Med surgeQuiz 6 chapters 27-30

The nurse is educating a patient with inflammatory bowel disease (IBD) about recommended nutritional choices. Which statement indicates that the nurse's teaching has been successful?

A. "I should try to eat foods like white rice and lean poultry."

The nurse is aware that an unresolved intestinal obstruction can lead to which complications?

B. Intestinal rupture and shock

The nurse is planning care for a patient who has experienced moderate diarrhea for 3 days. Which collaborative intervention is most important to include in the plan of care?

B. Limit the patient's diet to clear liquids.

The home health nurse is caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH). The nurse should carefully monitor the patient for which potential side effect?

B. Liver disorders

The nurse caring for an 80-year-old woman who is undergoing the extensive bowel preparation for a colonoscopy. The nurse should most closely monitor the patient for which potential complication?

B. Metabolic acidosis

The nurse is caring for an older adult patient diagnosed with diverticulitis. Which medication is the best choice to manage the patient's pain?

B. Morphine

Before a nurse can document the presence of diarrhea, which criteria must be met? (select all that apply.)

B. Multiple liquid or semiliquid stools in a 24-hour period C. Hyperactive bowel sounds D. Cramping

The nurse caring for the patient who is immediately postoperative with a new ileostomy. Which intervention is most important for the nurse to implement at this time?

B. Provide emotional support.

The nurse explains to the patient receiving bevacizumab (Avastin) for a tumor in the colon that the drug slows cancer cell growth by which process?

B. Reducing blood flow to the tumor

The nurse is caring for a patient who has been diagnosed with Crohn disease. When providing education concerning dietary recommendations, which statement indicates that the nurse's teaching has been successful?

B. Reducing dietary fat and fiber will be helpful in managing my condition."

The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. The nurse recognizes that this finding likely results from which underlying problem?

B. Retroperitoneal hemorrhage.

The nurse explains that a hernioplasty is a surgery that involves which process?

B. Sewing synthetic mesh over the abdominal wall defect to reduce the hernia.

The nurse is aware that patients who have chronic gastritis from renal failure may present with which first sign of this disorder?

B. Sudden massive hemorrhage

The nurse explains which advantage benefits patients with a Kock pouch ileostomy?

B. The patient does not have to wear a collection device.

A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate?

C. "Avoid large meals, limit sweets, and drink small amounts of liquids between meals."

The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen. The patient is receiving total parenteral nutrition (TPN), and the physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response is best for the nurse to make?

C. "The TPN you are receiving has high amounts of glucose."

The nurse is caring for a patient who has been experiencing severe diarrhea and can now resume solid foods. The nurse educates the patient about appropriate food choices. Which food choice indicates that the nurse's teaching has been successful?

C. Applesauce

The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur at which time?

C. At bedtime

The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention?

C. Confusion

The nurse caring for a patient admitted with peritonitis who has developed a paralytic ileus. While auscultating bowel sounds, the nurse assesses flatus. What is the significance of this finding?

C. Flatus indicates returning peristalsis

The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make?

C. Gallstones are usually treated with surgery. Tell me more about your concerns."

The nurse is educating a patient with Barrett esophagus. Which statement indicates that the patient requires a need for further instruction?

C. I should consider switching to smokeless tobacco."

The nurse is educating a patient with a hiatal hernia. Which statement indicates that the patient understands the nurse's teaching?

A. "I should avoid tea and chocolate."

The nurse calculates the body mass index (BMI) of a man who is 6 feet tall and weighs 150 pounds. Which value is correct?

A. 21.0

For which patient should the nurse question an order for esomeprazole (Nexium)?

A. A 55-year-old female who takes digoxin

The nurse is teaching a group of patients about the process of a mechanical bowel obstruction. Which example should the nurse include in the teaching?

A. A tumor obstructs the lumen of the bowel.

The nurse is caring for a patient who returns to the floor at lunch time after undergoing an upper GI (UGI series). Which action is most important for the nurse to perform first?

A. Administer a laxative.

A nurse is caring for a patient who is 4 hours postoperative after a laparoscopic cholecystectomy. The patient reports abdominal fullness and mild discomfort. After verifying that the patient's vital signs are stable, what action is most important for the nurse to take next?

A. Ambulate the patient.

The nursing is planning care for a patient with an acute exacerbation of inflammatory bowel disease (IBD). Which action(s) is/are most important for the nurse to include in the care plan? (select all that apply.)

