Med Surge GI
A client has a new colostomy. The nurse has provided teaching related to when the client should irrigate the colostomy. Which client statement indicates correct understanding of the teaching?
"I plan to irrigate it in the late morning, the same time I had a bowel movement every day before I had my surgery."
A client who had a transurethral resection of the prostate is to be discharged from the outpatient surgical department. Which client statement indicates to the nurse that discharge teaching about self-care is understood?
"I will notify my health care provider if persistent bleeding occurs."
Which statement by a client who is scheduled for bariatric surgery indicates to the nurse that further preoperative teaching is necessary?
"I'm going to have a figure like a model in about a year."
A client who was admitted with severe abdominal pain and vomiting states, "I know I am very sick. Do you think I have cancer?" What is the best response by the nurse?
"What are your feelings about the diagnosis of cancer?"
A client who had abdominal surgery asks the nurse about when the client can return to work after discharge. The most appropriate response by the nurse is:
"What type of work did you have in mind?"
A client is admitted to the hospital with ascites. The client reports drinking a quart of vodka mixed in orange juice every day for the past three months. To assess the potential for withdrawal symptoms, which question would be appropriate for the nurse to ask the client?
"When was your last drink of vodka?
When advising a college student about dietary choices, the nurse should consider the caloric value of the most commonly ordered fast foods eaten by active young adults. List the following foods in order from the one with the least number of calories to the one with the most number of calories.
A garden salad has 95 calories. One slice of French toast has 126 calories. Six chicken tenders have 236 calories. An order of French fries has 372 calories. A hamburger with cheese has 720 calories.
A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease?
A gnawing sensation relieved by food
Which clinical indicators identified by the nurse support the probable presence of a fecal impaction in a client? (Select all that apply.)
Abdominal cramps Fecal liquid seepage Hyperactive bowel sounds
A nurse is caring for a client with cirrhosis of the liver. Which laboratory test should the nurse monitor that, when abnormal, might identify a client who may benefit from neomycin enemas?
Ammonia level
A client has a diagnosis of hemorrhoids. Which signs and symptoms does the nurse expect the client to report? (Select all that apply.)
Anal itching Blood in stool Rectal pressure Pain when defecating
Which interventions should the nurse anticipate will be prescribed initially for a client who had a hemorrhoidectomy? (Select all that apply.)
Applying moist heat Administering stool softeners
To be most effective when teaching colostomy care to a client, the nurse must first:
Assess barriers to learning colostomy care
A nurse assesses a client with the diagnosis of an intestinal obstruction in the descending colon. When auscultating the midabdomen, the nurse expects to hear:
Borborygmi
A nurse is caring for a postoperative client who had a gastrectomy. What early client response indicates that peristalsis has returned?
Borborygmi are auscultated
A client is admitted via the emergency department with the tentative diagnosis of diverticulitis. Which test commonly is prescribed to assess for this problem?
CT scan
After an acute episode of gastrointestinal (GI) bleeding, a client is diagnosed with gastric ulcer. The client receives a prescription for ranitidine (Zantac) 150 mg twice a day to be taken with meals. The nurse contacts the health care provider about the prescription because ranitidine:
Can be administered by a variety of routes
A nurse is teaching a group of adults about the signs and symptoms of colorectal cancer. What is the most common clinical manifestation that the nurse should include in the teaching program?
Change in bowel habits
A nurse is caring for a client with a diagnosis of cholecystitis. For which clinical manifestation of obstructive jaundice should the nurse assess the client?
Clay-colored stools
A nurse is administering an enema to a client who is scheduled for gastrointestinal surgery. What should the nurse do when the client complains of abdominal cramps during the enema?
Close the lumen of the tubing and wait until the discomfort subsides.
A self-help group of clients with irritable bowel syndrome have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to minimize in the diet to decrease gastrointestinal (GI) irritability?
Cola drinks
Which response should the nurse expect when assessing a client who is dehydrated? (Select all that apply.)
Confusion Sunken eyeballs Decreased blood pressure
A nurse identifies that clients with cancer often lose weight and may become cachectic. What common response do clients with cancer experience regardless of the site of the cancer that accounts for this weight loss?
CorrectTumor necrosis factor affects the satiety center
A client with a history of recurrent cholecystitis is scheduled for an abdominal cholecystectomy. What should the nurse specifically emphasize when planning preoperative teaching for this client?
Coughing and deep breathing
An 85-year-old client has a three-day history of nausea, vomiting, and diarrhea. The client develops weakness and confusion and is admitted to the hospital. To best monitor the client's rehydration status, the nurse should assess the client's:
Daily weight
A client has a body mass index (BMI) of 35 and verbalizes the need to lose weight. The nurse encourages the client to lose weight safely by changing which dietary habits?
Decrease portion size and fat intake
A nurse is teaching a client about the differences between the terms saturated and unsaturated, when used in reference to fats. Which important factor in relation to these types of fats should the nurse include in the teaching?
