MS 44, 45, 46, 47, 48 (rationale is on the top of next card)

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Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and white blood cells (WBCs) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition. 7. After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? A) Volvulus B) Intussusception C) Tumor D) Abdominal surgery

Constipation may result from insufficient dietary fiber and water. A diet low in fiber predisposes people to constipation because the stools produced are small in volume and dry. Increasing the carbohydrate, fat, and protein content will not facilitate the passage of stool. 13. The nurse is assessing a client for fecal impaction, and when inserting a lubricated, gloved finger, the stool feels like small rocks. What does the nurse document this finding as? A) Scybala B) Hard stool C) Fecal Impaction D) Obstruction

A single lumen suction catheter (Levin tube) can adhere to the lining of the stomach and cause irritation, therefore should be set at a low-intermittent setting. Dark red drainage in the suction collection canister is an expected finding. Urine output of 30 mL or greater per hour is expected finding as is a soft abdomen with sluggish bowel sounds. 24. The nurse fills a tube feeding bag with two 8-oz cans of commercially prepared formula. The client is to receive the formula at 80 mL/hour via continuous gastrostomy feeding tube and pump. How many hours will this bag of formula run before becoming empty? ____________ hours

6 hours

A double-barrel colostomy, which is performed most often in the transverse section of the large intestine, contains both a proximal and distal stoma. 35. The nurse is preparing to irrigate a client's single-barrel colostomy after surgery. What postoperative day should the nurse irrigate the colostomy? A) Fourth or fifth postoperative day B) The day after surgery C) The seventh postoperative day D) The colostomy should be irrigated immediately postop

A prolonged recovery period usually is unnecessary. Most clients resume normal activities within 1 week. 31. A client had an open cholecystectomy with a T-tube insertion, and the nurse is measuring the bile drainage every 8 hours. When should the nurse notify the physician? A) If more than 500 mL of bile drainage is present in 24 hours. B) If the bile drainage is dark green. C) If there is 100 mL in the drainage pouch after 8 hours. D) If there is 10 mL/hour of drainage in 24 hours.

Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign. 9. When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report? A) Rectal bleeding B) Pain C) Itching D) Soreness

The nurse educates the client about ways to avoid constipation, control a cough, and perform proper body mechanics—how to wear and care for skin under a truss. Analgesics are not required for the prevention of a hernia. The client should bend at the knees not at the waist. 29. The nurse is talking with a group of clients that are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? A) Change in bowel habits B) Excess gas C) Daily bowel movements D) Abdominal cramping when having a bowel movement

The nurse is correct to instruct the client to assume the supine position. Also the nurse places a rolled towel beneath the right lower ribs. #32.The nurse is caring for a client following gastrointestinal diagnostic testing. The client verbalizes being ashamed because he is having frequent gas. Which nursing suggestion is best?A)"Having gas following the procedure is normal. Expel the gas to decrease discomfort."B)"Do not be ashamed. Everyone has gas following the procedure."C)"The nursing staff is used to having clients with gas due to the procedure completed."D)"Nurses anticipate that client will have gas following the procedure and provide privacy."

The rectum is packed with gauze during surgery to absorb drainage and promote gradual healing. The rectal pack usually is removed in 5 to 7 days. 28. The nurse is instructing a client with an ileostomy on appliance use and changing it. What statement made by the client demonstrates the client understands of using a new appliance for the first time? A) "I will patch test it first on nonirritated skin at the inner aspect of my forearm." B) " I can expect the new appliance to sting or itch for the first 24 hours." C) "When changing the appliance and faceplate, I should scrub vigorously to remove all debris." D) "I should change the faceplate every 8 hours."

When a client is being assessed for cholelithiasis, the urine appears dark brown, whereas the stools may be light colored. Bowel sounds are present because cholelithiasis does not cause lack of bowel motility. The stool does not contain blood or mucus. 5. Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes? A) Increased appetite and thirst B) Vomiting and diarrhea C) Low blood pressure and pulse D) Decreased urination and constipation

Young male clients may wish to collect and store sperm for later use if they plan to have children. Sexual dysfunction in men after a total colectomy is unusual but sometimes occurs. If such dysfunction persists after a colectomy, operative and nonoperative options are available to facilitation erection. 20. A client will be having a total colectomy in 4 days. The client does not have an obstruction. What does the nurse anticipate instructing the client about doing prior to the surgery to prepare the bowel? A) Instructing the client about dietary restrictions and lavage agents B) Making sure the client drinks 2 L of fluid prior to the procedure C) Instructing the client to have no food except clear liquids for 4 days D) There will be no special preparation, and the client may eat until midnight the night prior to surgery.

Good oral hygiene should include gentle tooth brushing and use of oral antiseptic mouthwash to maintain integrity and avoid infections of teeth and gums. Blood transfusions may become necessary if WBC production is compromised but not specific to oral hygiene. Dental cleanings monthly will not prevent infection. Lead shields are not specific for preventing infection. 20. Which nursing interventions are primary in the care of a client receiving internal sealed radiation? Select all that apply. A) Time, distance, and shielding B) Count wires/threads every shift. C) Maintain ink markings on the skin. D) Administer treatments through the intravenous port. E) Provide rest periods between treatments. F) Encourage family involvement in direct care.

A, B

If the protruding structures can be replaced in the abdominal cavity, it is a reducible hernia. An irreducible or incarcerated hernia is one in which the intestine cannot be replaced in the abdominal cavity because of edema of the protruding segment and constriction of the muscle opening through which it has emerged. If the process continues without treatment, the blood supply to the trapped segment of bowel can be cut off, leading to gangrene. This development is referred to as a strangulated hernia. 28. A client is being discharged from the outpatient care center after having an inguinal hernia reduced nonsurgically. What can the nurse instruct the client to do to decrease the incidence of recurrence? Select all that apply. A) Avoid heavy lifting and strenuous exercise. B) Avoid constipation. C) How to wear a truss. D) Take analgesics for pain. E) Bend at the waist.

A, B, C

In very dark-skinned clients, the nurse inspects the hard palate, gums, conjunctiva, and surrounding tissues for discoloration. If the skin appears jaundiced, the nurse inspects the sclera if it is yellow. #18.The nurse is assessing the abdomen of the client with an undiagnosed disorder. In which sequence would the nurse conduct the abdominal assessment? (Use all options.)A)PalpationB)InspectionC)AuscultationD)Percussion

A, B, C, D

Press the adhesive faceplate around the stoma for about 30 seconds. This measure ensures secure attachment of the pouch to the peristomal skin. A large amount of adhesive is not necessary to adhere the faceplate around the stoma. The adhesive faceplate should be pressed from the stomal edge outward. The faceplate should not be wiped with alcohol first. 32. A male client will be having an ileoanal anastomosis for the treatment of chronic ulcerative colitis. What is the benefit to this client of having this procedure rather than a total colectomy? Select all that apply. A) Maintains bowel continence B) Unlikely to experience bladder dysfunction C) Unlikely to experience erectile dysfunction D) Unlikely to experience infertility E) Able to have the procedure as an outpatient

A, B, C, D

Chenodiol (Chenix) suppresses hepatic synthesis of cholesterol and cholic acid to dissolve gallstones. It is administered orally to dissolve gallstones and may require long-term therapy for effectiveness. Pancreatin (Creon) is a pancreatic enzyme and does not have the properties to dissolve gallstones. Tacrolimus (Prograf) is used to prevent transplant rejection as is cyclosporine (Sandimmune). 24. The nurse is caring for a client with cirrhosis of the liver. What symptoms exhibited by the client would indicate to the nurse that he is experiencing central nervous system effects of the disease? Select all that apply. A) Asterixis B) Joint stiffness C) Positive Babinski reflex D) Cough E) Fetor hepaticus

A, C, E

The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure. #7.When examining the abdomen of a client with complaints of nausea and vomiting, which of the following would the nurse do first?A)PalpationB)InspectionC)AuscultationD)Percussion

Magnesium products may cause ECG changes with prolonged use. The nurse should perform an ECG and compare it to the last one performed. A CBC would not establish a specific problem for the overuse of magnesium products, nor would listening to bowel sounds. Administering an oil retention enema would not be indicated at this time because the patient is not complaining of constipation and may overstimulate peristalsis. 18. The nurse is caring for a patient who has had diarrhea for 3 days. What major problems associated with severe or prolonged diarrhea should the nurse monitor for when caring for this patient? Select all that apply. A) Oral candidiasis B) Dehydration C) Electrolyte imbalances D) Vitamin deficiencies E) Rectal fissures

B, C, D

A disposable, or temporary, appliance is preferred in the immediate postoperative phase because the size of the stoma changes over time as a result of swelling from the procedure itself. The size of the stoma may change rapidly and differ from one appliance change to the next. After the stoma heals and reaches its final size and shape, a permanent appliance (reusable) may be used. A dry sterile dressing or wet to dry dressing should not be placed over the stoma due to the saturation of stool, which may cause maceration of the skin around the stoma. 15. A client with a colostomy is concerned with the odor that is left on the ostomy appliance and believes it may be caused by some of the medication that they take. What suggestion should the nurse provide to the client to determine if her medication is causing this problem? A) The client should abstain from her medications, reintroducing them one at a time to see which one is causing the odor. B) The client should abstain from taking any over-the-counter vitamin preparations because they are most likely the offending medication. C) The client can obtain a list of drugs from an ostomy association or appliance manufacturers. D) All colostomies have an offensive odor, and it is probably not the medication that is causing it.

A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding. 17. The nurse is administering medications to a patient that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? A) Spironolactone (Aldactone) B) Cholestyramine (Questran) C) Lactulose (Cephulac) D) Kanamycin (Kantrex)

Adrenal crisis is potentially life threatening and can result from the abrupt withdrawal of corticosteroids or significant stress after the client has been treated with corticosteroids. Cushing's disease is a disease when there are increased levels of cortisol released. Myxedema coma is a result of dangerously decreased levels of thyroid hormone, and thyroid storm is a dangerously increased level of thyroid hormone. 24. A client scheduled for a total colectomy has been taking the immunosuppressive agent, azathioprine (Imuran). When should the client be told to discontinue the medication to prevent negative effects on tissue healing? A) 3 days before surgery B) 1 week before surgery C) 1 month before surgery D) 3 months before surgery

Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery. 7. When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following? A) Gynecomastia B) Cutaneous spider angiomata C) Caput medusae D) Palmar erythema

Fatty foods delay stomach emptying (bloating) and can cause symptoms of gastrointestinal upset. Fried and deep fried foods contain elevated amounts of fat. The other options have a lower fat content. #13.The nurse is answering questions regarding fecal matter for a client who is scheduled for a colon resection. The client is asking questions regarding the composition of the fecal matter and when it becomes a formed mass. The nurse is most correct to state at which location?A)IleumB)CecumC)Sigmoid colonD)Duodenum

The client should eat slowly and chew food well with the mouth closed to help lessen the development of gas. Restricting oral intake should only be done with medical supervision and will not help with gas reduction. Enemas should not be administered. The stoma is only dilated when the stool volume decreases. 30. A client has been discharged from the acute care facility with an ileostomy. The client comes to the clinic for a follow-up visit and informs the nurse that the wound has been draining and they are having abdominal pain and running a fever. What does the nurse suspect is occurring with the client? A) The client is having an allergic reaction to the appliance. B) The client has developed anemia from blood loss. C) The client has developed a wound infection. D) The client is not emptying the pouch correctly.