A. Assess number and character of stools. B. Auscultate bowel sounds. D. Encouraging periods of rest. E. Assess for internal bleeding.

The nurse is caring for a patient who is complaining of postoperative gas pain. What intervention should nurse implement?

A. Assist the patient with ambulation.

The nurse is educating a patient who has gastroesophageal reflux disease (GERD) about dietary modification. Which information is most important for the nurse to include in the teaching plan?

A. Avoid highly seasoned or spiced foods.

The nurse is caring for a patient with esophageal varices with a new order for vasopressin (Pitressin). The nurse reviews the patient's history and notes that the patient's comorbidities include coronary artery disease (CAD), type 2 diabetes, gastroesophageal reflux disease (GERD), and fibromyalgia. The nurse should immediately notify the physician about which component of the patient's history?

A. CAD

The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem?

A. Cholecystitis

The nurse correctly recognizes that esophageal cancer is associated with which risk factor(s)? (select all that apply.)

A. Cigarette smoking D. Heavy alcohol use E. Smokeless tobacco

Which foods or beverages may trigger an attack of irritable bowel syndromes (IBS)? (select all that apply.)

A. Coffee B. Yogurt C. Whole wheat bread

The nurse is aware that the person with ulcerative colitis is a risk factor for developing which disorder?

A. Colon cancer

The nurse is caring for patient with a history of a chronic incarcerated hernia. The patient suddenly complains of abdominal pain and vomits dark material with a fecal odor. The nurse recognizes these signs as indications of which complication?

A. Complete intestinal obstruction

The nurse is reviewing the laboratory results of an assigned patient. The serum bilirubin is 2.8 mg/dL. The nurse anticipates that the patient's urine will display which finding?

A. Dark color

The nurse explains that the older adult is prone to digestive disorders related to which age-related change(s)? (select all that apply.)

A. Decreased hydrochloric acid C. Inadequate chewing D. Diminished intestinal motility E. Gastroesophageal sphincter incompetence

When assessing a patient's bowel sounds, nurse auscultates loud bowel sounds in each quadrant every 3 seconds. The nurse understands that these findings could indicate that the patient is experiencing which condition?

A. Diarrhea

The nurse instructs the patient on the weight reduction drug Orlistat (Xenical, Alli) that he may experience which side effect(s)? (select all that apply.)

A. Diarrhea C. Abdominal cramping E. Nausea

To best assist a patient with dysphagia, the nurse should implement which action(s)? (select all that apply.)

A. Encourage "practice swallowing" before the meal. B. Coach the patient to chew thoroughly. C. Assist the patient to sit upright with the head forward and chin tucked. D. Offer fluid during the meal.

Which action(s) should the nurse recommend to promote a patient's bowel health? (select all that apply.)

A. Exercise regularly. B. Include adequate bulk in the diet. C. Drink adequate water. D. Defecate at approximately the same time every day.

Which causative agent is the primary cause of Barrett esophagus?

A. Gastroesophageal reflux disease (GERD)

The nurse explains to an obese patient that initial medically supervised weight reduction includes which components(s)? (select all that apply.)

A. General health assessment B. Specialized exercise program C. Participation in a support group D. Stress reduction

The nurse is teaching a patient about peristomal skin care. Which information is most important for the nurse to include? (select all that apply.)

A. Gently remove the faceplate of the appliance to avoid skin irritation. C. Thoroughly rinse the skin. D. Apply a skin barrier to the peristomal area.

The nurse is talking with a patient who has been experiencing nausea and vomiting. The patient indicates an interest in using alternative therapies for the condition. Which product may aid in nausea management?

A. Ginger

Which contributing factor(s) may lead to hernia development? (select all that apply.)

A. Heavy lifting B. Chronic cough C. Straining with defecation D. Ascites

The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient?

A. Instruct the patient to sit and lean forward.

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test?

A. Liver biopsy

During a morning assessment, the nurse observes that a patient displays bulging flanks when supine with the knees flexed. Which action should the nurse take next?

A. Measure the patient's abdominal girth.

The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (select all that apply.)

A. Obesity C. Diabetes mellitus (DM) D. Taking cholesterol-lowering drugs E. Mexican American ethnicity

Which factor(s) increase the risk for developing pancreatic cancer? (select all that apply.)

A. Obesity C. Diabetes mellitus (DM) E. Smoking

The nurse is caring for a patient immediately following a liver biopsy. Which actions are appropriate for the nurse to take? (select all that apply.)

