PrepU 47

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Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? - Iron restriction - Low protein - Calorie restriction - Low residue

- Low residue

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction? - Purulent drainage from the gluteal fold - Decreased blood pressure - Sudden, sustained abdominal pain - Decreased urine output

- Sudden, sustained abdominal pain

A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for: - rupture of the appendix. - emotional distress related to the pain. - inflammation of the gallbladder. - ulceration of the appendix.

- rupture of the appendix.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder?

A change in bowel habits

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?

Abdominoperineal resection

When preparing a client for a hemorrhoidectomy, the nurse should take which action?

Administer an enema as ordered.

An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform? A) Encourage the patient to take stool softener daily. B) Assess the patient's food and fluid intake. C) Assess the patient's surgical history. D) Encourage the patient to take fiber supplements.

Ans: B Feedback: The nurse should follow the nursing process and perform an assessment prior to interventions. The patient's food and fluid intake is more likely to affect bowel function than surgery.

19. A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate? A) Watery, blood-streaked diarrhea B) Orange and foamy urine C) Increased abdominal girth D) Decreased cognition

Ans: B Feedback: If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. Bloody diarrhea, ascites, and cognitive changes are not associated with obstructive jaundice.

31. A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what? A) IV administration of immune globulins B) Transfusion of packed red blood cells and fresh-frozen plasma (FFP) C) Liver transplantation D) Lobectomy

Ans: C Feedback: Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure. This is preferred over other interventions, such as pharmacologic treatments, transfusions, and surgery.

23. A nurse is amending a patient's plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient's care plan? A) Mobilization with assistance at least 4 times daily B) Administration of beta-adrenergic blockers as ordered C) Vitamin B12 injections as ordered D) Administration of diuretics as ordered

Ans: D Feedback: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.

The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? 1. Antispasmodic 2. Anti-inflammatory 3. Antianxiety 4. Antiemetic

Antispasmodic

A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. What would be the most accurate response from the nurse?

Approximately 75%

The nurse is caring for a patient who is undergoing diagnostic testing for suspected malabsorption. When taking this patient's health history and performing the physical assessment, the nurse should recognize what finding as most consistent with this diagnosis? A) Recurrent constipation coupled with weight loss B) Foul-smelling diarrhea that contains fat C) Fever accompanied by a rigid, tender abdomen D) Bloody bowel movements accompanied by fecal incontinence

B Feedback: The hallmarks of malabsorption syndrome from any cause are diarrhea or frequent, loose, bulky, foul-smelling stools that have increased fat content and are often grayish (steatorrhea). Constipation and bloody bowel movements are not suggestive of malabsorption syndromes. Fever and a tender, rigid abdomen are associated with peritonitis.

Cystic Fibrosis

Blocked ducts and malabsorption in intestine. Pts benefit from about 1/2 of their consumption with increased appetite. Meconium ileus is present in newborns. ADEK vitamins are important. Give high protein, high kcal diet.

In women, which of the following types of cancer exceeds colorectal cancer?

Breast In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

The nurse is talking with a group of clients who 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? 1. Abdominal cramping when having a bowel movement 2. Daily bowel movements 3. Excess gas 4. Change in bowel habits

Change in bowel habits

Which term refers to a protrusion of the intestine through a weakened area in the abdominal wall?

Hernia

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer?

Hypotension, tachycardia, a rigid board-like abdomen

Keep a 1- to 2-week symptom and food diary to identify food triggers.

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

Less than 400 mL

A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:

Level of consciousness (LOC)

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to:

Low platelet count

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Low residue

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately?

Potassium

A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation?

Red, sensitive skin around the stoma site

Hiatal hernia

Regurgitation of acid into esophagus because upper part of stomach herniates upward into diaphragm. Gastric contents move in wrong direction at the correct rate. (metaphorically, you'd get cited for going the wrong way on a one-way street). Keep everything "Hi": High fowlers, high carb foods, high level of fluids with foods. S/sx: GERD while laying down postprandially.

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?

Sigmoidoscopy

When caring for a client with cirrhosis, which symptoms should a nurse report immediately?

Signs of GI bleeding Change in mental status

A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication?

Small bowel obstruction Small bowel obstruction is a serious systemic complication of regional enteritis. The other clinical signs are associated with ulcerative colitis. Refer to Table 24-4 in the text.

The nurse is reviewing the laboratory test results of a client with Crohn disease. Which of the following would the nurse most likely find?

Stool cultures negative for microorganisms or parasite

A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?

Stress incontinence

A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder?

There is a 70% chance that jaundice will occur Transmission of the virus is possible with oral-anal contact during sex Typically there is a spontaneous recovery

A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?

dehydration

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: hyperkalemia. hypokalemia. hyponatremia. hypernatremia.

hypokalemia

hypokalemia.

A client is having a blood urea nitrogen (BUN) test. BUN level is:

increased in renal disease and urinary obstruction.

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate?

metabolic acidosis

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

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: 1. tenderness and pain in the right upper abdominal quadrant. 2. severe abdominal pain with direct palpation or rebound tenderness. 3. jaundice and vomiting. 4. rectal bleeding and a change in bowel habits.

severe abdominal pain with direct palpation or rebound tenderness.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:

usual pattern of elimination.

A client has been experiencing lower GI difficulties that have increased in severity, and the gastroenterologist is concerned that the client's bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by the client's disorder?

water and electrolyte absorption

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: - caffeinated products. - spicy foods. - high-fiber diet. - fluids with meals.

- high-fiber diet.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: - hyperkalemia. - hypokalemia. - hyponatremia. - hypernatremia.

- hypokalemia.

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

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?

Keep a 1- to 2-week symptom and food diary to identify food triggers.

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?

Abdominal surgery

A patient admitted with inflammatory bowel disease asks the nurse for help with menu selections. What menu selection is most likely the best choice for this patient? A) Spinach B) Tofu C) Multigrain bagel D) Blueberries

Ans: B Feedback: Nutritional management of inflammatory bowel disease requires ingestion of a diet that is bland, low-residue, high-protein, and high-vitamin. Tofu meets each of the criteria. Spinach, multigrain bagels, and blueberries are not low-residue.

38. A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse's priority? A) Implementation of infection-control measures B) Close monitoring of skin integrity and color C) Frequent assessment of the patient's psychosocial status D) Administration of antiretroviral medications

Ans: A Feedback: Infection control is paramount following liver transplantation. This is a priority over skin integrity and psychosocial status, even though these are valid areas of assessment and intervention. Antiretrovirals are not indicated.

22. A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patient's plan? A) Increased potassium intake B) Fluid restriction to 2 L per day C) Reduction in sodium intake D) High-protein, low-fat diet

Ans: C Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no need for fluid restriction or increased protein intake.

Which of the following would a nurse expect to assess in a client with peritonitis? a) Hyperactive bowel sounds. b) Decreased pulse rate (HR). c) Slow, deep respirations. d) Board-like abdomen.

Board-like abdomen.

When caring for a client with cirrhosis, which symptom(s) should the nurse report immediately?

Change in mental status

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

Hypokalemia

A positive Rovsing's sign is indicative of appendicitis. A nurse knows to assess for this indicator by palpating the:

Left lower quadrant

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is

Octreotide (sandostatin)

To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement?

Pad the side rails on the bed

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?

Pain management

Cholelithiasis (gallstones)

RUQ pain with radiating pain into arm or shoulder (usually following a fatty meal). CF and diabetics have increased risk. 2 types of stones: calcium or cholesterol (70% of cases). If they cause obstruction, more likely to cause jaundice.

A client with recurrent urinary tract infections has just undergone a cystoscopy and reports slight hematuria during the first void after the procedure. What is the nurse's most appropriate action?

Reassure the client that this is not unexpected and then monitor the client for further bleeding.

After undergoing a liver biopsy, a client should be placed in which position?

Right lateral decubitus position Explanation: After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding. Semi-Fowler's position and the supine and prone positions wouldn't achieve this goal.

A patient is diagnosed with Zollinger-Ellison syndrome, a malabsorption disorder. The nurse knows to assess the patient for the characteristic clinical feature of:

Steatorrhea Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis. Refer to Table 24-2 in the text.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: a) Usual pattern of elimination b) Medications c) Allergies d) Family history of constipation/GI issues

Usual pattern of elimination

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:

paralytic ileus.

Most of the liver's metabolic functions are performed by:

parenchymal cells. Explanation: The parenchymal cells perform most of the liver's metabolic functions

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:

phytonadione (Mephyton).

Which is an appropriate nursing goal for the client who has ulcerative colitis? The client: a) uses a heating pad to decrease abdominal cramping. b) maintains a daily record of intake and output. c) accepts that a colostomy is inevitable at some time in his life. d) verbalizes the importance of small, frequent feedings.

verbalizes the importance of small, frequent feedings.

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

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: - An ileus. - A pelvic abscess. - Peritonitis - An abscess under the diaphragm.

- Peritonitis

paralytic ileus Bowel sounds are hypoactive or absent in a client with a paralytic ileus. Clients with Crohn's disease and gastroenteritis have hyperactive bowel sounds because of increased intestinal motility. A complete bowel obstruction causes absent bowel sounds below the obstruction and hyperactive sounds above the obstruction.

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:

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) Avoid bran cereals and beans in the diet. b) Increasing intake of fluids, 3-4 glasses/day. c) Avoid a daily exercise regimen. d) Adding fiber-rich foods to the diet gradually.

Adding fiber-rich foods to the diet gradually.

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition?

Anal fissure

25. A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patient's treatment? A) Decisional Conflict B) Deficient Knowledge C) Death Anxiety D) Disturbed Thought Processes

Ans: C Feedback: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the patient's likely fear of death, which is a realistic possibility. For most patients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The patient may or may not experience disturbances in thought processes.

8. A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate? A) Infusion of intravenous heparin B) IV administration of albumin C) STAT administration of vitamin K by the intramuscular route D) IV administration of octreotide (Sandostatin)

Ans: D Feedback: Octreotide (Sandostatin)—a synthetic analog of the hormone somatostatin—is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin are not administered and heparin would exacerbate, not alleviate, bleeding.

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? a) Left upper quadrant b) Right lower quadrant c) Left lower quadrant d) Right upper quadrant

B (The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.)

Broiled chicken with low-fiber pasta

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?

Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?

Hepatic encephalopathy

A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions?

Hepatic encephalopathy

A 33-year-old male patient with a history of IV heroin and cocaine use has been admitted to the medical unit for the treatment of endocarditis. The nurse should recognize that this patient is also likely to test positive for which of the following hepatitis viruses?

Hepatitis C Explanation: Transmission of hepatitis C occurs primarily through injection of drugs and through transfusion of blood products prior to 1992. Hepatitis A, B, and D are less likely to result from IV drug use.

A client is scheduled to undergo rhinoplasty in the morning, and reports medications used on a daily basis, which the nurse records on the client's chart. Which daily medications have the potential to result in constipation?

Laxative

The nurse is assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis?

Left lower quadrant

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal?

Maintaining the airway Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

When a nurse recommends the following laxative, she emphasizes that it should not be taken with meals. Choose the laxative.

Mineral Oil Mineral oil should never be taken with meals because it can impair the absorption of fat-soluble vitamins and delay gastric emptying. Refer to Table 24-1 in the text.

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?

Obtaining a blood pressure reading from the right arm

A client has undergone a liver biopsy. Which postprocedure position is appropriate?

On the right side Explanation: In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the client on his left side is not indicated. Positioning the client in the Trendelenburg position may be indicated if the client is in shock, but is not the position designed for the client after liver biopsy. The high Fowler position is not indicated for the client after liver biopsy.

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease?

Pad the side rails on the bed Explanation: Padding the side rails can reduce injury if the client becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint, and this would not be an initial measure to implement. Family and friends generally assist in calming a client.

Assessment:Physical:Liver dysfunction

Pallor, jaundice Petechiae, erythema, spider angiomas Gynecomastia Enlarged liver Neurologic: tremors asterixis, slurred speech,

A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a patient's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The patient is placed in a high Fowler's position and a BP cuff is secured around the arm in preparation for which of the following procedures?

Paracentesis

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: a) Ulcerative colitis b) Peritonitis c) Diverticulitis d) Diverticulosis

Peritonitis

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?

Peritonitis

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 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.

Gynecomastia is a common side effect of which of the following diuretics?

Spironolactone (Aldactone) Explanation: Gynecomastia is a common side effect caused by spironolactone. Pitressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained abdominal pain

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

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?

Tacrolimus

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

The client's hepatic function is decreasing. Explanation: The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

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?