The nurse is correct in assessing vital signs following a colonoscopy with polyp removal as a priority. Vital signs of an increases pulse rate and falling blood pressure can indicate a perforation and bleeding. If a perforation occurs and is not addressed at an early stage, the level of consciousness can become affected. There would be no reliable stool present in the bowel to Hemoccult test due to the cleansing agent and potential bleeding from the polyp removal. The ability to tolerate fluids relates to the sedation process and is not as high of a priority. #1. A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation? A) Provide adequate quantity of food. B) Obtain medical and allergy history. C) Assist client to increase dietary fiber. D) Obtain complete food history.

The nurse should instruct the client to avoid smoking for at least a day before the procedure of barium swallow because smoking stimulates gastric motility. The client is advised to take vitamin K before a liver biopsy and instructed to take three cleansing enemas before a barium enema. Instruction to avoid red meat would be appropriate for a client who is having a Hemoccult test. #3.A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure?A)Signs of perforationB)Client's ability to retain the bariumC)Client's tolerance for pain and discomfortD)Gag reflex

A gastrostomy tube enters the stomach through a surgically created opening into the abdominal wall. A jejunostomy tube enters jejunum or small intestine through a surgically created opening into the abdominal wall. A nasogastric tube passes through the nose into the stomach via the esophagus. An orogastric tube passes through the mouth into the stomach. 8. The nurse is checking the residual content for a client who is receiving intermittent feedings. Which residual content, if obtained, would lead the nurse to delay the feeding? A) 30 mL B) 60 mL C) 90 mL D) 120 mL

A preoperative "stress dose" of IV steroid (i.e., hydrocortisone) is given to clients who have been on prednisone within the previous 6 months to prevent adrenal crisis. Antibiotics, blood transfusions, and low-molecular-weight heparin will not supply cortisone, which is needed to prevent adrenal crisis. 23. What potentially life-threatening complication can the client have if corticosteroids are abruptly withdrawn or the client has significant stress due to the impending surgical procedure? A) Cushing's disease B) Myxedema coma C) Thyroid storm D) Adrenal crisis

It is essential for clients who have undergone appendectomy to avoid heavy lifting or unusual exertion for several months to minimize the risk of postoperative complications. However, the client need not avoid sunlight because there is no risk of photosensitivity. It is not essential for the client to avoid dairy products or purine-rich foods because these food products have no implications on the client's recovery. 3. After assessing a client with peritonitis, the nurse likely would document the client's bowel sounds as? A) Mild B) High-pitched C) Hyperactive D) Absent

Radiation treatment can suppress blood cell production, leading to low RBC, WBC, and platelet counts. Anemia can result in fatigue and lack of energy. With a low WBC count, infection is a concern but specific to fatigue. Advancing cancers can cause fatigue but not as significant during active treatment. 19. In a client receiving radiation therapy to the head, prevention of infection of the teeth and gums is important. Which is the primary nursing care measure that should be taken? A) Using a lead shield during treatments B) Blood transfusions as necessary C) Monthly dental cleanings and exams D) Use of topical antiseptic mouthwash

The nurse measures bile drainage every 8 hours or according to agency policy. If more than 500 mL of bile drains within 24 hours or if drainage is significantly reduced, the nurse notifies the physician. 32. A client with severe acute pancreatitis has a glucose level of 750 mg/dL. What does the nurse understand is the cause of this level of hyperglycemia? A) Increase in circulating calcium B) The client has not been taking the insulin and eating simple carbohydrates. C) The client has diabetes as well as pancreatitis. D) Imbalance of glucagon, insulin, and somatostatin

When a practitioner inserts a gloved and lubricated finger in the rectum, the stool may feel like small rocks, a condition referred to as scybala. The client may have hard stool or be impacted but the correct terminology to be documented is scybala. A fecal obstruction is not always able to be determined on digital examination and will require an x-ray. 14. A client at a long-term care facility informs the nurse that he is having cramping when trying to have a bowel movement, and all that is coming out is liquid. When the nurse reviews the client's last bowel movement history, it is determined that the client has not had a bowel movement in 7 days. What does the nurse understand is most likely occurring with this client? A) Scybala B) The history is incorrect of the last bowel movement. C) Diarrhea D) Encopresis

In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter. A KUB will not determine this. Colonic transit studies are used to determine how long it takes for food to travel through the intestines. Abdominal radiography will show the structure but does not determine the muscle ability surrounding the anal sphincter. 16. A client informs the nurse that he is taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about the taking a stimulant laxative? A) They can be habit forming and will require increasing doses to be effective. B) As long as the client is drinking 8 glasses of water per day, he can continue to take them. C) The laxative is safe to take with other medication the client is taking. D) The client should take a fiber supplement along with the stimulant laxative.

Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be absolute indicators of cirrhosis of the liver but may indicate other GI tract disorders. 15. A patient with cirrhosis is complaining to the nurse of itching. The client asks the nurse if the itching is because he has been taking warm baths. What is the best response by the nurse? A) "The itching is caused by the accumulation of bile salts." B) "The itching is related to dry skin from the warm baths." C) "The itching is most likely a side effect from some of the medications used in treatment." D) "The itching is related to a psychological response from the illness."

It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite. 2. The nurse would instruct a client who has an appendectomy to avoid which of the following? A) Heavy lifting B) Harsh sunlight C) Dairy products D) Purine-rich foods

Hemorrhage with peptic ulcer disease is initially handled through cold saline lavage via nasogastric tube. Increasing the IV rate is not a nursing measure. Administering oxygen is not indicated unless the client is experiencing respiratory difficulties. While having hematemesis, the head of the bed would remain elevated to avoid risk for aspiration. 31. A client is scheduled for a gastrojejunostomy as a surgical treatment of chronic peptic ulcer disease. The client asks the nurse to explain the stump left behind. Which is the best explanation provided by the nurse? A) "The stump prevents leaking in the abdomen." B) "Keeping the stump aids in digestion." C) "The stump helps to balance and tip the stomach." D) "The stump provides extra space for food."

Pepto-Bismol may cause the mucus membranes of the mouth to become darkly discolored. The other medications do not cause this problem. 34. A client with Crohn's disease informs the nurse that he is allergic to aspirin. What medication ordered for the treatment of Crohn's does the nurse know is contraindicated when a client is allergic to aspirin? A) Prednisone B) Sulfasalazine (Pentasa) C) Azathioprine (Imuran) D) Cyclosporine (Sandimmune)

The nurse is correct to assess the gag reflex prior to offering fluids for a client having an esophagogastroduodenoscopy (EGD). The other options are lower gastrointestinal studies typically requiring a bowel preparation. #28.The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment?A)DrowsinessB)Abdominal distentionC)Sore throatD)Thirst

A major complication after a liver biopsy is bleeding, so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy. #11.The nurse is providing community education at the mall. The nurse is instructing on the muscular tube that connects the mouth to the stomach. The nurse outlines this structure on a drawing and labels it with which of the following?A)PharynxB)PylorusC)EsophagusD)Ileum

Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating. Elevated temperature and chills can be a significant finding for infection and should be reported. Constipation with rectal bleeding is not indicative of dumping syndrome. 40. A client is being evaluated for an esophageal tumor. Which nursing assessment finding presents the greatest concern? A) Weight loss B) Difficulty swallowing C) Back pain D) Gastric reflux

The chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Excess gas, daily bowel movements, and abdominal cramping when having a bowel movement are not indicators of colon cancer. 30. A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client? A) Colectomy B) Segmental resection C) Abdominoperineal resection D) A low colectomy

When a client is managing herniation with a truss, the nurse informs the client to keep the skin clean and dry or to use cornstarch to absorb moisture. This minimizes the risk for infection. Use of warm, woolen clothes will not help reduce moisture; it may increase the moisture and increase the risk of infections. If the client's bowel movements are regular, laxatives would not be necessary. However, the client would need teaching to prevent constipation. Applying sunscreen is a general recommendation for any client to reduce the risk of exposure to ultraviolet radiation from the sun. 6. The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find? A) Decreased white blood cell count B) Increased albumin levels C) Stool cultures negative for microorganisms or parasite D) Decreased erythrocyte sedimentation rate

Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension. 20. The nurse is administering furosemide (Lasix) to promote urinary excretion of excess fluids for a client with cirrhosis. When administering Lasix to this client, what should the nurse closely monitor? A) Potassium level B) Calcium level C) Magnesium level D) AST levels

Because lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds. 4. In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? A) Avoiding bran cereals and beans in the diet B) Adding fiber-rich foods to the diet gradually C) Limiting fluid intake to 5 to 6 glasses per day D) Minimizing activity levels for at least 2 months

Diuretics such as furosemide (Lasix) must be administered with caution because long-term use can cause sodium depletion. The other levels do not relate to the administration of furosemide (Lasix). 21. A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? A) Vitamin K B) Octreotide (Sandostatin) C) Vasopressin (Pitressin) D) Epinephrine

Karaya gum, which becomes gelatinous when in contact with moisture, is commonly used in place of an adhesive. Karaya gum protects the skin and promotes adhesion of the ostomy appliance. 14. The nurse is caring for a patient in the immediate postoperative phase after having a colostomy created. What type of appliance should the nurse use at this time? A) A reusable pouch appliance should be used. B) A disposable or temporary appliance should be used. C) A dry sterile dressing should be used over the stoma. D) A wet to dry dressing should be used over the stoma to keep it moist.

