needs that should be assessed by an RN. For this reason, Medicare requires that the initial assessment must be done by an RN, although LPN/LVNs and social workers are likely to be part of the health care team.

A client admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this client? Applying hydrocortisone cream Cleaning the area with soap and hot water Using sitz baths three times daily Wearing absorbent cotton underwear

Clients with skin breakdown may use sitz baths for comfort 2 or 3 times daily. Barrier creams, not hydrocortisone creams, may be used. The skin should be cleaned gently with soap and warm water. Absorbent cotton underwear helps keep the skin dry, but is not a comfort measure.

The RN on the medical-surgical unit receives a shift report about four clients. Which client does the nurse assess first? A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern A 40-year-old with pneumonia who has abdominal distention and decreased bowel sounds in all quadrants A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

Ecchymoses in the abdominal area may indicate intraperitoneal or intra-abdominal bleeding; this client requires rapid assessment and interventions. The client who is post colon resection, the client with pneumonia, and the client with FAP do not have an urgent need for further assessment or intervention.

A client suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the client about this test? "During the test, you will drink small amounts of an antacid as directed by the technician." "If you have IBS, hydrogen levels may be increased in your breath samples." "The test will take between 30 and 45 minutes to complete." "You must have nothing to drink (except water) for 24 hours before the test."

Excess hydrogen levels are produced in clients with IBS. This is due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted. The client will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes. The client has breath samples taken every 15 minutes for 1 to 2 hours. The client needs to be NPO (except for water) for 12 hours before the test.

A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem? (Select all that apply.) Antihistamines Caffeinated drinks_ Stress_ Sleeping pills Anxiety_

Factors such as ingestion of coffee or other gastric stimulants, stress, anxiety, and milk allergy are being investigated as possible causes of IBS. Antihistamines and sleeping pills are not suspected as causing IBS.

An 80-year-old client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider request does the nurse implement first? Administer acetaminophen (Tylenol) 650 mg rectally. Draw blood for a complete blood count and serum electrolytes. Obtain a stool specimen for culture and sensitivity. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

Fluid therapy is the focus of treatment for clients with gastroenteritis. Older clients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure. Acetaminophen 650 mg should be rapidly administered rectally, and blood draws and stool specimen collection should be implemented rapidly, but prevention and treatment of dehydration are the priorities for this client.

A client with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The client asks the nurse how this is helpful for improving symptoms. How does the nurse reply? "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." "It provides key nutrients and extra calories to promote healing." "It is bland and reduces the secretion of gastric acids." "It does not contain caffeine or other GI tract stimulants."

For less severe exacerbations, an elemental or semi-elemental product such as Vivonex PLUS may be prescribed to induce remission. These products are absorbed in the jejunum and therefore permit the distal small intestine and colon to rest. Nutritional supplements such as Ensure or Sustacal are added to provide nutrients and more calories. GI stimulants such as caffeinated beverages and alcohol should be avoided, but this is not the reason for using Vivonex PLUS.

What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? Bulk-forming laxatives Saline laxatives Stimulant laxatives Stool-softening agents

For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water. Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.

A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond? "Have you asked your health care provider what he or she thinks your chances are?" "It is hard to know what can predispose a person to develop a certain disease." "No. Just because they both had CRC doesn't mean that you will have it, too." "The only way to know whether you are predisposed to CRC is by genetic testing."

Genetic testing is the only definitive way to determine whether the client has a predisposition to develop CRC. A higher incidence of the disease has been noted in families who have a history; however, it is not the responsibility of the nurse to engage in genetic counseling, and this client might not be predisposed to developing CRC. Asking the client what the health care provider thinks is an evasive response by the nurse and does not address the client's concerns.

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? Clients with CD experience about 20 loose, bloody stools daily. Clients with UC may experience hemorrhage. The peak incidence of UC is between 15 and 40 years of age. Very few complications are associated with CD.

Hemorrhage is commonly experienced by clients with UC. Five to six stools daily is common with CD. The peak incidences of UC are between 15 to 25 and 55 to 65 years of age. Fistulas commonly occur as a complication of CD.