A. Position the patient on the right side. B. Assess the patient's pain. C. Monitor vital signs every 15 minutes for the first hour. E. Assess for hematoma at puncture site.

The nurse is caring for a 70-year-old patient who was diagnosed with gastroenteritis after returning from a camping trip to Mexico. Which manifestation(s) is/are consistent with this diagnosis? (select all that apply.)

A. Positive stool culture for Giardia or Shigella B. Abdominal cramping D. Mucus in stool E. Blood in stool

he nurse is caring for a patient who is suspected of having oral cancer. When reviewing the patient's health history, which finding provides supportive data for the diagnosis?

A. Presence of leukoplakia

The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as which type of bariatric surgery?

A. Restrictive

In caring for a patient with hepatitis B, a nurse would employ which precautions?

A. Standard Precautions

The nurse is caring for a patient who is postoperative after esophageal resection. Shortly after the nurse starts a feeding, the patient suddenly becomes dyspneic and complains of substernal pain. What should the nurse do first?

A. Stop the feeding.

The nurse is caring for a patient who complains, "I don't see why I can't have a CT scan instead of the expensive MRI!" Which response is most appropriate for the nurse to make?

A. The MRI provides better contrast between normal and pathologic tissue

The nurse is percussing a patient's abdomen and hears a dull thud in the right upper quadrant. This sound indicates that nurse is percussing over which location?

A. The liver

The nurse is educating a group of patients about high-fiber dietary selections. Which patient menu selection indicates that the nurse's teaching has been successful?

A. Turkey sandwich on whole wheat toast, pears, and tea

The nurse preparing a teaching plan for a 20-year-old woman who is taking sulfasalazine (Azulfidine) for Crohn disease. Which information should the nurse include in the teaching plan? (select all that apply.)

A. void tanning beds or going outside during peak hours of sun while taking sulfasalazine (Azulfidine). B. If taking sulfasalazine (Azulfidine) while on oral contraceptives, use a backup method of birth control. D. Be aware that sulfasalazine (Azulfidine) may cause gastrointestinal (GI) upset. E. Be aware that sulfasalazine (Azulfidine) may turn the urine orange.

The nurse is caring for a patient with suspected dysphagia. Which action is most appropriate for the nurse to take?

B. Instruct the patient to take practice swallows before the meal.

The presence of which diagnostic criteria are used to confirm the diagnosis of irritable bowel syndrome (IBS)? (select all that apply.)

B. Abdominal pain with a change in stool consistency C. Mucorrhea E. Bloating

The nurse is caring for a patient scheduled to have an MRI study. Which instruction(s) should the nurse include in the teaching? (select all that apply.)

B. All metal objects, including dental bridges, jewelry, and body piercings, must be removed. D. A radiopaque medium may be injected during the procedure. E. There may be a tingling sensation in metal alloy filling of the teeth.

The nurse is presenting a program about bulimia nervosa to a group of student nurses. After the program, the participants correctly identify which method(s) of treatment? (select all that apply.)

B. Antidepressant medications C. Psychotherapy D. Behavior modification

The nurse is caring for a patient with anorexia nervosa. Which intervention(s) might the nurse use to stimulate appetite? (select all that apply.)

B. Arrange for preferred foods to be served. C. Encourage family members to bring food from home. D. Suggest that family members or friends come and socialize during the meal. E. Allow ample time to eat and enjoy the meal.

The nurse is caring for a patient who underwent a cholecystectomy 3 days ago. Which assessment finding best indicates to the nurse that the bile flow is no longer obstructed from entering the bowel?

B. Dark brown stool

The nurse is discussing bariatric surgery complications with a patient. Which statement indicates that the patient accurately understands the nurse's teaching about common procedural side effects?

B. Gallstones are a common occurrence in patients who have bariatric surgery."

A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate?

B. Hepatitis A is not transmitted as a result of close contact with an infected individual."

The nurse is assessing a patient's bowel sounds. After auscultating each quadrant for 30 seconds, the nurse fails to hear any sounds. How should the nurse document this finding?

B. Hypoactive bowel sounds

The nurse is caring for a patient with cirrhosis. The nurse is educating the patient about nutritional implications related to his diagnosis. Which statement indicates that the nurse's teaching has been successful?

B. I should choose proteins like cottage cheese and quinoa instead of chicken."

Conservative treatment of diverticulosis includes which management? (select all that apply.)

