Module 6 Exam 2: Adult Health Theory II ATI, Lewis, Elsevier - Gastrointestinal Issues

A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. Take the medication with food. B. Monitor for diarrhea. C. Wait 1 hr before taking other oral medications. D. Maintain a low‑fiber diet.

A. Advise the client to take aluminum hydroxide on an empty stomach. B. I nclude in the teaching that aluminum hydroxide can cause constipation. C. CORRECT: Advise the client not to take oral medications within 1 hr of an antacid. D. I nclude in the teaching for the client to increase dietary fiber due to the constipating effect of the medication. (ATI)

A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Take the medication 1 hr before a meal. B. Limit NSAID s when taking this medication. C. Expect skin flushing when taking this medication. D. Increase fiber intake when taking this medication. E. Chew the medication thoroughly before swallowing.

A. CORRECT: Take the medication 1 hr before meals. B. CORRECT: Limit taking NSAID s when on this medication. C. S kin flushing is not an adverse effect of this medication. D. Fiber intake does not need to be increased when taking this medication. E. S wallow the capsule whole. It should not be crushed or chewed. (ATI)

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? Antibiotic(s), antacid, and corticosteroid Antibiotic(s), aspirin, and antiulcer/protectant Antibiotic(s), proton pump inhibitor, and bismuth Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

Antibiotic(s), proton pump inhibitor, and bismuth

The nurse determines a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? Nausea Belching Epigastric pain Difficulty swallowing

Epigastric pain

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse will determine the medication was effective when which symptom has been resolved? Diarrhea Heartburn Constipation Lower abdominal pain

Heartburn

Two days after a bowel resection for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site

Impaired peristalsis Rationale: Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? Bisacodyl Lubiprostone Cascara sagrada Magnesium hydroxide

Magnesium hydroxide Rationale: Milk of magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

...Lewis Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing a. beef b. meat and milk c. poultry and eggs d. home-preserved vegetables

b. meat and milk ...(Lewis)

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings b. extension of the tumor into the aorta c. leakage of fluids into the mediastinum d. esophageal perforation with fistula formation into the lung

c. leakage of fluids into the mediastinum (Lewis)

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? "It would be beneficial for you to eliminate drinking alcohol." "You'll need to drink at least two to three glasses of milk daily." "Many people find that a minced or pureed diet eases their symptoms of PUD." "Taking medication will allow you to keep your present diet while minimizing symptoms."

"It would be beneficial for you to eliminate drinking alcohol."

The nurse teaches senior citizens at a community center how to prevent food poisoning at social events. Which community member statement reflects accurate understanding? "Pasteurized juices and milk are safe to drink." "Alfalfa sprouts are safe if rinsed before eating." "Fresh fruits do not need to be washed before eating." "Ground beef is safe to eat if cooked until it is brown."

"Pasteurized juices and milk are safe to drink."

...Elsevier The nurse is teaching a group of college students how to prevent food poisoning. Which comment shows an understanding of foodborne illness protection? "Eating raw cookie dough from the package is a great snack when you do not have time to bake." "Since we only have one cutting board, we can cut up chicken and salad vegetables at the same time." "To save refrigerator space, leftover food can be kept on the counter if it is in sealed containers." "When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."

"When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate." ...(Elsevier)

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 7:00 AM, 10:00 PM, and 1:00 PM 8:00 AM, 12:00 PM, and 4:00 PM 9 AM and 3 PM 9:00 AM, 12:00 PM, and 3:00 PM

8:00 AM, 12:00 PM, and 4:00 PM Rationale: A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

Which patient would be at highest risk for developing oral candidiasis? A 74-yr-old patient who has vitamin B and C deficiencies A 22-yr-old patient who smokes 2 packs of cigarettes per day A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks A 58-yr-old patient who is receiving amphotericin B for 2 days

A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks

A nurse is caring for a client following a paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A. Client report of upper chest pain B. Decreased urine output C. Pallor D. Temperature elevation

