Prep U test 3 (chapter 47)

What bowel sounds are heard with crohns What bowel sounds are heard with obstruction

-hyperactive -Absent

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate? respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis

metabolic acidosis

Which drug is considered a Bulk forming laxative? Magnesium hydroxide Bisacodyl Mineral oil Psyllium hydrophilic mucilloid

Psyllium hydrophilic mucilloid

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? Hyperkalemia Hypokalemia Hyponatremia Hypernatremia

The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." "I need to use laxatives regularly to prevent constipation." "I need to drink 2 to 3 liters of fluids every day." "I should exercise four times per week."

"I need to use laxatives regularly to prevent constipation."

Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following? Osteoporosis Deep vein thrombosis Hypotension Pneumonia

-Osteoporosis Patients with IBD also have a significantly increased risk of osteoporotic fractures due to decreased bone mineral density. Patients are not at increased risk of deep vein thrombosis, hypotension, or pneumonia.

Celiac disease (celiac sprue) is an example of which category of malabsorption? Infectious diseases Mucosal disorders causing generalized malabsorption Luminal problems causing malabsorption Postoperative malabsorption

Mucosal disorders causing generalized malabsorption -the mucosal villi of the small intestine become denuded and cannot function. Crohn's disease (regional enteritis) and radiation enteritis are other examples of mucosal disorders.

Which is a true statement regarding regional enteritis (Crohn's disease)? It has a progressive disease pattern. It is characterized by pain in the lower left abdominal quadrant. The clusters of ulcers take on a cobblestone appearance. The lesions are in continuous contact with one another.

The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? Increase the rate of administration. Discontinue the irrigation immediately. Clamp the tubing and allow client to rest. Change irrigation fluid to normal saline.

The nurse should clamp the tubing and allow the client to rest when the client begins to report cramping during colostomy irrigation. Once the cramping has stopped, the nurse can resume the irrigation.

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 taking a stimulant laxative? They can be habit forming and will require increasing doses to be effective. As long as the client is drinking 8 glasses of water per day, he can continue to take them. The laxative is safe to take with other medication the client is taking. The client should take a fiber supplement along with the stimulant laxative.

They can be habit forming and will require increasing doses to be effective.

Vomiting results in which of the following acid-base imbalances? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

Which drug is considered a stimulant laxative? Magnesium hydroxide Bisacodyl Mineral oil Psyllium hydrophilic mucilloid

-Bisacodyl

A client has developed hepatitis A after eating con- taminated oysters. The nurse assesses the client for which expected assessment finding?1. Malaise 2. Dark stools3. Weight gain4. Left upper quadrant discomfort

. 1Rationale: Hepatitis causes gastrointestinal symptoms such as anorexia, nausea, right upper quadrant discomfort, and weight loss. Fatigue and malaise are common. Stools will be light- or clay-colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts. Test-TakingStrategy:Focusonthesubject,expectedassessment findings. Recalling the function of the liver will direct you to the correct option. Remember that fatigue and malaise are common

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. A peanut butter sandwich and fruit cup Broiled chicken with low-fiber pasta Salami on whole grain bread and V-8 juice A fruit salad with yogurt

Broiled chicken with low-fiber pasta

Which client would be at greatest risk for the development of an anorectal fistula? A 50-year-old male with diverticulosis A 35-year-old female with Crohn's disease A 42-year-old female with irritable bowel syndrome A 60-year-old male with polyps of the colon

Clients with Crohn's disease have an increased risk for the development of anorectal abscesses and anorectal fistulae. Diverticulosis, irritable bowel syndrome, and colon polyps are not typically associated with anorectal fistulae.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: A small bowel disorder. Intestinal malabsorption. Inflammatory colitis. A disorder of the large bowel.

Intestinal malabsorption.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? "I don't understand this; I took the medication the doctor ordered and followed the diet." "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." "I don't understand why this happened again; I didn't travel out of the country." "I don't like oatmeal, so it doesn't matter that I can't have it."

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________. Rovsing's sign; acute appendicitis McBurney's sign; acute appendicitis Rovsing's sign; perforation McBurney's sign; perforation

Rovsing's sign; acute appendicitis

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). What diagnosis will the nurse suspect for this client? inflammatory bowel disease (IBD) colorectal cancer diverticulitis liver failure

IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort.

