Brunner and Suddarth's Textbook of Medical-surgical Nursing- Chapter 38, 39, 40, 41, 43,44

Multiple Choice 26. A client has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test? A. Glucose tolerance test B. ERCP C. Pancreatic biopsy D. Abdominal ultrasonography

A Rationale: A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making decisions about surgical resection of the pancreas. This specific clinical information is not provided by ERCP, biopsy, or ultrasound. PTS: 1 REF: p. 1437 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 14. A nurse is providing care for a client who has a diagnosis of irritable bowel syndrome (IBS). When planning this client's care, the nurse should collaborate with the client and prioritize what goal? A. Client will accurately identify foods that trigger symptoms. B. Client will demonstrate appropriate care of his ileostomy. C. Client will demonstrate appropriate use of standard infection control precautions. D. Client will adhere to recommended guidelines for mobility and activity.

A Rationale: A major focus of nursing care for the client with IBS is to identify factors that exacerbate symptoms. Surgery is not used to treat this health problem and infection control is not a concern that is specific to this diagnosis. Establishing causation likely is more important to the client than managing physical activity. PTS: 1 REF: p. 1293 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. A nurse is caring for a client who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the client? A. Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN. B. Administer a hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN. C. Administer 3 ampules of dextrose 50% immediately prior to discontinuing the PN. D. Administer 3 ampules of dextrose 50% 1 hour after discontinuing the PN.

A Rationale: After administration of the PN solution is gradually discontinued, an isotonic dextrose solution is given for 1 to 2 hours to protect against rebound hypoglycemia. The other listed actions would likely cause hyperglycemia. PTS: 1 REF: p. 1316 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. A client has been scheduled for an ultrasound of the gallbladder the following morning. What should the nurse do in preparation for this diagnostic study? A. Have the client refrain from food and fluids after midnight. B. Administer the contrast agent orally 10 to 12 hours before the study. C. Administer the radioactive agent intravenously the evening before the study. D. Encourage the intake of 64 ounces of water 8 hours before the study.

A Rationale: An ultrasound of the gallbladder is most accurate if the client fasts overnight, so that the gallbladder is distended. Contrast and radioactive agents are not used when performing ultrasonography of the gallbladder, as an ultrasound is based on reflected sound waves. PTS: 1 REF: p. 1421 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. 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

A Rationale: 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. PTS: 1 REF: p. 1391 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 4. A 35-year-old client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize? A. Insertion of a nasogastric tube B. Insertion of a central venous catheter C. Administration of a mineral oil enema D. Administration of a glycerin suppository and an oral laxative

A Rationale: Decompression of the bowel through a nasogastric tube is necessary for all clients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present. PTS: 1 REF: p. 1304 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 23. An adult client has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this client's plan of care? A. Measure the client's abdominal girth daily. B. Limit the use of opioid analgesics. C. Monitor the client for signs of dysphagia. D. Encourage activity as tolerated.

A Rationale: Due to the risk of ascites, the nurse should monitor the client's abdominal girth. There is no specific need to avoid the use of opioids or to monitor for dysphagia, and activity is usually limited. PTS: 1 REF: p. 1433 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 27. A group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect health care 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 clients on airborne precautions

A Rationale: 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. PTS: 1 REF: p. 1391 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 25. The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of: A. total gastrectomy. B. bariatric surgery. C. diverticulitis. D. gastroesophageal reflux disease (GERD).

A Rationale: If a total gastrectomy is performed, injection of vitamin B12 will be required for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin B12 so that it may be absorbed in the ileum. Bariatric surgery, diverticulitis and GERD do not necessitate total gastrectomy and subsequent vitamin B12 supplementation. PTS: 1 REF: p. 1278 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 3. A client's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the client's laboratory studies, what finding is most closely associated with this diagnosis? A. Increased bilirubin B. Decreased serum cholesterol C. Increased blood urea nitrogen (BUN) D. Decreased serum alkaline phosphatase level

A Rationale: If the flow of blood is impeded, bilirubin, a pigment derived from the breakdown of red blood cells, does not enter the intestines. As a result, bilirubin levels in the blood increase. Cholesterol, BUN, and alkaline phosphatase levels are not typically affected. PTS: 1 REF: p. 1419 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 35. A nurse on a solid organ transplant unit is planning the care of a client 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 client's psychosocial status D. Administration of antiretroviral medications

A Rationale: 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. PTS: 1 REF: p. 1410 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 13. A client is being discharged after a liver transplant and the nurse is performing discharge education. When planning this client's continuing care, the nurse should prioritize what risk diagnosis? 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

A Rationale: 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. PTS: 1 REF: p. 1410 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. A nurse is preparing to administer a client's intravenous fat emulsion simultaneously with parenteral nutrition (PN). What principle should guide the nurse's action? A. Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. B. The nurse should prepare for placement of another intravenous line, as intravenous fat emulsions may not be infused simultaneously through the line used for PN. C. Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site after running the emulsion through a filter. D. The intravenous fat emulsions can be piggy-backed into any existing IV solution that is infusing.

A Rationale: Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. The client does not need another intravenous line for the fat emulsion. The IVFE cannot be piggy-backed into any existing IV solution that is infusing. PTS: 1 REF: p. 1314 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 38. The nurse's review of a client's most recent laboratory results indicates a bilirubin level of 3.0 mg/dL (51 mmol/L). The nurse assesses the client for: A. jaundice. B. bleeding. C. malnutrition. D. hypokalemia.

A Rationale: Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.0 mg/dL (34 mmol/L). Elevated bilirubin levels are not associated with hypokalemia, malnutrition or bleeding, though these complications may result from the underlying liver disorder. PTS: 1 REF: p. 1371 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A. Two to three 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

A Rationale: Lactulose is given 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 client's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool. PTS: 1 REF: p. 1383 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 35. 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? A. Laparoscopic cholecystectomy B. Methyl tertiary butyl ether (MTBE) infusion C. Intracorporeal lithotripsy D. Extracorporeal shock wave therapy (ESWL)

A Rationale: Most of the nonsurgical approaches, including lithotripsy and dissolution of gallstones, provide only temporary solutions to gallstone problems and are infrequently used. Cholecystectomy is the preferred treatment. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 34. A client with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure? A. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure. B. Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR. C. A laparoscopic approach allows for the removal of the entire gallbladder. D. A laparoscopic approach can be performed under conscious sedation.

A Rationale: Open surgery has largely been replaced by laparoscopic cholecystectomy (removal of the gallbladder through a small incision through the umbilicus). As a result, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. Both approaches allow for removal of the entire gallbladder and must be performed under general anesthesia in an operating theater. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 6. A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite? A. High levels of alcohol consumption B. History of bowel obstruction C. History of diverticulitis D. Longstanding psychosocial stress

A Rationale: Risk factors include high alcohol intake; cigarette smoking; and high-fat, high-protein, low-fiber diet. Diverticulitis, obstruction, and stress are not noted as risk factors for colorectal cancer. PTS: 1 REF: p. 1325 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 5. A 37-year-old client presents at the emergency department (ED) reporting nausea and vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's spouse states that the client was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the client for what health problem? A. Severe pancreatitis with possible peritonitis B. Acute cholecystitis C. Chronic pancreatitis D. Acute appendicitis with possible perforation

A Rationale: Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis. PTS: 1 REF: p. 1430 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 6. A triage nurse in the emergency department is assessing a client who presented with reports of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this client'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?"

A Rationale: 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. PTS: 1 REF: p. 1367 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. A client with gastric cancer has been scheduled for a total gastrectomy. During the preoperative assessment, the client confides in the nurse feeling the surgery will "mutilate" the client's body. The nurse should plan interventions that address what nursing diagnosis? A. Disturbed body image B. Deficient knowledge related to the risks of surgery C. Anxiety about the surgery D. Low self-esteem

A Rationale: The client's choice of words ("mutilate") suggests a change in body image. This may or may not be rooted in anxiety or a lack of knowledge. It may cause an eventual reduction in self-esteem but the essence of the statement is the client's body image. PTS: 1 REF: p. 1281 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 18. A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? A. Fried chicken B. Mashed potatoes C. Dinner roll D. Tapioca pudding

A Rationale: The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as fried chicken, as fatty foods may bring on an episode of cholecystitis. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 21. The nurse is providing care for a client whose inflammatory bowel disease has necessitated hospital treatment. Which of the following would most likely be included in the client's medication regimen? A. Antidiarrheal medications 30 minutes before a meal B. Antiemetics on a PRN basis C. Vitamin B12 injections to prevent pernicious anemia D. Beta adrenergic blockers to reduce bowel motility

A Rationale: The nurse administers antidiarrheal medications 30 minutes before a meal as prescribed to decrease intestinal motility and administers analgesics as prescribed for pain. Antiemetics, vitamin B12 injections and beta blockers do not address the signs, symptoms, or etiology of inflammatory bowel disease. PTS: 1 REF: p. 1311 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 8. A nurse is caring for a client with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the client 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

A Rationale: The nurse will document that a client 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. PTS: 1 REF: p. 1381 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand

Multiple Choice 32. The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurse's assessments most directly addresses a major complication of TPN? A. Checking the client's capillary blood glucose levels regularly B. Having the client frequently rate his or her hunger on a 10-point scale C. Measuring the client's heart rhythm at least every 6 hours D. Monitoring the client's level of consciousness each shift

A Rationale: The solution, used as a base for most TPN, consists of a high dextrose concentration and may raise blood glucose levels significantly, resulting in hyperglycemia. This is a more salient threat than hunger, though this should be addressed. Dysrhythmias and decreased LOC are not among the most common complications. PTS: 1 REF: p. 1314 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 31. Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse's anticipatory guidance should include what information? A. The possibility of surgery, chemotherapy and radiotherapy B. The possibility of needing a short-term or long-term colostomy C. The benefits of weight loss and exercise as tolerated during recovery D. The good prognosis for clients who are treated for gastric cancer

A Rationale: Treatment of gastric cancer is usually multimodal, but does not necessitate a colostomy. Weight loss is not a goal during recovery; exercise is not a high priority and may be unrealistic. The prognosis for clients with gastric cancer is generally poor. PTS: 1 REF: p. 1278 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 36. A 55-year-old female client with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? A. Destruction of the client's liver tumor B. Restoration of portal vein patency C. Destruction of a liver abscess D. Reversal of metastasis

A Rationale: 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. PTS: 1 REF: p. 1406 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 5. A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this client's care, which of the following nursing diagnoses should the nurse prioritize? A. Ineffective tissue perfusion related to bowel ischemia B. Imbalanced nutrition: Less than body requirements related to impaired absorption C. Anxiety related to bowel obstruction and subsequent hospitalization D. Impaired skin integrity related to bowel obstruction

A Rationale: When the bowel is completely obstructed, the possibility of strangulation and tissue necrosis (i.e., tissue death) warrants surgical intervention. As such, this immediate physiologic need is a nursing priority. Nutritional support and management of anxiety are necessary, but bowel ischemia is a more immediate threat. Skin integrity is not threatened. PTS: 1 REF: p. 1303 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 34. A client has come to the clinic reporting pain just above her umbilicus. When assessing the client, the nurse notes Sister Mary Joseph nodules. The nurse should refer the client to the primary provider to be assessed for what health problem? A. A GI malignancy B. Dumping syndrome C. Peptic ulcer disease D. Esophageal/gastric obstruction

A Rationale: Palpable nodules around the umbilicus, called Sister Mary Joseph nodules, are a sign of a GI malignancy, usually a gastric cancer. This would not be a sign of dumping syndrome, peptic ulcer disease, or esophageal/gastric obstruction. PTS: 1 REF: p. 1278 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 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

A, B Rationale: People who are at high occupational risk for contracting hepatitis B, 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. PTS: 1 REF: p. 1389 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 41. A nurse is preparing to discharge a client home on parenteral nutrition. What should an effective home care teaching program address? Select all that apply. A. Preparing the client to troubleshoot for problems B. Teaching the client and family strict aseptic technique C. Teaching the client and family how to set up the infusion D. Teaching the client to flush the line with sterile water E. Teaching the client when it is safe to leave the access site open to air

A, B, C Rationale: An effective home care teaching program prepares the client to store solutions, set up the infusion, change the dressings, and troubleshoot for problems. The most common complication is sepsis. Strict aseptic technique is taught for hand hygiene, handling equipment, changing the dressing, and preparing the solution. Tap water is never used for flushes and the access site must never be left open to air. PTS: 1 REF: p. 1316 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 22. A client with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the client should be informed that this procedure will involve the removal of which of the following? Select all that apply. A. Gallbladder B. Part of the stomach C. Duodenum D. Part of the common bile duct E. Part of the rectum

A, B, C, D Rationale: A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The rectum is not affected. PTS: 1 REF: p. 1441 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 39. A client's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment question(s) addresses likely etiologic factors? Select all that apply. A. "How many alcoholic drinks do you typically consume in a week?" B. "Have you ever been tested for diabetes?" C. "Have you ever been diagnosed with gallstones?" D. "Would you say that you eat a particularly high-fat diet?" E. "Does anyone in your family have cystic fibrosis?"