A. A report of sharp, constant abdominal pain is associated with bowel perforation. B. D ecreased urine output is associated with bladder perforation during a paracentesis. C. Pallor may indicate hypovolemia related to fluid removal of ascites fluid during the procedure. D. CORRECT: Fever is an indication of bowel perforation during a paracentesis.(ATI)

A nurse is reviewing the health record of a client who has a suspected tumor of the jejunum. The nurse should expect a prescription for which of the following tests? (Select all that apply.) A. Blood alpha‑fetoprotein B. Endoscopic retrograde cholangiopancreatography (ER CP) C. Gastrointestinal x‑ray with contrast D. Small bowel capsule endoscopy (M2A) E. Colonoscopy

A. Blood alpha‑fetoprotein is a laboratory test used in cases of suspected liver cancer. B. An ER CP is used to visualize the duodenum, biliary ducts, gall bladder, liver, and pancreas. C. CORRECT: A gastrointestinal x‑ray with contrast involves the client drinking barium, which is then traced through the small intestine to the junction with the colon. This would identify a tumor in the jejunum. D. CORRECT: M2A is a procedure in which the client swallows a capsule with a glass of water for a video enteroscopy to visualize the entire small bowel over an 8‑hr period. E. A colonoscopy is the use of a flexible fiberoptic colonoscope, which enters through the anus, to visualize the rectum and the sigmoid, descending, transverse, and ascending colon. (ATI)

A nurse is planning care for a client who has a small bowel obstruction and a nasogastric (NG) tube in place. Which of the following interventions should the nurse include? (Select all that apply.) A. Document the NG drainage with the client's output. B. Irrigate the NG tube every 8 hr. C. Assess bowel sounds. D. Provide oral hygiene every 2 hr. E. Monitor NG tube for placement.

A. CORRECT: Document the NG drainage as output. This helps determine the amount of fluid replacement needed. B. 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. Provide frequent oral hygiene to provide comfort. E. CORRECT: Check the placement of the NG tube prior to irrigation to prevent aspiration and periodically to prevent an increase in abdominal distention. (ATI)

A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (Select all that apply.) A. Evaluate intake and output. B. Monitor laboratory reports of electrolytes. C. Provide three large meals a day. D. Administer ibuprofen for pain. E. Observe stool characteristics.

A. CORRECT: Evaluate the client's intake and output to prevent electrolyte loss and dehydration. B. CORRECT: Monitor the client's electrolyte laboratory values to prevent fluid loss and dehydration. C. I nstruct the client to eat small, frequent meals. D. I nstruct the client to avoid taking ibuprofen, an NSAID , because of its erosive capabilities. E. CORRECT: Instruct the client to report to the provider any indication of the presence of blood in the stools, which can indicate gastrointestinal bleeding. (ATI)

ATI.... A nurse is reviewing bowel prep using polyethylene glycol with a client scheduled for a colonoscopy. Which of the following instructions should the nurse include? A. Check with the provider about taking current medications when consuming bowel prep. B. Consume a normal diet until starting the bowel prep. C. Expect the bowel prep to not begin acting until the day after all the prep is consumed. D. Discontinue the bowel prep once feces start to be expelled.

A. CORRECT: Instruct the client to check with the provider about taking current medication, because some medications can be withheld when taking polyethylene glycol due to their lack of absorption. B. I nstruct the client to consume a clear liquid diet prior to starting the bowel prep. C. I nstruct the client that the actions of polyethylene glycol begin within 2 to 3 hr after consumption. D. I nstruct the client to consume the full amount prescribed. (ATI)

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. High‑pitched bowel sounds 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: High‑pitched bowel sounds are a manifestation of a small‑ or large‑bowel obstruction. D. Abdominal distention is a finding in a client who has a small bowel obstruction. E. Metabolic alkalosis due to the loss of gastric acid is a finding in a client who has a small bowel obstruction.(ATI)

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? A. Eat three moderate‑sized meals a day. B. Drink at least one glass of water with each meal. C. Eat a bedtime snack that contains a milk product. D. Increase protein in the diet.