Which of the following is the most common symptom of a polyp? Rectal bleeding Abdominal pain Diarrhea Anorexia

Rectal bleeding

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Diarrhea Pain Bloating Abdominal distention

The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

A16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is per- formed. Which nursing intervention is most appropriate to facilitate normal growth and devel- opment postoperatively? 1. Encourage the client to rest and read. 2. Encourage the parents to room in with the client. 3. Allow the family to bring in the client's favorite computer games. 4. Allow the client to interact with others in his or her (Adolescent) same age group.

4

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included? Encourage the client to avoid exercise. Instruct the client to cleanse perianal area with warm water. Teach the client how to do sitz baths at home using warm water three to four times each day. Encourage the client to follow diet and medication instructions.

-Encourage the client to avoid exercise. Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? Suggest fluid intake of at least 2 L/day Instruct the client to avoid prune or apple juice Assist the client regarding the correct diet or to minimize food intake Instruct the client to keep a record of food intake

The nurse should suggest a fluid intake of at least 2 L/day to help the client avoid constipation. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the client to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the client to keep a record of food intake in case of diarrhea, because this helps identify specific foods that irritate the gastrointestinal tract.

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 taking a stimulant laxative? They can be habit forming and will require increasing doses to be effective. As long as the client is drinking 8 glasses of water per day, he can continue to take them. The laxative is safe to take with other medication the client is taking. The client should take a fiber supplement along with the stimulant laxative.

They can be habit forming and will require increasing doses to be effective. 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.

A nurse is caring for a client with cardiac disease. The client asks the nurse which medication is best for help with regular bowel movements. What is the best response by the nurse? Docusate Magnesium hydroxide Bisacodyl Mineral oil

Docusate (Colace) can be used safely by patients who should avoid straining, such as cardiac clients. Magnesium hydroxide (Milk of Magnesia) is a saline agent. Bisacodyl (Dulcolax) is a stimulant laxative. Mineral oil is a lubricant laxative.

A patient is not having daily bowel movements and has begun taking a laxative for this problem. What should the nurse educate the patient about regarding laxative use? When taking the laxatives, plenty of fluid should be taken as well. The laxatives should be taken no more than 3 times a week or laxative addiction will result. Laxatives should not be routinely taken due to destruction of nerve endings in the colon. Laxatives should never be the first response for the treatment of constipation; natural methods should be employed first.

Laxatives should not be routinely taken due to destruction of nerve endings in the colon.

Aclient had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? 1. 2. 3. 4. This is a normal, expected event. The client is experiencing early signs of ischemic bowel. The client should not have the nasogastric tube removed. This indicates inadequate preoperative bowel preparation.

1Rationale: As peristalsis returns following creation of a colos- tomy,theclientbeginstopassmalodorousflatus.Thisindicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options 2, 3, and 4 are incorrect interpretations. Test-Taking Strategy: Focus on the subject, that the client is passing flatus from the stoma. Think about the normal func- tioning of the gastrointestinal tract and note the time frame in the question to assist in answering correctly.

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): anorectal abscess. anal fistula. hemorrhoid. anal fissure.

anal fissure. Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

A client presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate which area? Between the umbilicus and the left iliac crest Between the umbilicus and the anterior superior iliac spine In the left periumbilical area In the upper right quadrant slightly below the diaphragm

-Between the umbilicus and the anterior superior iliac spine Local tenderness in the right lower quadrant is elicited at McBurney's point when pressure is applied between the umbilicus and the anterior superior iliac spine.

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? Ciprofloxacin Methotrexate Azathioprine Sulfasalazine

Sulfasalazine 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. Methotrexate or azathioprine are used when failure to maintain remission necessitates the use of an immune-modulating agent. Ciprofloxacin is used as an effective adjunct to treat the disease.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? Right upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant

Right lower quadrant

A client has undergone esophagogastroduodenos- copy. The nurse should place highest priority on which item as part of the client's care plan? 1.Monitoring the temperature2. Monitoring complaints of heartburn3. Giving warm gargles for a sore throat4. Assessing for the return of the gag reflex

4Rationale: The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate per- foration of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitor- ing for sore throat and heartburn are also important; however, the client's airway is the priority.

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement? 1. "I know I must sign the consent form."2. "Ihopethethroatspraykeepsmefrom gagging." 3. "I'm glad I don't have to lie still for this procedure." 4. "I'm glad some intravenous medication will be given to relax me."