A, B, C, D Rationale: Eighty percent of clients with acute pancreatitis have biliary tract disease such as gallstones or a history of long-term alcohol abuse. Diabetes and high-fat consumption are also associated with pancreatitis. Cystic fibrosis is not a noted etiologic factor for pancreatitis. PTS: 1 REF: p. 1429 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse's health education should include what guidelines? Select all that apply. A. Avoid drinking alcohol B. Adopt a low-residue diet C. Avoid nonsteroidal anti-inflammatories D. Take calcium gluconate as prescribed E. Prepare for the possibility of surgery

A, C Rationale: Clients with chronic gastritis are encouraged to avoid alcohol and NSAIDs. Calcium gluconate is not a common treatment and the condition is not normally treated with surgery. Dietary modifications are usually recommended, but this does not necessitate a low-residue diet. PTS: 1 REF: p. 1268 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 33. The nurse is providing care for a client whose peptic ulcer disease will be treated with a Billroth I procedure (gastroduodenostomy). Which statement(s) by the client indicates effective knowledge of the procedure? Select all that apply. A. "I will be at risk of developing diarrhea, nausea, and feeling light-headed after eating." B. "It is likely that I will need to receive nutrition directly into my veins." C. "One of my nerves, the vagus nerve, may be cut during the surgery." D. "I can eat a normal diet again after 3 to 5 weeks." E. "This surgery will remove part of my stomach and colon."

A, C Rationale: This surgery carries a risk for dumping syndrome and may be performed with a truncal vagotomy, in which the vagus nerve is severed. Dumping syndrome is a condition in which food empties rapidly from the stomach to the duodenum, resulting in diarrhea, nausea, and feeling light-headed after eating a meal. Parenteral nutrition is not expected, though life-long dietary modifications will be necessary. A portion of the duodenum is removed, but not the colon. PTS: 1 REF: p. 1279 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 19. A client's health care provider has ordered a "liver panel" in response to the client'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)

A, C, D Rationale: 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. PTS: 1 REF: p. 1369 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 30. A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client'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 client positioning

A, C, E Rationale: Administering diuretics, implementing fluid restrictions, and enhancing client positioning can optimize the management of fluid volume excess. Calcium channel blockers and calorie restriction do not address this problem. PTS: 1 REF: p. 1399 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 26. A client with a diagnosis of colon cancer is 2 days' postoperative following bowel resection and anastomosis. The nurse has planned the client's care in the knowledge of potential complications. What assessment should the nurse prioritize? A. Close monitoring of temperature B. Frequent abdominal auscultation C. Assessment of hemoglobin, hematocrit, and red blood cell levels D. Palpation of peripheral pulses and leg girth

B Rationale: After bowel surgery, it is important to frequently assess the abdomen, including bowel sounds and abdominal girth, to detect bowel obstruction. The resumption of bowel motility is a priority over each of the other listed assessments, even though each should be performed by the nurse. Obstruction can develop more quickly than infection in most cases. PTS: 1 REF: p. 1330 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. A client 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 client NPO until the results of test are known. B. Keep client NPO until the client's gag reflex returns. C. Administer analgesia until post-procedure tenderness is relieved. D. Give the client a cold beverage to promote swallowing ability.

B Rationale: After the examination, fluids are not given until the client's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the client'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. PTS: 1 REF: p. 1376 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 10. What health promotion teaching should the nurse prioritize to prevent drug-induced hepatitis? A. Finish all prescribed courses of antibiotics, regardless of symptom resolution. B. Adhere to dosing recommendations of over-the-counter analgesics. C. Ensure that expired medications are disposed of safely. D. Ensure that pharmacists regularly review drug regimens for potential interactions.

B Rationale: 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. PTS: 1 REF: p. 1392 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 30. A client with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the client has a perforated ulcer? A. The client has abdominal bloating that developed rapidly. B. The client has a rigid, "board-like" abdomen that is tender. C. The client is experiencing intense lower right quadrant pain. D. The client is experiencing dizziness and confusion with no apparent hemodynamic changes.

B Rationale: An extremely tender and rigid (board-like) abdomen is suggestive of a perforated ulcer. None of the other listed signs and symptoms is suggestive of a perforated ulcer. PTS: 1 REF: p. 1276 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 27. The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease? A. Performing 15 minutes of physical activity at least three times per week B. Avoiding taking aspirin to treat pain or fever C. Taking multivitamins as prescribed and eating organic foods whenever possible D. Maintaining a healthy body weight

B Rationale: Aspirin and other NSAIDs are implicated in chronic gastritis because of their irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection. Exercise and a healthy body weight are beneficial to overall health but do not prevent gastritis. PTS: 1 REF: p. 1267 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 40. A nurse is aware of the high incidence of catheter-related bloodstream infections in clients receiving parenteral nutrition. What nursing action has the greatest potential to reduce catheter-related bloodstream infections? A. Use clean technique and wear a mask during dressing changes. B. Change the dressing no more than weekly. C. Apply antibiotic ointment around the site with each dressing change. D. Irrigate the insertion site with sterile water during each dressing change.

B Rationale: CVAD dressings are changed every 7 days unless the dressing is damp, bloody, loose, or soiled, in which case they should be changed more often. Sterile technique (not clean technique) is used. Irrigation and antibiotic ointments are not normally used. PTS: 1 REF: p. 1316 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 22. A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client'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

B Rationale: Esophageal varices are a major cause of mortality in clients 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. PTS: 1 REF: p. 1375 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 21. The nurse is caring for a client who has just returned from the ERCP removal of gallstones. The nurse should monitor the client for signs of what complications? A. Pain and peritonitis B. Bleeding and perforation C. Acidosis and hypoglycemia D. Gangrene of the gallbladder and hyperglycemia

B Rationale: Following ERCP removal of gallstones, the client is observed closely for bleeding, perforation, and the development of pancreatitis or sepsis. Blood sugar alterations, gangrene, peritonitis, and acidosis are less likely complications. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 20. A nurse is providing care for a client 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 client to conduct online research into colostomies. B. Engage the client in dialogue about the implications of having the colostomy. 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.

B Rationale: For many clients, being able to dialogue frankly about the effect of the ostomy with a nonjudgmental nurse is helpful. Emphasizing the benefits of the intervention is unlikely to improve the client's body image, since the benefits are likely already known. Online research is not likely to enhance the client's body image and some ostomies are permanent. PTS: 1 REF: p. 1319 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 19. During a client's scheduled home visit, an older adult client has stated to the community health nurse that the client has been experiencing hemorrhoids of increasing severity in recent months. The nurse should recommend which of the following? A. Regular application of an OTC antibiotic ointment B. Increased fluid and fiber intake C. Daily use of OTC glycerin suppositories D. Use of an NSAID to reduce inflammation

B Rationale: Hemorrhoid symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation. A high-residue diet that contains fruit and bran along with an increased fluid intake may be all the treatment that is necessary to promote the passage of soft, bulky stools to prevent straining. Antibiotics, regular use of suppositories, and NSAIDs are not recommended, as they do not address the etiology of the health problem. PTS: 1 REF: p. 1335 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 8. A nurse is conducting health screening with a diverse group of clients. Which client likely has the most risk factors for developing hemorrhoids? A. A 45-year-old teacher who stands for 6 hours per day B. A pregnant woman at 28 weeks' gestation C. A 37-year-old construction worker who does heavy lifting D. A 60-year-old professional who is under stress

B Rationale: Hemorrhoids commonly affect 50% of clients after the age of 50. Pregnancy may initiate hemorrhoids or aggravate existing ones. This is due to increased constipation during pregnancy. The significance of pregnancy is greater than that of standing, lifting, or stress in the development of hemorrhoids. PTS: 1 REF: p. 1335 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 13. A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain? A. Aspirin every 4 to 6 hours as prescribed B. Application of heat 15 to 20 minutes each hour C. Application of an ice pack for no more than 15 minutes D. Application of liniment rub to affected area

B Rationale: If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the abdominal cavity during the procedure), the nurse may recommend use of a heating pad for 15 to 20 minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding. PTS: 1 REF: p. 1425 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 17. A nurse is caring for a client 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

B Rationale: 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. PTS: 1 REF: p. 1372 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 13. A nurse caring for a client with a newly created ileostomy assesses the client and notes that the client has not had ostomy output for the past 12 hours. The client also reports 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 health care provider. C. Encourage the client to mobilize in order to enhance motility. D. Contact the health care provider and obtain a swab of the stoma for culture.

B Rationale: 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. PTS: 1 REF: p. 1322 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 9. A nurse is caring for a client who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this client, the nurse should describe what aspect of this diagnostic procedure? A. The need to protect the incision postprocedure B. The use of moderate sedation C. The need to infuse 50% dextrose during the procedure D. The use of general anesthesia

B Rationale: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not given and the procedure does not involve the creation of an incision. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 29. A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response? A. Ensure that the client's sodium intake does not exceed recommended levels. B. Report this finding to the primary provider due to the possibility of hepatic encephalopathy. C. Inform the primary provider that the client should be assessed for alcoholic hepatitis. D. Implement interventions aimed at ensuring a calm and therapeutic care environment.

B Rationale: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the client'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 client's physiologic deterioration. PTS: 1 REF: p. 1404 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 35. A nurse is initiating parenteral nutrition (PN) to a postoperative client who has developed complications. The nurse should initiate therapy by performing which of the following actions? A. Starting with a rapid infusion rate to meet the client's nutritional needs as quickly as possible B. Initiating the infusion slowly and monitoring the client's fluid and glucose tolerance C. Changing the rate of administration every 2 hours based on serum electrolyte values D. Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body

B Rationale: PN solutions are initiated slowly and advanced gradually each day to the desired rate as the client's fluid and glucose tolerance permits. The formulation of the PN solutions is calculated carefully each day to meet the complete nutritional needs of the individual client based on clinical findings and laboratory data. It is not infused more quickly at mealtimes. PTS: 1 REF: p. 1314 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 28. A client has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the client'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

B Rationale: 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 client 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 client may die of fulminant hepatic failure unless he or she receives a liver transplant. PTS: 1 REF: p. 1392 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 2. The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action? A. Contact the care provider to have the client's hemoglobin and hematocrit measured. B. Document these expected assessment findings. C. Apply barrier ointment to the stoma as prescribed. D. Cleanse the stoma with alcohol or chlorhexidine.

B Rationale: Redness and slight bleeding are expected, so no further intervention or assessment is likely necessary. PTS: 1 REF: p. 1321 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 27. A nurse at an outpatient surgery center is caring for a client who had a hemorrhoidectomy. What discharge education topics should the nurse address with this client? A. The appropriate use of antibiotics to prevent postoperative infection B. The correct procedure for taking a sitz bath C. The need to eat a low-residue, low-fat diet for the next 2 weeks D. The correct technique for keeping the perianal region clean without the use of water

B Rationale: Sitz baths are usually indicated after perianal surgery. A low-residue, low-fat diet is not necessary and water is used to keep the region clean. Postoperative antibiotics are not routinely prescribed. PTS: 1 REF: p. 1336 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 10. A 16-year-old presents at the emergency department reporting right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this client'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 Rationale: The client 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. PTS: 1 REF: p. 1299 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined? A. By considering the client's age and prognosis B. By objectively determining the client's medical need C. By objectively assessing the client's willingness to adhere to post-transplantation care D. By systematically ruling out alternative treatment options

B Rationale: The client 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. PTS: 1 REF: p. 1408 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 3. A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response? A. Administer a Fleet enema as prescribed and remain with the client. B. Contact the primary care provider promptly and report these signs of perforation. C. Position the client supine and insert an NG tube. D. Page the primary provider and report that the client may be obstructed.