A. Consume small, frequent meals rather than moderate‑sized meals. B. E liminate liquids with meals and for 1 hr prior to and following meals. C. Avoid milk products. D. CORRECT: Eat a high‑protein, high‑fat, low‑fiber, and moderate‑ to low‑carbohydrate diet.(ATI)

A nurse is completing discharge teaching for a client who has an infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding of the teaching? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."

A. Corticosteroid use is a contributing factor to an infection caused by H. pylori. B. An esophagogastroduodenoscopy is done to evaluate for the presence of H. pylori and to evaluate effectiveness of treatment. C. CORRECT: A combination of antibiotics and a histamine2 receptor antagonist is used to treat an infection caused by H. pylori. D. H. pylori is evaluated by obtaining gastric samples, not a throat swab.(ATI)

A nurse is teaching a client who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the teaching? A. "The medicine coats the lining of my stomach." B. "The medication should stop the pain right away." C. "I will take my pill at bedtime." D. "I will monitor for bleeding from my nose."

A. Famotidine decreases gastric acid output. It does not have a protective coating action. B. The client might need to take famotidine for several days before pain relief occurs when starting this therapy. C. CORRECT: The client should take famotidine at bedtime, which suppresses nocturnal acid production. D. I nstruct the client to monitor for GI bleeding when taking famotidine. (ATI)

A nurse is completing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse include in the teaching? A. Mucus will be present in stool for 5 to 7 days after surgery. B. Expect 500 to 1,000 mL of semiliquid stool after 2 weeks. C. Stoma should be moist and pink. D. Change the ostomy bag when it is . full.

A. Mucus and blood can be present for 2 to 3 days after surgery. B. Output should become stool‑like, semi‑formed, or formed within days to weeks. C. CORRECT: A pink, moist stoma is an expected finding for a colostomy. D. The ostomy bag should be changed when it is . to . full.(ATI)

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? Write an incident report about this untoward event. Attempt to have the family convince the patient to take the ordered dose. Withhold the medication at this time and try to administer it later in the day. Chart the dose as not given on the medical record and explain in the nursing progress notes.

Chart the dose as not given on the medical record and explain in the nursing progress notes. Rationale: Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

The nurse teaching young adults about behaviors that put them at risk for oral cancer includes a. discouraging use of chewing gum b. avoiding use of perfumed lip gloss c. avoiding use of smokeless tobacco d. discouraging drinking of carbonated beverages

c. avoiding use of smokeless tobacco(Lewis)

The nurse is teaching the patient and family that peptic ulcer are a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood c. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol

c. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol (Lewis)

The nurse explains to the patient with Vincent's infection that treatment will include a. tetanus vaccination b. viscous lidocaine rinses c. amphotericin B suspension d. topical application of antibiotics

d. topical application of antibiotics(Lewis)

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about A. cancer support groups, alopecia, and stomatitis. B. avitaminosis, ostomy care, and community resources. C. prosthetic devices, skin conductance, and grief counseling. D. wound and skin care, nutrition, drugs, and community resources.

d. wound and skin care, nutrition, drugs, and community resources(Lewis)

A patient with a history of peptic ulcer disease has presented to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate? Providing IV fluids and inserting a nasogastric (NG) tube Administering oral bicarbonate and testing the patient's gastric pH level Performing a fecal occult blood test and administering IV calcium gluconate Starting parenteral nutrition and placing the patient in a high-Fowler's position

Providing IV fluids and inserting a nasogastric (NG) tube

After administration of a dose of metoclopramide, which patient assessment finding would show the medication was effective? Decreased blood pressure Absence of muscle tremors Relief of nausea and vomiting No further episodes of diarrhea

Relief of nausea and vomiting

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but reports of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the provider. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.