Step 1:2 × 8 oz = 16 oz Step 2:1 oz : 30 mL :: 16 oz : X mL X = 480 mL Step 3: 480 mL / 80 mL = 6 hours 25. Which nursing action provides the most reliable means to assess placement of a client's nasogastric tube, prior to each medication administration? A) Using auscultation technique B) Measure pH of aspirates C) Place end of tube in water and observe for bubbling D) Radiographic confirmation

Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line. 36. The nurse is counseling an adolescent who has a body mass index of 33%. Which of the following complications is of greatest concern? A) Heart disease B) Orthopedic problems C) Lifelong obesity D) Psychosocial problems

Indications of CNS effects include disorientation, confusion, personality changes, memory loss, a flapping tremor called asterixis, a positive Babinski reflex, sulfurous breath odor (fetor hepaticus), and lethargy to deep coma. Cough and joint stiffness are not indicators of CNS effects of cirrhosis. 25. A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? A) Paracentesis B) Liver transplantation C) High-dose corticosteroids D) Azathioprine (Imuran)

Parenteral injections or intranasal administrations (Nascobal) of vitamin B12 are used to prevent deficiencies in clients who have had most or all of the ileum removed because this area is responsible for B12 absorption. Vitamin B12 does not prevent thrombosis or constipation or aid digestion. 5. Which of the following instructions should the nurse include in the teaching plan of a client who has undergone colostomy? A) Restrict traveling by air. B) Limit outdoor activities. C) Avoid tight clothing. D) Chew food well.

Esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but less likely to be as significant as esophageal tumor/cancer. 35. A client is preparing for discharge to home, following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? A) Slows gastric emptying B) Provides much needed rest C) Allows for better absorption of vitamin B12 D) Removes tension on internal suture line

The goal of the oral preparation is to eliminate fecal matter to visualize the colon structures. Having a clean colon free of fecal matter does allow for easy of passage of the scope and eliminates gas. The client is sedated throughout the procedure so does not experience pain. #27.The nurse is working in a diagnostic testing unit focusing on gastrointestinal studies. For which testing procedure is the nurse correct to assess the gag reflex before offering fluids?A)EsophagogastroduodenoscopyB)SigmoidoscopyC)PeritoneoscopyD)Colonoscopy

Whenever possible, prednisone should be tapered and discontinued before surgery to avoid negative effects of the drug on tissue healing. The client will have liquid stools after the ileostomy through the pouch because the stool is not formed. Hypertension and increase in blood loss do not necessarily correlate with the corticosteroid use. 22. A client is to have a total colectomy and has been on prednisone 3 months ago for the treatment of Crohn's disease. What medication does the nurse anticipate administering in the preoperative phase to prevent adrenal crisis? A) Intravenous hydrocortisone B) Intravenous antibiotics C) Blood transfusion D) A low-molecular-weight heparin

In the incubation phase, the virus replicates within the liver, and the client is asymptomatic. Late in this phase, the virus can be found in blood, bile, and stools. At this point, the client is considered infectious. 27. A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? A) Elevated white blood cell count B) Elevated alpha-fetoprotein C) Decreased AST levels D) Decreased alkaline phosphatase levels

When assessing the abdomen, the nurse would first inspect or observe the abdomen. This would be followed by auscultation, percussion, and, lastly, palpation. #8.The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure?A)In the right upper quadrantB)At the umbilicusC)At the lower border of the liverD)Just below the last rib

Inform the client that an assigned staff nurse will be there when the client first views and touches the stoma. Such information gives reassurance that a familiar nurse will be available to answer questions and give support. The client will not be expected to perform stoma care directly after the surgical procedure because he will require medication for pain and discomfort. An expected outcome is that the client will be able to perform self-care of the stoma. The stoma will not be covered; it will have an appliance that is clear. 27. A client who had a total colectomy with an ileostomy has rectal packing in place to absorb drainage and promote healing. When does the nurse know that the rectal packing will be removed? A) Within 24 hours B) 2 days C) Within 1 week D) In 2 weeks

Serum albumin level is a helpful lab value for assessing nutritional status of a client. Normal serum albumin levels 3.5 to 5 g/dL are not reflected in this client and would indicate a low protein level. Arterial blood pH is normal between 3.45 and 4.35. Hemoglobin levels of 11 to 17 g/dL are within normal levels. BUN level of 34 mg/dL is elevated and indicative of kidney problems but not specific to nutritional problems. 13. A client with bacterial infection is suspected of suffering from malnutrition. Which nursing assessment finding would be most significant in evaluating this client? A) Nitrogen balance B) Serum albumin level C) Urine creatinine/height index D) Total lymphocyte count (TLC)

The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination. 5. A client with a hernia decides to manage the herniation with a truss. The nurse would emphasize which of the following? A) Using laxatives to ensure regular bowel movement B) Wearing warm, woolen clothes to avoid dryness C) Applying a sunscreen to prevent exposure to direct sunlight D) Using cornstarch to absorb moisture in the area

An anorectal abscess is common in clients with Crohn's disease. The other disorders do not predispose the client to risk for anorectal abscess. 32. The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? A) The bowel twists and turns itself and obstructs the intestinal lumen. B) One part of the intestine telescopes into another portion of the intestine. C) The bowel protrudes through a weakened area in the abdominal wall. D) A loop of intestine adheres to an area that is healing slowly after surgery.

Three major problems associated with severe or prolonged diarrhea include dehydration, electrolyte imbalances, and vitamin deficiencies. 19. The nurse is following an order to collect a stool specimen from a patient who is having diarrhea for ova and parasites. What does the nurse understand may be required when obtaining this specimen? A) The nurse will be testing for blood in the stool. B) The nurse may have to obtain several samples. C) The test is routine and may be placed in a regular stool specimen cup. D) The stool must be placed on a slide prior to bringing it to the lab.

When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. Vomiting, diarrhea, low blood pressure and pulse, and constipation do not indicate the development of secondary diabetes. 6. A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? A) Potassium B) Vitamin K C) Vitamin B D) Oral bile acids

Complications from severe acute pancreatitis are serious and sometimes fatal. Hyperglycemia results from an imbalance of glucagon, insulin, and somatostatin. Increase in circulating calcium does not result in an increase in glucose levels. The nurse cannot assume that the client has diabetes and is noncompliant. 33. The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? A) Dull pain, points to epigastric area B) Sharp, stabbing pain in the left lower quadrant of the abdomen C) Severe midabdominal to upper abdominal pain radiating to both sides and to the back D) Severe abdominal pain that radiates to the right shoulder

If the abdomen appears enlarged, the nurse measures it according to a set routine. Measuring the abdominal girth is the most accurate method of determining an increase or decrease in abdominal distention. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis. The nurse would report to the physician about abdominal enlargement along with other parameters of the assessment. 2. A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b (Intron A, Roferon-A) in combination with ribavirin (Rebetol). Which of the following instructions should a nurse provide this client? A) Avoid calcium-rich foods. B) Maintain an exercise regimen. C) Use strict birth control methods. D) Avoid hot water baths or soaks.

A cancerous mass in the lower third of the rectum will result in a abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity. 31. A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? A) A client with Crohn's disease B) A client with hemorrhoids C) A client with colon cancer D) A client with diverticulosis

Age-related considerations when administering medications to a geriatric client include administering medications slowly and allowing time between medications due to a decreased motility in the esophagus. Also the client has a weakened gag reflex, which may allow the client to choke. The client has a decrease elasticity of the rectal wall potentially causing fecal incontinence. Geriatric client has a decrease in saliva production requiring water with oral medication administration. There is also a decrease in the amount of gastric secretions, which could produce nausea. #34.The nurse is caring for a geriatric client experiencing diarrhea. When instructing on the body site where water and electrolytes are absorbed, the nurse is most correct to instruct on which location?A)The small bowelB)The stomachC)The large bowelD)The cecum

An MRI scanner is a narrow, tunnel-like machine that will enclose the client during the test. Clients who are claustrophobic (fear enclosed spaces) may need sedation because it is imperative that they lie still and not panic during the test. Therefore, the nurse should notify the physician about the client's statement. Typically, the client is NPO for 6 to 8 hours before the test, and he or she must remove any metal objects, credit cards, jewelry, and watch before the test. The machine makes loud repetitive noises while the test is in progress, so earphones may be helpful. #10.The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following?A)Signs and symptoms of bleedingB)Return of the gag reflexC)Passage of stoolD)Intake and output

Because the client is showing signs of pain related to the pressure and the reflux of gastric secretions, it is essential to inform him or her to remain upright for at least 2 hours after meals because an upright position helps prevent reflux. Encouraging the client to eat frequent, small, well-balanced meals; to avoid alcohol and tobacco products; and to eat slowly and chew foods thoroughly would be appropriate for a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. 5. A client with esophageal cancer has difficulty in swallowing. Which of the following would be appropriate to help the client achieve improved nutrition? A) Give high-protein, semiliquid foods. B) Provide oral liquids through a straw. C) Give liquid supplements for meals. D) Encourage small, frequent meals.

Cells in hair follicles are very sensitive to chemotherapy and may result in alopecia after the second round of treatment. Hair loss associated with chemotherapy is usually temporary. Returning hair may be different in texture or color. Offering use of wigs may help self-esteem in the client, but this does not explain alopecia or return of hair. 23. In caring for a client immediately following gastric cancer surgery, which nursing assessment finding would require priority attention? A) Levine tube set to high continuous suction B) Moderate amount dark red drainage in the suction container C) Urine output at 40 mL/hour D) Abdomen soft with sluggish bowel sounds

Decreased appetite may be a result of diminished oxygenation to the appetite centers of the brain. With a history of chronic obstructive pulmonary disease, oxygen deprivation may be occurring, and this is a starting assessment for this client. Seasonal allergies can aggravate breathing difficulties but not as significant as COPD. Removal of the gallbladder is not indicated in current weight loss issues. Osteoarthritis may make it more difficult for the client to shop for food but not as significant as oxygen deprivation. 12. The wound care nurse suspects a nutritional problem with a client who presents with weight loss, poor appetite, and delayed healing. Which of the following laboratory findings would be most indicative of a nutritional problem? A) Serum albumin level 2 g/dL B) Arterial blood pH 7.43 C) Hemoglobin level 13 g/dL D) Blood urea nitrogen level 34 mg/dL

Disturbed body image, low self-esteem, and fear of rejection by others can lead to behaviors of frustration and inability to cope in a social world. Working on this issue is primary. Disturbed personal identity is not supported by the information provided. Sedentary lifestyle can contribute to obesity but not the major issue. Risk for self-mutilation is not supported with trying to cause a nonfatal injury. 38. A client, who is recovering from bariatric surgery, is returning from the postanesthesia care unit. Which nursing assessment is of greatest concern in the immediate postoperative period for this client? A) Impaired Gas Exchange B) Self-Care Deficit C) Impaired Mobility D) Diarrhea

Drug-induced hepatitis occurs when a drug reaction damages the liver. This form of hepatitis can be severe and fatal. High-dose corticosteroids usually administered first to treat the reaction. Liver transplantation may be necessary. Paracentesis would be used to withdrawal fluid for the treatment of ascites. Azathioprine (Imuran) may be used for autoimmune hepatitis. 26. The nurse is reviewing laboratory work that is consistent with a client being positive for hepatitis and in the incubation phase of the illness. What should the nurse be concerned with at this stage of the illness? A) The client is infectious. B) The client may have enlargement of the liver and spleen. C) The client will have weight loss. D) The client has jaundice.