B Rationale: The client's change in status is suggestive of perforation, which is a surgical emergency. Obstruction does not have this presentation involving fever and abdominal rigidity. An enema would be strongly contraindicated. An order is needed for NG insertion and repositioning is not a priority. PTS: 1 REF: p. 1302 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 12. A client has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the client 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

B Rationale: 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. PTS: 1 REF: p. 1413 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 12. The nurse is caring for a client who is undergoing diagnostic testing for suspected malabsorption. When taking this client'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 Rationale: 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. PTS: 1 REF: p. 1291 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 37. A nurse is caring for a client with a subclavian central line who is receiving parenteral nutrition (PN). In preparing a care plan for this client, what nursing diagnosis should the nurse prioritize? A. Risk for activity intolerance related to the presence of a subclavian catheter B. Risk for infection related to the presence of a subclavian catheter C. Risk for functional urinary incontinence related to the presence of a subclavian catheter D. Risk for sleep deprivation related to the presence of a subclavian catheter

B Rationale: The high glucose content of PN solutions makes the solutions an idea culture media for bacterial and fungal growth, and the central venous access devices provide a port of entry. Prevention of infection is consequently a high priority. The client will experience some inconveniences with regard to toileting, activity, and sleep, but the infection risk is a priority over each of these. PTS: 1 REF: p. 1315 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 39. A nurse is caring for a client who is receiving parenteral nutrition. When writing this client's plan of care, which of the following nursing diagnoses should be included? A. Risk for peripheral neurovascular dysfunction related to catheter placement B. Ineffective role performance related to parenteral nutrition C. Bowel incontinence related to parenteral nutrition D. Chronic pain related to catheter placement

B Rationale: The limitations associated with PN can make it difficult for clients to maintain their usual roles. PN does not normally cause bowel incontinence and catheters are not associated with chronic pain or neurovascular dysfunction. PTS: 1 REF: p. 1318 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 9. 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 client to take stool softener daily. B. Assess the client's food and fluid intake. C. Assess the client's surgical history. D. Encourage the client to take fiber supplements.

B Rationale: The nurse should follow the nursing process and perform an assessment prior to interventions. The client's food and fluid intake is more likely to affect bowel function than surgery. PTS: 1 REF: p. 1287 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 29. A client has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this client? A. Oral oxycodone B. IV hydromorphone C. IM meperidine D. Oral naproxen

B Rationale: The pain of acute pancreatitis is often very severe and pain relief may require parenteral opioids such as morphine, fentanyl, or hydromorphone. There is no clinical evidence to support the use of meperidine for pain relief in pancreatitis. Opioids are preferred over NSAIDs. PTS: 1 REF: p. 1431 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 26. A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client'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)

B Rationale: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that antiviral agents are most effective. Immune globulins and FFP are not indicated. PTS: 1 REF: p. 1390 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. A nurse is caring for a client with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The client asks how this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drug's pharmacodynamics? A. It inhibits the synthesis of bile. B. It inhibits the synthesis and secretion of cholesterol. C. It inhibits the secretion of bile. D. It inhibits the synthesis and secretion of amylase.

B Rationale: UDCA acts by inhibiting the synthesis and secretion of cholesterol, thereby desaturating bile. UDCA does not directly inhibit either the synthesis or secretion of bile or amylase. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 33. A client is admitted to the unit with acute cholecystitis. The health care provider has stated that surgery will be scheduled in 4 days. The client asks why the surgery is being put off for a week when he has a "sick gallbladder." What rationale would underlie the nurse's response? A. Surgery is delayed until the client can eat a regular diet without vomiting. B. Surgery is delayed until the acute symptoms subside. C. The client requires aggressive nutritional support prior to surgery. D. Time is needed to determine whether a laparoscopic procedure can be used.

B Rationale: Unless the client's condition deteriorates, surgical intervention is delayed just until the acute symptoms subside (usually within a few days). There is no need to delay surgery pending an improvement in nutritional status, and deciding on a laparoscopic approach is not a lengthy process. PTS: 1 REF: p. 1422 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 11. A nurse is preparing a plan of care for a client with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize? A. Disturbed body image B. Impaired skin integrity C. Nausea D. Risk for deficient fluid volume

B Rationale: While each of the diagnoses may be applicable to a client with pancreatic drainage, the priority nursing diagnosis is Impaired Skin Integrity. The drainage is often perfuse and destructive to tissue because of the enzyme contents. Nursing measures must focus on steps to protect the skin near the drainage site from excoriation. The application of ointments or the use of a suction apparatus protects the skin from excoriation. PTS: 1 REF: p. 1438 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 8. A client with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The client has come to the office for a routine postsurgical appointment. The client is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse? A. "The majority of clients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief." B. "Pain relief occurs by 6 months in most clients who undergo this procedure, but some people experience a recurrence of their pain." C. "Your health care provider will likely want to discuss the removal of your gallbladder to achieve pain relief." D. "You are probably not appropriately taking the medications for your pancreatitis and pain, so we will need to discuss your medication regimen in detail."

B Rationale: Pain relief from a pancreaticojejunostomy often occurs by 6 months in more than 85% of the clients who undergo this procedure, but pain returns in a substantial number of clients as the disease progresses. This client had surgery 3 months ago; the client has 3 months before optimal benefits of the procedure may be experienced. There is no obvious indication for gallbladder removal and nonadherence is not the most likely factor underlying the pain. PTS: 1 REF: p. 1437 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 17. A client with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that additional teaching is needed regarding this medication when the client states: A. "It is important that I see my health care provider for scheduled follow-up appointments while taking this medication." B. "I will take this medication for 2 weeks and then gradually stop taking it." C. "If I lose weight, the dose of the medication may need to be changed." D. "This medication will help dissolve small gallstones made of cholesterol."

B Rationale: Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. This drug can reduce the size of existing stones, dissolve small stones, and prevent new stones from forming. Six to 12 months of therapy is required in many clients to dissolve stones, and monitoring of the client is required during this time. The effective dose of medication depends on body weight. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 18. A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply. A. Pepsin B. Lipase C. Amylase D. Trypsin E. Ptyalin

B, C, D Rationale: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Pepsin is secreted by the stomach and ptyalin is secreted in the saliva. PTS: 1 REF: p. 1210 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 38. A nurse is creating a care plan for a client who is receiving parenteral nutrition. The client's care plan should include nursing action(s) relevant to what potential complications? Select all that apply. A. Dumping syndrome B. Clotted or displaced catheter C. Pneumothorax D. Hyperglycemia E. Line sepsis

B, C, D, E Rationale: Common complications of PN include a clotted or displaced catheter, pneumothorax, hyperglycemia, and infection from the venous access device (line sepsis). Dumping syndrome applies to enteral nutrition, not PN. PTS: 1 REF: p. 1316 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 17. An adult client has been diagnosed with diverticular disease after ongoing challenges with constipation. The client will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply. A. Anticholinergic medications B. Increased fiber intake C. Enemas on alternating days D. Reduced fat intake E. Fluid reduction

B, D Rationale: Clients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged. PTS: 1 REF: p. 1291 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 33. A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client reports falling when transferring to the commode. The client'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 client's commode and supply a bedpan. B. Complete an incident report and submit it to the unit supervisor. C. Have the client assessed by the primary provider due to the risk of internal bleeding. D. Perform a focused abdominal assessment in order to rule out injury.

C Rationale: A fall would necessitate thorough medical assessment due to the client'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. PTS: 1 REF: p. 1403 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. A nurse is assessing a client's stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding? A. Irrigate the ostomy to clear a possible obstruction. B. Contact the primary care provider to report this finding. C. Document that the stoma appears healthy and well perfused. D. Document a nursing diagnosis of Impaired Skin Integrity.

C Rationale: A healthy, viable stoma should be shiny and pink to bright red. This finding does not indicate that the stoma is blocked or that skin integrity is compromised. PTS: 1 REF: p. 1321 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 30. A client is scheduled for the creation of a continent ileostomy. What dietary guidelines should the nurse encourage during the weeks following surgery? A. A minimum of 30 g of soluble fiber daily B. Increased intake of free water and clear juices C. High intake of strained fruits and vegetables D. A high-calorie, high-residue diet

C Rationale: A low-residue diet is followed for the first 6 to 8 weeks. Strained fruits and vegetables are given. These foods are important sources of vitamins A and C. Adequate fluid intake is important, but it does not need to be particularly high. High fiber intake would lead to complications. PTS: 1 REF: p. 1323 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 7. A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem? A. Adherence to a high-fiber diet will help the polyps resolve. B. The client should be assured that this is a normal, age-related physiologic change. C. The client's polyps constitute a risk factor for cancer. D. The presence of polyps is associated with an increased risk of bowel obstruction.

C Rationale: Although most polyps do not develop into invasive neoplasms, they must be identified and followed closely. They are very common, but are not classified as a normal, age-related physiologic change. Diet will not help them resolve and they do not typically lead to obstructions. PTS: 1 REF: p. 1326 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 10. A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize what topic? A. Management of fluid balance in the home setting B. The need for blood glucose monitoring for the next week C. Signs and symptoms of intra-abdominal complications D. Appropriate use of prescribed pancreatic enzymes

C Rationale: Because of the early discharge following laparoscopic cholecystectomy, the client needs thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or pancreatic enzymes. PTS: 1 REF: p. 1425 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 16. 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? A. Keep a food diary to determine the foods that exacerbate the client's symptoms. B. Provide the client with a bland, low-residue diet. C. Toilet the client on a frequent, scheduled basis. D. Liaise with the primary provider to obtain an order for loperamide.

C Rationale: Because the client's fecal incontinence is most likely attributable to cognitive decline, frequent toileting is an appropriate intervention. Loperamide is unnecessary in the absence of diarrhea. Specific foods are not likely to be a cause of, or solution to, this client's health problem. PTS: 1 REF: p. 1293 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 18. A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn disease, rather than ulcerative colitis, as the cause of the client'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

C Rationale: Bloody stool is far more common in cases of UC than in Crohn disease. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohn) and clients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohn disease often has a more prolonged and variable course. PTS: 1 REF: p. 1305 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 30. A client has just been diagnosed with chronic pancreatitis. The client is underweight and in severe pain and diagnostic testing indicates that over 80% of the client's pancreas has been destroyed. The client asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response? A. "The symptoms of pancreatitis mimic those of much less serious illnesses." B. "Your body doesn't require pancreatic function until it is under great stress, so it is easy to go unnoticed." C. "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost." D. "It's likely that your other organs were compensating for your decreased pancreatic function."

C Rationale: By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been lost. Late detection is not usually attributable to the vagueness of symptoms. The pancreas contributes continually to homeostasis and other organs are unable to perform its physiologic functions. PTS: 1 REF: p. 1429 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 24. A community health nurse is caring for a client whose multiple health problems include chronic pancreatitis. During the most recent home visit, the nurse learns that the client is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurse's most appropriate action? A. Administer a PRN dose of pancreatic enzymes as prescribed. B. Teach the client about the importance of abstaining from alcohol. C. Arrange for the client to be transported to the hospital. D. Insert an NG tube, if available, and stay with the client.

C Rationale: Chronic pancreatitis is characterized by recurring attacks of severe upper abdominal and back pain, accompanied by vomiting. The onset of these acute symptoms warrants hospital treatment. Pancreatic enzymes are not indicated and an NG tube would not be inserted in the home setting. Client education is a later priority that may or may not be relevant. PTS: 1 REF: p. 1433 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 14. A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals that the client 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

C Rationale: Clients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleep most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Clients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and clients 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. PTS: 1 REF: p. 1383 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze

Multiple Select 20. A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client'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

C Rationale: Clients 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. PTS: 1 REF: p. 1375 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. A client is admitted to the ICU with acute pancreatitis. The client's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of clients with acute pancreatitis have what health issue? A. Type 1 diabetes B. An impaired immune system C. Undiagnosed chronic pancreatitis D. An amylase deficiency

C Rationale: Eighty percent of clients with acute pancreatitis have biliary tract disease or a history of long-term alcohol abuse. These clients usually have had undiagnosed chronic pancreatitis before their first episode of acute pancreatitis. Diabetes, an impaired immune function, and amylase deficiency are not specific precursors to acute pancreatitis. PTS: 1 REF: p. 1429 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 4. A nurse who provides care in a community clinic assesses a wide range of individuals. The nurse should identify which client as having the highest risk for chronic pancreatitis? A. A 45-year-old obese woman with a high-fat diet B. An 18-year-old man who is a weekend binge drinker C. A 39-year-old man with chronic alcoholism D. A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day

C Rationale: Excessive and prolonged consumption of alcohol accounts for most cases of chronic pancreatitis in Western societies. PTS: 1 REF: p. 1433 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice Chapter 41: Management of Patients with Intestinal and Rectal Disorders 1. A nurse is working with a client who has chronic constipation. What should be included in client teaching to promote normal bowel function? A. Use glycerin suppositories on a regular basis. B. Limit physical activity in order to promote bowel peristalsis. C. Consume high-residue, high-fiber foods. D. Resist the urge to defecate until the urge becomes intense.