Density
Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? (Select all that apply.)
Dysrhythmias Muscle weakness
To help prevent long-term complications associated with gastric bypass surgery, the nurse needs to educate the client. Identify the factors that should be included in the nurse's teaching plan for this client. (Select all that apply.)
Eat foods rich in calcium. Consume a diet high in protein. Receive vitamin B12 injections routinely
A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? (Select all that apply.)
Ecchymosis Yellow sclera Pain in right upper quadrant
A client is admitted with anorexia, weight loss, abdominal distention, and abnormal stools. A diagnosis of malabsorption syndrome is made. What nursing action should the nurse implement to best meet this client's needs?
Encourage the consumption of high-protein foods
A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care?
Encouraging expression of concerns
A client with advanced bone cancer is experiencing cachexia. The nurse discusses the nutritional aspect of palliative care with the family. Why is it important to explain these nutritional interventions to the family?
Enhance the quality of the client's life
A health care provider prescribes a sigmoidoscopy for one client and a barium enema for another client. What is a nursing responsibility common to preparing both of these clients for these procedures?
Ensuring an understanding of the procedure
A paracentesis is prescribed for a client recently admitted to a medical unit. The nurse recalls that the procedure is performed for what reasons? (Select all that apply.)
Extract peritoneal fluid Improve respiratory status Obtain peritoneal fluid for culture
A client eats a meal that contains 13 g of fat, 31 g of carbohydrates, and 5 g of protein. What is this client's total caloric intake for this meal? Record your answer using a whole number. ______ kilocalories
Fat contains 9 kilocalories per gram; carbohydrates and proteins contain 4 kilocalories per gram; therefore, 117 + 124 + 20 = 261 kilocalories.
A nurse is planning a community health program about screening for cancer. Which information recommended by the American Cancer Society (ACS) should the nurse include?
Fecal occult blood testing should be performed yearly beginning at age 50 years
A client develops peritonitis and sepsis after the surgical repair of a ruptured diverticulum. What signs should the nurse expect when assessing the client? (Select all that apply.)
Fever Tachypnea Abdominal rigidity
An active adolescent is admitted to the hospital for surgery for an ileostomy. When planning a teaching session about self-care, the nurse includes sports that should be avoided by a client with an ileostomy. Which should be included on the list of sports to be avoided? (Select all that apply.)
Football Ice hockey
A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn's disease. Which expected outcome is most important for this client?
Gains a half pound per week
A nurse is eliciting a health history from a client with ulcerative colitis. What factor does the nurse consider to be most likely associated with the client's colitis?
Genetic predisposition
A health care provider prescribes an upper gastrointestinal (GI) series and a barium enema. The client asks, "Why do I have to have barium for these tests?" The nurse's best response is "Barium:
Gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays."
A nurse is assessing a client for dehydration, The client has had diarrhea and vomiting for 48 hours. What are indicators of dehydration? (Select all that apply.)
Headache The skin on the client's forehead remains tented after being pinched
During a client's paracentesis, 1500 mL of fluid is removed. The nurse monitors the client for which sign of a potentially severe response?
Heart rate increases from 80 to 135
A nurse is caring for several postoperative clients who had abdominal surgery. What independent nursing intervention can help prevent the development of thrombophlebitis?
Helping the client to perform in-bed exercises
A nurse is caring for several postoperative clients who had abdominal surgery. What independent nursing intervention can help prevent the development of thrombophlebitis?
Helping the client to perform in-bed exercises.
A client is admitted to the hospital with a diagnosis of peptic ulcer. The nurse should assess the client for which complication commonly associated with the diagnosis?
Hemorrhage
A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan?
Hepatitis-C
A nurse is caring for a client who is recovering from an acute episode of alcoholism. Which component of a therapeutic diet should the nurse encourage the client to consume?
High protein
A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone (Aldactone).What should the nurse monitor the client for?
Hyperkalemia
A client has a paracentesis during which 1500 mL of fluid is removed. The nurse should monitor the client carefully for
Hypovolemic shock
A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. The nurse concludes that the most likely cause of this client's ascites is:
Impaired portal venous return
A nurse is caring for a client who is admitted to the hospital with ascites and a diagnosis of cirrhosis of the liver. The nurse concludes that the probable cause of ascites is:
Impaired portal venous return
A client with jaundice associated with hepatitis expresses concern over the change in skin color. The nurse explains that this color change is a result of:
Inability of the liver to remove normal amounts of bilirubin from the blood
Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. The nurse responds, "It:
Inhibits gastric acid secretion
A client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. A nursing priority is to:
Institute fall prevention/safety measures
A client is scheduled to begin chemotherapy two weeks after the client had surgery for colon cancer. The nurse explains to the client that the delay in instituting drug therapy is planned because the chemotherapy:
Interferes with cell growth and delays wound healing
A client is admitted with a diagnosis of cancer of the colon. What information about malignant tumors of the colon should the nurse consider when caring for this client?