B. Increasing fluid intake C. Taking stool softeners D. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for discomfort E. Taking bulk laxatives

The nurse is educating a patient with diverticulitis. Which statement indicates that the nurse's teaching about the importance of seeking treatment has been successful?

C. If left untreated, the inflamed bowel can perforate and cause peritonitis."

The nurse is caring for a patient with a Salem sump tube for decompression. The patient displays dyspnea and reports feeling full and nauseated. What action should the nurse take first?

C. Irrigate the tube with normal saline.

The nurse is caring for a patient with a 4-day-old ileostomy. The patient complains of cramping, the nurse notes a drop in the effluent for the ileostomy, and the bowel sounds are rapid with a "tinkling" sound. What action should the nurse take?

C. Notify the charge nurse immediately.

The physician has prescribed rifaximin (Xifaxan) for a patient with cirrhosis. The patient questions why he must take this medication. Which response by the nurse is most appropriate?

C. Rifaximin (Xifaxan) kills intestinal flora.

The nurse cautions that constant stress can cause which alteration to the gastrointestinal (GI) system?

C. Stress increases the gastric secretions, which irritate and finally ulcerate the gastric mucosal lining.

The nurse is caring for a patient with a peptic ulcer. The patient also has a history of chronic bronchitis, diabetes, and arthritis. Which component of the patient's history is the most likely contributing factor to the patient's ulcer?

C. The patient takes ibuprofen daily for arthritis pain.

The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan?

C. To diagnose abnormal contraction of the gallbladder

The nurse is caring for a patient being treated for new onset of gallstones. The patient asks the nurse if he will have to have surgery. How should the nurse respond?

C. Treatment for gallstones may include diet modification and weight loss, medications, or surgery."

Which age-related change predisposes older adult patients to diverticula?

Chronic constipation increases intra-abdominal pressure and allows herniation.

The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse's teaching has been successful?

D. "I should let these Steri-Strips fall off on their own."

A 36-year-old woman who had an ascending colostomy angrily declares, "I don't want this hateful thing on my body! This nasty thing is not me." Which response is most appropriate for the nurse to make?

D. "What about this colostomy concerns you the most?"

The nurse explains that the diagnosis of morbidly obese is reserved for people who exceed which percentage of their recommended weight?

D. 100%

The nurse is reviewing a student nurse's charting and notes that the student has documented absent bowel sounds. The nurse reminds the student that in order to document absent bowel sounds, one must auscultate each quadrant at what period of time?

D. 5 minutes

The nurse is caring for multiple patients. The nurse determines that which patient has the highest risk for developing gallstones?

D. A 50-year-old obese Mexican American woman who has type 1 diabetes.

The nurse is caring for a patient who is being treated for extensive burns. The nurse notes the presence of coffee-ground material in the Salem sump catheter. The nurse correctly recognizes which factor as the likely cause?

D. A physiologic stress ulcer

The nurse is caring for a patient 1-day postoperative after a transverse colostomy. When assessing the stoma, which finding requires the nurse's immediate action?

D. A purplish-red stoma

A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse anticipates that the health care provider will likely recommend which treatment?

D. An injection of hepatitis B immune globulin (HBIG)

The nurse is caring for a patient whose home medications include bismuth subsalicylate (Pepto Bismol). The nurse should educate the patient about which side effect of this medication?

D. Black stools

The nurse is preparing to administer liquid laxative to a patient in preparation for a colonoscopy. Which action should the nurse take?

D. Chill the laxative and pour it over ice.

The nurse is obtaining a history of a patient with hepatitis A. Which question is most appropriate for the nurse to ask?

D. Do you eat shellfish or oysters often?"

The nurse is preparing a teaching plan for a patient with gastroesophageal reflux disease (GERD) who has been prescribed multi-drug therapy for treatment. Which information is most important for the nurse to obtain?

D. Do you think you can afford these prescriptions?"

The nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology?

D. Hepatitis causes liver congestion that obstructs bile flow.

The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis?

D. Increased prothrombin time

The nurse is performing preprocedure teaching for a patient scheduled to undergo a liver biopsy. After listening to the information, the patient states, "I am so scared. I just don't know if I can do this procedure." Which response is best?

D. understand that you are afraid. Tell me more about your concerns."

A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours. Before giving the bolus, the nurse aspirates a residual of 100 mL. Which action is most appropriate?

Document the residual and hold the feeding.

Which type of hernia can lead to necrosis?

Strangulated hernia