C Rationale: Goals for the client include restoring or maintaining a regular pattern of elimination by responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods, learning about methods to avoid constipation, relieving anxiety about bowel elimination patterns, and avoiding complications. Ongoing use of pharmacologic aids should not be promoted, due to the risk of dependence. Increased mobility helps to maintain a regular pattern of elimination. The urge to defecate should be heeded. PTS: 1 REF: p. 1289 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 22. A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client 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 client knows that he or she will be responsible for care after discharge. B. Reassure the client that many people are fearful after the creation of an ostomy. C. Acknowledge the client's reluctance and initiate discussion of the factors underlying it. D. Arrange for the client to be seen by a social worker or spiritual advisor.

C Rationale: If the client is reluctant to participate in ostomy care, the nurse should attempt to dialogue about this with the client and explore the factors that underlie it. It is presumptive to assume that the client's behavior is motivated by fear. Assessment must precede referrals and emphasizing the client's responsibilities may or may not motivate the client. PTS: 1 REF: p. 1324 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 25. A student nurse is caring for a client who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments? A. Fluid output B. Oral intake C. Blood glucose levels D. BUN and creatinine levels

C Rationale: In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels every 4 to 6 hours. Output should be monitored but in most cases it is not more important than serum glucose levels. A client on parenteral nutrition would have no oral intake to monitor. Blood sugar levels are more likely to be unstable than indicators of renal function. PTS: 1 REF: p. 1431 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 3. A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments? 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

C Rationale: 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. PTS: 1 REF: p. 1373 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 28. A client is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication? A. Sudden increase in random blood glucose readings B. Increased abdominal girth accompanied by decreased level of consciousness C. Fever, increased heart rate and decreased blood pressure D. Abdominal pain unresponsive to analgesics

C Rationale: Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS). Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis. PTS: 1 REF: p. 1433 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 37. A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk? A. Chronic jaundice B. Pigment stones in portal circulation C. Central nervous system damage D. Hepatomegaly

C Rationale: 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. PTS: 1 REF: p. 1371 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 11. Diagnostic testing has revealed that a client's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this client's plan of care will focus on what intervention? A. Cryosurgery B. Liver transplantation C. Lobectomy D. Laser hyperthermia

C Rationale: 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. PTS: 1 REF: p. 1406 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 20. A nurse is creating a care plan for a client with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan? A. Bed rest reduces the client's metabolism and reduces the risk of metabolic acidosis. B. Reduced activity protects the physical integrity of pancreatic cells. C. Bed rest lowers the metabolic rate and reduces enzyme production. D. Inactivity reduces caloric need and gastrointestinal motility.

C Rationale: The acutely ill client is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. Staying in bed does not release energy from the body to fight the disease. PTS: 1 REF: p. 1433 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Select 5. A client who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize? A. The client will obtain measurement of drainage from the T-tube. B. The client will exercise three times a week. C. The client will take immunosuppressive agents as required. D. The client will monitor for signs of liver dysfunction.

C Rationale: The client is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The client 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 client to measure drainage from a T-tube as the client wouldn't go home with a T-tube. The nurse may teach the client 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. PTS: 1 REF: p. 1410 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 27. A client has been admitted to the hospital for the treatment of chronic pancreatitis. The client has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize? A. Educating the client about expectations and care following surgery B. Educating the client about the management of blood glucose after discharge C. Educating the client about postdischarge lifestyle modifications D. Educating the client about the potential benefits of pancreatic transplantation

C Rationale: The client's lifestyle (especially regarding alcohol use) is a major determinant of the course of chronic pancreatitis. The disease is not often managed by surgery, and blood sugar monitoring is not necessarily indicated for every client after hospital treatment. Transplantation is not an option. PTS: 1 REF: p. 1433 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 33. A critical care nurse is caring for a client diagnosed with acute pancreatitis. The nurse knows this client should be started on parenteral nutrition (PN) after what indications? A. 5% deficit in body weight compared to pre-illness weight and increased caloric need B. Calorie deficit and muscle wasting combined with low electrolyte levels C. Inability to take in adequate oral food or fluids within 7 days D. Significant risk of aspiration coupled with decreased level of consciousness

C Rationale: The indications for PN include an inability to ingest adequate oral food or fluids within 7 days. Weight loss, muscle wasting combined with electrolyte imbalances, and aspiration indicate a need for nutritional support, but this does not necessary have to be parenteral. PTS: 1 REF: p. 1313 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 7. A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows to immediately report what assessment finding to the health care provider? A. Decreased breath sounds B. Drainage of bile-colored fluid onto the abdominal dressing C. Rigidity of the abdomen D. Acute pain with movement

C Rationale: The location of the subcostal incision will likely cause the client to take shallow breaths to prevent pain, which may result in decreased breath sounds. The nurse should remind clients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be given for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the health care provider, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure. PTS: 1 REF: p. 1427 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 37. A nurse is providing discharge education to a client who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods? A. High-fiber foods B. Low-purine, nutrient-dense foods C. Low-fat foods high in proteins and carbohydrates D. Foods that are low-residue and low in fat

C Rationale: The nurse encourages the client to eat a diet that is low in fats and high in carbohydrates and proteins immediately after surgery. There is no specific need to increase fiber or avoid purines. A low-residue diet is not indicated. PTS: 1 REF: p. 1427 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 23. A client 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 client's treatment? A. Decisional conflict B. Deficient knowledge C. Death anxiety D. Disturbed thought processes

C Rationale: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the client's likely fear of death, which is a realistic possibility. For most clients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The client may or may not experience disturbances in thought processes. PTS: 1 REF: p. 1378 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 2. A nurse is performing an admission assessment of a client with a diagnosis of cirrhosis. What technique should the nurse use to palpate the client'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.

C Rationale: 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. PTS: 1 REF: p. 1369 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 29. A nurse is planning discharge teaching for a 21-year-old client 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 client's coping after discharge? A. The family's ability to take care of the client's special diet needs B. The family's ability to monitor the client's changing health status C. The family's ability to provide emotional support D. The family's ability to manage the client's medication regimen

C Rationale: Emotional support from the family is key to the client'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 client's health status. It is highly beneficial if the family is willing and able to accommodate the client's dietary needs, but emotional support is paramount and cannot be solely provided by the client alone. PTS: 1 REF: p. 1311 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze

Multiple Choice 29. A client is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the client to first seek care? A. Hematemesis and persistent sensation of fullness B. Abdominal bloating and recurrent constipation C. Intermittent pain and bloody stool D. Unexplained bowel incontinence and fatty stools

C Rationale: When the client is symptomatic from a tumor of the small intestine, benign tumors often present with intermittent pain. The next most common presentation is occult bleeding. The other listed signs and symptoms are not normally associated with the presentation of small intestinal tumors. PTS: 1 REF: p. 1283 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 11. A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate? A. Reassure the client that the procedure is relatively low risk and that clients are usually successful in adjusting to an ostomy. B. Provide the client with educational materials that match the client's learning style. C. Encourage the client to write down these concerns and questions to bring forward to the surgeon. D. Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.

D Rationale: A wound-ostomy-continence (WOC) nurse is a registered nurse who has received advanced education in an accredited program to care for clients 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 client's psychosocial and learning needs. Reassurance does not address the client's questions, and education may or may not alleviate anxiety. PTS: 1 REF: p. 1321 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. A client has been treated in the hospital for an episode of acute pancreatitis. The client has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes. What is the nurse's most appropriate response? A. Educate the client about the link between alcohol use and pancreatitis. B. Ensure that the client knows the importance of attending follow-up appointments. C. Refer the client to social work or spiritual care. D. Encourage the client to connect with a community-based support group.

D Rationale: After the acute attack has subsided, some clients may be inclined to return to their previous drinking habits. The nurse provides specific information about resources and support groups that may be of assistance in avoiding alcohol in the future. Referral to Alcoholics Anonymous as appropriate or other support groups is essential. The client already has an understanding of the effects of alcohol, and follow-up appointments will not necessarily result in lifestyle changes. Social work and spiritual care may or may not be beneficial. PTS: 1 REF: p. 1433 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 25. A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes? A. Preventing infection B. Maintaining skin and tissue integrity C. Preventing nausea and vomiting D. Maintaining fluid and electrolyte balance

D Rationale: All of the listed focuses of care are important for the client with a small bowel obstruction. However, the client's risk of fluid and electrolyte imbalances is an immediate threat to safety, and is a priority in nursing assessment and interventions. PTS: 1 REF: p. 1304 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 25. A client with esophageal varices is being cared for in the ICU. The varices have begun to bleed. The client has Ringer lactate at 150 cc/hr infusing. The nurse should also anticipate what intervention? A. Positioning the client supine B. Administering diuretics C. Oxygen by nasal cannula D. Administering volume expanders

D Rationale: Because clients 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. Supine positioning could exacerbate bleeding because of the effects of gravity. Nasal cannula are unlikely to meet the client's oxygenation needs. PTS: 1 REF: p. 1377 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Select Chapter 43: Assessment and Management of Patients with Hepatic Disorders 1. A nurse is caring for a client with liver failure and is performing an assessment of the client's increased risk of bleeding. The nurse recognizes that this risk is related to the client's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? A. Alterations in glucose metabolism B. Retention of bile salts C. Inadequate production of albumin by hepatocytes D. Inability of the liver to use vitamin K

D Rationale: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin. PTS: 1 REF: p. 1366 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Select 31. 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? 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

D Rationale: 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. PTS: 1 REF: p. 1407 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 28. A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. Which of the following actions should the nurse prioritize? A. Teaching the client about necessary nutritional modification B. Helping the client weigh treatment options C. Teaching the client about the etiology of gastritis D. Providing the client with physical and emotional support

D Rationale: For acute gastritis, the nurse provides physical and emotional support and helps the client manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time. PTS: 1 REF: p. 1268 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 9. 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

D Rationale: 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 client 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 against the hepatitis B virus, but plays no role in protection for the client exposed to hepatitis A. Albumin confers no therapeutic benefit. PTS: 1 REF: p. 1386 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. A nurse is providing care for a client whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis? A. Risk for disuse syndrome B. Unilateral neglect C. Risk for trauma D. Ineffective tissue perfusion

D Rationale: Grafted skin is highly vulnerable to inadequate perfusion and subsequent ischemia and necrosis. This is a priority over chronic pain, which is unlikely to be a long-term challenge. Neglect and disuse are not risks related to the graft site. PTS: 1 REF: p. 1236 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 38. A client presents to the emergency department (ED) reporting severe right upper quadrant pain. The client states that the family doctor said the pain was caused by gallstones. The ED nurse should recognize what possible complication of gallstones? A. Acute pancreatitis B. Atrophy of the gallbladder C. Gallbladder cancer D. Gangrene of the gallbladder

D Rationale: In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are compressed, compromising its vascular supply. Gangrene of the gallbladder with perforation may result. Pancreatitis, atrophy, and cancer of the gallbladder are not plausible complications. PTS: 1 REF: p. 1430 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 23. A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the client's most recent laboratory tests, the nurse should prioritize what finding? A. White blood cell level B. Creatinine level C. Hemoglobin level D. Potassium level

D Rationale: In elderly clients, it is important to monitor the client's serum electrolyte levels closely. Diarrhea is less likely to cause an alteration in white blood cell, creatinine, and hemoglobin levels. PTS: 1 REF: p. 1291 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. A client 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

D Rationale: 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. PTS: 1 REF: p. 1407 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 31. A client has been experiencing occasional episodes of constipation and has been unable to achieve consistent relief by increasing physical activity and improving the client's diet. When introducing the client to the use of laxatives, what teaching should the nurse emphasize? A. The effect of laxatives on electrolyte levels B. The underlying causes of constipation C. The risk of fecal incontinence D. The risk of becoming laxative-dependent

D Rationale: Laxatives should not normally be used on an ongoing basis because of the risk of dependence. In most cases they have a minimal effect on electrolyte levels. A client who has increased activity and improved diet likely has an understanding of the usual causes of constipation. Excessive laxative use could lead to diarrhea or fecal incontinence, but for most clients the risk of dependence is more significant. PTS: 1 REF: p. 1289 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 7. A nurse is participating in the emergency care of a client 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

D Rationale: Octreotide—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 given, and heparin would exacerbate, not alleviate, bleeding. PTS: 1 REF: p. 1377 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 31. A client has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the client is most likely to require which of the following situations? A. Inpatient rehabilitation B. Rehabilitation in the home setting C. Intensive physical therapy D. Hospice care

D Rationale: Pancreatic carcinoma has only a low survival rate regardless of the stage of disease at diagnosis or treatment. As a result, there is a higher likelihood that the client will require hospice care than physical therapy and rehabilitation. PTS: 1 REF: p. 1440 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 15. A client has been experiencing disconcerting GI symptoms that have been worsening in severity. Following medical assessment, the client has been diagnosed with lactose intolerance. The nurse should recognize an increased need for what form of health promotion? A. Annual screening colonoscopies B. Adherence to recommended immunization schedules C. Regular blood pressure monitoring D. Frequent screening for osteoporosis

D Rationale: Persons with lactose intolerance often experience hypocalcemia and a consequent risk of osteoporosis related to malabsorption of calcium. Lactose intolerance does not create an increased need for screening for colorectal cancer, immunizations, or blood pressure monitoring. PTS: 1 REF: p. 1295 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 16. A client is being treated for acute pain from an episode of pancreatitis. The nurse has identified a nursing diagnosis of Ineffective Breathing Pattern related to pain secondary to effects of surgery. Which intervention should the nurse perform in order to best address this diagnosis? A. Position the client supine to facilitate diaphragm movement. B. Administer corticosteroids by nebulizer as prescribed. C. Perform oral suctioning as needed to remove secretions. D. Administer analgesic per orders.