Feedings typically are delayed if the residual content measures more than 100 mL for intermittent feedings or 10% to 20% of the hourly amount of a continuous feeding. Thus, a residual content of 120 mL would require the nurse to delay the feeding. 9. A client has undergone a total gastrectomy for refractory ulcers. The nurse would explain the need for lifelong treatment with which of the following? A) Vitamin B12 replacement B) Combination antibiotic therapy C) Subcutaneous insulin therapy D) Antiemetics such as ondansetron

Filgrastim (Neupogen) is used to manage chemotherapy-induced leukopenia. Thrombocytopenia and anemia can also occur with bone marrow suppression but would not be treated with Neupogen. Polycythemia is not indicated in cancer treatment. 22. The client is concerned about hair loss while receiving chemotherapy. Which is the best response from the nurse in explaining chemotherapy-induced alopecia? A) Hair loss is temporary. B) Hair color changes as it returns. C) Returning hair will be the same color and texture. D) Use of a wig may help to decrease concern.

For a nursing diagnosis of Disturbed Body Image, the expected outcome is that the client verbalizes what the changes will be and the benefits to future health. This demonstrates that the client understands and is accepting of the changes that are to occur. Giving instructions is a nursing intervention and not an outcome. Demonstrating adequate coping skills is not a measurable goal and supporting and promoting communication does not correlate with the nursing diagnosis of body image. 26. The client expresses fears about looking at the stoma for the first time. What can the nurse inform the client will occur when he first views and touches the stoma? A) An assigned staff nurse will be there when the stoma is exposed for view. B) The client will be expected to perform self-care of the stoma after surgery. C) The client will not have to look at the stoma; a family member can do the care. D) The stoma will be covered so the client will not have to view it.

In a vagotomy, the vagus nerve is severed to decrease stimulation of gastric acid secretion. A delay in gastric emptying can be experienced after a vagotomy but is not the intended outcome. A portion of the stomach is removed to reduce acid by removing the source of acid secretion. Clients may experience dumping syndrome as a result of this surgery, which can result in malabsorption and anemia. Pernicious anemia can be an adverse effect of this surgery. 33. The nurse is holding a teaching workshop on managing the symptoms of hiatal hernia in the elderly. Which of the following lifestyle modifications should be included in the presentation? A) Eliminating tobacco use B) Aerobic exercising C) Avoiding excess stress D) Providing adequate rest

In the usual surgical procedure for a conventional ileostomy, the entire colon and rectum are removed (total colectomy). The terminal end of the ileum is brought out through a separate area on the right lower quadrant of the abdomen slightly below the umbilicus, near the outer border of the rectus muscle. The end is averted and sutured to the skin, a process referred to as a matured stoma. An appendectomy is removal of the appendix. A double-barrel colostomy may be a temporary colostomy for rest of the bowel. Abdominoperineal resection removes the anus, rectum, and part of the sigmoid colon. 12. The client is having a total colectomy with an ileostomy created. What does the nurse explain to the client that the stool consistency will be? A) Liquid or mushy B) Bloody, soft C) Small balls of feces D) Thin and firm

Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area. 10. After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent? A) Loperamide (Imodium) B) Bismuth subsalicylate (Pepto-Bismol) C) Kaolin and pectin (Kaopectate) D) Bisacodyl (Dulcolax)

Irritating foods such as spices, caffeine, and alcohol should be avoided because these will assist in decreasing gastric acidity. Eating smaller meals is recommended to avoid lower pressure in the lower esophageal sphincter. Gastric reflux of acid is more likely to occur with positioning flat and lying down after a meal, so this should be avoided. 27. The client is ordered cimetidine (Tagamet) H2-receptor antagonist agent for the short-term management of gastroesophageal reflux disease (GERD). Which of the following assessment findings is most important in determining care of this client? A) Elevation of liver enzymes B) Smoking with use C) Uses antacids 2 hours after dose D) Impotence

It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently. #21.The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first?A)Radiography of the gallbladderB)Barium enemaC)Small bowel seriesD)Barium swallow

Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms. 25. A client comes to the clinic complaining of not having a bowel movement in several days, abdominal cramping, and nausea. When the nurse puts the client on the stretcher, he vomits a large amount of fecal material. What should the first action by the nurse be? A) Notify the physician. B) Start an IV of Ringer's lactate. C) Insert an intestinal tube. D) Insert a nasogastric tube.

Lactulose (Cephulac) is administered to detoxify ammonium and to act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients. Potassium-sparing diuretics such as spironolactone (Aldactone) are used to treat ascites. Cholestyramine (Questran) is a bile acid sequestrant and reduces pruritus. Kanamycin (Kantrex) decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent. 18. A client with cirrhosis is complaining of severe pruritus related to the accumulation of bile salts. What can be prescribed for the client to relieve the itching? A) Cholestyramine (Questran) B) Kanamycin (Kantrex) C) Lactulose (Cephulac) D) Cyclosporine (Sandimmune)

Loperamide (Imodium) and diphenoxylate with atropine sulfate (Lomotil) are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate (Pepto-Bismol) and kaolin and pectin (Kaopectate) are examples of absorbent antidiarrheal agents. Bisacodyl (Dulcolax) is a chemical stimulant laxative. 11. A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? A) The consistency of stool and comfort when passing stool B) That the client has a bowel movement daily C) That the stool is formed and soft D) The client is able to fully evacuate with each bowel movement

Most clients with IBS describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain. 21. The nurse is caring for four clients with diarrhea. Which client is most likely to be diagnosed with Crohn's disease? A) A 24 year-old Caucasian eastern European Jewish female B) A 46 year-old African American male C) A 32 year-old female from Vietnam D) A 63 year-old Hispanic female with a history of cancer of the vulva

Mucous membranes may be dry, and skin turgor may be poor in clients suffering from dehydration as a result of fluid losses from the GI tract. Checking the skin for discoloration and inspecting the sclera if it is yellow is taken into consideration when the client could have symptoms of jaundice, not fluid losses. Distended abdominal veins are not associated with dehydration. #2.When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include?A)Avoid smoking for at least 12 to 24 hours before the procedure.B)Take vitamin K before the procedure.C)Take three cleansing enemas before the procedure.D)Avoid the intake of red meat before the procedure.

Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract. Hemolytic jaundice is caused by excess destruction of red blood cells. Hepatocellular jaundice is caused by liver disease. Cirrhosis of the liver would be an example of hepatocellular jaundice. 13. A client has been diagnosed with Laennec's cirrhosis. What does the nurse understand that this type of cirrhosis is caused by? A) Chronic alcohol intake B) Infection C) Scarring around the bile ducts D) Autoimmune response

Skin may itch (pruritus) from accumulated bile salts related to the diseased liver. It is not related to the baths or a psychological response from the illness. Medication side effect may cause itching, but the most likely cause is the accumulation of bile salts. 16. A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? A) A liver biopsy B) A CT scan C) A prothrombin time D) Platelet count

The nurse should assist the client to increase the dietary fiber in her food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information; however, it would not help reduce constipation. #2. A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort? A) Keeping the head of the bed elevated. B) Positioning the client flat on the abdomen or side. C) Providing a tracheostomy tray near the bed. D) Turning the client's head to the side.

The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative. 17. The nurse is obtaining data from an older adult client who is being seen in the clinic for a checkup. The client informs the nurse that he is taking a daily dose of Epsom salts to have a daily bowel movement. What priority intervention should the nurse anticipate doing to detect the changes that can occur from prolonged use? A) Obtaining an ECG B) Obtaining blood for a complete blood count C) Listening to the patient's bowel sounds D) Administering an oil retention enema

When using a new adhesive product, remember to patch test it first on nonirritated skin at the inner aspect of the client's forearm. Inform the client that the most common causes of discomfort are reactions to the adhesive or solvent used to remove it or irritation from leaking fecal drainage. In such cases, the client may experience stinging, tingling, or itching immediately after an appliance change. If a sensation is prolonged or intensified, remove the appliance regardless of whether it has been on for 1 hour or several days. Avoid rubbing, which may further irritate skin. If the faceplate is changed too frequently, skin around stoma may become raw and excoriated secondary to removal of protective layers of epithelium with the faceplate. 29. A client with an ileostomy tells the nurse that he is having a lot of problems with the formation of gas. What can the nurse tell the client to help her with this common issue? A) Eat slowly and chew food well with mouth closed. B) Restrict fluids. C) Administer an enema to clear out the stool. D) Dilate the stoma.

The best objective data with useful information is the fact that the client has lost 22 lb in 2 months, indicating significant weight loss in a short period of time. This is data that, with further questioning, could provide further details for diagnosis. A client verbalizing symptoms of nausea and pain are subjective data. The client's temperature is slightly elevated. Viewing the client's seated posture offers little data. #17.The nurse is assessing a client of color for jaundice. In which location would the nurse assess for discoloration? Select all that apply.A)The scleraB)The gumsC)The handsD)The nailsE)The hard palateF)The conjunctiva

A, B, E, F

Some medications, especially vitamins, antibiotics, and antituberculosis drugs, cause particularly strong odors that cling to the appliance. The client can obtain a list of drugs that may leave an odor on an ostomy appliance from an ostomy association or ostomy appliance manufacturers. The client should not abstain from taking prescribed medications because this could cause severe complications. The client should check with the physician prior to taking any over-the-counter medications but not abstain from taking them if they are prescribed. All colostomy odors can be controlled with interventions and may be caused by medications. 16. The nurse is discussing care of the client's ileostomy and is instructing the client to avoid certain medications that may pass through without being absorbed. What medications should the nurse instruct the client to avoid? Select all that apply. A) Enteric-coated products B) Liquid medication C) Slow-release beads D) Layered tablets E) Chewable tablets

A, C, D

1.When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important?A)Checking if the skin is discoloredB)Checking if the mucous membranes are dryC)Examining the sclera if it is yellowD)Observing for distended abdominal veins

A continent ileostomy involves the creation of an internal reservoir for the storage of GI effluent. It stores the effluent for several hours until the client removes it with a catheter. Initially, the reservoir is emptied every 2 to 4 hours, and then three to four times per day as the capacity of the reservoir increases (usually about in 6 months). This reservoir eliminates the need to wear an external appliance. Stool will continue to be liquid at all times. A continent ileostomy does have a nipple valve through which a catheter is inserted to drain the reservoir. 9. The nurse is assessing the stool consistency of a client with an ascending colostomy. Which of the following would the nurse expect to find? A) Liquid B) Semiliquid C) Soft D) Formed

A female client who has been prescribed recombinant interferon alpha-2b in combination with ribavirin should be instructed to use strict birth control methods. This is because ribavirin may cause birth defects. It is not essential for the client to avoid calcium-rich foods or hot baths or soaks. The client needs to maintain physical rest during therapy. 3. Which of the following interventions would be appropriate for a client who has undergone surgery for a liver disorder and has started shivering? A) Provide the client with warm fluids. B) Cover the client with a light blanket. C) Ensure that the room temperature is below 70° F. D) Place the client on a hypothermia blanket.