Reposition the tube and check for placement. Rationale: The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The provider does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? Back pain 3 or 4 hours after eating a meal Chest pain relieved with eating or drinking water Burning epigastric pain 90 minutes after breakfast Rigid abdomen and vomiting following indigestion

Rigid abdomen and vomiting following indigestion

A patient with ulcerative colitis is scheduled for a colon resection with placement of an ostomy. The nurse should plan to include which prescribed measure in the preoperative preparation? Selecting the stoma site Where to purchase ostomy supplies Teaching about how to irrigate a colostomy Following a high-fiber diet the day before surgery

Selecting the stoma site Rationale: Care that is unique to ostomy surgery includes selecting the best site for the stoma. Instructions to irrigate the colostomy and where to purchase ostomy supplies will be done postoperatively. A clear liquid diet will be used the day before surgery with the bowel cleansing.

The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? Take a dose of mineral oil at the same time. Add extra salt to food on at least one meal tray. Ensure a dietary intake of 10 g of fiber each day. Take each dose with a full glass of water or other liquid

Take each dose with a full glass of water or other liquid. Rationale: Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

A patient with ulcerative colitis is scheduled for a total proctocolectomy with permanent ileostomy. The wound, ostomy, and continence nurse is selecting the site where the ostomy will be placed. What should be included in site consideration? Protruding areas make the best sites. The patient must be able to see the site. The site should be outside the rectus muscle area. The appliance will need to be placed at the waist line.

The patient must be able to see the site. Rationale: In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance

A patient complaining of nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? Tremors Constipation Double vision Numbness in fingers and toes

Tremors

(Lewis)... M.J. calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to a. administer antiemetic drugs and observe skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs d. offer her mother large quantities of Gatorade to decrease the risk of sodium depletion.

b. give her mother sips of water and elevate the head of her bed to prevent aspiration (Lewis)

The pernicious anemia that may accompany gastritis is due to a. Chronic autoimmune destruction of cobalamin stores in the body b.progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs

c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa (Lewis)

The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. limiting alcohol intake to one serving per day b.only taking aspirin with milk or bread products c. avoiding taking aspirin and drugs containing aspirin d. only taking only drugs prescribed by the health care provider e. taking all drugs 1 hour before mealtime to prevent further bleeding

c. avoiding taking aspirin and drugs containing aspirin d. only taking drugs prescribed by the health care provider(Lewis)

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? "It will increase bulk in the stool." "It will lubricate the intestinal tract to soften feces." "It will increase fluid retention in the intestinal tract." "It will increase peristalsis by stimulating nerves in the colon wall."

"It will increase peristalsis by stimulating nerves in the colon wall." Rationale: Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk-forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse is preparing to administer famotidine to a patient after a laparotomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will prevent air from accumulating in the stomach, causing gas pains." "It will reduce the amount of acid in the stomach while you are not eating." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

"It will reduce the amount of acid in the stomach while you are not eating." Rationale: Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked and help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

"The tube will help to drain the stomach contents and prevent further vomiting." Rationale: The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain (select all that apply)? a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

Correct answers: a, b, c, d, e Rationale: All these conditions could cause acute abdominal pain(Lewis)

A nurse is providing care to a client who is 1 day postoperative following a paracentesis. The nurse observes clear, pale‑yellow fluid leaking from the operative site. Which of the following is an appropriate nursing intervention? A. Place a clean towel near the drainage site. B. Apply a dry, sterile dressing. C. Apply direct pressure to the site. D. Place the client in a supine position.

3. A. Cover the operative site to prevent infection and allow for assessment of drainage. B. CORRECT: Application of a sterile dressing will contain the drainage and allow continuous assessment of color and quantity. C. Application of direct pressure can cause discomfort and potential harm to the client. D. Place the client with the head of the bed elevated to promote lung expansion.(ATI)

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Client reports pain relieved by eating. B. Client states that pain often occurs at night. C. Client reports a sensation of bloating. D. Client states that pain occurs 30 min to 1 hr after a meal. E. Client experiences pain upon palpation of the epigastric region.