A client with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the client's care does the nurse make certain to discuss with the health care provider before the client's discharge? Having a home health consultation for wound care Requesting an antianxiety medication Requesting pain medication for the client's osteoarthritis Placing the client in a skilled nursing facility for rehabilitation

Home health services are most appropriate for this client because wound care will be extensive and the client's mobility may be limited. No indication suggests that the client is experiencing anxiety regarding postoperative care. Pain medication may be needed for the client's osteoarthritis, but this is not the highest priority. A skilled nursing facility is not necessary if the client can remain in his or her home with sufficient support services.

A client admitted with severe gastroenteritis has been started on an IV, but the client continues having excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing? Balsalazide (Colazal) Loperamide (Imodium) Mesalamine (Asacol) Milk of Magnesia (MOM)

If the health care provider determines that antiperistaltic agents are necessary, an initial dose of loperamide (Imodium) 4 mg can be administered orally, followed by 2 mg after each loose stool, up to 16 mg daily. Balsalazide is not the best choice for control of diarrhea in this scenario. Mesalamine is used for clients with ulcerative colitis for long-term therapy. MOM is a laxative.

A certified Wound, Ostomy, and Continence Nurse is teaching a client about caring for a new ileostomy. What information is most important to include? "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." "Call the health care provider if your stoma has a bluish or pale look." "Notify the health care provider if output from your stoma has a sweetish odor." "Remember that you must wear a pouch system at all times."

If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the health care provider must be notified immediately. It is true that output from the stoma after surgery may be a loose, greenish-colored liquid that may contain some blood, but this information is not the highest priority for instruction. It is normal for output from the stoma to have very little odor or a sweetish smell. Although it is true that the client will be required to wear a pouch system at all times, this is not the highest priority for instruction.

A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? "A drink of diet soda with dinner is OK for me." "I need to go for a walk every evening." "Maintaining a low-fiber diet will manage my constipation." "Watching the amount of fluid that I drink with meals is very important."

Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages. Caffeinated beverages can cause bloating or diarrhea and should be avoided in clients with IBS. Fiber is encouraged in clients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups of fluid should be consumed daily to promote normal bowel function.

A client who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The client tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? A list of medical supply facilities where wound care supplies may be purchased Proper handwashing techniques to avoid cross-contamination of the client's wound The amount of pain medication that the client is allowed to take in each dose Written and oral instructions regarding symptoms to report to the health care provider

It is most important to provide the client and case manager with both written and oral instructions on reportable symptoms to avoid the development of complications. Although instruction on proper handwashing and the client's medication regimen are important, they are not the highest priority. It will be the home health nurse's responsibility to bring supplies to the client's home.

A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices? "Drinking carbonated beverages will help with your abdominal distress." "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." "Lactose-containing foods should be reduced or eliminated from your diet." "Raw vegetables and high-fiber foods may help to diminish your symptoms."

Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of clients with UC. Carbonated beverages are GI stimulants that can cause discomfort and should be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms; nurses should never advise clients that any amount of cigarette smoking is "OK." Raw vegetables and high-fiber foods can cause GI symptoms in clients with UC.

A client is admitted with severe viral gastroenteritis caused by norovirus. The client asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? "You may have contracted it from an infected infant." "You may have consumed contaminated food or water." "You may have come into contact with an infected animal." "You may have had contact with the blood of an infected person."

Norovirus is the leading foodborne disease that causes gastroenteritis. It is transmitted via the fecal-oral route from person to person and from contaminated food and water. Vomiting causes the virus to become airborne. Campylobacter can be transmitted by contact with infected infants or animals. Escherichia coli may be spread via animals and contaminated food, water, or fomites. HIV may be spread via the blood, but not norovirus. Campylobacter and E. coli both cause bacterial gastroenteritis, while norovirus causes viral gastroenteritis.