3Rationale: The client does have to lie still for ERCP, which takes about 1 hour to perform. The client also has to sign a con- sent form. Intravenous sedation is given to relax the client, and an anesthetic spray is used to help keep the client from gagging as the endoscope is passed.

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? Weight loss due to malabsorption Blood and mucus in the stool Chronic constipation with sporadic bouts of diarrhea Client is awakened from sleep due to abdominal pain.

Chronic constipation with sporadic bouts of diarrhea Most clients with irritable bowel syndrome (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.

Aclient is diagnosed with viral hepatitis, complain- ing of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? 1. Select foods high in fat.2. Increase intake of fluids, including juices.3. Eat a good supper when anorexia is not as severe. 4. Eat less often, preferably only 3 large meals daily.

2 Rationale:Althoughnospecialdietisrequiredtotreatviralhep- atitis, it is generally recommended that clients consume a low-fat diet,asfatmaybetoleratedpoorlybecauseofdecreasedbilepro- duction. Small, frequent meals are preferable and may even pre- vent nausea. Frequently, appetite is better in the morning, so it is easiertoeatagoodbreakfast.Anadequatefluidintakeof2500to 3000 mL/day that includes nutritional juices is also important. Test-Taking Strategy: Focus on the subject, a diet for viral hep- atitis. Think about the pathophysiology associated with hepa- titis and focus on the client's complaints to direct you to the correct option.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in pre- venting dumping syndrome? 1. Ambulate following a meal.2. Eat high-carbohydrate foods.3. Limit the fluids taken with meals.4. Sit in a high Fowler's position during meals.

3Rationale: Dumping syndrome is a term that refers to a constel- lation of vasomotor symptoms that occurs after eating, espe- cially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. 1. Diarrhea2. Black, tarry stools3. Hyperactive bowel sounds 4. Gray-blue color at the flank5. Abdominal guarding and tenderness6. Left upper quadrant pain with radiation to the back

4, 5, 6Rationale: Grayish-blue discoloration at the flank is known as Grey-Turner's sign and occurs as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The cli- ent may demonstrate abdominal guarding and may complain of tenderness with palpation. The pain associated with acute pancreatitis is often sudden in onset and is located in the epi- gastric region or left upper quadrant with radiation to the back. The other options are incorrect.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? Appendicitis Rectal fissures Bowel perforation Diverticulitis

-Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of? Crohn's disease Ulcerative colitis Irritable bowel syndrome Diverticulitis

-Crohn's disease The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

A client has been brought into the ED via ambulance, reporting acute generalized abdominal pain, nausea, fever, and constipation. The healthcare provider suspects appendicitis, but testing has not been performed yet to make a definitive diagnosis. What will the nurse most likely do while initially caring for this client? Explain to the client why analgesics are being withheld. Frequently palpate the abdomen to assess for changes that might indicate the onset of a perforation. Perform the test for rebound tenderness. Administer a laxative to relieve the client's constipation.

-Explain to the client why analgesics are being withheld. Analgesics may be withheld initially to avoid masking symptoms that may affect the diagnosis. Avoid multiple or frequent palpation of the abdomen; there is danger of causing the appendix to rupture. Perform the test for rebound tenderness at the end of the examination because a positive response causes pain and muscle spasm and makes it difficult to complete the rest of the assessment. Do not administer laxatives or enemas to a client who is experiencing fever, nausea, and abdominal pain, even though the client may complain of feeling constipated. Laxatives and cathartics may cause the appendix to rupture.

A client has symptoms suggestive of peritonitis. Nursing management would not include: limiting analgesics to avoid the formation of paralytic ileus. accurate recording of input and output. inserting a nasogastric tube. inserting a urinary retention catheter.

-limiting analgesics to avoid the formation of paralytic ileus. Analgesics such as meperidine or IV morphine sulfate are ordered to relieve pain and promote rest. Because hypovolemia can occur from fluids leaking into the peritoneal cavity, input and output are monitored closely to assist in determining fluid replacement. A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and stagnant upper GI fluids. If hypovolemia is present, renal perfusion can become decreased, requiring close monitoring.