A. A client who has a duodenal ulcer will report that pain is relieved by eating. B. Pain that rarely occurs at night is an expected finding. C. CORRECT: A client report of a bloating sensation is an expected finding. D. CORRECT: A client who has a gastric ulcer will often report pain 30 to 60 min after a meal. E. CORRECT: Pain in the epigastric region upon palpation is an expected finding.(ATI)

A nurse is assessing a client in an extended care facility. The nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to a fecal impaction? A. The client reports one bowel movement yesterday. B. The client is having small, frequent liquid stools. C. The client is flatulent. D. The client indicates vomiting once this morning.

A. A report of a bowel movement yesterday does not indicate a mechanical obstruction of the large intestine due to a fecal impaction. B. CORRECT: Small, frequent liquid stools can be passed around a fecal impaction. Other manifestations include constipation and rectal pain. C. The presence of flatus does not indicate a mechanical obstruction of the large intestine due to a fecal impaction. D. A report of a single episode of vomiting does not indicate a mechanical obstruction of the large intestine due to a fecal impaction. Frequent vomiting is a manifestation of a small‑bowel obstruction.(ATI)

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness

A. CORRECT: Manifestations of perforation include a rigid, board‑like abdomen. B. CORRECT: Tachycardia occurs due to gastrointestinal bleeding that accompanies a perforation. C. Hypotension is an expected finding in a client who has a perforation and bleeding. D. Circumoral cyanosis is not a manifestation of perforation. E. CORRECT: Rebound tenderness is an expected finding in a client who has a perforation.(ATI)

A nurse is teaching a client who will undergo a sigmoidoscopy. Which of the following information about the procedure should the nurse include? (Select all that apply.) A. Increased flatulence can occur following the procedure. B. NPO status should be maintained preprocedure. C. Conscious sedation is used. D. Repositioning will occur throughout the procedure. E. Fluid intake is limited the day after the procedure.

A. CORRECT: Teach the client that increased flatulence can occur due to the instillation of air during the procedure. B. CORRECT: Instruct the client to remain NPO after midnight the night before the procedure. C. I nform the client that sedation is not indicated for a sigmoidoscopy. D. Inform the client that the position to lie for the procedure is on the left side. E. I nstruct the client to increase, not limit fluid intake following the procedure.(ATI)

A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12‑hr shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained.

A. CORRECT: The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin. B. No other medications or fluids should be administered through the IV tubing being used to administer TPN due to the increased risk of infection and disruption of the rate of TPN infusion. C. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection. D. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr. E. aPTT measures the coagulability of the blood, which is unnecessary during the administration of TPN.(ATI)

...ATI A nurse is completing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include? A. Keep a food diary to identify triggers to exacerbation. B. Consume 15 to 20 g of fiber daily. C. Plan three moderate to large meals per day. D. Limit fluid intake to 1 L each day.

A. CORRECT: The client should keep a food diary to identify foods that trigger exacerbation of manifestations. B. The client should increase daily fiber intake to 30 to 40 g. C. The client should eat small frequent meals. D. The client should drink 2 to 3 L fluids per day to promote a consistent bowel pattern.(ATI)

A nurse is caring for a client who is receiving TPN solution. The current bag of solution was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag. B. Infuse the remaining solution at the current rate and then hang a new bag. C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag. D. Remove the current bag and hang a bag of lactated Ringer's.