A home health client has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the client with self-care? Instructing the client about the use of electrolyte-containing oral rehydration products Administering loperamide (Imodium) 4 mg from the client's medicine cabinet Checking and reporting the client's heart rate and blood pressure in lying, sitting, and standing positions Teaching the client how to clean the perineal area after each loose stool

Obtaining the client's blood pressure and heart rate is included in the education of home health aides and other UAP. Client teaching and medication administration are complex skills that should be performed by licensed nurses who have the education and scope of practice needed to safely implement these actions.

A client with ulcerative colitis is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the client's medication regimen? Corticosteroid therapy will be stopped. Sulfasalazine (Azulfidine) will be stopped. Corticosteroid therapy will be tapered. Sulfasalazine (Azulfidine) will be tapered.

Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period. Stopping corticosteroid therapy abruptly is unsafe—steroids must be gradually decreased in clients. Usually the amount that they have been taking dictates how quickly or slowly they can be stopped. Sulfasalazine therapy will be taken on a long-term basis. It may be increased or decreased, depending on the client's symptoms, but will likely never be stopped. These decisions are made over a long period of therapy.

A client with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." "It is inherited, so it could run in your family." "It might be caused by a virus, so you could have gotten it almost anywhere." "Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine."

Stating that the disorder is the result of flattening of the mucosa of the large intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? Steak with pasta Spaghetti with tomato sauce Steamed broccoli with turkey Tuna salad with wheat crackers

Steamed broccoli with turkey contains low-fat meat and no refined carbohydrates. Animal fat from red meats is carcinogenic, and pasta is high in refined carbohydrates, which are known to contribute to colon cancer. Spaghetti and wheat crackers also contain large amounts of refined carbohydrates.

A client newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the client about why this therapy has been prescribed? "It is to stop the diarrhea and bloody stools." "This will minimize your GI discomfort." "With this medication, your cramping will be relieved." "Your intestinal inflammation will be reduced."

Sulfasalazine (Azulfidine) is one of the primary treatments for UC. It is thought to inhibit prostaglandin synthesis and thereby reduce inflammation. Although it is hoped that reduction of inflammation will cause the diarrhea and bloody stools to stop, this is not the way that the drug works. Antidiarrheal drugs "stop" diarrhea. The drug's action as an anti-inflammatory will diminish the client's pain as the inflammation subsides, but this is not the purpose of the drug—it is not an analgesic.

A client with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? Asks the client whether family members could be trained in stoma care Has another client with a stoma who performs self-care talk with the client Requests that the health care provider request antidepressants and a psychiatric consult Suggests that the health care provider request a home health consultation so stoma care can be performed by a home health nurse

Talking with another client who successfully cares for his or her stoma may give the client the confidence to begin his or her self-care. If at all possible, the client should perform stoma care so that he or she can be as independent as possible. Although the client may need medication for depression, the priority is to encourage the client to look at, touch, and begin caring for the stoma. A home health nurse can be a support, but cannot provide all of the care that the client will need.

An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which client does the charge nurse assign to the float nurse? A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

The ICU nurse is familiar with the care of a client with peritonitis, including monitoring for complications such as sepsis and kidney failure. The client with CD who has a draining enterocutaneous fistula, the client with UC who needs discharge teaching, and the client with questions about an ileo-anal reservoir are best assigned to a medical-surgical nurse who is more familiar with the care and teaching needed for clients with their respective disorders.

Which client does the charge nurse assign to an experienced LPN/LVN? A 28-year-old who requires teaching about how to catheterize a Kock ileostomy A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

The LPN/LVN should be familiar with the purpose, adverse effects, and client teaching required for neomycin. Teaching about how to catheterize a Kock ileostomy, assessing the client with UC with a high white blood cell count, and monitoring the client with gastroenteritis receiving IV fluids present complex problems that require assessment or intervention by an RN.