D Rationale: The client has ineffective breathing patterns due to pain. To increase the likelihood of the client being able to perform interventions for his/her respiratory status, it would be important to treat acute pain first. A supine position will result in increased pressure on the diaphragm and potentially decreased respiratory expansion. Steroids and oral suctioning are not indicated. PTS: 1 REF: p. 1432 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice Chapter 44: Management of Patients with Biliary Disorders 1. A nurse is assessing a client who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the client's pain, the nurse should anticipate that it may radiate to what region? A. Left upper chest B. Inguinal region C. Neck or jaw D. Right shoulder

D Rationale: The client may have biliary colic with excruciating upper-right abdominal pain that radiates to the back or right shoulder. Pain from cholecystitis does not typically radiate to the left upper chest, inguinal area, neck, or jaw. PTS: 1 REF: p. 1418 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 19. A nurse is assessing an older adult client with gallstones. The nurse is aware that the client may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly client may include what examples? A. Fever and pain B. Chills and jaundice C. Nausea and vomiting D. Signs and symptoms of septic shock

D Rationale: The elderly client may not exhibit the typical symptoms of fever, pain, chills jaundice, and nausea and vomiting. Symptoms of biliary tract disease in the elderly may be accompanied or preceded by those of septic shock, which include oliguria, hypotension, change in mental status, tachycardia, and tachypnea. PTS: 1 REF: p. 1426 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 16. A nurse is performing an admission assessment for an 81-year-old client 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

D Rationale: 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. PTS: 1 REF: p. 1367 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 14. A client returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the client for signs and symptoms of what serious potential complication of this surgery? A. Diabetic coma B. Decubitus ulcer C. Wound evisceration D. Bile duct injury

D Rationale: The most serious complication after laparoscopic cholecystectomy is a bile duct injury. Clients do not face a risk of diabetic coma. A decubitus ulcer is unlikely because immobility is not expected. Evisceration is highly unlikely, due to the laparoscopic approach. PTS: 1 REF: p. 1425 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 12. A home health nurse is caring for a client discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the client who has had pancreatic surgery? A. Proteinuria and hyperkalemia B. Hemorrhage and hypercalcemia C. Weight loss and hypoglycemia D. Malabsorption and hyperglycemia

D Rationale: The nurse arrives at this diagnosis based on the complications of malabsorption and hyperglycemia. These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a low-fat diet, and vitamin supplementation often are also required to meet the client's nutritional needs and restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery, but the electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common complication, but hypoglycemia is less likely. PTS: 1 REF: p. 1442 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 28. Which of the following is the most plausible nursing diagnosis for a client whose treatment for colon cancer has necessitated a colostomy? A. Risk for unstable blood glucose due to changes in digestion and absorption B. Unilateral neglect related to decreased physical mobility C. Risk for excess fluid volume related to dietary changes and changes in absorption D. Ineffective sexuality patterns related to changes in self-concept

D Rationale: The presence of an ostomy frequently has an effect on sexuality; this should be addressed thoughtfully in nursing care. None of the other listed diagnoses reflects the physiologic changes that result from colorectal surgery. PTS: 1 REF: p. 1320 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 21. A nurse is amending a client's plan of care in light of the fact that the client has recently developed ascites. What should the nurse include in this client's care plan? A. Mobilization with assistance at least 4 times daily B. Administration of beta-adrenergic blockers as prescribed C. Vitamin B12 injections as prescribed D. Administration of diuretics as prescribed

D Rationale: Use of diuretics along with sodium restriction is successful in 90% of clients 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. PTS: 1 REF: p. 1373 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 43: Assessment and Management of Clients With Hepatic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 2. A client has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse explain the pathophysiology of this client's health problem? A. "Toxins have accumulated and inflamed your pancreas." B. "Bacteria likely migrated from your intestines and became lodged in your pancreas." C. "A virus that was likely already present in your body has begun to attack your pancreatic cells." D. "The enzymes that your pancreas produces have damaged the pancreas itself."

D Rationale: Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the autodigestion of the pancreas. Less commonly, toxic substances and microorganisms are implicated as the cause of pancreatitis. PTS: 1 REF: p. 1430 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 26. A client has experienced symptoms of dumping syndrome following gastric surgery. To what physiologic phenomenon does the nurse attribute this syndrome? A. Irritation of the phrenic nerve due to diaphragmatic pressure B. Chronic malabsorption of iron and vitamins A and C C. Reflux of bile into the distal esophagus D. Influx of extracellular fluid into the small intestine

D Rationale: The rapid bolus of hypertonic food from the stomach to the small intestines draws extracellular fluid into the lumen of the intestines to dilute the high concentrations of electrolytes and sugars, which results in intestinal dilation, increased intestinal transit, hyperglycemia, and the rapid onset of GI and vasomotor symptoms, which characterizes dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux. PTS: 1 REF: p. 1279 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 17. A client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the client, what advantage should the nurse describe? A. The entire peritoneal cavity can be visualized. B. The test allows for painless biopsy collection. C. The capsule is endoscopically placed in the intestine. D. The test is noninvasive.

D Rationale: Capsule endoscopy allows for the noninvasive visualization of the mucosa of the small intestine. This procedure allows visualization of the GI tract, but not the peritoneal cavity. The capsule consists of a chip video camera without a mechanism to obtain a biopsy. The capsule is swallowed and is not endoscopically placed in the small intestine. PTS: 1 REF: p. 1224 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 30. A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure? A. Colonoscopy B. Barium enema C. ERCP D. Upper gastrointestinal fibroscopy

A Rationale: During colonoscopy, tissue biopsies can be obtained, as needed, and polyps can be removed and evaluated. This is not possible during a barium enema, ERCP, or gastroscopy. PTS: 1 REF: p. 1222 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Chapter 38: Assessment of Digestive and Gastrointestinal Function 1. A nurse is caring for a client who is scheduled for a colonoscopy and whose preparation will include polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem would contraindicate the use of this form of bowel preparation? A. Inflammatory bowel disease B. Intestinal polyps C. Diverticulitis D. Colon cancer

A Rationale: The use of a lavage solution is contraindicated in clients with intestinal obstruction or inflammatory bowel disease. It can safely be used with clients who have polyps, colon cancer, or diverticulitis. PTS: 1 REF: p. 1219 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 7. A nurse is caring for a client who has undergone neck resection with a radial forearm free flap. The nurse's most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurse's most appropriate action? A. Document the findings as being consistent with a viable graft. B. Promptly report these indications of venous congestion. C. Closely monitor the client and reassess in 30 minutes. D. Reposition the client to promote peripheral circulation.

B Rationale: A graft that is blue with mottling may indicate venous congestion. This finding constitutes a risk for tissue ischemia and necrosis; prompt referral is necessary. PTS: 1 REF: p. 1236 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 4. A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom? A. Burning pain on swallowing B. Regurgitation of undigested food C. Symptoms mimicking a myocardial infarction D. Chronic parotid abscesses

B Rationale: An esophageal diverticulum is an outpouching of mucosa and submucosa that protrudes through the esophageal musculature. Food becomes trapped in the pouch and is frequently regurgitated when the client assumes a recumbent position. The client may experience difficulty swallowing; however, burning pain is not a typical finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid abscesses are not associated with a diagnosis of esophageal diverticulum. PTS: 1 REF: p. 1255 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 22. A client returns to the unit after a neck dissection. The surgeon placed a Jackson-Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the health care provider immediately for what finding? A. Presence of small blood clots in the drainage B. 60 mL of milky or cloudy drainage C. Spots of drainage on the dressings surrounding the drain D. 120 mL of serosanguinous drainage

B Rationale: Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours. Milky drainage is indicative of a chyle fistula, which requires prompt treatment. PTS: 1 REF: p. 1240 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 16. A client is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production? A. Muscle wasting B. Chronic jaundice in the absence of liver disease C. The presence of fat in the client's stool D. Persistently low hemoglobin and hematocrit

D Rationale: In the absence of intrinsic factor, vitamin B12 cannot be absorbed, and pernicious anemia results. This would result in a marked reduction in hemoglobin and hematocrit. PTS: 1 REF: p. 1210 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 10. A client was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize? A. Esophageal or pyloric obstruction related to scarring B. Uncontrolled proliferation of H. pylori C. Gastric hyperacidity related to excessive gastrin secretion D. Chronic referred pain in the lower abdomen

A Rationale: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of peptic ulcer disease, but would not be an expected finding for a client who has ingested a corrosive substance. Bacterial proliferation and hyperacidity would not occur. PTS: 1 REF: p. 1272 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 34. A medical client's CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding? A. The client may have cancer, but other GI disease must be ruled out. B. The client most likely has early-stage colorectal cancer. C. The client has a genetic predisposition to gastric cancer. D. The client has cancer, but the site is unknown.

A Rationale: CA 19-9 levels are elevated in most clients with advanced pancreatic cancer, but they may also be elevated in other conditions such as colorectal, lung, and gallbladder cancers; gallstones; pancreatitis; cystic fibrosis; and liver disease. A cancer diagnosis cannot be made solely on CA 19-9 results. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 23. A client with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the client's continuing care in the home setting, what assessment question is most relevant? A. "Does anyone in your family have experience at giving injections?" B. "Are you going to be anywhere with strong sunlight in the next few months?" C. "Are you aware of your blood type?" D. "Do any of your family members have training in first aid?"

A Rationale: Clients with malabsorption of vitamin B12 need information about lifelong vitamin B12 injections; the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the client to receive the injections from a health care provider. Questions addressing sun exposure, blood type and first aid are not directly relevant. PTS: 1 REF: p. 1270 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 27. A nurse is caring for an 83-year-old client who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the client's health issues? A. Stomach emptying takes place more slowly. B. The villi and epithelium of the small intestine become thinner. C. The esophageal sphincter becomes incompetent. D. Saliva production decreases.

A Rationale: Delayed gastric emptying occurs in older adults and may contribute to nausea. Changes to the small intestine and decreased saliva production would be less likely to contribute to nausea. Loss of esophageal sphincter function is pathologic and is not considered an age-related change. PTS: 1 REF: p. 1212 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 26. A nurse is caring for a client who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the client's appetite? A. Encourage the family to bring in the client's favorite foods. B. Limit visitors at mealtimes so that the client is not distracted. C. Avoid offering food unless the client initiates. D. Provide thorough oral care immediately after the client eats.