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply. 1. Fever2. Positive Cullen's sign3. Complaints of indigestion4. Palpable mass in the left upper quadrant5. Pain in the upper right quadrant after a fatty meal6. Vague lower right quadrant abdominal discomfort

1, 3, 5Rationale: During an acute episode of cholecystitis, the client may complain of severe right upper quadrant pain that radiates to the right scapula or shoulder or experience epigastric pain after a fatty or high-volume meal. Fever and signs of dehydra- tion would also be expected, as well as complaints of indiges- tion, belching, flatulence, nausea, and vomiting. Options 4 and 6 are incorrect because they are inconsistent with the ana- tomical location of the gallbladder. Option 2 (Cullen's sign) is associated with pancreatitis.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. 1. Maintain NPO (nothing by mouth) status. 2. Encourage coughing and deep breathing. 3. Give small, frequent high-calorie feedings. 4. Maintain the client in a supine and flat position. 5. Give hydromorphone intravenously as pre- scribed for pain. 6. Maintain intravenous fluids at 10 mL/hour to keep the vein open.

1,2,5Rationale: The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointesti- nal secretions, so adequate intravenous hydration is necessary. Because abdominal pain is a prominent symptom of pancrea- titis, pain medications such as morphine or hydromorphone are prescribed. Meperidine is avoided, as it may cause seizures. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help to ease the pain. The client is susceptible to respiratory infections because the retro- peritoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, mea- sures such as turning, coughing, and deep breathing are instituted.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? "I should increase the fiber in my diet." "I will need to avoid caffeinated beverages." "I'm going to learn some stress reduction techniques." "I can have exacerbations and remissions with Crohn's disease."

1Rationale: Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counsel- ing. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high- protein diet. Alow-fiber diet may be prescribed, especially dur- ing periods of exacerbation.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? 1. "I need to limit my intake of dietary fiber."2. "I need to drink plenty, at least 8 to 10 cups daily."3. "I need to eat regular meals and chew my food well."4. "I will take the prescribed medications because they will regulate my bowel patterns."

1Rationale: IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimina- tion habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel func- tion. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1. Notify the health care provider (HCP).2. Administer the prescribed pain medication.3. Call and ask the operating room team to per- form surgery as soon as possible.4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

1Rationale: On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

The health care provider has determined that a cli- ent has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis? 1. 2. 3. 4. "I have had unprotected sex with multiple partners." "I ate shellfish about 2 weeks ago at a local restaurant." "I was an intravenous drug abuser in the past and shared needles." "I had a blood transfusion 30 years ago after major abdominal surgery."

2Rationale: Hepatitis Ais transmitted by the fecal-oral route via contaminated water or food (improperly cooked shellfish), or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids, such as in the cases of intravenous drug abuse, history of blood transfu- sion, or unprotected sex with multiple partners.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mLof green-brown drainage since the surgery. Which nursing intervention is most appropriate? 1. Clamp the T-tube.2. Irrigate the T-tube.3. Document the findings.4. Notify the health care provider.

3Rationale: Following cholecystectomy, drainage from the T- tube is initially bloody and then turns a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.

A client presents with an infection in the area between the internal and external sphincters. In which chronic disease is this condition commonly seen? Crohn's disease diverticulosis ulcerative colitis irritable bowel syndrome

Crohn's disease An anorectal abscess is common in clients with Crohn's disease.

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? Age younger than 40 years Low-fat, low-protein, high-fiber diet History of skin cancer Familial polyposis

Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years and a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer.

The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? Maintaining skin integrity Beginning a bowel program to establish continence Instituting a diet high in fiber and increase fluid intake Determining the need for surgical intervention to correct the problem

Fecal incontinence can disrupt perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or older adult patient.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. The appendix may develop gangrene and rupture, especially in a middle-aged client. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

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 board-like. What complication does the nurse determine may be occurring at this time? Constipation Paralytic ileus Peritonitis Accumulation of gas

Peritonitis Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and board-like 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.

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? leukocytosis; elevated hematocrit; low sodium, potassium, and chloride leukopenia, decreased hematocrit; low sodium, potassium, and chloride leukocytosis; metabolic alkalosis; elevated sodium, potassium, and chloride leukopenia; metabolic acidosis; elevated sodium, potassium, and chloride

leukocytosis; elevated hematocrit; low sodium, potassium, and chloride Tests of serum electrolytes may indicate low levels of sodium, potassium, and chloride. Metabolic alkalosis is evidenced by arterial blood gas results. A complete blood count (CBC) shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? tenderness and pain in the right upper abdominal quadrant jaundice and vomiting severe abdominal pain with direct palpation or rebound tenderness rectal bleeding and a change in bowel habits

severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.