Abdominal paracentesis may be performed to remove ascitic fluid. Abdominal fluid is rapidly removed by careful introduction of a needle through the abdominal wall, allowing the fluid to drain. Fluid is removed from the lung via a thoracentesis. Fluid cannot be removed with an abdominal CT scan, but it can assist with placement of the needle. Fluid cannot be removed via an upper endoscopy. 23. A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones? A) Pancreatin (Creon) B) Chenodiol (Chenix) C) Tacrolimus (Prograf) D) Cyclosporine (Sandimmune)

Acute hemorrhage from esophageal varices is life threatening. Resuscitative measures include administration of IV fluids and blood products. IV octreotide (Sandostatin) is started as soon as possible. Sandostatin is preferred because of fewer side effects. Octreotide reduces pressure in the portal venous system and is preferred to the previously used agents, vasopressin (Pitressin) or terlipressin. Vitamin K promotes blood coagulation in bleeding conditions, resulting from liver disease. 22. The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed? A) Thoracentesis B) Abdominal paracentesis C) Abdominal CT scan D) Upper endoscopy

Adrenal crisis is potentially life threatening and may result from the abrupt withdrawal of corticosteroids. Therefore, the nurse should closely monitor a client who is scheduled for an ileostomy surgery for adrenal insufficiency, resulting from corticosteroid withdrawal. Withdrawal of corticosteroids does not cause cerebral anoxia, cardiac dysrhythmias, or hypothyroidism. 2. Which of the following interventions would the nurse need to keep in mind when a loop colostomy of a client is to be opened? A) Provide the client with plenty of fluids before the procedure. B) Prepare the client for the pungent odor before the procedure. C) Elevate the client's legs before and during the procedure. D) Note the color and amount of fecal material during the procedure.

After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy. #5.Which of the following would be most important to ensure that a client does not retain any barium after a barium swallow?A)Placing any stool passed in a specific preservativeB)Monitoring the stool passage and its colorC)Observing the color of urineD)Monitoring the volume of urine

Antacids containing magnesium and aluminum hydroxides tend to cause diarrhea in some clients. In such cases, switching to an aluminum-only antacid or calcium-containing antacid may be helpful. Antacids may be given two to four times per day or as frequently as every 1 to 2 hours. They are not administered within 1 hour of histamine2-receptor antagonists or other oral medications because they may decrease absorption of the other drug. Sore throat and fever are adverse effects associated with histamine2-receptor antagonists, not antacids, which need to be reported. #4. Which of the following interventions would be most appropriate for a client with a hiatal hernia and nursing diagnosis of Acute Pain related to reflux of gastric secretions? A) Encourage the client to eat frequent, small, well-balanced meals. B) Inform the client to remain upright for at least 2 hours after meals. C) Instruct the client to avoid alcohol or tobacco products. D) Instruct the client to eat slowly and chew the food thoroughly.

Cleansing of the bowel before surgery is carried out using dietary restriction in combination with laxative or lavage agents, depending on the client's condition (i.e., presence or absence of obstruction) and according to the surgeon's preference. There are no benefits to the client drinking 2 L of fluids for 4 days prior to the procedure or only taking in only liquids for 4 days. 21. A client is scheduled to have a total colectomy due to a colon mass and is also taking prednisone for asthma. The physician has instructed the client to taper down on the prednisone and discontinue. What negative outcome does the nurse know may occur if the client does not adhere to the instructions? A) Liquid stools after surgery B) Delayed or altered tissue healing C) Hypertension D) Increase in blood loss

Drugs that contain sulfasalazine are contraindicated in patients with aspirin allergies. The other medications listed do not contain aspirin. 47. When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? A) Report the condition to the physician immediately. B) Measure abdominal girth according to a set routine. C) Provide the client with nonprescription laxatives. D) Ask the client about food intake.

ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder. 30. A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? A) Normal activities may be resumed the day after surgery. B) Normal activities may be resumed in 1 week. C) Normal activities may be resumed in 2 weeks. D) Normal activities may be resumed in 1 month.

If a total gastrectomy (removal of the stomach) is performed, the client receives vitamin B12 injections or intranasal vitamin B12 for life because, without the stomach, the intrinsic factor necessary for absorption of vitamin B12 no longer is produced. However, B12 therapy usually is not necessary for 1 or 2 years after surgery because the body uses very small amounts of this vitamin and body reserves usually are sufficient for several years. Combination antibiotic therapy is used to treat ulcers due to H. pylori. Subcutaneous insulin and antiemetics are not typically used. 10. After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? A) "I need to chew my food slowly and thoroughly." B) "I need to drink 8 oz of water before eating." C) "A total serving should amount to be less than 1 cup." D) "I should pick cereals with less than 2 g of fiber per serving."

Immediately after insertion, the tube should be secured to the client's nose to prevent dislodgement or accidental removal. The nurse is also assessing the amount and consistency of drainage. Sending the client to x-ray for verification of placement may be protocol for some institutions but would be done after the tube is secure. Instilling water may be a routine adopted to maintain patency of the tube but is not the first action. 16. Following abdominal surgery, excessive drainage from the client's nasogastric tube is observed. Which assessment finding is most likely to occur? A) Metabolic acidosis—pH 7.24, PaCO2 45 mm Hg, HCO3 19 mEq/L B) Metabolic alkalosis—pH 7.52, PaCO2 35 mm Hg, HCO3 28 mEq/L C) Respiratory acidosis—pH 7.28, PaCO2 60 mm Hg, HCO3 25 mEq/L D) Respiratory alkalosis—pH 7.73, PaCO2 20 mm Hg, HCO3 26 mEq/L

Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C. 9. A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which of the following client statements indicates that the teaching was successful? A) "The physician will use a balloon to compress the vessels." B) "I might need to have this procedure done again." C) "It's seems odd that a rubber band can block off the vessels." D) "A catheter will be inserted through my belly to fix the vessels."

It is essential that the client understands that the cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed. #23.The nurse is instructing the client on frequent sensations experienced when a contrast agent is injected into the body during diagnostic studies. Which sensation is most common?A)Light-headednessB)A warm sensationC)Heart palpitationsD)Chills

It is most important that the nurse calculate the drip rate of the intravenous fluids because the client will not be able to have an electrical or mechanical pump operating during the MRI. The MRI electrical charges during the test can affect the pump. It is also important to advise the client of the loud noises and offer support to the client. Water is typically not available in the waiting area prior to testing. #25.The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior?A)Complete blood count (CBC)B)Prothrombin time (PT)C)Blood chemistryD)Erythrocyte sedimentation rate (ESR)

Measurement of abdominal girth is done at the widest point, which is usually the umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib would be inappropriate sites for abdominal girth measurement. #9.When preparing a client for magnetic resonance imaging (MRI) of the abdomen, which statement would indicate the need to notify the physician?A)"I haven't had anything to eat or drink since midnight last night."B)"I really don't like to be in small, enclosed spaces."C)"I left all my jewelry and my watch at home."D)"I brought earphones to shut out the loud noise."

Measuring pH of aspirates is recommended method to confirm placement. Although radiographic confirmation is the most reliable method, this is usually reserved for initial placement or uncertainty of placement. X-rays would not be performed prior to each medication administration, not realistic. Auscultation technique and placing end of tube in water should not be used in determining location. 26. A client, who has occasional gastric symptoms, is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching? A) "Eating two large meals a day, instead of three." B) "Eliminating bothersome foods will help." C) "Sleeping flat without pillows is beneficial." D) "Taking a nap after meals, when possible."

Metabolic alkalosis is most likely to occur with prolonged or excessive nasogastric suctioning because acids are removed from the stomach a loss of hydrogen ions occurs. A rise in pH levels also occurs with respiratory alkalosis, but because the cause is gastro, this is a metabolic problem. A decrease in pH levels below 7.35 would result in acidosis. 17. The client is scheduled for external beam radiation for the treatment of an upper gastrointestinal cancer. Which is the most significant factor in the nursing care of this client? A) Do not stand at the foot of the bed. B) Avoid washing off markings. C) Radiation precautions for body fluids. D) Limit time in client's room.

Prochlorperazine is a phenothiazine that inhibits the chemoreceptor trigger zone (CTZ) and the vomiting center in the brain. Ondansetron blocks receptors for 5 HT3, affecting the neural pathways involved in nausea and vomiting. Hydroxyzine and promethazine are antihistamines that block H1 receptors, resulting in a decrease in stimulation of the CTZ and vomiting. 7. A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following? A) Jejunostomy tube B) Gastrostomy tube C) Nasogastric tube D) Orogastric tube

Protein and calorie deficits interfere with immune function, resulting in a low TLC. Nitrogen balance and serum albumin are significant for low protein levels but not as important with immune functioning. Urine creatinine/height index would be helpful in evaluation of body muscle mass but not as significant for immune problems. 14. The nurse is caring for a young woman who is struggling with weight loss issues, without apparent physical cause. Which is the most likely nursing assessment for this nutritional disorder in which normal body weight is not maintained? A) Bulimia B) Anorexia nervosa C) Kwashiorkor D) Crohn's disease

Signs of wound infection are wound drainage, abdominal pain, and elevated temperature. These symptoms do not indicate an allergic reaction, anemia, or not emptying the pouch correctly. 31. When the nurse is teaching the client about attachment of the faceplate around the stoma, what measure will ensure secure attachment of the pouch to the peristomal skin? A) Apply a large quantity of adhesive around the stoma prior to attaching the faceplate. B) Press the adhesive faceplate around the stoma for about 30 seconds. C) Press the adhesive faceplate from the outward edge of the stoma inward. D) Wipe the faceplate with alcohol to remove debris.