Intestinal obstructions usually are malignant
A nurse is assessing two clients. One client has ulcerative colitis and the other client has Crohn's disease. Which is more likely to be identified in the client with ulcerative colitis than the client with Crohn's disease?
Involvement starting distally with rectal bleeding that spreads continuously up the colon
A client who recently immigrated to the United States has a chronic vitamin A deficiency. What information about vitamin A should the nurse consider when assessing this client for clinical indicators of this deficiency?
It is a necessary element of rhodopsin, which controls responses to light and dark environments.
A nurse provides dietary teaching for a client with an acute exacerbation of colitis, and afterward the client makes a list of foods that can be included on the diet. Which food choices indicate that the teaching was effective? (Select all that apply.)
Jelly sandwich Lean roast beef Scrambled eggs
A nurse is assisting a health care provider to perform a sigmoidoscopy. In which position should the nurse place the client for this procedure?
Knee-to-chest
A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the client's discomfort?
Lactase
A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client?
Left Sims
A nurse is obtaining a history and performing a physical assessment of a client who has cancer of the tongue. Which clinical findings should the nurse expect to identify? (Select all that apply.)
Leukoplakia Alterations in taste Enlarged cervical lymph nodes
A client with a history of ulcerative colitis has a large portion of the large intestine removed and the creation of an ileostomy. For which potential life-threatening complication should the nurse assess the client after this surgery?
Limited water reabsorption caused by removal of intestine
A client reports experiencing nausea, dyspnea, and right upper quadrant pain unrelieved by antacids. The pain occurs most often after eating in fast-food restaurants. Which diet should the nurse instruct the client to follow?
Low fat
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which classic signs of hepatic coma should the nurse assess this client? (Select all that apply.)
Mental confusion Flapping hand tremors
The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium (Colace) daily. Before discharge, the nurse teaches the client that an intermittent side effect of this medication may be:
Mild abdominal cramping
A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist? (Select all that apply.)
Nizatidine (Axid) Ranitidine (Zantac) Famotidine (Pepcid)
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. The priority nursing intervention is to:
Observe the client for increasing confusion
On the third postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action?
Obtain the client's vital signs.
A nurse obtains daily stool specimens for a client with chronic bowel inflammation. The nurse concludes that these stool examinations were prescribed to determine:
Occult blood
A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply.
Oliguria Irritability Hypotension
A nurse is planning care for a client admitted to the hospital with abdominal spasms and pain associated with severe diarrhea. What primary serum blood level should the nurse monitor?
Potassium
After a subtotal gastrectomy a client is returned to the surgical unit. Which is the best nursing action to prevent pulmonary complications?
Promoting frequent turning and deep breathing to mobilize secretions
A nurse is caring for a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery. The nurse concludes that the client understands teaching about the purpose of TPN when the client states, "TPN:
Provides total nutrition when gastrointestinal (GI) function is questionable.
A nurse is teaching menu planning to a client who has a high triglyceride level. Which nutrient avoided by the client indicates that teaching about foods that are high in fat was understood?
Red meat
A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition?
Report signs of bleeding no matter how slight.
An older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the health care provider will most likely prescribe?
Resume small, easily digested feedings gradually.
A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? (Select all that apply.)
Rye Oats Wheat
A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for signs that strangulation of the intestine may have occurred. What is an early sign of strangulation?
Sharp abdominal pain
A client is recovering from an acute episode of alcoholism that included esophageal involvement. What are the components of a therapeutic diet that are most appropriate for the nurse to include in the teaching plan for this client? (Select all that apply.)
Soft diet High protein diet High carbohydrate diet
A nurse is caring for a client who is cachectic. What information about the function of adipose tissue in fat metabolism is necessary to better address the needs of this client?
Stores triglycerides for energy reserves
When planning discharge teaching for a client who had an ileostomy, the nurse places primary emphasis on:
Telling the client whom to contact if assistance is needed
Megadoses of vitamin A are taken by a client. Why should the nurse question this practice?
The liver has a great storage capacity for vitamin A, even to toxic amounts.
An older adult is hospitalized for weight loss and dehydration because of nutritional deficits. What should the nurse consider when caring for this client?
The nutritional needs of an older adult are unchanged except for a decreased need for calories.
A client is cautioned to avoid vitamin D toxicity while increasing protein intake. Which nutrient selected by the client indicates to the nurse that the dietary teaching is understood?
Tofu
A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole (Flagyl). The nurse explains, "Antibiotics are prescribed to:
Treat Helicobacter pylori infection."
After a bilateral inguinal hernia repair (herniorrhaphy) the nurse should assess the client for the development of:
Urinary retention
A client reports pain as a result of a gastric ulcer. What clinical findings is the nurse most likely to identify during an assessment of the client's pain? (Select all that apply.)
Vomiting relieves pain. Pain described as gnawing. Pain occurs a half hour after meals.