The client's natural bowel function may become sluggish. Explanation: 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.

usual pattern of elimination.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:

Hypotension

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Clamp the tubing and give the patient a rest period.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Pancreatic cancer

This disease has a hereditary form, but smoking increases risk. The disease is 2-3x more likely for smokers. Pts may have a zollinger-ellison tumor, wt loss, jaundice with clay stools and dark urine, diabetes, ascites. No specific markers, but CEA and CA 19-9 may be used to track progression. Clinicians role to initially discuss prognosis, not the nurses.

Manometry and pneumatic dilation serve what purpose:

This first thing is a tool that measures the pressure in the esophageal sphincter and the second thing is a procedure in which an inflated balloon attached to a catheter that goes down the esophagus and keeps the esophageal sphincter open. After this procedure, assess for perforation.

Pancreas characteristics

This is an accessory organ that has a neutral pH. It contains 3 enzymes: Proteolytic enzymes - trypsinogen and chymotrypsinogen; Amylase - if elevated, can be sign of obstruction and acenar cell damage; and Lipase - if elevated, can be sign of acenar cell damage.

Liver characteristics

This is the largest gland in the body. It removes waste from the blood and secretes it in bile.

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?

Transjugular intrahepatic portosystemic shunting (TIPS)

The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy?

Upright

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?

Watery diarrhea Explanation: The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.

What is the recommended dietary treatment for a client with chronic cholecystitis?

low-fat diet Explanation: The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications?

metabolism of medications Explanation: Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.

A client with rheumatoid arthritis tells the nurse that she feels "quite alone" in adjusting to changes in her lifestyle. The nurse should respond by: a) telling the client about her community's arthritis support group. b) referring the client and her husband for counseling to decrease her sense of isolation. c) suggesting that the client develop a hobby to occupy her time. d) suggesting that the client discuss her feelings with her minister.

telling the client about her community's arthritis support group.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: - hypernatremia. - hyponatremia. - hyperkalemia. - hypokalemia.

- hypokalemia.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum

enterostomal nurse The surgeon should collaborate with the enterostomal nurse who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member?

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor?

Albumin

3. A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? A) Assessment of blood pressure and assessment for headaches and visual changes B) Assessments for signs and symptoms of venous thromboembolism C) Daily weights and abdominal girth measurement D) Blood glucose monitoring q4h

Ans: C Feedback: Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose or VTE.

34. A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patient's family how to safely perform which of the following actions? A) Aspirating bile from the catheter using a syringe B) Removing the catheter when output is 15 mL in 24 hours C) Instilling antibiotics into the catheter D) Assessing the patency of the drainage catheter

Ans: D Feedback: Families should be taught to provide basic catheter care, including assessment of patency. Antibiotics are not instilled into the catheter and aspiration using a syringe is contraindicated. The family would not independently remove the catheter; this would be done by a member of the care team when deemed necessary.

Acute Pancreatitis general characteristics

Characteristics of this are: An inflammatory process that begins in acenar cells. Inactive enzymes within organ become active and breaks the organ down by autologous destruction. Two forms: Edematous (interstitial) - mild Necrotizing and/or hemorrhagic - more severe. Necrosis activates other enzymes such as platelet activating factor and causes an increase in vascular permeability that causes fluid shifts in abdominal cavity. Shock is possible.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? a) Tell the client you are almost finished and to hold still for the next 1-2 minutes. b) Water should flow in over a 45 minute period. c) Allow only tepid fluid to enter the colon slowly. d) Clamp the tubing and give the patient a rest period.

Clamp the tubing and give the patient a rest period.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Hepatitis C increases a person's risk for liver cancer. Explanation: 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.

The nurse is assessing the client for the presence of a Chvostek sign. What electrolyte imbalance would a positive Chvostek sign indicate?

Hypocalcemia

The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician?

Nausea

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?

Reduce fluid accumulation and venous pressure. Explanation: 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.

What symptoms of perforation might the nurse observe in a client with an intestinal obstruction?

Sudden, sustained abdominal pain Abdominal distention

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?

Sulfasalazine

The health care provider prescribes sulfasalazine for the client with ulcerative colitis. Which instruction should the nurse give the client about taking this medication? a) Take the total dose at bedtime. b) Avoid taking it with food. c) Take it with a full glass (240 mL) of water. d) Stop taking it if urine turns orange-yellow.

Take it with a full glass (240 mL) of water.

A healthcare provider prescribes a combination of three drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client?

The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori

Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of:

Two 6 oz glasses of wine. Explanation: Intake of 60 g/day for men and 30 g/d for women (10 g of alcohol is equivalent to 1 oz of bourbon, 12 ounces of beer, or 4 ounces of red wine) is sufficient to cause liver injury.

A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client?

"You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs."

Which of the following would a nurse expect to assess in a client with peritonitis? - Board-like abdomen - Deep slow respirations - Decreased pulse rate - Hyperactive bowel sounds

- Board-like abdomen

Which of the following would a nurse expect to assess in a client with peritonitis? - Decreased pulse rate - Deep slow respirations - Board-like abdomen - Hyperactive bowel sounds

- Board-like abdomen

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: a) increasing fluid intake to prevent dehydration. b) consuming a low-protein, high-fiber diet. c) taking only enteric-coated medications. d) wearing an appliance pouch only at bedtime.

A (Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.)

Loperamide (Imodium) Loperamide and diphenoxylate with atropine sulfate are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate and kaolin and pectin are examples of absorbent antidiarrheal agents. Bisacodyl is a chemical stimulant laxative.

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?

The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75?

Agitation

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?

Albumin Explanation: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A client with acute pancreatitis has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, lab results indicate hypovolemia. What will the physician order to treat the large amount of protein-rich fluid that has been released into the client's tissues and peritoneal cavity?

Albumin Diuretics

A nurse is teaching a client about the types of chronic liver disease. The teaching is determined to be effective when the client correctly identifies which type of cirrhosis as being caused by scar tissue surrounding portal areas?

Alcoholic cirrhosis

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

B (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.)

A client has been diagnosed with cancer in the descending colon. Which symptoms would the nurse expect the client to report?

Narrowing of stools Constipation

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? a) Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. b) Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. c) Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. d) The appendix may develop gangrene and rupture, especially in a middle-aged client.

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

hypokalemia.

Ammonia Conversion

The use of amino acids from protein for gluconeogenesis results in the formation of ammonia as a by-product. Ammonia converts into urea.

2. A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient's liver? A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand. B) Place the left hand over the abdomen and behind the left side at the 11th rib. C) Place hand under right lower rib cage and press down lightly with the other hand. D) Hold hand 90 degrees to right side of the abdomen and push down firmly.

Ans: C Feedback: To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.

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? 1. Blood and mucus in the stool 2. Chronic constipation with sporadic bouts of diarrhea 3. Weight loss due to malabsorption 4. Client is awakened from sleep due to abdominal pain.

Chronic constipation with sporadic bouts of diarrhea

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?

Hypotension

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Hypotension is a clinical manifestation of this disease process.

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?

It is the third most common cancer in the United States.

A client with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?

Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained abdominal pain Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?

Until the gag reflex returns Explanation: After the endoscopic examination, fluids are not given until the patient's gag reflex returns.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?

Wear a mask when performing exchanges.

The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend? Carcinoembryonic antigen (CEA) test after age 50 Proctosigmoidoscopy after age 30 Annual digital examination after age 40 Barium enema after age 20

Annual digital examination after age 40

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program? - It is the third most common cancer in the United States. - The lifetime risk of developing colorectal cancer is 1 in 10. - The incidence of colorectal cancer decreases with age. - Colorectal cancer has no hereditary component.

- It is the third most common cancer in the United States.

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? - The consistency of stool and comfort when passing stool - That the client has a bowel movement daily - That the stool is formed and soft - The client is able to fully evacuate with each bowel movement

- The consistency of stool and comfort when passing stool

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? a) Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. b) Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. c) Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered. d) Prepare to administer a corticosteroid IV.

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

12. Diagnostic testing has revealed that a patient's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patient's plan of care will focus on what intervention? A) Cryosurgery B) Liver transplantation C) Lobectomy D) Laser hyperthermia

Ans: C Feedback: Surgical resection is the treatment of choice when HCC is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While cryosurgery and liver transplantation are other surgical options for management of liver cancer, these procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical treatment for liver cancer.

Hypokalemia

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?

Respiratory alkalosis

White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

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.

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? - White blood cell (WBC) count 22.8/mm3 - Hematocrit 42% - Serum sodium 135 mEq/L - Serum potassium 4.2 mEq/L

- White blood cell (WBC) count 22.8/mm3

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control? a) The client exhibits signs of adequate GI perfusion. b) The client maintains skin integrity. c) The client expresses positive feelings about himself. d) The client verbalizes a manageable level of discomfort.

A (Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.)

17. A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient's current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A) Two to 3 soft bowel movements daily B) Significant increase in appetite and food intake C) Absence of nausea and vomiting D) Absence of blood or mucus in stool

Ans: A Feedback: Lactulose (Cephulac) is administered to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the patient's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool.

18. A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding? A) Similar liver size and texture as in younger adults B) A nonpalpable liver C) A slightly enlarged liver with palpably hard edges D) A slightly decreased size of the liver

Ans: D Feedback: The most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, and is not expected to have hardened edges.

A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has?

Bleeding esophageal varices Explanation: The patient with bleeding esophageal varices may present with hematemesis, melena, or general deterioration in mental or physical status and often has a history of alcohol abuse. Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia) may be present. The scenario does not describe hemolytic jaundice, hepatic insufficiency, or portal hypertension.

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about?

Burning sensation localized in the back of mid-epigastrium Feeling of emptiness that precedes meals from 1-3 hours Severe gnawing pain that increases in severity as the day progresses

Gastritis characteristics

Characteristics of this is inflammation of stomach that can be caused by HCl and pepsin. Loss of intrinsic factor can occur. Can be acute or chronic. Eliminate cause if possible and encourage 6 small meals, decreased stress and increased rest.

Chronic constipation with sporadic bouts of diarrhea

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?

Hypercalcemia

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance?

Hypocalcemia

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

Hypokalemia

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes?

Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish Sexual activity

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?

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.

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?

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

A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement?

My appetite should come back tomorrow

A 64-year-old client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and is lethargic. Serum sodium level is above 145 mEq/l (145 mmol/L). Should the nurse start salt tablets when caring for this client?

No, sodium intake should be restricted.

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a board-like abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action? Start an IV with lactated Ringer's solution. Notify the health care provider. Administer a retention enema. Administer an opioid analgesic.

Notify the health care provider.

Peritonitis

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider?

Tachycardia and tachypnea

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:

The digestion of dietary and blood proteins. Explanation: Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

Flexible sigmoidoscopy The treatment of fecal incontinence depends on the cause. A rectal examination and other endoscopic examinations, such as a flexible sigmoidoscopy, are performed to rule out tumors, inflammation, or fissures. X-ray studies such as barium enema, computed tomography (CT), anorectal manometry, and transit studies may be helpful in identifying alterations in intestinal mucosa and muscle tone or in detecting other structural or functional problems.

A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b in combination with ribavirin. Which of the following instructions should a nurse provide this client?

Use strict birth control methods. Explanation: 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.

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

Which client requires immediate nursing intervention? The client who: complains of epigastric pain after eating. complains of anorexia and periumbilical pain. presents with a rigid, board-like abdomen. presents with ribbonlike stools.

presents with a rigid, board-like abdomen

A 16-year-old presents at the emergency department complaining of right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this patient's nursing care, the nurse should prioritize what nursing diagnosis? A) Imbalanced Nutrition: Less Than Body Requirements Related to Decreased Oral Intake B) Risk for Infection Related to Possible Rupture of Appendix C) Constipation Related to Decreased Bowel Motility and Decreased Fluid Intake D) Chronic Pain Related to Appendicitis

B Feedback: The patient with a diagnosis of appendicitis has an acute risk of infection related to the possibility of rupture. This immediate physiologic risk is a priority over nutrition and constipation, though each of these concerns should be addressed by the nurse. The pain associated with appendicitis is acute, not chronic.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?

Hypotension

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? 1. Normal erythrocyte sedimentation rate (ESR) 2. Subnormal temperature 3. Hypotension 4. Bradycardia

Hypotension

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?

Metabolic alkalosis

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? - lack of free water intake - lack of solid food - lack of exercise - increased fiber

- lack of free water intake

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?

Bowel perforation

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? Increasing fluid intake to prevent dehydration Wearing an appliance pouch only at bedtime Consuming a low-protein, high-fiber diet Taking only enteric-coated medications

Increasing fluid intake to prevent dehydration

A client with pancreatitis has been receiving total parenteral nutrition (TPN) for the past week. Which nursing intervention helps determine if TPN is providing adequate nutrition? a) Recording fluid intake and output b) Monitoring the client's weight every day c) Accelerating the infusion if it falls behind schedule d) Ensuring that the TPN tubing has an in-line filter

Monitoring the client's weight every day

A patient's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather that ulcerative colitis, as the cause of the patient's signs and symptoms? A) A pattern of distinct exacerbations and remissions B) Severe diarrhea C) An absence of blood in stool D) Involvement of the rectal mucosa

Ans: C Feedback: Bloody stool is far more common in cases of UC than in Crohn's. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohn's) and patients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohn's often has a more prolonged and variable course.