Some preparations such as potassium chloride (Slow-K) leave a "ghost" of the wax matrix coating, but that does not indicate the drug has been unabsorbed. The client should not take another potassium supplement that could increase the risk of elevated potassium levels. The dose was not omitted, and there is not a defect in the medication; it is an expected effect. 18. A client is preparing to have colorectal surgery and will have a colostomy created temporarily in hopes that he may be able to have it reversed in 6 months. The client is very concerned about the care of the colostomy. What preoperative interaction would the client benefit from? A) Discussing other options with the surgeon B) Meeting with an enterostomal therapist C) Going to a support group with other clients that have colostomies D) Watching a video about colostomies

Telling the client that a familiar nurse will be with him the first time provides the client with reassurance that he will not be alone and will have the support of a familiar person to answer questions and provide comfort and support. Telling the client not to worry about it now, that everybody feels anxious, and that he'll do just fine discounts the client's feelings and is not therapeutic. 8. A client is to undergo surgery for the creation of a continent ileostomy. Which statement by the client indicates successful teaching? A) "I'll need to empty the appliance more frequently." B) "I'll need to learn how to empty the reservoir several times a day." C) "My stool will be loose initially but then become formed in a week or so." D) "I'll just push on the valve and the drainage will flow out easily."

The client, returning from an upper gastrointestinal series, needs to increase fluids in an effort to eliminate the barium from the body through a bowel movement. General anesthesia is not used. The client typically does not have nausea and vomiting following the procedure. If the client is able to ambulate independently prior to the procedure, the client will be able to ambulate independently following. #20.Which nursing instruction is correct to provide the client following a barium enema?A)The client will maintain a low residue diet.B)The stools may be a white or clay colored.C)Sips of fluid may be increased if tolerated.D)An enema will be used to clear the bowel.

The ileal catheter of a Kock pouch or continent ileostomy typically is removed in approximately 10 to 14 days, when ileal drainage stabilizes. 11. A client is having a procedure that will remove the entire colon and rectum and will bring the end of the ileum through a separate area on the right lower quadrant of the abdomen. What type of procedure does the nurse understand this client will be having? A) Appendectomy B) Total colectomy C) Double-barrel colostomy D) Abdominoperineal resection

The liver metabolizes and biotransforms the medications ingested. Geriatric clients who experience polypharmacy or multiple medications have an elevated risk of liver impairment. Routine liver function studies monitor the status of the liver and its ability to metabolize. #15.The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland?A)GallbladderB)PancreasC)StomachD)Liver

The most common complaint of clients with pancreatitis is severe midabdominal to upper abdominal pain, radiating to both sides and straight to the back. The other answers are not pain that is usually associated with acute pancreatitis. 34. What medication will the nurse administer to the client with pancreatitis in order to reduce the activity of the vagus nerve? A) Pancreatin (Creon) B) Atropine C) Famotidine (Pepcid) D) Omeprazole (Prilosec)

The nurse informs the client that he or she may experience a warm sensation and nausea when the contrast agent is instilled. The client is instructed to take a couple of deep breaths, and, many times, the sensation will go away. The other options are not frequently encountered. #24.The nurse is accompanying the client to the diagnostic imaging unit for a magnetic resonance imaging (MRI). Which action, by the nurse, is most important prior to the test?A)Instruct the client that the scanner makes loud clanging.B)Calculate drop per minute for intravenous fluids and infuse by gravity.C)Support client, if nervous, by words of encouragement.D)Ensure that the client does not ingest fluids in the waiting area.

The nurse is correct to fully assess the client experiencing abdominal distention following an esophagogastroduodenoscopy (EGD). Abdominal distention could indicate complications such as perforation and bleeding. The client experiences drowsiness from the sedative during the early recovery process and a sore throat from passage of the scope. The client may also experience thirst because the client has not had liquids for a period of time. #29.The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?A)A complete blood count including differentialB)Serum antibodies for H. pyloriC)A sigmoidoscopyD)Gastric analysis

The nurse should monitor the volume of suctioned gastric secretions in a client who has undergone colostomy surgery. The nurse should monitor vital signs once every 4 hours and take temperature by any route other than rectal. The nurse should also ensure that the client's fluid intake is adequate and not minimized. 4. A nurse is preparing to administer the prescribed vitamin B12 to a client who has had most of his ileum removed. The nurse understands that this is necessary for which reason? A) Prevents thrombosis B) Prevents deficiencies C) Aids proper digestion D) Prevents constipation

The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the pancreas. #16.A nurse is employed as a gastroenterologist's office nurse. When assessing the client, which objective data would provide useful information for diagnosis?A)Client verbalizing symptoms of nauseaB)22-lb weight loss in 2 monthsC)Patient verbalizes chills and fatigueD)Client seated and stating pain

The physician should be notified immediately to examine the client because the client is exhibiting signs of an intestinal obstruction. Starting the IV and inserting a nasogastric tube would be interventions that the physician will order after seeing the client. The nurse does not insert intestinal tubes. 26. The nurse is preparing discharge instructions for the client with diverticulosis. When instructing the client to increase dietary fiber, what should the nurse inform the patient is the amount that should be taken in daily? A) 10 to 20 g B) 20 to 35 g C) 35 to 45 g D) 45 to 60 g

To reduce the risk for bowel incontinence, the nurse should instruct a client who has undergone ileoanal reservoir surgery to perform perineal exercises. The client need not avoid high-protein food, take walks, or perform warm water soaks because these do not minimize the risk of bowel incontinence. 7. A client who is scheduled for an ileostomy surgery says to the nurse, "I'm afraid I won't be able to look at that stoma." Which response by the nurse would be most therapeutic? A) "That's something you don't have to think about now." B) "I'll make sure there is a familiar nurse here with you the first time." C) "It's okay, everybody feels this anxious about this." D) "Don't worry, I'm sure that you will be able to do this just fine."

When fat cells reach a certain size, they divide to form new fat cells. When a person loses weight, fat cells can decrease in size but not in number. Obesity in childhood can lead to lifelong obesity. Heart disease, orthopedic, and psychosocial problems are all complications associated with long standing obesity. 37. A distressed obese teenager has attempted suicide due to peer ridicule and teasing. Which nursing diagnosis is of primary concern for this client? A) Disturbed Personal Identity B) Disturbed Body Image C) Sedentary Lifestyle D) Risk for Self-Mutilation

The nurse is correct to tell the client that what he is experiencing is normal and encourage the client to release the gas to decrease pain and discomfort. Proving information relieving the embarrassment and stating the benefit of the action is most helpful. #33.The nurse is caring for a geriatric client at a long-term care facility. When administering the client's medications, which age-related changes of the client are anticipated? Select all that apply.A)Increased saliva causing droolingB)Decreased motility in the esophagusC)A weak gag reflexD)Increased amount of gastric secretionsE)Decreased elasticity of the rectal wall

B, C, E

A major goal for a client with esophageal cancer is adequate or improved nutrition and eventually stable weight. Because he has difficulty in swallowing, the nurse should ensure that the client receives soft foods or high-calorie, high-protein, semiliquid foods to get improved nutrition. Providing oral liquids alone will not provide improved nutrition. Using a straw leads to bloating and should be avoided. Providing liquid supplements are used in between meals, not as meals. Encouraging small, frequent meals will give improved nutrition to a client who does not have any difficulty in swallowing. 6. A client with nausea and vomiting is to receive an antiemetic that inhibits the vomiting center in the brain. Which of the following would the nurse expect the physician to order most likely? A) Ondansetron (Zofran) B) Hydroxyzine (Vistaril) C) Prochlorperazine (Compazine) D) Promethazine (Phenergan)

After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withhold fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly; keeping total serving sizes to less than 1 cup; and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving. 11. An elderly client presents with a complaint of 10-lb weight loss over the past month. Which assessment finding is most important in determining the care of this client? A) History of seasonal allergies B) History gallbladder removal C) History of COPD D) History of osteoarthritis

After the first stage of surgery, clients experience an almost continuous discharge of mucus from the anus and a frequent discharge of fecal material from the ileostomy. Initially, clients cannot control the frequent watery discharge. 34. The nurse is preparing a client for surgery and observes on the operative permit that the client will be having a double-barrel colostomy. What portion of the large intestine is the nurse aware that this is performed? A) Descending B) Ascending C) Transverse D) Sigmoid

Alpha-fetoprotein, a serum protein normally produced during fetal development, is a marker that, if elevated, can induce a primary malignant liver tumor. Total bilirubin and serum enzyme levels may be elevated. White blood cell count elevation would indicate an inflammatory response. 28. A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? A) Hepatitis B) Biliary colic C) Cholelithiasis D) Cholecystitis

Anorexia nervosa is a nutritional disorder that is characterized by a refusal to maintain normal body weight in the absence of physical cause. Anorexia nervosa is considered a psychiatric disorder in a relentless pursuit of thinness. Bulimia is an eating disorder in which voracious appetite is followed by purging and is most likely found in normal to overweight individuals. Kwashiorkor is a severe protein deficiency associated with lack of protein in the diet. Crohn's disease can result in nutritional deficiencies but has apparent physiological cause. 15. A client with complaints of nausea and vomiting has been ordered a nasogastric tube insertion. Which action should the nurse take first once the NG tube is inserted? A) Send client to x-ray for verification of placement. B) Connect the NG tube to high continuous wall suction. C) Secure the NG tube and assess drainage. D) Instill 50 mL of water to keep tube patent.

Caput medusa is a term used to denote the appearance of dilated veins over the client's abdomen. Gynecomastia refers to enlarged breasts in a male, which may occur because the dysfunctional liver is unable to metabolize estrogen. Palmer erythema refers to the bright pink appearance of the palms, and cutaneous spider angiomata refers to tiny, spiderlike blood vessels that may be apparent in a client with cirrhosis due to the liver's inability to inactivate estrogen. 8. A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? A) Hepatitis B is transmitted primarily by the oral-fecal route. B) Hepatitis A is frequently spread by sexual contact. C) Hepatitis C increases a person's risk for liver cancer. D) Infection with hepatitis G is similar to hepatitis A.

Cholestyramine (Questran) may be prescribed to bind bile salts and relieve pruritus. Kanamycin (Kantrex) is prescribed to reduce the bacterial count in the intestine. Lactulose (Cephulac) is used to decrease the amount of ammonia level in the blood. Cyclosporine (Sandimmune) is used to prevent rejection of a transplanted organ. 19. A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? A) Cure the cirrhosis. B) Treat the esophageal varices. C) Reduce fluid accumulation and venous pressure. D) Promote optimal neurologic function.