A. CORRECT: The current bag of TPN should not hang more than 24 hr due to the risk of infection. B. A bag of TPN should not infuse for more than 24 hr due to the risk of infection. C. The rate of TPN infusion should never be increased abruptly due to the risk of hyperglycemia. D. Administration of TPN should never be discontinued abruptly. If the solution needs replacing and another bag is not available, use dextrose 10% in water to maintain blood glucose levels.(ATI)

A nurse is having difficulty arousing a client following an esophagogastroduodenoscopy (EGD). Which of the following is the priority action by the nurse? A. Assess the client's airway. B. Allow the client to sleep. C. Prepare to administer an antidote to the sedative. D. Evaluate preprocedure laboratory findings.

A. CORRECT: When using the airway, breathing, and circulation priority‑setting framework, assessing and maintaining an open airway is the priority action the nurse should take. B. Continue to allow the client to rest. However, another action is the priority. C. Prepare to administer an antidote to the sedative used during the procedure. However, another action is the priority. D. Evaluate the preprocedure laboratory findings. However, another action is the priority.(ATI)

A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding? A. "I will continue taking my warfarin while I complete these tests." B. "I'm glad I don't have to follow any special diet at this time." C. "This test determines if I have parasites in my bowel." D. "This is an easy way to screen for colon cancer."

A. Clients are instructed to stop taking anticoagulants prior to obtaining stool specimens for fecal occult blood testing because they can interfere with the results. B. Clients are instructed to avoid consuming red meat, chicken, and fish prior to obtaining stool specimens for fecal occult blood testing because this can interfere with the results. C. Fecal occult blood testing does not identify parasites present in stool. D. CORRECT: Fecal occult blood testing is a screening procedure for colon cancer.(ATI)

A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? A. Pernicious anemia is caused when the cells producing gastric acid are damaged. B. Expect a monthly injection of vitamin B12. C. Plan to take vitamin K supplements. D. Pernicious anemia is caused by an increased production of intrinsic factor.

A. D amage to parietal cells has occurred, which leads to pernicious anemia and causes a decrease of the intrinsic factor by the stomach parietal cells. B. CORRECT: Include in the information that the client will receive a monthly injection of vitamin B12 to treat pernicious anemia due to a decrease of the intrinsic factor by the stomach parietal cells. C. Vitamin K supplements are given to clients who have a bleeding disorder. D. Parietal cell damage results in insufficient production of intrinsic factor by the stomach parietal cells. (ATI)

A nurse is completing an admission assessment for 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. Emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. Blood potassium 3.0 mEq/L E. WBC 10,000/uL

A. Profuse emesis is an expected finding for a client who has a small bowel obstruction. Do not report this finding to the provider. B. CORRECT: This urine specific gravity is greater than the expected reference range of 1.005 to 1.030. An increased urine specific gravity is an indication of dehydration. Report this finding to the provider. C. CORRECT: The Hct is greater than the expected reference range of 42% to 52% for males and 37% to 47% for females. An elevated HCT indicates hemoconcentration, which is due to dehydration. D. CORRECT: This potassium is below the expected reference range of 3.5 to 5.0 mEq/L caused by potassium loss from vomiting. Hypokalemia can cause dysrhythmias, muscle weakness, and lethargy, and requires potassium replacement. Report this finding to the provider. E. This WBC is within the expected reference range of 5,000 to 10,000/mm3. Do not report this finding to the provider. (ATI)

A charge nurse is teaching a group of nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements by a unit nurse indicates understanding of the purpose of the procedure? A. "The client will have increased duodenal gastric emptying." B. "The client will have a reduction of gastric acid secretions." C. "The client will have an increase of gastric mucus secretion." D. "The client will have an increased secretion of hydrogen/potassium ATPase enzymes."

A. Pyloroplasty will increase gastric emptying, which is performed to widen the opening from the stomach to the duodenum. B. CORRECT: Selective vagotomy will reduce gastric acid secretions. C. Prostaglandin analog medication will stimulate mucosal protection and decrease gastric acid secretions. D. A histamine2 antagonist medication will inhibit gastric secretion by inhibiting the hydrogen/potassium ATPase enzyme system in the gastric parietal cells. (ATI)

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? An UAP on the unit who has hospice experience An LPN that has worked on the unit for 10 years An RN with 6 months of experience on the surgical unit An RN who has floated to the surgical unit from pediatrics

An RN with 6 months of experience on the surgical unit Rationale: The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a LPN/VN or UAP.