33. A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patient's fluid volume excess? Select all that apply. A) Administering diuretics B) Administering calcium channel blockers C) Implementing fluid restrictions D) Implementing a 1500 kcal/day restriction E) Enhancing patient positioning

Ans: A, C, E Feedback: Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize the management of fluid volume excess. Calcium channel blockers and calorie restriction do not address this problem.

40. A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL. For what complication is this patient at risk? A) Chronic jaundice B) Pigment stones in portal circulation C) Central nervous system damage D) Hepatomegaly

Ans: C Feedback: Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for CNS damage. There are not specific risks of hepatomegaly or chronic jaundice resulting from high bilirubin.

37. A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following? A) Continuous monitoring for portal hypertension B) Administration of immunosuppressive drugs during the first weeks after transplantation C) Real-time monitoring of vascular changes in the hepatic system D) Delivery of a continuous chemotherapeutic dose

Ans: D Feedback: In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter does not monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system.

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 bots of diarrhea

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is MOST appropriate? a) Cutting the faceplate opening no more than 2" larger than the stoma b) Scrubbing the area around the stoma c) Gently washing the area surrounding the stoma using a facecloth and mild soap d) Eliminating wrinkles in the faceplate

Gently washing the area surrounding the stoma using a facecloth and mild soap

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Hypotension Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.

A client diagnosed with colon cancer presents with the characteristic symptoms of a left-sided lesion. Which symptoms are indicative of this disorder? Select all that apply.

Narrowing stools Constipation Abdominal distention

The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician? a) Pain b) Low-grade fever c) Rebound tenderness d) Nausea

Nausea Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on?

Proton-pump inhibitor and two antibiotics

Which of the following diagnostic studies definitely confirms the presence of ascites?

Ultrasound of liver and abdomen Explanation: Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites. An abdominal x-ray, colonoscopy, and computed tomography of the abdomen would not confirm the presence of ascites.

Which position should be used for a client undergoing a paracentesis?

Upright at the edge of the bed Explanation: The client should be placed in an upright position on the edge of the bed or in a chair with the feet supported on a stool. The Fowler position should be used for the client confined to bed.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from:

perforation of the colon caused by the liver biopsy. Explanation: After any invasive procedure, the nurse must stay alert for complications in the affected region — in this case, the abdomen. This client exhibits classic signs and symptoms of a perforated colon — severe abdominal pain, fever, and a decreasing level of consciousness. After detecting these findings, the nurse must notify the physician immediately — the client is experiencing a medical emergency and requires abdominal surgery and bowel resection. There is no reason to suspect bleeding resulting from the liver biopsy, although this condition must be ruled out. Bleeding would cause hypotension and signs of decreasing perfusion to major organs, not severe pain. Liver biopsy doesn't involve the use of contrast media.

- Peritonitis

An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients?

Decreased abdominal strenght

The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do?

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation.

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?

Normal activities may be resumed in 1 week

Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis?

Such clients cannot tolerate high-glucose concentration.

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

fecal incontinence

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 reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. - Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. - 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.

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? a) Normal erythrocyte sedimentation rate (ESR) b) Subnormal temperature c) Hypotension d) Bradycardia

C (Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.)

An older adult has a diagnosis of Alzheimer disease and has recently been experiencing fecal incontinence. However, the nurse has observed no recent change in the character of the client's stools. What is the nurse's most appropriate intervention?

Keep a food diary to determine the foods that exacerbate the client's symptoms.

The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

Notify the physician. Abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the physician.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

Peritonitis Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

A client's large bowel obstruction has failed to resolve spontaneously and the client's worsening condition has warranted admission to the medical unit. Which of the following aspect of nursing care is most appropriate for this client?

Preparing the client for surgical bowel resection

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?

Radioisotope liver scan Explanation: A radioisotope liver scan assesses liver size and hepatic blood flow and obstruction. MRI is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. EEG is used to detect abnormalities that occur with hepatic coma.

A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment?

electrocardiogram (ECG) results

lack of free water intake

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? 1. lack of solid food 2. lack of exercise 3. increased fiber 4. lack of free water intake

lack of free water intake

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? lack of free water intake lack of solid food lack of exercise increased fiber

lack of free water intake

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?

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

Ranson's criteria

With this tool, if 2 criteria, manage with supportive care. if 4 criteria, 15% mortality rate; if 5-6 critera, 40% mortality rate; if 7+ criteria, over 40% mortality rate.

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? - Accumulation of gas - Constipation - Paralytic ileus - Peritonitis

- Peritonitis

Which category of laxatives draws water into the intestines by osmosis? - Bulk-forming agents (e.g., psyllium) - Saline agents (e.g., magnesium hydroxide) - Stimulants (e.g., bisacodyl) - Fecal softeners (e.g., docusate)

- Saline agents (e.g., magnesium hydroxide)

39. A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? A) Destruction of the patient's liver tumor B) Restoration of portal vein patency C) Destruction of a liver abscess D) Reversal of metastasis

Ans: A Feedback: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique does not address circulatory function or abscess formation. It does not allow for the reversal of metastasis.

27. A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer's lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient? A) Arterial line B) Diuretics C) Foley catheter D) Volume expanders

Ans: D Feedback: Because patients with bleeding esophageal varices have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes. Diuretics would reduce vascular volume. An arterial line and Foley catheter are likely to be ordered, but neither actively maintains the patient's volume.

Crohn's characteristics include:

More common in women. Can occur anywhere from mouth to anus, but most common site is terminal ileum. Skip lesions, entire thickness of bowel wall is affected, can also cause skin lesions and arthritis. It is slow and progressive with no cure. S/s/ include hyperactive BS, crampy pain, RLQ tenderness, bloody diarrhea, malabsoprtion, scalloped folds.

The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient?

Respiratory assessment related to increased thoracic pressure Explanation: If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? - Hemorrhoids - Weight gain - Duodenal ulcers - Polyps

- Polyps

A nurse is working with a patient who is learning to care for a continent ileostomy (Kock pouch). Following the initial period of healing, the nurse is teaching the patient how to independently empty the ileostomy. The nurse should teach the patient to do which of the following actions? A) Aim to eventually empty the pouch every 90 minutes. B) Avoid emptying the pouch until it is visibly full. C) Insert the catheter approximately 5 cm into the pouch. D) Aspirate the contents of the pouch using a 60 mL piston syringe.

Ans: C Feedback: To empty a Kock pouch, the catheter is gently inserted approximately 5 cm to the point of the valve or nipple. The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. It is not appropriate to wait until the pouch is full, and this would not be visible. The contents of the pouch are not aspirated.

28. A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention? A) Administration of immune globulins B) A regimen of antiviral medications C) Rest and watchful waiting D) Administration of fresh-frozen plasma (FFP)

Ans: B Feedback: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP are not indicated.

Celiac sprue is an example of which category of malabsorption? a) Infectious diseases causing generalized malabsorption b) Mucosal disorders causing generalized malabsorption c) Luminal problems causing malabsorption d) Postoperative malabsorption

Mucosal disorders causing generalized malabsorption

Chronic pancreatitis

Progressively worse with increased pancreatic fibrous tissue. Very high fat and very low fat diets can both cause. Fetal position helps pain. Attacks can occur for a period of 2 ays up to 2 weeks. Seeing food causes pain. Pts appear malnourished and malabsorption syndrome can occur once only 10% of pancreas is left. Pts have exocrine insufficiency.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? - Prepare the client for a gastrostomy tube placement. - Administer topical ointment to the rectal area to decrease bleeding. - Administer morphine (Duramorph PF) routinely, as ordered. - Test all stools for occult blood.

- Test all stools for occult blood.

A nurse is planning discharge teaching for a 21-year-old patient with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the patient's coping after discharge? A) The family's ability to take care of the patient's special diet needs B) The family's ability to monitor the patient's changing health status C) The family's ability to provide emotional support D) The family's ability to manage the patient's medication regimen

Ans: C Feedback: Emotional support from the family is key to the patient's coping after discharge. A 21-year-old would be expected to self-manage the prescribed medication regimen and the family would not be primarily responsible for monitoring the patient's health status. It is highly beneficial if the family is willing and able to accommodate the patient's dietary needs, but emotional support is paramount and cannot be solely provided by the patient alone.

15. A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure? A) Position the patient on the right side with a pillow under the costal margin after the procedure. B) Administer 1 unit of albumin 90 minutes before the procedure as ordered. C) Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure. D) Confirm that the patient's electrolyte levels have been assessed prior to the procedure.

Ans: A Feedback: Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Prior administration of albumin or PRBCs is unnecessary. Coagulation tests should be performed, but electrolyte analysis is not necessary.

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? Loud bowel sounds Borborygmus Tenesmus Peristalsis

Borborygmus

A positive Rovsing's sign is indicative of appendicitis. A nurse knows to assess for this indicator by palpating the:

Left lower quadrant.

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome?

Minimizing social isolation

An adolescent, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention is appropriate? a) Providing small, frequent meals b) Providing high-fiber snacks c) Administering digestive enzymes before meals as ordered d) Administering antibiotics with meals as ordered

Providing small, frequent meals

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin Explanation: Vasopressin may be the initial therapy for esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? - Stoma site not sensitive to touch - Beefy red stoma site - Clear mucus mixed with yellow urine drained from the appliance bag - Red, sensitive skin around the stoma site

- Red, sensitive skin around the stoma site

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason? - The client may develop arthritis or arthralgia. - The client's natural bowel function may become sluggish. - The client may lose his or her appetite. - The client may develop inflammatory bowel disease.

- The client's natural bowel function may become sluggish.

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?

Measure abdominal girth according to a set routine. Explanation: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. 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.

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis? a) Recent weight loss and temperature elevation b) Presence of blood in the client's stool and recent hypertension c) Adventitious breath sounds and hypertension d) Presence of easy bruising and bradycardia

Recent weight loss and temperature elevation

A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which nursing measure is the highest priority for this client? a) Educate the client concerning changes occurring in the gallbladder as a result of pregnancy. b) Discuss nutritional strategies to decrease the possibility of heartburn. c) Support the client's use of acetaminophen to relieve pain. d) Refer the client to her health care provider for evaluation and treatment of the pain

Refer the client to her health care provider for evaluation and treatment of the pain

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? The consistency of stool and comfort when passing stool That the client has a bowel movement daily That the stool is formed and soft The client is able to fully evacuate with each bowel movement

The consistency of stool and comfort when passing stool

The nurse is caring for a client who describes changes in his voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal?

Urine retention

During the first few weeks after a cholecystectomy, the client should follow a diet that includes: a) a decreased intake of fruits, vegetables, whole grains, and nuts, to minimize pressure within the small intestine. b) ingestion of pancreatic enzymes with meals to replace the normal enzyme secretion that has been surgically altered. c) at least four servings daily of meat, cheese, and peanut butter to increase protein intake that aids incisional healing. d) a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at any one time.

a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at any one time.

20. During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus? A) Following proper hand-washing techniques B) Avoiding chemicals that are toxic to the liver C) Wearing a condom during sexual contact D) Limiting alcohol intake

Ans: A Feedback: Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major method of prevention. Hepatitis E is transmitted by the fecal-oral route, principally through contaminated water in areas with poor sanitation. Consequently, none of the other listed preventative measures is indicated.

5. A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding? A) Document the presence of normal bile output. B) Irrigate the drainage system with normal saline as ordered. C) Aspirate a sample of the drainage for culture. D) Promptly report this assessment finding to the primary care provider.

Ans: A Feedback: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

29. A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace? A) Disposing of sharps appropriately and not recapping needles B) Performing meticulous hand hygiene at the appropriate moments in care C) Adhering to the recommended schedule of immunizations D) Wearing an N95 mask when providing care for patients on airborne precautions

Ans: A Feedback: HCV is bloodborne. Consequently, prevention of needlestick injuries is paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control, but these actions do not directly mitigate the risk of HCV.

14. A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patient's continuing care, the nurse should prioritize which of the following risk diagnoses? A) Risk for Infection Related to Immunosuppressant Use B) Risk for Injury Related to Decreased Hemostasis C) Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis D) Risk for Contamination Related to Accumulation of Ammonia

Ans: A Feedback: Infection is the leading cause of death after liver transplantation. Pulmonary and fungal infections are common; susceptibility to infection is increased by the immunosuppressive therapy that is needed to prevent rejection. This risk exceeds the threats of injury and unstable blood glucose. The diagnosis of Risk for Contamination relates to environmental toxin exposure.