Cimetidine has a higher risk of drug interactions than other H2-receptor antagonists. Cimetidine binds hepatic enzymes and can interfere with metabolism of other drugs resulting in elevated liver enzymes and liver damage. Smoking should be avoided—it increases gastric secretions and decreases effectiveness of cimetidine. Antacids can be used if taken 1 hour prior to or 2 hours following doing with cimetidine. Impotence and gynecomastia are adverse effects of this drug. 28. The nurse is evaluating the medication list of a client with acute gastritis. Which medication would create the most concern? A) Cardiac glycoside (Digoxin) B) Loop diuretic (Lasix) C) Anti-arthritis medication (Advil) D) Antihistamine (Benadryl)

Clients benefit from preoperative interactions with a specially certified nurse, referred to as an enterostomal therapy nurse; enterostomal therapist; or wound, ostomy, and continent nurse. This nurse assists with marking placement of the stoma and collaborates with the surgeon regarding placement and the client's educational needs. Other options may not be available for this client, especially if there is a tumor present. Going to a support group would be a good option in the postoperative management because the client should be given information from the professional prior to going to surgery. Watching the video with the therapist and having the option to answer questions would be a better choice than watching it alone. 19. A male client, age 32 years, was recently married, and he and his wife would like to have children. The client is scheduled to have a total colectomy and is concerned with being able to have children. What is the best answer given by the nurse related to the client's concern? A) "There is no risk of you not being able to father children after this surgery." B) "I certainly understand your concern, but there are other options such as artificial insemination and adoption." C) "You may want to consider collection and storing of sperm for later use if you are planning to have children." D) "Infertility is a side effect of this surgery and should be considered carefully."

Clients with an ileostomy should avoid enteric-coated products and some modified-release drugs, such as slow-release beads and layered tablets. These products may pass through without being absorbed. The client may take liquid and chewable tablets because they will go through the breakdown process in the stomach. 17. A client with an ileostomy who has been discharged from the hospital calls the clinic and asks the nurse if he should take another one of his "potassium pills" because there is a waxy coating on the ileostomy from the pill. What is the best response by the nurse? A) "You should take another pill because the residue means the potassium was not absorbed." B) "You will just have to omit the dose for today because we don't know how much of the medication was absorbed." C) "Some medications like this leave a "ghost" of the wax matrix coating, but it doesn't mean the drug wasn't absorbed." D) "There must have been a defect in the medication for it to leave the waxy coating."

Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicylate, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. MTX or Imuran are used when failure to maintain remission necessitates the use of an immune-modulating agent. Cipro is used as an effective adjunct to treat the disease. 23. The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? A) Referred pain B) Rebound pain C) Rovsing's sign D) Cremasteric reflex

Expansion of the tumor causes back pain. This is a late symptom of esophageal tumor/cancer and usually indicates invasion of surrounding tissues. The beginning symptoms of esophageal tumor include vague discomfort, swallowing difficulties, weight loss, and regurgitation. 1. A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason? A) The client may develop inflammatory bowel disease. B) The client may develop arthritis or arthralgia. C) The client's natural bowel function may become sluggish. D) The client may lose his appetite.

For external beam radiation, special markings are placed on the client's skin to identify exact area of treatment. These markings should not be removed. Distance and shielding apply to internal sealed radiation. Special precautions for body fluids are not indicated with external beam radiation. 18. The client receiving radiotherapy complains of increased fatigue. The nurse understands that the most significant reason for this symptom is related to which factor? A) The cancer is advancing to other tissues. B) Cancer cells are dying at a high rate. C) Radiation suppresses red blood cell production. D) Fighting off infection can be exhausting.

In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium. 8. A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder? A) Abdominal distention B) Frank blood in the stool C) A change in bowel habits D) Abdominal pain

It is essential to position the client with the head of the bed elevated because it is easier for the client to breathe deeply and cough up secretions after recovering from the anesthetic. Positioning the client flat either on the abdomen or side with the head turned to the side will facilitate drainage from the mouth. A tracheostomy tray is kept by the bed for respiratory distress or airway obstruction. When mouth irrigation is carried out, the nurse should turn the client's head to the side to allow the solution to run in gently and flow out. #3. A client is prescribed a magnesium and aluminum hydroxide antacid to treat gastroesophageal reflux disease (GERD). The nurse cautions this client to do which of the following? A) Take it at the same time as other prescribed drugs. B) Limit the frequency of use to two times per day. C) Watch for possible antacid-related diarrhea. D) Report any complaints of sore throat or fever to the physician.

Monitoring stool passage and its color will ensure that the client remains barium free following a barium swallow test. The white or clay color of the stool would indicate barium retention. The stool should be placed in a special preservative if the client undergoes a stool analysis. Observing the color and volume of urine will not ensure that the client is barium free because barium is not eliminated through urine but through stool. #6.After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected?A)LiverB)IleumC)StomachD)Large intestine

Normally, total bilirubin concentration ranges from 0.2 to 1.3 mg/dL. If the serum bilirubin level exceeds 2.5 mg/dL, jaundice is visible, notably on the skin, oral mucous membranes, and, especially, sclera. 12. A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? A) Hemolytic jaundice B) Hepatocellular jaundice C) Obstructive jaundice D) Cirrhosis of the liver

Persistent portal hypertension allows varices to form again, making it necessary to repeat injection sclerotherapy or variceal banding regularly. Injection sclerotherapy involves passing an endoscope orally to locate the varix. Balloon tamponade is used to compress actively bleeding esophageal varices as a temporary measure. Variceal banding involves using a rubber band over the varix to restrict blood flow that eventually leads to sloughing. 10. A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? A) Chenodiol (Chenix) B) Ursodiol (Actigall) C) Tacrolimus (Prograf, FK506) D) Interferon alfa-2b, recombinant (Intron A, Roferon-A)

Sealed-source radiation is inserted into the body cavity while contained in a sealed applicator to treat cancer of the mouth and tongue. Threads or wires are attached to the applicator and should be counted each shift to insure all are accounted for. Radiation is emitted from the source so safety measures should be instituted to protect staff and visitors. No ink markings or IV ports are required with internal sealed radiation treatment. Because the treatment is continuous, rest periods are not provided. 21. The plan of care for the cancer client includes weekly blood counts. Changes in which of the following laboratory values would be the most likely reason for an order of filgrastim (Neupogen) injection? A) Thrombocytopenia B) Polycythemia C) Leukopenia D) Anemia

Sometimes, if a client has been constipated for a long time, the client may begin passing liquid stool around an obstructive stool mass called encopresis, a phenomenon sometimes misinterpreted as diarrhea. The liquid stool results from dry stool stimulating nerve endings in the lower colon and rectum, which increases peristalsis. Scybala is hard, rocklike stool. The nurse cannot make a judgment about the correctness of the last bowel movement if it is not documented. Encopresis will mimic diarrhea, but there is an obstructive mass above where the liquid stool is leaking around. 15. The nurse is preparing a patient for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the patient for? A) Kidneys, ureters, bladder (KUB) B) Colonic transit studies C) Defecography D) Abdominal radiography

Stool specimens obtained to identify parasites and their ova are placed in special preservatives and analyzed separately by the microbiology department. Several samples may be needed because parasites are not typically shed with each stool. The nurse would obtain a Hemoccult card to obtain testing for blood in the stool. The specimen will not be placed on a slide by the nurse but taken to the lab for testing. 20. A patient informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The patient states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? A) Weight loss due to malabsorption B) Blood and mucus in the stool C) Chronic constipation with sporadic bouts of diarrhea D) Client is awakened from sleep due to abdominal pain.

Sudden sharp mid-epigastric pain and abdominal rigidity are symptoms of perforation and needs immediate intervention. Pain relieved with food only to return an hour later is typical of peptic ulcer disease. Explosive diarrhea without further symptoms bears attention but not immediate. 30. A client with a history of peptic ulcer disease is admitted for hematemesis associated with gastric bleeding. Which is the most appropriate action of the nurse? A) Administer oxygen. B) Increase intravenous flow rate. C) Prepare for nasogastric irrigations. D) Lower the head of the bed.

The client must have coagulation studies before the procedure such as a PT or PTT because a major complication after a liver biopsy is bleeding. Clients at risk for serious bleeding may receive precautionary vitamin K. A complete blood count and blood chemistry may be completed for baseline values. Typically, an ESR is not associated with the procedure. #26.The nurse is instructing a client prior to a colonoscopy. The client states, "Why do I have to drink this disgusting liquid?" The nurse is most correct to verbalize the goal of the oral preparation as which of the following?A)"To allow ease of passage of the scope through the colon"B)"To decrease pain associated with fecal matter being pressed against the colon wall"C)"To cleanse the bowel to promote clear visualization of structures"D)"To eliminate gas from the internal portion of the colon"

The esophagus begins at the base of the pharynx and ends at the opening of the stomach. Layers of muscular tissue surround the esophagus. The pharynx is part of the throat situated immediately inferior to the mouth and nasal cavity. The pylorus is the region of the stomach that connects to the duodenum. The ileum is a portion of the small intestine. #12.The nurse is assessing a client who is stating gastrointestinal upset and a feeling of bloating. Which type of meal would the nurse anticipate causing these types of symptoms?A)Grilled chicken on a spinach saladB)Steamed rice with pork and broccoliC)Hamburger and French friesD)Salmon with cheddar mashed potatoes

The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium. #4.A client undergoing a diagnostic examination for gastrointestinal disorder was given polyethylene glycol/electrolyte solution as a part of the test preparation. Which of the following measures should the nurse take once the solution is administered?A)Instruct the client to have low-residue meals.B)Allow the client to ingest fat-free meal.C)Permit the client to drink only clear liquids.D)Provide saline gargles to the client.

The nurse is correct in instructing the client that water and electrolytes are mainly absorbed in the small bowel. The other options are not the best site for absorption. #35.The nurse is caring for a client following a colonoscopy. During the procedure, two medium-sized polyps were removed. Which nursing assessment in the recovery area is a priority?A)Assessment of level of consciousnessB)Hemoccult test of stoolC)Vital signsD)Ability to tolerate liquids

The nurse is correct to assess the abdomen in a specific order to be able to judge the undisturbed status of the abdominal region. Begin with inspection of the abdomen using the nurse's assessment skills. Next, auscultate the abdomen before percussing and finally palpating. #19.The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon return to the nursing unit, what does the nurse identify as the client goal?A)Recover from the general anesthesiaB)Decrease nausea and vomitingC)Increase the amount of fluidsD)Ambulate independently

The nurse should instruct a client who has undergone colostomy to chew food properly. This helps decrease gas that results chiefly from swallowing air rather than from digestion. The client need not limit or avoid traveling or outdoor activities. If traveling by air, the nurse should instruct the client to take ostomy supplies in carry-on luggage to prevent their loss if luggage is misdirected or lost. If the client requires firm tight support, he or she should find a stoma shield to help prevent irritation or undue pressure on the stoma. 6. A client has had surgery to create an ileoanal reservoir surgery. Which instruction would the nurse give to reduce the risk for bowel incontinence? A) Avoid high-protein food. B) Take frequent brisk walks. C) Perform perineal exercises. D) Perform warm water soaks.