A Rationale: Family involvement and home-cooked favorite foods may help the client to eat. Having visitors at mealtimes may make eating more pleasant and increase the client's appetite. The nurse should not place the complete onus for initiating meals on the client. Oral care after meals is necessary, but does not influence appetite. PTS: 1 REF: p. 1241 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 8. A client presents to the clinic reporting vomiting and burning in the mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? A. Infection with Helicobacter pylori B. Excessive stomach acid secretion C. An incompetent pyloric sphincter D. A metabolic acid-base imbalance

A Rationale: H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Excessive stomach acid secretion leads to gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori. Sphincter dysfunction and acid-base imbalances do not cause peptic ulcer disease. PTS: 1 REF: p. 1278 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 19. A client's neck dissection surgery resulted in damage to the client's superior laryngeal nerve. What area of assessment should the nurse consequently prioritize? A. The client's swallowing ability B. The client's ability to speak C. The client's management of secretions D. The client's airway patency

A Rationale: If the superior laryngeal nerve is damaged, the client may have difficulty swallowing liquids and food because of the partial lack of sensation of the glottis. Damage to this particular nerve does not inhibit speech and only indirectly affects management of secretions and airway patency. PTS: 1 REF: p. 1243 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 2. A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client's subsequent care? A. The client will be monitored closely to detect malignant changes. B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C. Small amounts of blood are likely to be present in the stools and are not cause for concern. D. Antacids may be discontinued when symptoms of heartburn subside.

A Rationale: In the client with Barrett esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer, necessitating close monitoring. H2 receptor antagonists are commonly prescribed for clients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for clients with GERD, they should be taken as prescribed whether or not the client is symptomatic. PTS: 1 REF: p. 1257 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. A nurse is preparing to place a client's prescribed nasogastric tube. What anticipatory guidance should the nurse provide to the client? A. Insertion is likely to cause some gagging. B. Insertion will cause some short-term pain. C. A narrow-gauge tube will be inserted before being replaced with a larger-gauge tube. D. Topical anesthetics will be used to reduce discomfort during insertion.

A Rationale: Insertion may cause gagging until the tube has passed beyond the throat. Insertion is often unpleasant, but not normally painful. Anesthetic is not usually applied and there is no initial need for a small-gauge tube. PTS: 1 REF: p. 1255 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 23. A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug? A. Metoclopramide B. Omeprazole C. Lansoprazole D. Calcium carbonate

A Rationale: Metoclopramide (Reglan) is useful in promoting gastric motility. Omeprazole and lansoprazole are proton pump inhibitors that reduce gastric acid secretion. Calcium carbonate does not affect gastric emptying. PTS: 1 REF: p. 1258 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 6. A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What client most likely faces the highest immediate risk of oral cancer? A. A 65-year-old man with alcoholism who smokes B. A 45-year-old woman who has type 1 diabetes and who wears dentures C. A 32-year-old man who is obese and uses smokeless tobacco D. A 57-year-old man with GERD and dental caries

A Rationale: Oral cancers are often associated with the use of alcohol and tobacco, which when used together have a synergistic carcinogenic effect. Most cases of oral cancers occur in people over the age of 60 and a disproportionate number of cases occur in men. Diabetes, dentures, dental caries, and GERD are not risk factors for oral cancer. PTS: 1 REF: p. 1235 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 12. An advanced practice nurse is assessing the size and density of a client's abdominal organs. If the results of palpation are unclear to the nurse, what assessment technique should be implemented? A. Percussion B. Auscultation C. Inspection D. Rectal examination

A Rationale: Percussion is used to assess the size and density of the abdominal organs and to detect the presence of air-filled, fluid-filled, or solid masses. Percussion is used either independently or concurrently with palpation because it can validate palpation findings. PTS: 1 REF: p. 1216 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. Diagnostic imaging and physical assessment have revealed that a client with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? A. Peritonitis B. Gastritis C. Gastroesophageal reflux D. Acute pancreatitis

A Rationale: Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer. PTS: 1 REF: p. 1277 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 7. A client who experienced a large upper gastrointestinal (GI) bleed due to gastritis has had the bleeding controlled and is now stable. For the next several hours, the nurse caring for this client should assess for what signs and symptoms of recurrence? A. Tachycardia, hypotension, and tachypnea B. Tarry, foul-smelling stools C. Diaphoresis and sudden onset of abdominal pain D. Sudden thirst, unrelieved by oral fluid administration

A Rationale: Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Clients who have had one GI bleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage. Hemorrhage is not normally associated with sudden thirst or diaphoresis. PTS: 1 REF: p. 1276 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember

Multiple Choice 3. A client has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The client is scheduled for an appendectomy but questions the nurse about how a person's health is affected by the absence of the appendix. How should the nurse best respond? A. "Your appendix doesn't play a major role in health, so you won't notice any difference after your recovery from surgery." B. "The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate." C. "Your body will absorb slightly fewer nutrients from the food you eat, but you won't be aware of this." D. "Your small intestine will adapt over time to the absence of your appendix."

A Rationale: The appendix is an appendage of the cecum (not the small intestine) that has little or no physiologic function. Its absence does not affect digestion or absorption. PTS: 1 REF: p. 1209 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 2. A nurse is promoting increased protein intake to enhance a client's wound healing. What is the enzyme that will initiate the digestion of the protein that the client consumes? A. Pepsin B. Intrinsic factor C. Lipase D. Amylase

A Rationale: The enzyme that initiates the digestion of protein is pepsin. Intrinsic factor combines with vitamin B12 for absorption by the ileum. Lipase aids in the digestion of fats and amylase aids in the digestion of starch. PTS: 1 REF: p. 1210 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice Chapter 39: Management of Patients with Oral and Esophageal Disorders 1. The nurse determines that a client who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the nurse's priority when suctioning this client? A. Avoid applying suction on or near the suture line. B. Position client on the non-operative side with the head of the bed down. C. Assess the client's ability to perform self-suctioning. D. Evaluate the client's ability to swallow saliva and clear fluids.

A Rationale: The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Self-sectioning may be unsafe because the client may damage the suture line. Following a modified radical neck dissection with graft, the client is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing the viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the client's ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the client's need for suctioning. PTS: 1 REF: p. 1240 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 23. A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client? A. "Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food." B. "As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to form acid." C. "The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the stomach provides this environment." D. "The acidic environment in the stomach exists to buffer the highly alkaline environment in the esophagus."

A Rationale: The stomach, which stores and mixes food with secretions, secretes a highly acidic fluid in response to the presence or anticipated ingestion of food. The stomach does not turn food directly into acid, and the esophagus is not highly alkaline. Pancreatic enzymes are not synthesized in a highly acidic environment. PTS: 1 REF: p. 1210 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 33. A client has a gastrostomy tube that has been placed to drain stomach contents by low intermittent suction. What is the nurse's priority during this aspect of the client's care? A. Measure and record drainage. B. Monitor drainage for change in color. C. Titrate the suction every hour. D. Feed the client via the G tube as prescribed.

A Rationale: This drainage should be measured and recorded because it is a significant indicator of GI function. The nurse should indeed monitor the color of the output, but fluid balance is normally the priority. Frequent titration of the suction should not be necessary and feeding is contraindicated if the G tube is in place for drainage. PTS: 1 REF: p. 1251 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 8. The nurse is preparing to perform a client's abdominal assessment. What examination sequence should the nurse follow? A. Inspection, auscultation, percussion, and palpation B. Inspection, palpation, auscultation, and percussion C. Inspection, percussion, palpation, and auscultation D. Inspection, palpation, percussion, and auscultation

A Rationale: When performing a focused assessment of the client's abdomen, auscultation should always precede percussion and palpation because they may alter bowel sounds. The traditional sequence for all other focused assessments is inspection, palpation, percussion, and auscultation. PTS: 1 REF: p. 1215 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 7. A client has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should give what instructions to the client? A. "Take no NSAIDs within 72 hours of the test." B. "Take prescribed medications as usual." C. "Avoid over-the-counter (OTC) vitamin C supplements." D. "Do not use fiber supplements before the test."

A Rationale: In the past, clients were advised to avoid ingesting red meats, aspirin, nonsteroidal anti-inflammatory drugs, turnips, and horseradish for 72 hours prior to the study because it was thought that these were associated with false-positive results; likewise, clients were advised to avoid ingesting vitamin C from supplements or foods as it was believed that this was associated with false-negative results. However, these restrictions are no longer advised as their actual effects on test results have not been established; plus, they unnecessarily restricted client participation in screening. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 24. A client comes to the clinic reporting pain in the epigastric region. What statement by the client is specific to the presence of a duodenal ulcer? A. "My pain resolves when I have something to eat." B. "The pain begins right after I eat." C. "I know that my father and my grandfather both had ulcers." D. "I seem to have bowel movements more often than I usually do."

A Rationale: Pain relief after eating is associated with duodenal ulcers. This type of ulcer is not associated with family history or increased frequency of bowel movements. Pain immediately after eating is typical of gastric ulcers, not duodenal. PTS: 1 REF: p. 1272 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 3. A medical nurse who is caring for a client being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this client. What is a priority psychosocial outcome for this client? A. Indicates acceptance of altered appearance and demonstrates positive self-image B. Freely expresses needs and concerns related to postoperative pain management C. Compensates effectively for alteration in ability to communicate related to dysarthria D. Demonstrates effective stress management techniques to promote muscle relaxation

A Rationale: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the client's appearance is visibly altered. The face generally appears asymmetric, with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Clients who have had head and neck surgery generally report less pain as compared with other postoperative clients; however, the nurse must assess each individual client's level of pain and response to analgesics. Clients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation. PTS: 1 REF: p. 1241 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 21. A nurse is caring for a client who has had surgery for oral cancer. When addressing the client's long-term needs, the nurse should prioritize interventions and referrals with what goal? A. Enhancement of verbal communication B. Enhancement of immune function C. Maintenance of adequate social support D. Maintenance of fluid balance

A Rationale: Verbal communication may be impaired by radical surgery for oral cancer. Addressing this impairment often requires a long-term commitment. Immune function, social support, and fluid balance are all necessary, but communication is a priority issue for clients recovering from this type of surgery. PTS: 1 REF: p. 1239 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 20. The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply. A. Splenic vein B. Inferior mesenteric vein C. Gastric vein D. Inferior vena cava E. Saphenous vein

A, B, C Rationale: This portal venous system is composed of five large veins: the superior mesenteric, inferior mesenteric, gastric, splenic, and cystic veins, which eventually form the vena portae that enters the liver. The inferior vena cava is not part of the portal system. The saphenous vein is located in the leg. PTS: 1 REF: p. 1209 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 37. A client has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of the hormonal effects of stress, including norepinephrine release. Release of this substance would have what effect on the client's gastrointestinal function? Select all that apply. A. Decreased motility B. Increased sphincter tone C. Increased enzyme release D. Inhibition of secretions E. Increased peristalsis

A, B, D Rationale: Norepinephrine generally decreases GI motility and secretions, but increases muscle tone of sphincters. Norepinephrine does not increase the release of enzymes. PTS: 1 REF: p. 1211 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 27. A nurse is caring for a client in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristic(s) of this stage of the disease? Select all that apply. A. Perforation into the mediastinum B. Development of an esophageal lesion C. Erosion into the great vessels D. Painful swallowing E. Obstruction of the esophagus

A, C, E Rationale: In the later stages of esophageal cancer, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Painful swallowing and the emergence of a lesion are early signs of esophageal cancer. PTS: 1 REF: p. 1261 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice Chapter 40: Management of Patients with Gastric and Duodenal Disorders 1. A nurse is caring for a client who just has been diagnosed with a peptic ulcer. When teaching the client about his new diagnosis, how should the nurse best describe it? A. Inflammation of the lining of the stomach B. Erosion of the lining of the stomach or intestine C. Bleeding from the mucosa in the stomach D. Viral invasion of the stomach wall

B Rationale: A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by bleeding and inflammation, but these are not the definitive characteristics. PTS: 1 REF: p. 1270 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 10. A nurse is caring for a newly admitted client with a suspected GI bleed. The nurse assesses the client's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location? A. Sigmoid colon B. Upper GI tract C. Large intestine D. Anus or rectum

B Rationale: Blood shed in sufficient quantities in the upper GI tract will produce a tarry-black color (melena). Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or if blood is noted on toilet tissue. PTS: 1 REF: p. 1214 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 24. Results of a client's preliminary assessment prompted an examination of the client's carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurse's most appropriate response to this finding? A. Perform a focused abdominal assessment. B. Prepare to meet the client's psychosocial needs. C. Liaise with the nurse practitioner to perform an anorectal examination. D. Encourage the client to adhere to recommended screening protocols.