7. A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patient's presentation? A) "How many alcoholic drinks do you typically consume in a week?" B) "To the best of your knowledge, are your immunizations up to date?" C) "Have you ever worked in an occupation where you might have been exposed to toxins?" D) "Has anyone in your family ever experienced symptoms similar to yours?"

Ans: A Feedback: Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status, occupational risks, and family history are also relevant considerations, but alcohol use is a more common etiologic factor in liver disease.

9. A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Palmar erythema

Ans: A Feedback: The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.

4. A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply. A) Immunization B) Use of standard precautions C) Consumption of a vitamin-rich diet D) Annual vitamin K injections E) Annual vitamin B12 injections

Ans: A, B Feedback: People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. The consistent use of standard precautions is also highly beneficial. Vitamin supplementation is unrelated to an individual's risk of HBV.

26. A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform? A) Keep patient NPO until the results of test are known. B) Keep patient NPO until the patient's gag reflex returns. C) Administer analgesia until post-procedure tenderness is relieved. D) Give the patient a cold beverage to promote swallowing ability.

Ans: B Feedback: After the examination, fluids are not given until the patient's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the patient's physical condition and mental status permit. The result of the test is known immediately. Food and fluids are contraindicated until the gag reflex returns.

11. A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis? A) Finish all prescribed courses of antibiotics, regardless of symptom resolution. B) Adhere to dosing recommendations of OTC analgesics. C) Ensure that expired medications are disposed of safely. D) Ensure that pharmacists regularly review drug regimens for potential interactions.

Ans: B Feedback: Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Finishing prescribed antibiotics and avoiding expired medications are unrelated to this disease. Drug interactions are rarely the cause of drug-induced hepatitis.

24. A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient's plan of care? A) Measurement of abdominal girth and body weight B) Assessment for variceal bleeding C) Assessment for signs and symptoms of jaundice D) Monitoring of results of liver function testing

Ans: B Feedback: Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse's assessments and should be prioritized over the other listed assessments, even though each should be performed.

32. A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the patient's cognition and behavior. What is the nurse's most appropriate response? A) Ensure that the patient's sodium intake does not exceed recommended levels. B) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy. C) Inform the primary care provider that the patient should be assessed for alcoholic hepatitis. D) Implement interventions aimed at ensuring a calm and therapeutic care environment.

Ans: B Feedback: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the patient's physiologic deterioration.

30. A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patient's care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma. A) 1, 2, 5, 4, 3 B) 1, 2, 3, 4, 5 C) 2, 3, 1, 4, 5 D) 3, 1, 2, 5, 4

Ans: B Feedback: Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure unless he or she receives a liver transplant.

13. A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases? A) Persistent fever and cognitive changes B) Abdominal pain and hepatomegaly C) Peripheral edema unresponsive to diuresis D) Spontaneous bleeding and jaundice

Ans: B Feedback: The early manifestations of malignancy of the liver include pain—a continuous dull ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.

35. A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patient's prioritization for receiving a donor liver be determined? A) By considering the patient's age and prognosis B) By objectively determining the patient's medical need C) By objectively assessing the patient's willingness to adhere to post-transplantation care D) By systematically ruling out alternative treatment options

Ans: B Feedback: The patient would undergo a classification of the degree of medical need through an objective determination known as the Model of End-Stage Liver Disease (MELD) classification, which stratifies the level of illness of those awaiting a liver transplant. This algorithm considers multiple variables, not solely age, prognosis, potential for adherence, and the rejection of alternative options.

36. A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient states that she fell when transferring to the commode. The patient's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action? A) Remove the patient's commode and supply a bedpan. B) Complete an incident report and submit it to the unit supervisor. C) Have the patient assessed by the physician due to the risk of internal bleeding. D) Perform a focused abdominal assessment in order to rule out injury.

Ans: C Feedback: A fall would necessitate thorough medical assessment due to the patient's risk of bleeding. The nurse's abdominal assessment is an appropriate action, but is not wholly sufficient to rule out internal injury. Medical assessment is a priority over removing the commode or filling out an incident report, even though these actions are appropriate.

16. A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

Ans: C Feedback: Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.

6. A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize? A) The patient will obtain measurement of drainage from the T-tube. B) The patient will exercise three times a week. C) The patient will take immunosuppressive agents as required. D) The patient will monitor for signs of liver dysfunction.

Ans: C Feedback: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.

10. A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine? A) The hepatitis A vaccine B) Albumin infusion C) The hepatitis A and B vaccines D) An immune globulin injection

Ans: D Feedback: For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular administration of immune globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A. Albumin confers no therapeutic benefit.

Mucosal disorders causing generalized malabsorption In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

Celiac sprue is an example of which category of malabsorption?

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?

Ineffective breathing pattern Explanation: In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this problem may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after the client establishes and maintains an effective breathing pattern.

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? a) Impaired gas exchange related to increased blood flow b) Excess fluid volume related to peripheral vascular disease c) Ineffective peripheral tissue perfusion related to venous congestion d) Risk for injury related to edema

Ineffective peripheral tissue perfusion related to venous congestion

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?

It is the third most common cancer in the United States. Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85). Colorectal cancer occurrence is higher in people with a family history of colon cancer.

The nurse is administering medications to a client 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?

Lactulose (Cephulac) Explanation: Lactulose 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 are used to treat ascites. Cholestyramine is a bile acid sequestrant and reduces pruritus. Kanamycin decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent.

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

Suggest fluid intake of at least 2 L/day

A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client?

Vasopressin (Pitressin) or ?Octreotide? Explanation: In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Vasopressin (Pitressin) may be the initial mode of therapy in urgent situations, because it produces constriction of the splanchnic arterial bed and decreases portal pressure. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

An apartment fire spreads to seven apartment units. Victims suffer burns, minor injuries, and broken bones from jumping from windows. Which client should be transported first? a) a 20-year-old with first-degree burns on her hands and forearms b) a middle-aged man with no injuries who has rapid respirations and coughs c) a 10-year-old with a simple fracture of the humerus who is in severe pain d) a woman who is 5 months pregnant with no apparent injuries

a middle-aged man with no injuries who has rapid respirations and coughs

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 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?

Cholelithiasis Explanation: Initially, with cholelithiasis clients experience belching, nausea, and right upper quadrant 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.

A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?

Liver biopsy

21. A patient's physician has ordered a "liver panel" in response to the patient's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply. A) Alanine aminotransferase (ALT) B) C-reactive protein (CRP) C) Gamma-glutamyl transferase (GGT) D) Aspartate aminotransferase (AST) E) B-type natriuretic peptide (BNP)

Ans: A, C, D Feedback: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.

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). The nurse suspects the client will be diagnosed with: a) inflammatory bowel disease (IBD). b) colorectal cancer. c) diverticulitis. d) liver failure.

A (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. Colorectal cancer is usually diagnosed after the client complains of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states he has chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.)

A nurse is providing care for a patient whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis? A) Encourage the patient to conduct online research into colostomies. B) Engage the patient in the care of the ostomy to the extent that the patient is willing. C) Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem. D) Emphasize the fact that the colostomy is temporary measure and is not permanent.

Ans: B Feedback: For some patients, becoming involved in the care of the ostomy helps to normalize it and enhance familiarity. Emphasizing the benefits of the intervention is unlikely to improve the patient's body image, since the benefits are likely already known. Online research is not likely to enhance the patient's body image and some ostomies are permanent.

A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home setting? A) Apply antibiotic ointment as ordered after cleaning the stoma. B) Apply a skin barrier to the peristomal skin prior to applying the pouch. C) Dispose of the clamp with each bag change. D) Cleanse the area surrounding the stoma with alcohol or chlorhexidine.

Ans: B Feedback: Guidelines for changing an ileostomy appliance are as follows. Skin should be washed with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to applying the pouch. Clamps are supplied one per box and should be reused with each bag change. Topical antibiotics are not utilized, but an antifungal spray or powder may be used

A nurse caring for a patient with a newly created ileostomy assesses the patient and notes that the patient has had not ostomy output for the past 12 hours. The patient also complains of worsening nausea. What is the nurse's priority action? A) Facilitate a referral to the wound-ostomy-continence (WOC) nurse. B) Report signs and symptoms of obstruction to the physician. C) Encourage the patient to mobilize in order to enhance motility. D) Contact the physician and obtain a swab of the stoma for culture.

Ans: B Feedback: It is important to report nausea and abdominal distention, which may indicate intestinal obstruction. This requires prompt medical intervention. Referral to the WOC nurse is not an appropriate short-term response, since medical treatment is necessary. Physical mobility will not normally resolve an obstruction. There is no need to collect a culture from the stoma, because infection is unrelated to this problem

A patient's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the patient has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation? A) Ensure that the patient knows that he or she will be responsible for care after discharge. B) Reassure the patient that many people are fearful after the creation of an ostomy. C) Acknowledge the patient's reluctance and initiate discussion of the factors underlying it. D) Arrange for the patient to be seen by a social worker or spiritual advisor.

Ans: C Feedback: If the patient is reluctant to participate in ostomy care, the nurse should attempt to dialogue about this with the patient and explore the factors that underlie it. It is presumptive to assume that the patient's behavior is motivated by fear. Assessment must precede referrals and emphasizing the patient's responsibilities may or may not motivate the patient.

A nurse is talking with a patient who is scheduled to have a hemicolectomy with the creation of a colostomy. The patient admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. Which of the following nursing actions is most appropriate? A) Reassure the patient that the procedure is relatively low risk and that patients are usually successful in adjusting to an ostomy. B) Provide the patient with educational materials that match the patient's learning style. C) Encourage the patient to write down these concerns and questions to bring forward to the surgeon. D) Maintain an open dialogue with the patient and facilitate a referral to the wound-ostomy-continence (WOC) nurse.

Ans: D Feedback: A wound-ostomy-continence (WOC) nurse is a registered nurse who has received advanced education in an accredited program to care for patients with stomas. The enterostomal nurse therapist can assist with the selection of an appropriate stoma site, teach about stoma care, and provide emotional support. The surgeon is less likely to address the patient's psychosocial and learning needs. Reassurance does not address the patient's questions, and education may or may not alleviate anxiety.

Colitis characteristics include:

Characteristics include mucosal and submucosal layers affected. Can cause frank bloody or watery stool, high temp, abdominal cramping, weight loss. More common in men. Starts distally.

Which of the following the are early manifestations of liver cancer? Select all that apply.

• Pain • Continuous aching in the back

An adolescent client scheduled for an emergency appendectomy is to be transferred directly from the emergency department to the operating room. Which statement by the client should the nurse interpret as most significant? a) "It hurts when you press on my stomach." b) "I feel like I am going to throw up." c) "All of a sudden it does not hurt at all." d) "The pain is centered around my navel."

"All of a sudden it does not hurt at all."

A client is complaining of problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool?

Increase dietary fiber.

The mother of a 16-year-old girl calls the emergency department, suspecting her daughter's abdominal pain may be appendicitis. In addition to pain, her daughter has a temperature of 100° F (37.7° C) and has vomited twice. What should the nurse tell the mother? a) "It's most likely the flu because your daughter is too young to have appendicitis." b) "Give your daughter a laxative to rule out the possibility that constipation is causing the pain." c) "Gently press on the lower left quadrant of your daughter's abdomen to test for rebound tenderness." d) "Bring your daughter into the emergency department immediately before her appendix has a chance to rupture."

"Bring your daughter into the emergency department immediately before her appendix has a chance to rupture."

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse shuld tell the client: a) "The side effects of steroids outweigh their benefits to clients with ulcerative colitis." b) "Ulcerative colitis can be cured by the use of steroids." c) "Steroids are used in severe flare-ups because they can decrease the incidence of bleeding." d) "Long-term use of steroids will prolong periods of remission."

"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. Based on the diagnosis of acute pancreatitis the nurse will provide which explanation for the prescribed interventions? a) "I will be starting antibiotic therapy once the blood cultures are obtained." b) "I can offer you ibuprofen for pain with a small sip of water." c) "Activity is important, so you will be scheduled for physical therapy." d) "You are not allowed anything by mouth so that your pancreas can rest"

"You are not allowed anything by mouth so that your pancreas can rest"

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 keep a record of food intake - Assist the client regarding the correct diet or to minimize food intake - Instruct the client to avoid prune or apple juice

- Suggest fluid intake of at least 2 L/day

GGT normal

0-30 u/L gamma-glutamyl transferase

Liver biopsy postprocedure

1. Immediately after the biopsy, assist the patient to turn on to the right side; place a pillow under the costal margin, and caution the patient to remain in this position, recumbent and immobile, for several hours. Instruct the patient to avoid coughing or straining. 1. In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation is prevented.

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required?

1.5 L

A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount?

450 mL

Which client would be at greatest risk for the development of an anorectal fistula?