Water is reabsorbed by means of diffusion across the intestinal membrane as the contents move through the colon. By the time the mixture reaches the descending and sigmoid colon, the portion of the bowel adjacent to the rectum, it is a formed mass. The ileum and duodenum are located in the small intestine. The cecum is located at the beginning of the large intestine. #14.The nurse is caring for a geriatric client and notices polypharmacy. Which diagnostic studies are anticipated?A)Complete blood countB)UrinalysisC)Liver function studiesD)Blood chemistry

When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the RLQ, this is referred to as a positive Rovsing's sign and suggests acute appendicitis. Referred pain indicates pain in another area but is not necessarily manipulated by the examiner. Rebound pain is indicated when the pain of palpation is worse when the pressure is off of the site. The cremasteric reflex is a superficial reflex that is present in male patients. 24. A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? A) Constipation B) Paralytic ileus C) Peritonitis D) Accumulation of gas

When the loop colostomy of a client is to be opened, the nurse should prepare the client for the pungent odor of cauterized tissue before the procedure. Intake of fluid and elevation of the legs have no implications in such a procedure. There is an initial gush of fecal material during the procedure. However, the nurse need not note the color and amount of fecal material passed. 3. Which intervention would be most appropriate for a client who has undergone colostomy surgery? A) Monitoring vital signs once a day. B) Taking temperature by rectal route. C) Monitoring the volume of gastric secretions. D) Minimizing the client's fluid intake.

Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa. #30.The nurse is reviewing the results of a Hemoccult test with the client. Which question, asked by the nurse, is important to screen for the potential of a false-positive result. Select all that apply.A)"Do you take an iron supplement on a daily basis?"B)"Does your diet include a moderate amount of vitamin C?"C)"Are you prescribed regular strength aspirin daily?"D)"Can you tell me the amount of alcohol that you drink on an average week?"E)"When was the last time that you included red meat in your diet?"

C, D, E

A high-fiber diet supplemented with bran or prescription of a bulk-forming agent (e.g., Metamucil) helps avoid constipation. The goal is for clients to consume 20 to 35 g of fiber daily. The other amounts are not correct. 27. The nurse is admitting a client to the acute care facility with abdominal pain related to an umbilical hernia. The nurse is palpating the protrusion, and the client states that it suddenly feels better. What type of hernia does the nurse understand this client has? A) Strangulated B) Incarcerated C) Irreducible D) Reducible

Advil is an NSAID and is contraindicated with peptic ulcer disease or gastric irritation. Digoxin and Lasix have little effects on gastric secretions. Benadryl decreases presence of histamine aggravating hypersecretion in the stomach. 29. A client with peptic ulcer disease complains of sharp mid-epigastric pain. Which assessment finding is most important to the care of this client? A) Pain is relieved with food. B) Pain returns 1 hour after eating. C) Explosive diarrhea D) Rigid abdomen

Approximately 60% of people older than 70 years of age will develop hiatal hernias. Because tobacco use reduces esophageal sphincter tone, which can result in reflux, tobacco should be avoided. Aerobic exercising, managing stress, and providing adequate rest are good for general health not specific to the management of hiatal hernias. 34. An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom? A) Hiatal hernia B) Gastroesophageal reflux disease C) Gastritis D) Esophageal tumor

Atropine or other anticholinergics are given to reduce the activity of the vagus nerve, which stimulates the pancreas. Histamine2-receptor antagonists such as famotidine or proton pump inhibitors such as omeprazole may be administered to suppress gastric acid and decrease pancreatic activity. Pancreatin (Creon) is a pancreatic enzyme and does not decrease vagus nerve activity. 48. A client who is scheduled for an ileostomy surgery and been taking corticosteroids is instructed to taper the drug, eventually discontinuing it. The nurse would monitor this client for which of the following? A) Cerebral anoxia B) Cardiac dysrhythmias C) Hypothyroidism D) Adrenal insufficiency

Billroth II procedure or gastrojejunostomy is a procedure in which the duodenum stump is left intact to provide for digestive enzymes to enter the intestine (via bile ducts) and assist in digestion. The end of the duodenum is sutured shut to prevent any leaking of contents. The stump is not used for food storage or placement of the stomach. 32. A client with peptic ulcer disease is scheduled for a partial gastrectomy and vagotomy. The nurse understands the surgery will accomplish which of the following physiologic effects? A) Improve the nutritional status. B) Delay gastric emptying. C) Prevent pernicious anemia. D) Remove source of acid secretion.

Clients who are more prone to this disorder include those with a family history of the disease, those who are white with a European and/or Jewish ancestry, and those who smoke. The other client's listed do not have these risk factors. 22. A client is recently diagnosed with Crohn's disease and is beginning treatment. What first-line treatment does the nurse expect that the client will be placed on to decrease the inflammatory response? A) Ciprofloxacin (Cipro) B) Methotrexate (MTX) C) Azathioprine (Imuran) D) Sulfasalazine (Azulfidine)

Extremely obese clients are at greater risk for complications related to anesthesia and surgery. Obstructive sleep apnea and impaired breathing can be a problem requiring continuous or positive airway pressure devices. Self-care deficit and impaired mobility are real problems that need to be addressed but less significant than airway issues. Diarrhea due to dumping syndrome is not an immediate post-op issue. 39. Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client? A) Abdominal distention, elevated temperature, weakness before eating B) Constipation, rectal bleeding following bowel movements C) Persistent loose stools, chills, hiccups after eating D) Weakness, diaphoresis, diarrhea 90 minutes after eating

Immunosuppressive agents such as azathioprine, 6-mercaptopurine, and cyclosporine should be discontinued 3 to 4 weeks before surgery to prevent negative effects on tissue healing. Aspirin-containing compounds are discontinued at least 1 week before surgery to decrease the risk of bleeding. 25. A client who will be having a portion of colon removed and colostomy created informs the nurse that he "will not be attractive any longer." The nurse determines the nursing diagnosis is Disturbed Body Image related to the stoma and altered bowel elimination. What expected outcome related to this diagnosis will the client have? A) The client will be given instructions on how to care for the ostomy. B) The client will demonstrate adequate coping skills. C) The client will be allowed time and support to promote communication. D) Client verbalizes what the changes will be and the benefits to future health.

In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time. 12. A client is complaining of problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool? A) Increase the carbohydrate content of the diet. B) Increase dietary fat consumption. C) Increase dietary protein such as lean meats. D) Increase dietary fiber.

In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery. 33. The nurse is observing the mucous membranes of a client's mouth and notices that they are darkly discolored. The client has been taking medication for diarrhea. What medication should the nurse ask the client if he has been taking? A) Diphenoxylate with atropine sulfate (Lomotil) B) Loperamide (Imodium) C) Kaopectate D) Pepto-Bismol

In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus and cyclosporine are two immunosuppressants that may be used. Chenodiol and ursodiol are agents used to dissolve gallstones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission. 11. The nurse is admitting a client to their room at the hospital and observes that the client's skin and sclera are jaundice. What does the nurse expect the client's total bilirubin levels to be? A) 0.2 mg/dL B) 1.0 mg/dL C) 2.0 mg/dL D) 3.0 mg/dL

Initially, with cholelithiasis clients experience belching, nausea, and RUQ discomfort, with pain or cramps after high-fat meal. Symptoms become acute when a stone blocks bile flow from the gallbladder. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain called biliary colic. The symptoms do not correlate with hepatitis. 29. What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? A) Colonoscopy B) Abdominal x-ray C) Cholecystectomy D) Endoscopic retrograde cholangiopancreatography (ERCP)

Laennec's or alcoholic cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Postnecrotic cirrhosis results from destruction of liver cells secondary to infection. Biliary cirrhosis is caused by scarring around the bile ducts in the liver. Laennec's cirrhosis does not occur because of an autoimmune disorder. 14. When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? A) Yellow-green B) Black and tarry C) Blood tinged D) Clay-colored or whitish

Radiography of the gallbladder should be performed before other GI exams in which barium is used because residual barium tends to obscure the images of the gallbladder and its duct. #22.The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized?A)The client will fast prior to the procedure.B)The client will have moderate sedation.C)The client will receive antibiotics before and after the procedure.D)The client will change positions frequently throughout the procedure.

The consistency of fecal material ranges from semiliquid to formed depending on the area from which the colostomy is formed. With an ascending colostomy, stool would be semiliquid. An ileostomy would produce liquid stool; a transverse colostomy would produce soft stool; a sigmoid colostomy would produce formed stool. 10. A client undergoes surgery for a Kock pouch and returns to the nursing unit. The nurse anticipates that the ileal catheter will be removed in about? A) 3 to 4 days B) 5 to 7 days C) 7 to 9 days D) 10 to 14 days

The fecal material discharged from an ileostomy is liquid or mushy and contains digestive enzymes. The stool does not have time to harden since there is not the large intestine available to process. 13. The nurse is providing ostomy care to the client with an ileostomy. What can the nurse use to protect the skin and promote adhesion of the ostomy appliance? A) Adhesive glue B) Tincture of Benzoin C) Vaseline D) Karaya gum

The ileoanal reservoir, also called an ileoanal anastomosis, is a procedure that maintains bowel continence. It is performed on selected clients who have chronic ulcerative colitis or whose disease does not affect the anorectal sphincter. Besides allowing the client to control bowel elimination, this procedure, as opposed to a conventional ileostomy with total colectomy, preserves innervation to the male genitalia. Subsequently, the male client is unlikely to experience bladder dysfunction, erectile dysfunction, or infertility. The client will not be able to have this surgery done on an outpatient basis; they require postoperative care for a longer duration. 33. A client is having the first stage of an ileoanal anastomosis. What should the nurse inform the client they will experience? A) Solid stool from the anus B) Very little discharge from the anus C) Control of the fecal material from the anus D) Continuous discharge of mucus from the anus

When obtaining a positive Hemoccult test, the client needs to be screened for a false-positive test results. Substances that may cause a false-positive include red meat, aspirin, and excessive alcohol. Screening for the frequency and amount of these are important. False-negative results are screened in individuals who ingest ascorbic acid and iron supplements. #31.The nurse is assisting the physician in a percutaneous liver biopsy. In which position would the nurse assist the client to assume?A)A high Fowler's positionB)Lithotomy positionC)Dorsal recumbent positionD)Supine position

When the client is shivering, the nurse should cover the client with a light blanket. This will prevent the client from shivering. This is because the client who has undergone surgery for liver disorder also faces the risk of hyperthermia related to infection, rejection, or both. Providing the client with warm fluids will not control shivering. The client is covered with a hypothermia blanket if the temperature rises to 105º F. The room temperature need not be below 70° F. 4. The nurse would expect to observe which of the following when assessing a client with cholelithiasis? A) Stools that contain blood and mucus B) Bowel sounds that are absent C) Stools that appear small and dry D) Urine that appears dark brown

MS 44, 45, 46, 47, 48 (rationale is on the top of next card)

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