The nurse is caring for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention? Offer the patient an herbal supplement such as ginseng. Apply a cool washcloth to the forehead and provide mouth care. Take the patient for a walk in the hallway to promote peristalsis. Discontinue any medications that may cause nausea or vomiting.

Apply a cool washcloth to the forehead and provide mouth care

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply) Restricted to rectum Strictures are common Bloody, diarrhea stools Cramping abdominal pain Lesions penetrate intestine

Bloody, diarrhea stools Cramping abdominal pain Rationale: Manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia

Dumping syndrome

The nurse performs a detailed assessment of the abdomen of a patent with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.

Correct answers: a, b Rationale: With lower intestinal obstructions, abdominal distention is markedly increased and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation, not diarrhea.(Lewis)

Lewis... The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to a. increase fluid intake. b. administer an antibiotic. c. administer an antimotility drug. d. quarantine the patent to prevent spread of the virus.

Correct answer: a Rationale: Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting. The major concerns are transmission prevention, fluid and electrolyte replacement, and resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, wash your hands before and after contact with the patient and when handling body fluids of any kind. Flush vomitus and stool down the toilet, and wash contaminated clothing immediately with soap and hot water. (Lewis)

The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stool." c. I may not need to wear a drainage pouch if I irrigate it daily. d. Limiting my fluid intake should decrease the amount of output.

Correct answer: a Rationale: Because ileostomy drainage is a liquid to thin paste, the patient will need to wear a drainage bag at all times. The patient should use an open-ended drainable pouch. It is worn for 4 to 7 days. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear an ostomy pouch.(Lewis)

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu a. scrambled eggs and sausage. b. buckwheat pancakes with syrup. c. oatmeal, skim milk, and orange juice. d. yogurt, strawberries, and rye toast with butter.

Correct answer: a Rationale: Celiac disease is treated with lifelong avoidance of dietary gluten (wheat, barley, oats, rye products). Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is also found in some medications and in many food additives, preservatives, and stabilizers.(Lewis)

In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. has localized cramping pain. d. frequently develops peritonitis.

Correct answer: b Rationale: Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.(Lewis)

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would included an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

Correct answer: c Rationale: Stage I colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.(Lewis)

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. frequently results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.

Correct answer: c Rationale: Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn's disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.(Lewis)

...Lewis What should a patient be taught after a hemorrhoidectomy? a. Take mineral oil before bedtime. b. Eat a low-fiber diet to rest the colon. c. Administer oil-retention enema to empty the colon. d. Use prescribed pain medication before a bowel movement.

Correct answer: d Rationale: After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Give pain medication before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-retention enema is administered....(Lewis)

A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is a. applying a truss to the hernia site. b. allowing the patient to stand to void. c. supporting the incision during coughing. d. applying a scrotal support with an ice bag.

Correct answer: d Rationale: Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.(Lewis)

Assessment findings suggestive of peritonitis include (select all that apply) a. rebound tenderness. b. a soft, distended abdomen. c. dull, intermittent abdominal pain d. shallow respirations with bradypnea e. observing that the patient is lying still.

Correct answers: a, e Rationale: With peritoneal irritation, the abdomen is hard, and the patient has severe continuous abdominal pain that is worse with any sudden movement. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness. The patient lies very still and takes shallow breaths. Abdominal distention, tachypnea, fever, and tachycardia may occur.(Lewis)

The nurse asks a patient scheduled for colectomy to sign the operative permit as directed in the provider's preoperative orders. The patient states that the provider has not explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? Ask family members whether they have discussed the surgical procedure with the provider. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. Have the patient sign the form and state the provider will visit to explain the procedure before surgery. Delay the patient's signature on the consent and notify the provider about the conversation with the patient.