A 35-year-old female with Crohn's disease

Test all stools for occult blood.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver?

Ascites Hepatomegaly

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?

Ask the client to remain inactive for 5 minutes.

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?

Ask the client to remain inactive for 5 minutes. Explanation: After applying the ostomy appliance, the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.

A client with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?

Assess for a thrill or bruit over the vascular access site each shift.

A client has recovered well from bariatric surgery 3 weeks ago, but during the nurse's most recent assessment, the client states, "I'm having some trouble swallowing my food, and that was never an issue before." What is the nurse's best initial action?

Assess the client for signs and symptoms of dumping syndrome

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? a) Azotorrhea b) Borborygmus c) Tenesmus d) Diverticulitis

Borborygmus

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction?

Avoid aspirin and products that contain aspirin

A client with a history of IV drug use is being treated for hepatitis, and presents today with jaundice and arthralgias. This client most likely has hepatitis:

A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for?

Billroth I

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. 1. Salami on whole grain bread and V-8 juice 2. A peanut butter sandwich and fruit cup 3. Broiled chicken with low-fiber pasta 4. A fruit salad with yogurt

Broiled chicken with low-fiber pasta

The nurse is teaching a patient with an ostomy how to change the pouching system. Which of the following should the nurse include in the teaching of a patient with no peristomal skin irritation? a) Apply Kenalog spray b) Apply barrier powder c) Dry skin thoroughly after washing d) Dust with nystatin powder

C (The nurse should teach the patient without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, Kenalog spray, and nystatin powder are used when there is peristomal skin irritation and/or fungal infection.)

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?

CT scan

Stomach capacity

Capacity for this is 1500 mL

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?

Chenodiol

While listening to a client's chest, the nurse notes a rub during inspiration and expiration with a grating sound. When communicating to the health care provider, what should the nurse request in the SBAR communication? a) Chest x-ray b) Arterial blood gasses c) Broncodialator small volume nebulizer treatments d) Narcotic pain medications

Chest x-ray

Which of the following laxatives should be used by a cardiac patient who should avoid straining? a) Milk of Magnesia b) Colace c) Mineral Oil d) Dulcolax

Colace Colace can be used safely by patients who should avoid straining such as cardiac patients and those with anorectal disorders. Milk of Magnesia is a saline agent. Dulcolax is a stimulant. Mineral oil is a lubricant.

A nurse should expect to administer which medication to a client with gout? a) Aspirin b) Calcium gluconate c) Colchicine d) Furosemide

Colchicine

A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions?

Continue totake antacids even if your symptoms subside You may be prescribed H2-receptor antagonists for up to 1 year

A client with gastric cancer is having a resection. What is the nursing management priority for this client?

Correcting nutritional deficits

The nurse working in the ED is evaluating a patient for signs and symptoms of appendicitis. Which of the patient's signs/symptoms should the nurse include in the report to the physician on the patient's signs/symptoms of appendicitis? a) Left lower quadrant pain b) Pain when pressure is applied to the right lower quadrant of the abdomen c) High fever d) Nausea

D (Nausea is typically associated with appendicitis with or without vomiting. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.)

The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included?

Do not eat and drink at the same time Drink plenty of water, from 90 minutes after each meal to 15 minutes after each meal to 15 minutes before each meal Avoid fruit drinks and soda

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?

Endoscopy with mucosal biopsy Endoscopy with biopsy of the mucosa is the best diagnostic tool for malabsorption syndrome.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir?

Every 4 to 6 hours

Which of the following is accurate regarding regional enteritis?

Exacerbations and remissions

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

Familial polyposis

Protein Synthesis

Globulin-alpha & beta Albumin Fibrinogen Amino Acid Vitamin K

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Hemoglobin and hematocrit

Which type of jaundice is the result of increased destruction of red blood cells?

Hemolytic

After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?

I'll have to wear an external collection pouch for the rest of my life

During assessment of a patient with gastritis, the nurse practitioner attempts to distinguish acute from chronic pathology. One criteria, characteristic of gastritis would be the:

Immediacy of the occurence

Whipple procedure

In this procedure, the duodenum, the gallbladder, part of the common bile duct, part of the the stomach, and the head of the pancreas are removed. Pts are very ill before and after it.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? Inflammation of all layers of intestinal mucosa Infectious disease Disaccharidase deficiency Gastric resection

Inflammation of all layers of intestinal mucosa

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response?

Inform the primary provider that the vascular supply may be compromised.

A client reports having increased incidence of constipation. What can cause constipation?

Insufficient fiber Emotional stress Inactivity

Which is the most prominent signs of inflammatory bowel disease?

Intermittent pain and diarrhea

Minerals that are stored in the liver:

Iron&copper

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply.

Jaundice Petechiae Ecchymoses Explanation: The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

Loperamide

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

Loss of 2.2 lb (1 kg) in 24 hours

Which assessments are important in a client diagnosed with ascites?

Measurement of abdominal girth Explanation: Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the client diagnosed with ascites. Foul-smelling breath would not be considered an important assessment for this client.

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate?

Metabolic acidosis

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for?

Metabolic acidosis

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction? Nausea and vomiting Decrease in urine production Mucus in the stool Mucosal edema

Nausea and vomiting

severe abdominal pain with direct palpation or rebound tenderness.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

The nurse is teaching a patient who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the patient chooses which of the following food choices from the menu?

Pancakes with butter and honey and orange juice

During assessment of a client for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, what diagnosis will the nurse suspect?

Pancreatic insufficiency

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?

Respiratory acidosis

Which category of laxatives draws water into the intestines by osmosis?

Saline agents (e.g., magnesium hydroxide)

Which category of laxatives draws water into the intestines by osmosis?

Saline agents (magnesium hydroxide)

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?

Spironolactone (Aldactone)

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?

Spironolactone (Aldactone) Explanation: For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care?

Strain the client's urine following the procedure.

A client was admitted to a critical care unit with esophageal varices and a precarious physical condition. What predisposes the client to have bleeding varices?

Straining at stool Little protective tissue to protect fragile veins Rough food Chemical irritation

What clinical indication of hyperphosphatemia does the nurse assess in a patient?

Tetany

A nurse is educating a client who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the dietary teaching?

The amount of protein is not restricted in the diet

The nurse notes that a client with acute pancreatitis occasionally experiences muscle twitching and jerking. How should the nurse interpret the significance of these symptoms? a) The client is experiencing a reaction to meperidine. b) The client needs a muscle relaxant to promote rest. c) The client has a nutritional imbalance. d) The client may be developing hypocalcemia.

The client may be developing hypocalcemia.

Which outcome indicates effective client teaching to prevent constipation?

The client reports engaging in a regular exercise regimen.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?

The client's hands flap back and forth when the arms are extended

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason?

The client's natural bowel function may become sluggish.

solid. With a sigmoid colostomy, the feces are solid. With a descending colostomy, the feces are semimushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid.

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?

The physician will use an ultrasound guided paracentesis

Increase bilirubin may indicate

This may indicate obstruction.

Gall bladder characteristics

This structure stores about 30-50 mL of bile. Water is absorbed into the wall so bile is 5-10x more concentrated. If obstructed, no bile to intestine, so clay colored stool and jaundice may occur.

A patient is diagnosed with hypocalcemia. The nurse advises the patient and his family to immediately report the most characteristic manifestation. What is the most characteristic manifestation?

Tingling or twitching sensation in the fingers

Which symptom characterizes regional enteritis?

Transmural thickening

A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder? A. Trigeminal neuralgia B. Angina Pectoris C. Migraine Headache D. Bells Palsy

Trigeminal neuralgia

A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:

Trousseau's sign.

Colorectal cancer characteristics:

Tx is based on stage. R side causes intermittent pain, black tarry stool, ribboning blood. L side causes rectal bleeding and diarrhea. 3rd most common site of new cancer in the US.

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? Alcohol consumption Activity levels Usual pattern of elimination Current medications

Usual pattern of elimination

Which of the following is the most effective strategy to prevent hepatitis B infection

Vaccine Explanation: The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin (Pitressin)

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?

Vitamin K Explanation: 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.

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing?

Vitamin K deficiency

presents with a rigid, boardlike abdomen.

Which client requires immediate nursing intervention? The client who:

A 35-year-old female with Crohn's disease

Which of the following clients would be at greatest risk for the development of an anorectal fistula?

qqq A 35-year-old female with Crohn's disease

Which of the following clients would be at greatest risk for the development of an anorectal fistula?

Colorectal cancer is the third most common site of cancer in the United States.

Which statement provides accurate information regarding cancer of the colon and rectum?

Borborygmus

Which term refers to intestinal rumbling?

White blood cell (WBC) count 22.8/mm3

Gamma-glutamyl transferase (GGT) elevated in

alcohol abuse and makers for biliary cholestasis ( a condition where bile cannot flow from the liver to the duodenum)

When a client has an acute attack of diverticulitis, the nurse should first: a) encourage the client to drink a glass of water every 2 hr. b) prepare the client for a colonoscopy. c) assess the client for signs of peritonitis. d) encourage the client to eat a high-fiber diet.

assess the client for signs of peritonitis.

The liver manufactures and secretes________ which has a major role in the digestion and absorption of fats in the GI tract.

bile

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:

cannot tolerate high-glucose concentration. Explanation: Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

Aspartate aminotransferase (AST) indicate

damaged liver cells The studies are based on release of enzymes from damaged liver cells. These enzymes are elevated in liver cell damage.

Alanine aminotransferase (ALT) indicate

damaged liver cells The studies are based on release of enzymes from damaged liver cells. These enzymes are elevated in liver cell damage.

Indirect bilirubin

difference between total and direct bilirubin

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

fissure.

The bile produced by the liver is stored temporarily in the _________ until it is needed for digestion, at which time the ______ empties and bile enters the intestine

gallbladder gallbladder

Which of the following is the most common complication associated with peptic ulcer?

hemorrhage

inflammatory bowel disease (IBD)

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)

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

inflammatory bowel disease (IBD)

laxative

Largest glad in the body?

liver

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?

mental confusion

Which client requires immediate nursing intervention? The client who:

presents with a rigid, board-like abdomen.

Amino acids are used by the liver for

protein synthesis

When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report? Rectal bleeding Pain Itching Soreness

rectal bleeding

Breakdown of fatty acids into ketone bodies occurs primary when the availability of glucose for metabolism is limited as in

starvation or in uncontrolled dibetes

A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:

who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?

Discontinue the irrigation immediately.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

Do not suppress the urge to defecate. Drink at least 8 to 10 large glasses of fluid every day. Use bulk-forming laxatives Encourage an individualized exercise program

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? a) Drink at least 8 to 10 large glasses of fluid every day b) Do not include unprocessed bran in the diet c) Regular use of laxatives and enemas at home d) Discourage regular exercise if pt. is inactive

Drink at least 8 to 10 large glasses of fluid every day

What information should the nurse include in the teaching plan for a client being treated for diverticulosis?

Drink at least 8 to 10 large glasses of fluid every day The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?

Dry skin thoroughly after washing

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? Dry skin thoroughly after washing Apply barrier powder Apply triamcinolone acetonide spray Dust with nystatin powder

Dry skin thoroughly after washing

The nurse is reviewing the laboratory test results of a client with Crohn disease. Which of the following would the nurse most likely find?

stool cultures for microorganisms or parasite

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? a) Low p.o. fluids. b) Low-protein diet. c) Low residue diet. d) High-calorie diet.

Low residue diet.

As part of the management of constipation, the client is instructed to take 30 mL of mineral oil orally. How does mineral oil facilitate bowel evacuation?

Lubricates and softens fecal matter

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which of the following instructions would be most appropriate? a) Maintain a low-carbohydrate, low-fat diet. b) Maintain a high-fat, high-carbohydrate diet. c) Maintain a high-carbohydrate, low-fat diet. d) Maintain a high-fat, low-carbohydrate diet.

Maintain a high-carbohydrate, low-fat diet.

A client undergoes surgery to remove a malignant tumor followed by a urinary diversion procedure. Which postoperative procedure is the most important for the nurse to perform?

Maintain skin and stomal integrity.

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

Maintaining skin integrity

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

One part of the intestine telescopes into another portion of the intestine.

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

One part of the intestine telescopes into another portion of the intestine. 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.

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a) Polyps b) Hemorrhoids c) Duodenal ulcers d) Weight gain

Polyps

A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

Polyps

The most common cause of esophageal varices includes which of the following?

Portal hypertension

Which is the most common cause of esophageal varices?

Portal hypertension

It is important for the nurse to monitor serum electrolytes in a patient with acute diarrhea. Select the electrolyte result that should be immediately reported.

Potassium of 2.8 mEq/L

A client is being treated for prolonged diarrhea. Which foods should the nurse encourage the client to consume?