A client with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client? Attaching the tube to high continuous suction Auscultating for bowel sounds and peristalsis while the suction runs Connecting the tube to low intermittent suction Flushing the tube with 30 mL of normal saline every 24 hours

The NG tube should be attached to intermittent low suction unless otherwise requested by the health care provider. Continuous suction is rarely used because it can injure the gastric mucosa of the client's stomach. Bowel sounds should not be auscultated with suction on and running. The tube should be flushed every 4 hours, minimally.

A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? "It is usually ready to be closed in about 1 to 2 months." "This is something that you will have to discuss with your health care provider." "The period of time is indefinite—I am sorry that I cannot say." "You will probably have it for 6 months or longer, until things heal.

The RPC-IPAA has become the most effective alternate method for UC clients who have surgery to remove diseased portions of intestines. Stage 1 creates a temporary ileostomy to be used while an internally created pouch is healing. Stage 2 closes the ileostomy, and the client begins to use the pouch for storage of stool. The time between the surgeries is generally 1 to 2 months. Telling the client that he or she will have to discuss it with the health care provider evades the question; the nurse can give generalities to the client based on past practice and available data. The time that the client has the ileostomy is not "indefinite." The intent of this procedure is to eliminate the need to have a permanent ileostomy. The pouch should heal in 1 to 2 months, not 6 months; this estimate is not based on the expected outcome.

A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? Administers medication for pain Changes the nasogastric suction level from "intermittent" to "constant" Positions the client in high-Fowler's position Prepares the client for emergency surgery

The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention. Pain medication may mask the client's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the client's pain and could be particularly ineffective if a nonvented tube is in use. A high-Fowler's position will have no effect on an intestinal perforation or peritonitis, which this client is likely experiencing.

An obese client is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the client's home health nurse requires immediate action? Pain when coughing States, "I am too tired to walk very much" States, "I feel like the incision is splitting open" Temperature of 100.8° F (38.2° C).

The client feeling like the incision is splitting open is at risk for poor wound healing and possible wound dehiscence; the nurse should immediately assess the wound and notify the health care provider. Reports of pain when coughing, being too tired to ambulate, and a temperature of 100.8° F (38.2° C) all require further assessment or intervention, but are not as great a concern as the possibility of wound dehiscence for this client.

A client returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after the client is situated in bed? High Fowler's Lateral Sims' (side-lying) Semi-Fowler's Supine

The client is maintained in semi-Fowler's position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion. High-Fowler's position would be too high for the client postoperatively; it would place strain on the abdominal incision(s), and, if the client was still drowsy from anesthesia, this position would not enhance the client's ability to rest. Sims' position does not promote drainage to the lower abdomen. The supine position does not facilitate drainage to the abdomen or increased lung expansion; the client would be more likely to develop complications (wound drainage stasis and atelectasis) in this position.

A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client? "Avoid large crowds and anyone who is sick." "Do not take the medication if you are allergic to foods with fatty acids." "Expect difficulty with wound healing while you are taking this drug." "Monitor your blood pressure and report any significant decrease in it."

The client should avoid being around large crowds to prevent developing an infection. The client should not take the medication if he or she is allergic to certain proteins. Although immune suppression may occur to some degree, the client should not experience difficulty with wound healing while taking adalimumab. The client should not experience a decrease in blood pressure from taking this drug.

The nurse is caring for a client who is to be discharged after a bowel resection and the creation of a colostomy. Which client statement demonstrates that additional instruction from the nurse is needed? "I can drive my car in about 2 weeks." "I should avoid drinking carbonated sodas." "It may take 6 weeks to see the effects of some foods on my bowel patterns." "Stool softeners will help me avoid straining."

The client who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The client should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The client should avoid straining at stool.

A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? Femoral Reducible Strangulated Ventral

The hernia is reducible because its contents can be pushed back into the abdominal cavity. Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. It cannot be a ventral hernia because it would have to occur at the site of a previous surgical incision.

A client demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention? Assessing the client for changes in vital signs Medicating the client for pain Monitoring for changes in the client's mentation Preparing the client for emergency surgery

The highest priority for this client is to prepare him or her for emergency surgery so that the source of the infection can be removed. It is expected that the client will experience changes in vital signs as a result of the infectious process and accompanying pain. Although monitoring the client's vital signs is important, the client has an immediate need to go to surgery. Medicating the client for pain and determining whether the client is experiencing changes in mentation are important, but are not the highest priority.