B Rationale: CEA is a protein that is normally not detected in the blood of a healthy person; therefore, when detected it indicates that cancer is present, but not what type of cancer is present. The client would likely be learning that he or she has cancer, so the nurse must prioritize the client's immediate psychosocial needs, not abdominal assessment. Future screening is not a high priority in the short term. PTS: 1 REF: p. 1217 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 19. A client has been prescribed cimetidine for the treatment of peptic ulcer disease. When providing relevant health education for this client, the nurse should ensure the client is aware of what potential outcome? A. Bowel incontinence B. Drug-drug interactions C. Abdominal pain D. Heat intolerance

B Rationale: Cimetidine is associated with several drug-drug interactions. This drug does not cause bowel incontinence, abdominal pain, or heat intolerance. PTS: 1 REF: p. 1269 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 11. A nurse has auscultated a client's abdomen and noted one or two bowel sounds in a 2-minute period of time. How should the nurse document the client's bowel sounds? A. Normal B. Hypoactive C. Hyperactive D. Paralytic ileus

B Rationale: Documenting bowel sounds is based on assessment findings. The terms normal (sounds heard about every 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation. Paralytic ileus is a medical diagnosis that may cause absent or hypoactive bowel sounds, but the nurse would not independently document this diagnosis. PTS: 1 REF: p. 1216 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 20. A client has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of assessing the client's level of anxiety. Which of the following actions is most likely to accomplish this? A. The nurse gauges the client's response to hypothetical outcomes. B. The client is encouraged to express fears openly. C. The nurse provides detailed and accurate information about the disease. D. The nurse closely observes the client's body language.

B Rationale: Encouraging the client to discuss his or her fears and anxieties is usually the best way to assess a client's anxiety. Presenting hypothetical situations is a surreptitious and possibly inaccurate way of assessing anxiety. Observing body language is part of assessment, but it is not the complete assessment. Presenting information may alleviate anxiety for some clients, but it is not an assessment. PTS: 1 REF: p. 1283 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 35. A client has come to the clinic reporting blood in the stool. A fecal occult blood test is performed but is negative. Based on the client's history, the health care provider suggests a colonoscopy, but the client refuses, citing a strong aversion to the invasive nature of the test. What other test might the provider order to check for blood in the stool? A. A laparoscopic intestinal mucosa biopsy B. A fecal immunochemical test (FIT) C. Computed tomography (CT) D. Magnetic resonance imagery (MRI)

B Rationale: Fecal immunochemical tests (FIT) may be more accurate than guaiac testing and useful for clients who refuse invasive testing. CT or MRI cannot detect blood in stool. Laparoscopic intestinal mucosa biopsy is not performed. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 17. A client has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse's priority intervention? A. Administration of antiemetics B. Insertion of an NG tube for decompression C. Infusion of hypotonic IV solution D. Administration of proton pump inhibitors as prescribed

B Rationale: In treating the client with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. This is a priority over fluid or medication administration. PTS: 1 REF: p. 1277 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. A nurse is assessing a client who has peptic ulcer disease. The client requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the client? A. Most affected clients acquired the infection during international travel. B. Infection typically occurs due to ingestion of contaminated food and water. C. Many people possess genetic factors causing a predisposition to H. pylori infection. D. The H. pylori microorganism is endemic in warm, moist climates.

B Rationale: Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. The organism is endemic to many areas, not only warm, moist climates. Genetic factors have not been identified. PTS: 1 REF: p. 1271 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Select 28. The nurse is preparing to check for tube placement in the client's stomach as well as measure the residual volume. What are these nursing actions attempting to prevent? A. Gastric ulcers B. Aspiration C. Abdominal distention D. Diarrhea

B Rationale: Protecting the client from aspirating is essential because aspiration can cause pneumonia, a potentially life-threatening disorder. Gastric ulcers are not a common complication of tube feeding in clients with ET tubes. Abdominal distention and diarrhea can both be associated with tube feeding, but prevention of these problems is not the primary rationale for confirming placement. PTS: 1 REF: p. 1240 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 13. The nurse is caring for a client with gastrointestinal symptoms who reports being under a significant amount of stress at home and at work. Which gastrointestinal effect of stress should the nurse anticipate is affecting this client? A. Increased gastric acid secretion B. Slowed peristalsis C. Increased enteric blood flow D. Relaxed sphincter muscles

B Rationale: Stress stimulates the sympathetic nervous system which slows motility in the gastrointestinal tract, reduces gastric secretions, and causes vasoconstriction. Stimulation of the parasympathetic nervous system causes the non-voluntary sphincters to relax. PTS: 1 REF: p. 1209 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 15. A nurse is caring for clients in a stroke rehabilitation facility. Damage to what area of the brain will most affect a client's ability to swallow? A. Temporal lobe B. Medulla oblongata C. Cerebellum D. Pons

B Rationale: Swallowing is a voluntary act that is regulated by a swallowing center in the medulla oblongata of the central nervous system. Swallowing is not regulated by the temporal lobe, cerebellum, or pons. PTS: 1 REF: p. 1210 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 12. A nurse in an oral surgery practice is working with a client scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend what action? A. Rinse the mouth with alcohol before bedtime for the next 7 days. B. Use warm saline to rinse the mouth as needed. C. Brush around the area with a firm toothbrush to prevent infection. D. Use a toothpick to dislodge any debris that gets lodged in the socket.

B Rationale: The client should be assessed for bleeding after the tooth is extracted. The mouth can be rinsed with warm saline to keep the area clean. A firm toothbrush or toothpick could injure the tissues around the extracted area. Alcohol would injure tissues that are healing. PTS: 1 REF: p. 1233 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 25. A nurse is caring for a client who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this client, what would the nurse be sure to include? A. Increasing calcium intake to promote bone healing B. Avoiding chewing food for the specified number of weeks after surgery C. Techniques for managing parenteral nutrition in the home setting D. Techniques for managing a gastrostomy

B Rationale: The client who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. Increased calcium intake will not have an appreciable effect on healing. Enteral and parenteral nutrition are rarely necessary. PTS: 1 REF: p. 1234 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 28. A client has been scheduled for a urea breath test in one month's time. What nursing diagnosis most likely prompted this diagnostic test? A. Impaired dentition related to gingivitis B. Risk for impaired skin integrity related to peptic ulcers C. Imbalanced nutrition: Less than body requirements related to enzyme deficiency D. Diarrhea related to Clostridium difficile infection

B Rationale: Urea breath tests detect the presence of Helicobacter pylori, the bacteria that can live in the mucosal lining of the stomach and cause peptic ulcer disease. This test does not address fluid volume, nutritional status, or dentition. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 30. A client's NG tube has become clogged after the nurse instilled a medication that was insufficiently crushed. The nurse has attempted to aspirate with a large-bore syringe, with no success. What should the nurse do next? A. Withdraw the NG tube 2 inches (5 cm) and reattempt aspiration. B. Attach a syringe filled with warm water and attempt an in-and-out motion of instilling and aspirating. C. Withdraw the NG tube slightly and attempt to dislodge by flicking the tube with the fingers. D. Remove the NG tube promptly and obtain an order for reinsertion from the primary care provider.

B Rationale: Warm water irrigation is one of the methods that can be used to unclog a feeding tube. Removal is not warranted at this early stage and a flicking motion is unlikely to have an effect. The tube should not be withdrawn, even a few centimeters. PTS: 1 REF: p. 1251 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 39. A female client has presented to the emergency department with right upper quadrant pain; the health care provider has ordered abdominal ultrasound to rule out cholecystitis. The client expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best respond? A. "Abdominal ultrasound is very safe, but it can't be performed if you're pregnant." B. "Abdominal ultrasound poses no known safety risks of any kind." C. "Current guidelines state that a person can have up to 3 ultrasounds per year." D. "Current guidelines state that a person can have up to 6 ultrasounds per year."

B Rationale: An ultrasound produces no ill effects and there are not specific limits on its use, even during pregnancy. PTS: 1 REF: p. 1217 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 26. A client's sigmoidoscopy has been successfully completed and the client is preparing to return home. What teaching point should the nurse include in the client's discharge education? A. The client should drink at least 2 liters of fluid in the next 12 hours. B. The client can resume a normal routine immediately. C. The client should expect fecal urgency for several hours. D. The client can expect some scant rectal bleeding.

B Rationale: Following sigmoidoscopy, clients can resume their regular activities and diet. There is no need to push fluids, and neither fecal urgency nor rectal bleeding is expected. PTS: 1 REF: p. 1224 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 25. A nurse is assessing the abdomen of a client just admitted to the unit with suspected GI disease. Inspection reveals several diverse lesions on the client's abdomen. How should the nurse best interpret this assessment finding? A. Abdominal lesions are usually due to age-related skin changes. B. Integumentary diseases often cause GI disorders. C. GI diseases often produce skin changes. D. The client needs to be assessed for self-harm.

C Rationale: Abdominal lesions are of particular importance because GI diseases often produce skin changes. Skin problems do not normally cause GI disorders. Age-related skin changes do not have a pronounced effect on the skin of the abdomen when compared to other skin surfaces. Self-harm is a less likely explanation for skin lesions on the abdomen. PTS: 1 REF: p. 1215 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 9. A client who has been experiencing changes in his bowel function is scheduled for a barium enema. What instruction should the nurse provide for postprocedure recovery? A. Remain NPO for 6 hours postprocedure. B. Administer a Fleet enema to cleanse the bowel of the barium. C. Increase fluid intake to evacuate the barium. D. Avoid dairy products for 24 hours' postprocedure.

C Rationale: Adequate fluid intake is necessary to rid the GI tract of barium. The client must not remain NPO after the test and enemas are not used to cleanse the bowel of barium. There is no need to avoid dairy products. PTS: 1 REF: p. 1219 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning | Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 20. A client who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. What should the nurse include in the client's immediate postoperative plan of care? A. Teaching the client to self-suction B. Performing chest physiotherapy to promote oxygenation C. Positioning the client to prevent gastric reflux D. Providing a regular diet as tolerated

C Rationale: After recovering from the effects of anesthesia, the client is placed in a low Fowler position, and later in a Fowler position, to help prevent reflux of gastric secretions. The client is observed carefully for regurgitation and dyspnea because a common postoperative complication is aspiration pneumonia. In this period of recovery, self-suctioning is also not likely realistic or safe. Chest physiotherapy is contraindicated because of the risk of aspiration. Nutrition is prioritized, but a regular diet is contraindicated in the immediate recovery from esophageal surgery. PTS: 1 REF: p. 1262 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 14. A client has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this client? A. Placing the client in a left lateral position B. Administering opioids as prescribed C. Placing the client in Fowler position D. Teaching the client to use the client-controlled analgesia (PCA) system

C Rationale: After the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the client may be placed in Fowler position to facilitate breathing and promote comfort. Lateral positioning does not facilitate oxygenation or comfort. Medications do not facilitate spontaneous breathing. PTS: 1 REF: p. 1240 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 32. A clinic client has described recent dark-colored stools, and the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the client's current health status would contraindicate FOBT? A. Gastroesophageal reflux disease (GERD) B. Peptic ulcers C. Hemorrhoids D. Recurrent nausea and vomiting

C Rationale: FOBT should not be performed when there is hemorrhoidal bleeding. GERD, peptic ulcers, and nausea and vomiting do not contraindicate the use of FOBT as a diagnostic tool. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 12. A client is receiving education about an upcoming Billroth I procedure (gastroduodenostomy). This client should be informed that the client may experience which of the following adverse effects associated with this procedure? A. Persistent feelings of hunger and thirst B. Constipation or bowel incontinence C. Diarrhea and feelings of fullness D. Gastric reflux and belching

C Rationale: Following a Billroth I, the client may have problems with feelings of fullness, dumping syndrome, and diarrhea. Hunger and thirst, constipation, and gastric reflux are not adverse effects associated with this procedure. PTS: 1 REF: p. 1274 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 6. The nurse is caring for a client scheduled for a colonoscopy. The nurse should assist the client into what position during this diagnostic test? A. In a knee-chest position (lithotomy position) B. Lying prone with legs drawn toward the chest C. Lying on the left side with legs drawn toward the chest D. In a prone position with two pillows elevating the buttocks

C Rationale: For best visualization, colonoscopy is performed while the client is lying on the left side with the legs drawn up toward the chest. A knee-chest position, lying on the stomach with legs drawn to the chest, and a prone position with two pillows elevating the legs do not allow for the best visualization. PTS: 1 REF: p. 1223 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 29. The management of the client's gastrostomy is an assessment priority for the home care nurse. What statement would indicate that the client is managing the tube correctly? A. "I clean my stoma twice a day with alcohol." B. "The only time I flush my tube is when I'm putting in medications." C. "I flush my tube with water before and after each of my medications." D. "I try to stay still most of the time to avoid dislodging my tube."