Potassium-rich foods

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency?

Scurvy Explanation: Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate? a) respiratory acidosis b) respiratory alkalosis c) metabolic acidosis d) metabolic alkalosis

metabolic acidosis

In a client with enteritis and frequent diarrhea, the nurse should anticipate:

metabolic acidosis

A client has been diagnosed with cancer in the descending colon. Which symptoms would the nurse expect the client to report? Select all that apply.

narrowing of stools constipation

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

yellow sclerae.

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply.

• Ammonia conversion • Glucose metabolism • Protein metabolism

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply.

• fluid accumulation • venous pressure

The client's natural bowel function may become sluggish.

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?

Fissure

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

Every 4 to 6 hours The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir?

"You may have eaten contaminated restaurant food."

A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess?

A client with Crohn's disease

Assist client to increase dietary fiber.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? a) Excess fluid volume b) Decreased cardiac output c) Ineffective gastrointestinal tissue perfusion d) Deficient fluid volume

Deficient fluid volume

What is the primary nursing diagnosis for a client with a bowel obstruction?

Deficient fluid volume

The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for? Pain Fluid overload Fatigue Dehydration

Dehydration

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

Diarrhea

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

Diarrhea

high-fiber diet.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?

Endoscopy with mucosal biopsy

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify?

Enlarged liver size Ascites Hemorrhoids

Enterostomal nurse

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:

Intestinal malabsorption

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:

Intestinal malabsorption.

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a boardlike abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action?

Notify the health care provider.

Which statement indicates the client understands the lifestyle modifications required when managing ulcerative colitis? a) "I am allowed to have alcohol as long as I only drink wine." b) "I can eat popcorn for an evening snack." c) "I may have coffee with my meals." d) "I will have to stop smoking."

"I will have to stop smoking."

After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?

"I'll have to wear an external collection pouch for the rest of my life."

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

"Increase your fluid intake to 2 to 3 L per day."

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

"It is appropriate to warm the dialysate in a microwave."

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective?

"My urine will be eliminated through a stoma."

A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?

"You may have eaten contaminated restaurant food."

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? - Alcohol consumption - Activity levels - Usual pattern of elimination - Current medications

- Usual pattern of elimination

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?

Severe abdominal pain with direct palpation or rebound tenderness

Acute Pancreatitis symptoms

Severe epigastic pain that can radiate. N/v. Pain worsened by laying supine, the fetal position may help. Fever. Fluid shifts make managing shock difficult and less likely to be affected by vasoconstrictive meds. Kinin becomes activated (causes vasodilation). Severe disease: Abdominal distention with rigidity, peritonitis with rebound tenderness, septic shock. Assess for Cullen's sign (umbilicus) and Turner's sign (flanks)

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

Test all stools for occult blood.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? a) Administering an ointment b) Testing all stools for occult blood. c) Administering an opioid pain medication. d) Preparing a client for a gastrostomy tube.

Testing all stools for occult blood.

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?

The client exhibits signs of adequate GI perfusion

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?

The client exhibits signs of adequate GI perfusion.

Which is a true statement regarding regional enteritis (Crohn's disease)?

The clusters of ulcers take on a cobblestone appearance.

Right lower quadrant

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?

Drink at least 8 to 10 large glasses of fluid every day

A client is being treated for diverticulosis. Which information should the nurse include in this client's teaching plan?

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

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?

A community health nurse is performing a home visit to a 53-year-old patient who requires twice-weekly wound care on her foot. The patient mentions that she is currently having hemorrhoids, a problem that she has not previously experienced. What treatment measure should the nurse recommend to this patient? Daily application of topical antibiotics Decreased fluid intake Bathing, rather than showering, once per day A high-fiber diet with increased fruit intake

A high-fiber diet with increased fruit intake

A change in bowel habits

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: - alcohol consumption. - usual pattern of elimination. - current medications. - activity levels.

- usual pattern of elimination.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: - usual pattern of elimination. - alcohol consumption. - activity levels. - current medications.

- usual pattern of elimination.

Fatty acids used for the synthesis of

-Cholesterol-LDL, HDL -Lecithin-a fat -Lipoproteins-fat protein -Complex lipids

Functions of bile:

-Excretion of bilirubin -Aid in digestion -Emulsification of fats by bile salts

Direct bilirubin normal

0.1-0.4mg/dL

Total bilirubin normal

0.2-1.2mg/dL

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering?

0.45% NaCl

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution?

0.9% NS

AST normal

10-40 units per liter of serum aspartate aminotransferase

Below which serum sodium concentration might convulsions or coma occur?

135 mEq/L (135 mmol/L)

Suggest fluid intake of at least 2 L/day

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?

A client reports having increased incidence of constipation. What can cause constipation?

All options are correct.

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

Bisacodyl

Which drug is considered a stimulant laxative? a) Bisacodyl b) magnesium hydroxide c) mineral oil d) psyllium hydrophilic mucilloid

Bisacodyl Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline agent. Mineral oil is a lubricant. Psyllium hydrophilic mucilloid is a bulk-forming agent.

A patient is having a problem with retention of urine in the bladder. Which of the following diagnostic tests measures the amount of residual urine in the bladder?

Bladder ultrasonography

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching?

Drink 8 to 10 glasses of fluid daily.

Which of the following is a term used to describe intestinal rumbling?

Borborygmus

A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's diseterm-158ase, rather than ulcerative colitis, as the cause of the client's signs and symptoms?

An absence of blood in stool

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?

Angiography

The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?

Annual digital examination after age 40

A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate?

Anorexia Nausea and vomiting Epigastric fullness

A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patient's stools will have what characteristics? A) Watery with blood and mucus B) Hard and black or tarry C) Dry and streaked with blood D) Loose with visible fatty streaks

Ans: A Feedback: The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in patients who have ulcerative colitis.

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

Familial polyposis

Which characteristic is a risk factor for colorectal cancer?

Familial polyposis

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? a) Age under 40 years old. b) High-fat, high-protein, low-fiber diet. c) Familial polyposis (FHx of colon cancer). d) Familial history of basal cell carcinomas.

Familial polyposis (FHx of colon cancer).

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

Fecal incontinence

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

Fecal incontinence The nurse should anticipate fecal incontinence as one of the assessment findings. Other possible assessment findings include constipation and abdominal distention.

The mode of transmission of hepatitis A virus (HAV) includes which of the following?

Fecal-oral

How much water should you use to flush a nasogastric tube?

Flush NG tubes with 30 mL of water after each feeding and after each demonstration of medication.

A patient diagnosed with IBS is advised to eat a diet that is:

High in fiber.

An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?

Hypokalemia

Breast

In women, which of the following types of cancer exceeds colorectal cancer?

Which is a true statement regarding the nursing considerations in administration of metronidazole?

It leaves a metallic taste in the mouth

Notify the health care provider

Notify the health care provider.

A client with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the client will undergo what intervention?

Laparoscopic cholecystectomy

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which nursing diagnoses should the nurse consider when caring for this acutely ill client?

Potential for infection Acute pain and discomfort Alterations in respiratory function

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?

Prepare to assist with ventilation.

A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer?

Previous infection with H. pylori Age 55 years

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Purpura and petechiae

When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report?

Rectal bleeding

Which of the following is the most common symptom of a polyp?

Rectal bleeding

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

Rectal bleeding

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?

Usual pattern of elimination

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

Usual pattern of elimination

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: a) anorectal fistula b) anal fissure c) anal polyp d) hemorrhoids

anal fissure

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n):

anal fissure.

Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution? a) pain b) fluid balance c) altered level of consciousness d) anaphylactic reaction

anaphylactic reaction

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

anorexia, nausea, and vomiting.

The liver removes waste products from the bloodstream and secretes them into the________

bile

Liver biopsy percutaneous major complication is

bleeding. Leakage of bile causing peritonitis Pt, Ptt, and platelet count is done prior to biopsy

Pallor often seen with

chronic illness and jaundice

Drug Metabolism important pathway involves

conjugate (bind) of the medication with compounds glucuronic acid and acetic acid to make more water-soluble substances

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

constipation, diarrhea, or a combination of both

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:

cryoprecipitate and fresh frozen plasma.

fissure

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is:

gram-negative bacteria

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? - Avoiding bran cereals and beans in the diet - Adding fiber-rich foods to the diet gradually - Limiting fluid intake to 5 to 6 glasses per day - Minimizing activity levels for at least 2 months

- Adding fiber-rich foods to the diet gradually

The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery?

high Fowler's

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? - Anal fistula - Anorectal abscess - Hemorrhoid - Anal fissure

- Anal fissure

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse? - Diverticulitis - Ulcerative colitis - Appendicitis - Crohn's disease

- Appendicitis

A client with Crohn's disease is to receive prednisone as part of the treatment plan. Which of the following instructions would be appropriate? "Take the drug on an empty stomach to avoid upsetting your stomach." "Once your symptoms improve, you can stop taking the drug." "Make sure to increase your salt intake to compensate for the loss of fluid." "Avoid contact with other people who might have an infection."

"Avoid contact with other people who might have an infection."

A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?

"Hemodialysis is a treatment option that is usually required three times a week."

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?

"How often do you drink alcohol?" Explanation: The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: caffeinated products. spicy foods. high-fiber diet. fluids with meals.

high-fiber diet

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? - Assist client to increase dietary fiber. - Obtain medical and allergy history. - Provide adequate quantity of food. - Obtain complete food history.

- Assist client to increase dietary fiber.

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? - Obtain medical and allergy history. - Assist client to increase dietary fiber. - Obtain complete food history. - Provide adequate quantity of food.

- Assist client to increase dietary fiber.

Which term refers to intestinal rumbling? - Tenesmus - Azotorrhea - Borborygmus - Diverticulitis

- Borborygmus

Which is the most common presenting symptom of colon cancer? - Fatigue - Change in bowel habits - Anorexia - Weight loss

- Change in bowel habits

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? - Avoid daily exercise. - Use laxatives weekly. - Avoid unprocessed bran. - Drink 8 to 10 glasses of fluid daily.

- Drink 8 to 10 glasses of fluid daily.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? - Apply triamcinolone acetonide spray - Apply barrier powder - Dust with nystatin powder - Dry skin thoroughly after washing

- Dry skin thoroughly after washing

Which term refers to a protrusion of the intestine through a weakened area in the abdominal wall? - Tumor - Hernia - Volvulus - Adhesion

- Hernia

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? - Discontinue the use of any medication presently being taken to determine if medication is a trigger. - Keep a 1- to 2-week symptom and food diary to identify food triggers. - Document how much fluid is being taken to determine if the patient is overhydrating. - Begin an exercise regimen and biofeedback to determine if external stress is a trigger.

- Keep a 1- to 2-week symptom and food diary to identify food triggers.

Which drug is considered a stimulant laxative?

Bisacodyl

In women, which of the following types of cancer exceeds colorectal cancer?

Breast

Appendicitis characteristics include:

Characteristics include high WBCs, RLQ at McBurneys point with rebound tenderness.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? 1. Use laxatives weekly. 2. Drink 8 to 10 glasses of fluid daily. 3. Avoid daily exercise. 4. Avoid unprocessed bran.

Drink 8 to 10 glasses of fluid daily.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis?

Drink at least 8 to 10 large glasses of fluid every day

Which of the following is accurate regarding regional enteritis? Fistulas are common Severe diarrhea Severe bleeding Exacerbations and remissions

Exacerbations and remissions

The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan?

Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15-20 minutes

Gastric ulcers vs Duodenal ulcers

Gastric ulcers: Food makes worse Coffee ground or bright red emesis which makes it feel better Pain 0.5 - 1 hr after meals Age 50+ usually Can have increased stomach acid (tx PPI, Abx, etc) Duodenal ulcers: Food makes better Black tarry stool w/upper GI bleeding Pain usually 2-3 hr after meal Ages 30-60 usually

Loperamide

Vomiting results in which of the following acid-base imbalances?

Metabolic alkalosis

Which of the following is considered a bulk-forming laxative?

Metamucil

A female client is undergoing a bladder training program as treatment for urinary incontinence. Which of the following techniques would be the most appropriate suggestion?

Performing Kegel exercises.

Which type of diarrhea is caused by increased production of water and electrolytes by the intestinal mucosa and their secretion into the intestinal lumen?

Secretory diarrhea

A patient is prescribed Sandostatin for the treatment of esophageal varices. The nurse knows that the purpose of this cyclic octapeptide is to reduce portal pressure by:

Selective vasodilation of the portal system

The presence of mucus and pus in the stools suggests which condition?

Ulcerative colitis

Which condition indicates an overdose of lactulose?