Delay the patient's signature on the consent and notify the provider about the conversation with the patient. Rationale: The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the provider, who has the responsibility for obtaining consent.

Elsevier... The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Have visitors use the alcohol-based hand sanitizer. Wipe down equipment with ammonia-based disinfectant. Don gloves and gown before entering the patient's room.

Don gloves and gown before entering the patient's room. Rationale: Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room, and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach. (Elsevier)

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries

Dried beans, All Bran (100%) cereal, and raspberries Rationale: A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected? Tinnitus Drowsiness Reduced hearing Sensation of falling

Drowsiness

The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate? Iced tea Dry toast Hot coffee Plain yogurt

Dry toast

...Elsevier After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate.

Encourage the patient to ambulate as ordered. Rationale: Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? Barium swallow Endoscopic biopsy Capsule endoscopy Endoscopic ultrasonography

Endoscopic biopsy

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? Fecal impaction Perineal hygiene Dietary fiber intake Antidiarrheal agent use

Fecal impaction Rationale: Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities

Firmly distended abdomen Rationale: Manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

A patient has a sliding hiatal hernia. What nursing intervention will reduce the symptoms of heartburn and dyspepsia? Keeping the patient NPO Putting the bed in the Trendelenburg position Having the patient eat 4 to 6 smaller meals each day Giving various antacids to determine which one works for the patient

Having the patient eat 4 to 6 smaller meals each day

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction

High-pitched and hyperactive above the area of obstruction Rationale: Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent

Elsevier... The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? Pallor and diaphoresis Ecchymotic peripheral IV site Guaiac-positive diarrhea stools Heart rate 90, respiratory rate 20, BP 110/60

Pallor and diaphoresis (Elsevier)...

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for an exploratory laparotomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery

How to deep breathe and cough Rationale: Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

A hospitalized patient has just been diagnosed with diarrhea due to C. difficile. Which nursing interventions should be included in the patient's plan of care? (Select all that apply.) Initiate contact isolation precautions. Place the patient on a clear liquid diet. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Use hand sanitizer before and after any bodily fluid contact.

Initiate contact isolation precautions. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Rationale: Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Discontinue intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity.

Maintain a high intake of fluid and fiber in the diet. Rationale: Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? Turn, deep breathe, cough, and use spirometer every 4 hours. Maintain an upright position for at least 2 hours after eating. NG will have bloody drainage and it should not be repositioned. Keep in a supine position to prevent movement of the anastomosis.

NG will have bloody drainage and it should not be repositioned.

The nurse should administer an as-needed dose of magnesium citrate after noting what information when reviewing a patient's medical record? Abdominal pain and bloating No bowel movement for 3 days A decrease in appetite by 50% over 24 hours Muscle tremors and other signs of hypomagnesemia

No bowel movement for 3 days Rationale: Magnesium citrate is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? Sucralfate Cimetidine Omeprazole Metoclopramide

Omeprazole

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? Zolpidem Ondansetron Dexamethasone Morphine sulfate

Ondansetron

A patient with oral cancer is not eating. A small-bore feeding tube was inserted and the patient started on enteral feedings. Which patient goal would indicate improvement? Weight gain of 1 kg in 1 week Administer tube feeding at 25 mL/hr. Consume 50% of clear liquid tray this shift. Monitor for tube for placement and gastrointestinal residual.

Weight gain of 1 kg in 1 week

Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD) a. the best time to take an as needed antacid is 1 to 3 hours after meals b. a glass of warm milk at bedtime will decrease your discomfort at nights c. do not chew gum; the excess saliva will cause you to secrete more acid d. Limit your intake of foods high in protein because they take longer to digest

a. the best time to take an as needed antacid is 1 to 3 hours after meals. (Lewis)