A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client? Encourages the client to look at and touch the colostomy stoma Instructs the client about complete care of the colostomy Schedules a visit from a client who has a colostomy and is successfully caring for it Suggests that the client involve family members in the care of the colostomy

The initial intervention is to get the client comfortable looking at and touching the stoma before providing instructions on its care. Instructing the client about colostomy care will be much more effective after the client's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the client only after his or her anxiety level has stabilized. The client has begun to express feelings regarding the colostomy and its care; it is too soon to involve others. The client must get comfortable with this body image change first.

A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client? "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

The most effective way to manage diverticulitis is with a low-fiber diet while inflammation is present, followed by a high-fiber diet once the inflammation has subsided. Neither an exclusively low-fiber diet or an exclusively high-fiber diet will effectively manage diverticulitis. A high-fiber diet while diverticulitis is active will only worsen the disease and its symptoms.

The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions? a "A dark or purplish-looking stoma is normal and should not concern me." b"If the skin around the stoma is red or scratched, it will heal soon." c "I need to check for leakage underneath my colostomy." d"I should strive for a very tight fit when applying the barrier around the stoma."

The pouch system should be checked frequently for evidence of leakage to prevent excoriation. A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma should be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

The Certified Wound, Ostomy, and Continence Nurse is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects a correct understanding of the necessary self-management skills? "I will have my spouse change the bag for me." "If I have any leakage, I'll put a towel over it." "I need to call my home health nurse to come out if I have any problems." "I will make certain that I always have an extra bag available."

The statement that the client will be certain to bring an extra bag is the only statement illustrating that the client is taking responsibility to care for the colostomy. Using a towel is not an acceptable or effective way to cope with leakage. It is not realistic that the home health nurse can make frequent visits for the purpose of colostomy care.

The RN receives a change-of-shift report about four clients. Which client does the nurse assess first? A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

This client with possible appendicitis may have developed a perforation and may be at risk for peritonitis. Rapid assessment and possible surgical intervention are needed. The client with UC who had six liquid stools, the client whose colostomy bag does not have any stool in it, and the client who was admitted with acute gastroenteritis all need assessment and intervention by an RN, but they are not at immediate risk for life-threatening complications. The client with possible appendicitis has a life-threatening emergency.

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which client statement indicates a need for further teaching about this procedure? "I may have trouble urinating immediately after the surgery." "I will need to stay in the hospital overnight." "I should not eat after midnight the day of the surgery." "My chances of having complications after this procedure are slim."

Usually, the client is discharged 3 to 5 hours after MIIHR surgery. Male clients who have difficulty urinating after the procedure should be encouraged to force fluids and to assume a natural position when voiding. Clients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most clients who have MIIHR surgery have an uneventful recovery.

The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include? A slice of 5-grain bread Chuck steak patty (6 ounces) Strawberries (1 cup) Tomato (1 medium)

Whole-grain breads are recommended to be included in the diet of clients with diverticular disease because cellulose and hemicellulose types of fiber are found in them. Dietary fat should be reduced in clients with diverticular disease. If the client wants to eat beef, it should be of a leaner cut. Foods containing seeds, such as strawberries, should be avoided. Tomatoes should be avoided unless the seeds are removed. The seeds may block diverticula in the client and present problems leading to diverticulitis.

A client has an anal fissure. Which intervention most effectively promotes perineal comfort for the client? Administering a Fleet's enema when needed Applying heat to acute inflammation for pain relief Avoiding the use of bulk-forming agents Using hydrocortisone cream to relieve pain

Witch hazel wipes may be effective in relieving the pain associated with anal fissures. Enemas should be avoided when an anal fissure is present. Cold packs should be applied to acute inflammation to diminish discomfort. Bulk-forming agents should be used to decrease pain associated with defecation.