Watery diarrhea

What is the MOST common cause of small-bowel obstruction? a) adhesions b) ulcers c) hernias d) tumors

adhesions

What symptoms of perforation might the nurse observe in a client with an intestinal obstruction? Select all that apply.

sudden, sustained abdominal pain abdominal distention

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): a) Hemorrhoid b) Anorectal abscess c) Anal fistula d) Anal fissure

Anal fissure

Borborygmus

Ac client with a lengthy history of alcohol addiction is diagnosed with cirrhosis. The nurse emphasizes that the principal goal of cirrhosis therapy is:

Which term refers to intestinal rumbling?

Borborygmus

Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?

Alcoholic cirrhosis

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?

Alcoholism

The single modality of pharmacologic therapy for chronic type B viral hepatitis is:

Alpha- interferon

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? 1. A client with hemorrhoids 2. A client with Crohn's disease 3. A client with diverticulosis 4, A client with colon cancer

A client with Crohn's disease

Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?

Ammonia

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse?

"Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated."

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? - That the client has a bowel movement daily - That the stool is formed and soft - The client is able to fully evacuate with each bowel movement - The consistency of stool and comfort when passing stool

- The consistency of stool and comfort when passing stool

Serum Ammonia normal

15-45mcg/dL elevates in liver failure (liver is unable to convert ammonia to urea

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? a) Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. b) The appendix may develop gangrene and rupture, especially in a middle-aged client. c) Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. d) Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

A (A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.)

Gently washing the area surrounding the stoma using a facecloth and mild soap

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

Acute glomerulonephritis

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?

Adding fiber-rich foods to the diet gradually

Which is the most common presenting symptom of colon cancer?

Change in bowel habits

PUD characteristics

Characteristics include erosion of the mucus membrane. Pt reports dull gnawing in high epigastrium 1-2 hrs post eating with heartburn and melena (dark, tarry stool).

Peritonitis characteristics:

Characteristics include inflammation of visceral lining. Blumberg's sign is a s/sx (rebounding pain upon removing pressure.).

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately? a) Hematocrit 42% b) Serum sodium 135 mEq/L c) Serum potassium 4.2 mEq/L d) White blood cell (WBC) count 22.8/mm3

D (The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.)

Which nursing assessment is most important in a client diagnosed with ascites?

Daily measurement of weight and abdominal girth

Which of the following would be the most important nursing assessment in a patient diagnosed with ascites?

Daily weight and measurement of abdominal girth

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration?

Dark, concentrated urine

A client is recovering from gastric surgery. What is the correct position for the nurse to place this client?

Fowler's

A client is complaining of problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool? Increase the carbohydrate content of the diet. Increase dietary fat consumption. Increase dietary protein such as lean meats. Increase dietary fiber.

Increase dietary fiber

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam?

It visualizes the gallbladder and bile duct.

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

Metabolic alkalosis

In actively bleeding patients with esophageal varices, the initial drug of therapy is usually:

Pitressin

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?

The client's natural bowel function may become sluggish.

Peritonitis

Familial polyposis

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?

Vitamin A Explanation: Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A palpable liver presents as a

firm sharp ridge with a smooth surface

Flexible sigmoidoscopy

The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery? Prone Sims' left lateral High Fowler's Supine with head of bed elevated 15 degrees

High Fowler's

High in fiber.

A patient diagnosed with IBS is advised to eat a diet that is:

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? - Frank blood in the stool - A change in bowel habits - Abdominal distention - Abdominal pain

- A change in bowel habits

- 0.9% NS

Which client requires immediate nursing intervention? The client who: - complains of epigastric pain after eating. - complains of anorexia and periumbilical pain. - presents with a rigid, boardlike abdomen. - presents with ribbonlike stools.

- presents with a rigid, boardlike abdomen.

The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet?

A pear

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?

Bloating after meals

Which of the following would be the least important assessment in a patient diagnosed with ascites?

Foul-smelling breath

A priority nursing intervention for a client with hypervolemia involves which of the following?

Monitoring respiratory status for signs and symptoms of pulmonary complications.

Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome?

Rimonabant (Acomplia)

A patient with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which of the following would be the most appropriate response from the nurse?

Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated.

A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome?

Steatorrhea

Technique for palpating the liver

The examiner places one hand under the right lower rib cage and presses downward during inspiration with light pressure with the other hand.

A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which of the following client statements indicates that the teaching was successful?

"I might need to have this procedure done again." Explanation: 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.

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 need to use laxatives regularly to prevent constipation."

A patient diagnosed with IBS is advised to eat a diet that is: - Restricted to 1,200 calories/day. - Sodium-restricted. - High in fiber. - Low in residue.

- High in fiber.

The liver stores what vitamins?

A,B,D

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?

Clamp the tubing and allow client to rest.

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?

Computed tomography scan A computed tomography scan is the diagnostic of choice if the suspected diagnosis is diverticulitis; it can also reveal one or more abscesses. A barium enema or colonoscopy may be used to diagnosis diverticulosis. Magnetic resonance imaging would not be used to diagnose diverticulitis.

Hirschsprung's disease characteristics

Congenital aganglionic megacolon (young age) that makes colon constrict and no peristalsis, so no stool passed. Common in Down's syndrome pts.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see?

Constipation

A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include?

Excess fluid volume related to generalized edema

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

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

A client with a 10-year history of Crohn's disease is seeing the physician due to increased diarrhea and fatigue. Additionally, the client has developed arthritis and conjunctivitis. What is the most likely cause of the latest symptoms?

Crohn's disease

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following?

Cystoscopy

Which is an age-related change of the hepatobiliary system?

Decreased blood flow

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.

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)?

Extreme gastric hyperacidity Severe peptic ulcers Gastrin-secreting tumors of the pancreas

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply.

HCO3 PaCO2 pH

Which of the following laboratory test results would the nurse associate with obstructive jaundice?

Increased direct bilirubin

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

Clients with inflammatory bowel disease (IBD) are at significantly increased risk for which condition? Osteoporosis DVT Hypotension Pneumonia

Osteoporosis

Peritonitis

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

Peritonitis

Which of the following manifestations are associated with a deficiency of vitamin B12?

Pernicious anemia Macrocytic anemia Thrombocytopenia

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 lower quadrant

Notify the physician.

Cholelithiasis tx

Tx of choice for this is laprascopic surgery. T-tube can be used to remove stones and can be left in place after removal. It ensure patency and flow of common bile duct until edema decreases. ESWL uses shock waves to break apart stones ERCP is endoscopy that can be used to biopsy or irrigate. Have pt avoid excess fat in diet.

A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem?

Ulcerative colitis

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?

Ulcerative colitis

The nurse is teaching a client with recurrent urinary tract infections (UTIs) ways to decrease risk for additional UTIs. The nurse includes which information?

Void immediately after sexual intercourse.

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?

abdominoperineal resection

A client is admitted with acute pancreatitis. The nurse should monitor which laboratory values? a) decreased urine amylase level b) increased serum amylase and lipase levels c) increased calcium level d) decreased glucose level

increased serum amylase and lipase levels

Fatty acids can be broken down for the production of energy and

ketone bodies

Which symptoms will a nurse observe most commonly in clients with pancreatitis?

severe, radiating abdominal pain

An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? stool consistency and client comfort one bowel movement daily one bowel movement every other day two bowel movements daily

stool consistency and client comfort

Vitamin K is required by the liver for

synthesis of prothrombin and some of the other clotting factors.

A client is recovering from an abdominal-perineal resection. To promote wound healing after the perineal drains have been removed the nurse should encourage the client to: a) use a heating pad on the area. b) take sitz baths. c) shower daily. d) apply moist dressings to the area.

take sitz baths

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds?

Absent

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:

Acetaminophen Explanation: Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

ALT normal

7-56 units per liter of serum alanine aminotransferase

Borborygmus Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

Which statement provides accurate information regarding cancer of the colon and rectum? 1. Rectal cancer affects more than twice as many people as colon cancer. 2. Colorectal cancer is the third most common site of cancer in the United States. 3. Colon cancer has no hereditary component. 4. The incidence of colon and rectal cancer decreases with age.

Colorectal cancer is the third most common site of cancer in the United States.

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?

Computed tomography scan

An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients?

Decreased abdominal strength

An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients? Increased intestinal motility Decreased abdominal strength Increased intestinal bacteria Decreased production of hydrochloric acid

Decreased abdominal strength

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding?

Decreased gastric size

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? And A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

Clay-colored or whitish And Clay-colored stools

Which type of deficiency results in macrocytic anemia?

Folic acid Explanation: Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the client reviews the initial orders and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?

Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor?

Hemorrhage, Perforation, Penetration, Pyloric obstruction

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? 1. "I need to use laxatives regularly to prevent constipation." 2. "I need to drink 2 to 3 liters of fluids every day." 3. "I should exercise four times per week." 4. "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."

The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery?

High Fowler's

A patient diagnosed with IBS is advised to eat a diet that is: Sodium-restricted. High in fiber. Low in residue. Restricted to 1,200 calories/day.

High in fiber

When providing discharge teaching for a client with uric acid calculi, the nurse would include an instruction to avoid which type of diet? a) Low calcium b) High purine c) Low oxalate d) High oxalate

High purine

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?

High-dose corticosteroids

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings?

Hypercalcemia

A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration?

Electrocardiogram changes

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?

Elevated alpha-fetoprotein

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: a) Encourage caffeine and alcohol consumption at mild to moderate levels. b) Encourage a high-fiber diet daily. c) Encourage increased consumption of spicy foods, lactose, fried foods, corn, and wheat. d) Increase p.o. fluids only with/during meals.

Encourage a high-fiber diet daily.

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.

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. The nurse would prepare the patient for which of the following? a) Flexible sigmoidoscopy b) X-ray studies (i.e., barium enema) c) Computed tomography (CT) scan d) Anorectal manometry and transit studies

Flexible sigmoidoscopy

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

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

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?

Rovsing sign

A child is admitted to the emergency department and diagnosed with a suspected ruptured appendix. The parents are anxious about the child's condition and ask the nurse what to expect for immediate treatment. What is the best response by the nurse? a) "We will place a referral to the social worker to help you through this." b) "We will modify pain management strategies to control the situation." c) "We will be preparing your child for emergency surgery." d) "The focus of treatment is the initiation of antibiotic therapy."

"We will be preparing your child for emergency surgery."

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

"You must have the second one in 1 month and the third in 6 months." Explanation: Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process?

Inflammation of all layers of intestinal mucosa

A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first?

Administering I.V. fluids

Celiac sprue is an example of which category of malabsorption?

Mucosal disorders causing generalized malabsorption

GERD symptoms

Pyrosis, dyspepisa, dysphagia. Barrett's esophagus (acid in esophagus). Smoking is associated with both.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? 1. Inflammation of all layers of intestinal mucosa 2. Infectious disease 3. Gastric resection 4. Disaccharidase deficiency

Inflammation of all layers of intestinal mucosa

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?

The consistency of stool and comfort when passing stool

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect? a) with each meal and snack b) every 4 hours, at specified times c) in the morning and at bedtime d) three times daily between meals

with each meal and snack

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

• Do not suppress the urge to defecate. • Drink at least 8 to 10 large glasses of fluid every day. Avoid constipation. Do not suppress the urge to defecate. Consume at least 2 L/day (within limits of the client's cardiac and renal reserve) and include foods that are soft but have increased fiber, such as prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. Avoid the use of laxatives or enemas except when recommended by the physician. Exercise regularly if the current lifestyle is somewhat inactive.

Age-Related Changes of the Hepatobiliary System

• Steady decrease in size and weight of the liver, particularly in women • Decrease in blood flow • Decrease in replacement/repair of liver cells after injury • Reduced drug metabolism • Slow clearance of hepatitis B surface antigen • More rapid progression of hepatitis C infection and lower response rate to therapy • Decline in drug clearance capability • Increased prevalence of gallstones due to the increase in cholesterol secretion in bile • Decreased gallbladder contraction after a meal • Atypical clinical presentation of biliary disease • More severe complications of biliary tract disease

A patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals?

Maintaining the airway

Rovsing's sign; acute appendicitis

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.

Which symptom would the nurse most likely observe in a client with cholecystitis from cholelithiasis? a) nausea after ingestion of high-fat foods b) black stools c) elevated temperature of 103°F (39.4°C) d) decreased white blood cell count

nausea after ingestion of high-fat foods

A typical sign/symptom of appendicitis is:

nausea.

As part of the management of constipation, the client is instructed to take 30 mL of mineral oil orally. How does mineral oil facilitate bowel evacuation? - Irritates nerve endings in the intestinal mucosa - Lubricates and softens fecal matter - Increases the volume of intestinal contents - Decreases water retention of stool

- Lubricates and softens fecal matter

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

- Metabolic alkalosis

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is

15%

The nurse is assisting a client to drain his continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve?

2 in.

Glucose Metabolism

After a meal, glucose is taken up from the portal venous blood by the liver and converted into glycogen, which is stored in the hepatocytes. Subsequently, the glycogen is converted back to glucose (glycogenolysis) and released as needed into the bloodstream to maintain normal levels of blood glucose.

Absent. Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as:

Which set of arterial blood gas (ABG) results requires further investigation?

pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

A patient is being seen in the clinic for complaints of painful hemorrhoids. The nurse assesses the patient and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree? a) First degree b) Second degree c) Third degree d) Fourth degree

Third Degree

A client is being seen in the clinic for reports of painful hemorrhoids. The nurse assesses the client and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?

Third degree

This assessment of the pt indicates Appendicitis

EGD diagnostic tool characteristics

This diagnostic tool visualizes the oral pharynx, esophagus, stomach and duodenum.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

pH, 7.25; PaCO2 50 mm Hg

Appendicitis

Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

The blood that perfuses the liver comes from two sources:

A very vascular organ that receives blood from GI tract via the portal vein and from the hepatic artery

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care?

Application of an ostomy pouch

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?

Caput medusae

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

Clay-colored stools Explanation: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?

Colonoscopy

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? Colonoscopy Barium enema Flexible sigmoidoscopy CT scan

Colonoscopy

A 13-year-old girl is being evaluated for possible Crohn's disease. The nurse expects to prepare her for which diagnostic study? a) Genetic testing b) Myelography c) Cystoscopy d) Colonoscopy with biopsy

Colonoscopy with biopsy

A client has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical respectability. Which two are the procedures?

Computed tomography (CT) Endoscopic ultrasound

A client has an allergy to latex. What intervention would be of importance? a) Maintain standard precautions with powder free gloves. b) Use allergy free lotion to prevent skin breakdown. c) Determine if client is also allergic to kiwi and strawberries. d) Keep an epinephrine pen at the bedside.

Maintain standard precautions with powder free gloves.

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

The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease?

Its course is prolonged and variable

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:

sodium polystyrene sulfonate (Kayexalate)

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

solid

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

solid.

stool consistency and client comfort

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:

subnormal serum glucose and elevated serum ammonia levels. Explanation: In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

PUD treatment mnemonic

Please Make Tummy Better PMTB Proton Pump Inhibitor Metronidazole Tetracycline Bismuth subsalicylatel

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?

The client exhibits signs of adequate GI perfusion. Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

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.

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:

acute cholecystitis Explanation: Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.

A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention? a) difficulty breathing b) potential for aspiration c) airway obstruction d) infection

airway obstruction

The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for: a) suppression of the client's respiratory infection. b) decrease in bronchial secretions. c) thinning of tenacious, purulent sputum. d) less difficulty breathing

less difficulty breathing

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

A client has symptoms suggestive of peritonitis. Nursing management would not include:

limiting analgesics to avoid the formation of paralytic ileus.

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client ha

cirrhosis. Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid

decaffeinated coffee

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?

decompression Explanation: Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

Which is an accurate statement regarding gastric cancer?

the incidence of stomach cancer continues to decrease in the United States

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

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

- Familial polyposis

Which characteristic is a risk factor for colorectal cancer? - Familial polyposis - Low-fat, low-protein, high-fiber diet - Age younger than 40 years - History of skin cancer

- Familial polyposis

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be - Diarrhea - Fecal incontinence - Dark, tarry stools - Hemorrhoids

- Fecal incontinence

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? - Borborygmus - Tenesmus - Azotorrhea - Diverticulitis

- Borborygmus

- Bowel perforation

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for? - Anorectal manometry - Barium enema - Transit study - Flexible sigmoidoscopy

- Flexible sigmoidoscopy

A client is admitted for a transurethral resection of the prostate (TURP). Preoperative teaching will include which of the following information? a) "You will need to keep your abdominal incision clean and dry and cannot shower until the sutures are removed." b) "You will return from surgery and have a suprapubic catheter for 48 hours." c) "You will need to use a urinal and remain on bed rest for 24 hours after surgery." d) "You will return from surgery with a catheter in your bladder and fluid flowing into and out of it continuously."

"You will return from surgery with a catheter in your bladder and fluid flowing into and out of it continuously."

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 should exercise four times per week." - "I need to drink 2 to 3 liters of fluids every day."

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

The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction.

Amount of hydrochloric acid (HCL) secretion in the stomach

Which statement correctly identifies a difference between duodenal and gastric ulcers?

Vomiting is uncommon in clients with duodenal ulcers

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

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 (such as appendicitis, diverticulitis, ulcerative colitis, or 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.

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?

sigmoidoscopy

ALT, AST, and GGT are the most frequently

used tests of liver damage

- Borborygmus

The nurse is talking with a group of clients who 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? - Excess gas - Daily bowel movements - Abdominal cramping when having a bowel movement - Change in bowel habits

- Change in bowel habits

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? - Chronic constipation with sporadic bouts of diarrhea - Weight loss due to malabsorption - Blood and mucus in the stool - Client is awakened from sleep due to abdominal pain.

- Chronic constipation with sporadic bouts of diarrhea

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

- Hypokalemia

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? Low residue Low protein Calorie restriction Iron restriction

Low residue

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) Frank blood in stool b) Change in bowel habits c) Change in dietary habits d) Abdominal pain

Change in bowel habits

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation? a) Assisting to increase dietary fiber. b) Providing an adequate quantity of food. c) Obtaining medications and allergy history. d) Obtain medical and food history.

Assisting to increase dietary fiber.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?

Asterixis Explanation: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy

Change in bowel habits

Which statement provides accurate information regarding cancer of the colon and rectum?

Colorectal cancer is the third most common site of cancer in the United States.

What is the most common cause of small-bowel obstruction?

Adhesions

The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem?

Diminished deep tendon reflexes

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. 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.

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

- Rectal bleeding

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?

Abdominal paracentesis

Which of the following is considered an early symptom of gastric cancer?

Pain relieved by antacids

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

- Familial polyposis

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of?

Increasing fluid intake to prevent dehydration

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."

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?

Limit sodium and water intake.

Red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

When preparing a client for a hemorrhoidectomy, the nurse should take which action?

Administer an enema as ordered

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?

Asterixis Explanation: Hepatic encephalopathy is manifested by numerous central nervous system effects including: disorientation, confusion, personality changes, memory loss, a flapping tremor called asterixis, a positive Babinski reflex, sulfurous breath odor (referred to as fetor hepaticus), and lethargy to deep coma.

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 anterior superior iliac spine

Which of the following would a nurse expect to assess in a client with peritonitis?

Board-like abdomen

Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

Bowel perforation

Which is the most common presenting symptom of colon cancer? Fatigue Change in bowel habits Anorexia Weight loss

Change in bowel habits

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?

Change in the client's handwriting and/or cognitive performance Explanation: The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

Dumping syndrome

Characteristics include rapid passage of food into the jejunum and drawing of fluid into it due to hypertonic intestinal contents. Right direction, wrong rate (metaphorically, you'd get a speeding ticket). It causes vasomotor and *1) GI s/s with 2) reactive hypoglycemia. (Pt may appear confused or seem intoxicated). Can also cause 3) shock*. *Have pt lay on side with head of bed low while eating, avoid fluid w/meals (to slow down digestion) and avoid high carbs (these go through stomach fast). Everything needs to be low (HOB, fluids, carbs) and slow* Seen in gastric cancer, post surgery, along with seatorrhea.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? a) diarrhea b) pain c) bloating d) abdominal distention

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

A client with acute gastritis asks the nurse what might have caused the problem. What is a possible cause of acute gastritis?

Dietary indiscretion Excessive alcohol intake Radiation therapy

What would the nurse identify as a characteristic finding when assessing a client for pilonidal sinus?

Dilated pits of hair follicles in the cleft

A client with active schizophrenia has developed acute gastritis after ingesting a strongly alkaline solution during a psychotic episode. Which emergency treatments should the nurse anticipate using with the client?

Diluted lemon juice Diluted vinegar

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?

Endoscopic retrograde cholangiopancreatography (ERCP) Explanation: 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.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

Hepatic encephalopathy

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

high-fiber diet.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? - Gently washing the area surrounding the stoma using a facecloth and mild soap - Scrubbing fecal material from the skin surrounding the stoma - Maintaining wrinkles in the faceplate so it doesn't irritate the skin - Cutting the faceplate opening no more than 2? larger than the stoma

- Gently washing the area surrounding the stoma using a facecloth and mild soap

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? - Normal erythrocyte sedimentation rate (ESR) - Hypotension - Bradycardia - Subnormal temperature

- Hypotension

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? - Increasing fluid intake to prevent dehydration - Consuming a low-protein, high-fiber diet - Taking only enteric-coated medications - Wearing an appliance pouch only at bedtime

- Increasing fluid intake to prevent dehydration

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? - Gastric resection - Infectious disease - Disaccharidase deficiency - Inflammation of all layers of intestinal mucosa

- Inflammation of all layers of intestinal mucosa

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? - Calorie restriction - Low residue - Iron restriction - Low protein

- Low residue

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 liver biopsy Explanation: 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.

A client develops chronic pancreatitis. What would be the appropriate home diet for a client with chronic pancreatitis? a) A high-calcium, soft diet distributed over three meals and an evening snack daily b) A low-fat, bland diet distributed over five to six small meals daily c) a low-protein, high-fiber diet distributed over four to five moderate-sized meals daily d) A diabetic exchange diet distributed over three meals and two snacks daily

A low-fat, bland diet distributed over five to six small meals daily

A client with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the client's family how to safely perform which of the following actions?

Assessing the patency of the drainage catheter

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation?

Assist client to increase dietary fiber.

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond?

Bicarbonate-carbonic acid buffer system

A nurse is helping to plan a teaching session for a client who will be discharged with a colostomy. Which statement describes a healthy stoma? a) "The stoma should appear dark and have a bluish hue." b) "The stoma should remain swollen distal to the abdomen." c) "At first, the stoma may bleed slightly when touched." d) "A burning sensation under the stoma faceplate is normal."

C (The surgical site remains fresh for up to 1 week after a colostomy and touching the stoma normally causes slight bleeding. However, profuse bleeding should be reported immediately. A dark stoma with a bluish hue indicates impaired circulation; a normal stoma should appear red, similar to the buccal mucosa. Swelling should decrease in 6 weeks, leaving a stoma that protrudes slightly from the abdomen; continued swelling suggests a blockage. A burning sensation u)nder the faceplate is abnormal and indicates skin breakdown.)

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: 1. A pelvic abscess. 2. Peritonitis 3. An ileus. 4. An abscess under the diaphragm.

Defecography

The nurse is preparing a client 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 client for? Kidneys, ureters, bladder (KUB) Colonic transit studies Defecography Abdominal radiography

Defecography

An adult with appendicitis has severe abdominal pain. Which action will be the most effective to assist the client to manage pain prior to surgery? a) Apply moist heat to the abdomen. b) Teach client to massage the painful area. c) Provide distraction with music. d) Place the client in semi-Fowler's position with the knees to the chest.

Place the client in semi-Fowler's position with the knees to the chest

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?

Gently washing the area surrounding the stoma using a facecloth and mild soap

The nurse identifies which of the following types of jaundice in an adult experiencing a transfusion reaction?

Hemolytic Explanation: Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.

Which of the following is considered a bulk-forming laxative? a) Milk of Magnesia b) Mineral oil c) Metamucil d) Dulcolax

Metamucil Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.

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?

Obstructive jaundice

Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following?

Osteoporosis

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant?

Provide oral care every 2-3 hours.

Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis?

Severe, radiating abdominal pain

Which is a true statement regarding regional enteritis (Crohn's disease)?

The clusters of ulcers take on a cobblestone appearance. 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.

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen?

The medications will kill the bacteria and stop the acid production

A client presents to the emergency department with reports of acute GI distress, bloody diarrhea, weight loss, and fever. A family history of which of the following would be significant to this client's diagnosis? a) Peptic ulcers b) Crohn's disease c) Ulcerative colitis d) Appendicitis

Ulcerative colitis

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?

Ulcerative colitis 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 has a 10-year history of Crohn's disease and is seeing the physician due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease?

dietary approach varies.

A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed?

radical pancreatoduodenectomy Explanation: Radical pancreatoduodenectomy involves removing the head of the pancreas, resecting the duodenum and stomach, and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the jejunum. Cholecystojejunostomy is a rerouting of the pancreatic and biliary drainage systems, which may be done to relieve obstructive jaundice. This measure is considered palliative only. A pancreatectomy is the surgical removal of the pancreas. A pancreatectomy may be total, in which case the entire organ is removed, usually along with the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. A distal pancreatectomy is a surgical procedure to remove the bottom half of the pancreas.

rupture of the appendix.

A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for: a. rupture of the appendix. b. ulceration of the appendix. c. inflammation of the gallbladder. d. emotional distress related to the pain.

rupture of the appendix.

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?

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