C Rationale: Frequent flushing is needed to prevent occlusion, and should not just be limited to times of medication administration. Alcohol will irritate skin surrounding the insertion site and activity should be maintained as much as possible. PTS: 1 REF: p. 1247 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 32. A client who suffered a stroke had an NG tube inserted to facilitate feeding shortly after admission. The client has since become comatose and the client's family asks the nurse why the health care provider is recommending the removal of the client's NG tube and the insertion of a gastrostomy tube. What is the nurse's best response? A. "It eliminates the risk for infection." B. "Feeds can be infused at a faster rate." C. "Regurgitation and aspiration are less likely." D. "It allows caregivers to provide personal hygiene more easily."

C Rationale: Gastrostomy is preferred over NG feedings in the client who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely than with NG feedings. Both tubes carry a risk for infection; this change in care is not motivated by the possibility of faster infusion or easier personal care. PTS: 1 REF: p. 1249 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 29. A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse's assessment should focus on what potential cause? A. Diet high in red meat B. Upper GI bleed C. Hemorrhoids D. Use of iron supplements

C Rationale: Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool. Hemorrhoids are often a cause of anal bleeding since they occur in the rectum. Blood from an upper GI bleed would be dark rather than frank. Iron supplements make the stool dark, but not bloody and red meat consumption would not cause frank blood. PTS: 1 REF: p. 1216 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 4. A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the client's health problem? A. Consumes one or more protein drinks daily. B. Takes over-the-counter antacids frequently throughout the day. C. Smokes one pack of cigarettes daily. D. Reports a history of social drinking on a weekly basis.

C Rationale: Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralization of gastric acid and can underlie gastritis. Protein drinks do not result in gastric inflammation. Antacid use is a response to experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in clients with a history of consumption of alcohol on a daily basis. PTS: 1 REF: p. 1273 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 8. A nurse is assessing a client who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize? A. Assess ability to clear oral secretions. B. Assess for signs of infection. C. Assess for a patent airway. D. Assess for ability to communicate.

C Rationale: Postoperatively, the nurse assesses for a patent airway. The client's ability to manage secretions has a direct bearing on airway patency. However, airway patency is the overarching goal. This immediate physiologic need is prioritized over communication, though this is an important consideration. Infection is not normally a threat in the immediate postoperative period. PTS: 1 REF: p. 1236 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 4. An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the client has completed the test? A. Stool will be yellow for the first 24 hours' postprocedure. B. The barium may cause diarrhea for the next 24 hours. C. Fluids must be increased to facilitate the evacuation of the stool. D. Slight anal bleeding may be noted as the barium is passed.

C Rationale: Postprocedural client education includes information about increasing fluid intake; evaluating bowel movements for evacuation of barium; and noting increased number of bowel movements. The number of bowel movement is noted because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. Yellow stool, diarrhea, and anal bleeding are not expected. PTS: 1 REF: p. 1219 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 22. A nurse is providing preprocedure education for a client who will undergo a lower GI tract study the following week. What should the nurse teach the client about bowel preparation? A. "You'll need to fast for at least 18 hours prior to your test." B. "Starting today, take over-the-counter (OTC) stool softeners twice daily." C. "You'll need to have enemas the day before the test." D. "For 24 hours before the test, insert a glycerin suppository every 4 hours."

C Rationale: Preparation of the client includes emptying and cleansing the lower bowel. This often necessitates a low-residue diet 1 to 2 days before the test; a clear liquid diet and a laxative the evening before; NPO after midnight; and cleansing enemas until returns are clear the following morning. PTS: 1 REF: p. 1220 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Select 21. The nurse is providing health education to a client with a gastrointestinal disorder. What should the nurse describe as a major function of the GI tract? A. The breakdown of food particles into cell form for digestion B. The maintenance of fluid and acid-base balance C. The absorption into the bloodstream of nutrient molecules produced by digestion D. The control of absorption and elimination of electrolytes

C Rationale: Primary functions of the GI tract include the breakdown of food particles into molecular form for digestion; the absorption into the bloodstream of small nutrient molecules produced by digestion; and the elimination of undigested unabsorbed food stuffs and other waste products. Nutrients must be broken down into molecular form, not cell form. Fluid, electrolyte, and acid-base balance are primarily under the control of the kidneys. PTS: 1 REF: p. 1210 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 9. A client who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What should the goals of physical therapy for this client include? A. Muscle training to relieve dysphagia B. Relieving nerve paralysis in the cervical plexus C. Promoting maximum shoulder function D. Alleviating achalasia by decreasing esophageal peristalsis

C Rationale: Shoulder drop occurs as a result of radical neck dissection. Shoulder function can be improved by rehabilitation exercises. Rehabilitation would not be initiated until the client's neck incision and graft, if present, were sufficiently healed. Nerve paralysis in the cervical plexus and other variables affecting swallowing would be managed by a speech therapist rather than a physical therapist. PTS: 1 REF: p. 1242 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 15. A client has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this client's discharge education? A. Resumption of activities of daily living B. Pain control C. Promotion of adequate nutrition D. Strategies for promoting communication

C Rationale: The client who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. The nature of this surgery threatens the client's nutritional status; this physiologic need would likely supersede the resumption of ADLs. Pain should be under control prior to discharge and communication is not precluded by this surgery. PTS: 1 REF: p. 1234 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 11. A client who underwent a gastric resection 3 weeks ago is having their diet progressed on a daily basis. Following the latest meal, the client reports dizziness and palpitations. Inspection reveals that the client is diaphoretic. What is the nurse's best action? A. Insert a nasogastric tube promptly. B. Reposition the client supine. C. Monitor the client closely for further signs of dumping syndrome. D. Assess the client for signs and symptoms of aspiration.

C Rationale: The client's symptoms are characteristic of dumping syndrome, which results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is a less likely cause for the client's symptoms. Supine positioning will likely exacerbate the symptoms and insertion of an NG tube is contraindicated due to the nature of the client's surgery. PTS: 1 REF: p. 1279 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 14. A nurse is providing anticipatory guidance to a client who is preparing for a total gastrectomy. The nurse learns that the client is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the client's anxiety? A. Emphasize the fact that gastric surgery has a low risk of complications. B. Encourage the client to focus on the benefits of the surgery. C. Facilitate the client's contact with support services. D. Obtain an order for a PRN benzodiazepine.

C Rationale: The services of clergy, psychiatric clinical nurse specialists, psychologists, social workers, and psychiatrists are made available, and can reduce the client's anxiety. This is preferable to antianxiety medications. Downplaying the risks of surgery or focusing solely on the benefits is a simplistic and patronizing approach. PTS: 1 REF: p. 1281 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 10. A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action should the nurse recommend as having the greatest potential to prevent esophageal cancer? A. Promotion of a nutrient-dense, low-fat diet B. Annual screening endoscopy for clients over 50 with a family history of esophageal cancer C. Early diagnosis and treatment of gastroesophageal reflux disease D. Adequate fluid intake and avoidance of spicy foods

C Rationale: There are numerous risk factors for esophageal cancer but chronic esophageal irritation or GERD is among the most significant. This is a more significant risk factor than dietary habits. Screening endoscopies are not recommended solely on the basis of family history. PTS: 1 REF: p. 1257 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 3. A nurse is preparing to discharge a client after recovery from gastric surgery. What is an appropriate discharge outcome for this client? A. Bowel movements maintain a loose consistency. B. Three large meals per day are tolerated. C. Weight is maintained or gained. D. High calcium diet is consumed.

C Rationale: Weight loss is common in the postoperative period, with early satiety, dysphagia, reflux and regurgitation, and elimination issues contributing to this problem. The client should weigh oneself daily, with a goal of maintaining or gaining weight. The client should not have bowel movements that maintain a loose consistency, because this would indicate diarrhea and would warrant intervention as it is a symptom of dumping syndrome. The client should be able to tolerate six small meals per day, rather than three large meals. The client does not require a diet excessively rich in calcium but should consume a diet high in calories, iron, vitamin A and vitamin C. PTS: 1 REF: p. 1277 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 31. The nurse is administering medications to a client through a feeding tube. Which action should the nurse take? A. Flush the tube with 5 mL of water before administering medication. B. Turn the tube feeding off for 1 hour before administering the medication. C. Administer each medication separately. D. Flush with 50 mL of water between each medication.

C Rationale: When administering several medications through a feeding tube, each medication should be administered separately with 15 mL of water administered between each medication. Prior to administering medication, the tube feed should be paused (there is no need to wait one hour) and flushed with 15 mL of water. PTS: 1 REF: p. 1247 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember

Multiple Choice 13. A nurse is providing client education for a client with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The client has recently been prescribed misoprostol. What would the nurse be most accurate in informing the client about the drug? A. It reduces the stomach's volume of hydrochloric acid B. It increases the speed of gastric emptying C. It protects the stomach's lining D. It increases lower esophageal sphincter pressure

C Rationale: Misoprostol is a synthetic prostaglandin that, like prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the client to peptic ulceration. Misoprostol does not reduce gastric acidity, improve emptying of the stomach, or increase lower esophageal sphincter pressure. PTS: 1 REF: p. 1269 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand

Multiple Choice 34. The nurse is caring for a client who had a low-profile gastrostomy device placed. Which instruction should the nurse give the client and family? A. Wear the tubing outside of clothing. B. Use tape to secure the device. C. Bring the connection tubing if going to the hospital. D. Change the wet-to-dry dressing daily.

C Rationale: To administer a feeding with a low-profile feeding device, special tubing is connected to the device. This client needs to be instructed to take this tubing to the hospital and when traveling. A low-profile gastrostomy device sits flush with the skin so it is easily concealed under clothes. The device does not require tape or other type of securement system. This device also does not require any type of dressing, including a wet-to-dry dressing. PTS: 1 REF: p. 1250 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 31. The nurse is caring for a client with a duodenal ulcer and is relating the client's symptoms to the physiologic functions of the small intestine. What do these functions include? Select all that apply. A. Secretion of hydrochloric acid (HCl) B. Reabsorption of water C. Secretion of mucus D. Absorption of nutrients E. Movement of nutrients into the bloodstream

C, D, E Rationale: The small intestine folds back and forth on itself, providing a very large surface area for secretion and absorption, the process by which nutrients enter the bloodstream through the intestinal walls. Water reabsorption primarily takes place in the large bowel. HCl is secreted by the stomach. PTS: 1 REF: p. 1209 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 9. A client with a peptic ulcer disease has had metronidazole added to their current medication regimen. What health education related to this medication should the nurse provide? A. Take the medication on an empty stomach. B. Take up to one extra dose per day if stomach pain persists. C. Take at bedtime to mitigate the effects of drowsiness. D. Avoid drinking alcohol while taking the drug.

D Rationale: Alcohol must be avoided when taking metronidazole and the medication should be taken with food. This drug does not cause drowsiness and the dose should not be adjusted by the client. PTS: 1 REF: p. 1269 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 14. A client has returned to the medical unit after a barium enema. When assessing the client's subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider? A. Large, wide stools B. Milky white stools C. Three stools during an 8-hour period of time D. Streaks of blood present in the stool

D Rationale: Barium has a high osmolarity and may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output (large stools). The barium will give the stools a milky white appearance, and it is not uncommon for the client to experience an increase in the number of bowel movements. Blood in fecal matter is not an expected finding and the nurse should notify accordingly. PTS: 1 REF: p. 1214 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. A nurse is creating a care plan for a client receiving nasogastric tube feedings. Which intervention should the nurse include? A. Check the gastric residual volume every 4 hours. B. Hold the tube feeding if the gastric residual volume is greater than 200 mL. C. Position client flat in bed during feedings. D. Use client assessment findings to determine tolerance of feedings.

D Rationale: Client indicators of tolerance to tube feedings include abdominal distention, client report of discomfort, vomiting, hypoactive bowel sounds, and diarrhea. Previously, gastric residual volume (GRV) was checked as an indicator of tube feeding tolerance. Professional organizations such as the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN) no longer advocate using GRVs to monitor tolerance of enteral feedings. Therefore, unless policy states otherwise, GRV should not be checked every 4 hours and the feeding should not be held for a GRV greater than 250 mL. The head of the bed should be elevated 30 degrees while a tube feeding is being administered to reduce the risk for aspiration. PTS: 1 REF: p. 1246 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 13. A client has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies? A. Radiation therapy often results in secondary brain tumors. B. Surgical complications are exceedingly common. C. Diagnosis rarely occurs until the cancer is end stage. D. Metastases are common and respond poorly to treatment.

D Rationale: Deaths from malignancies of the head and neck are primarily attributable to local-regional metastasis to the cervical lymph nodes in the neck. This often occurs by way of the lymphatics before the primary lesion has been treated. This local-regional metastasis is not amenable to surgical resection and responds poorly to chemotherapy and radiation therapy. This high mortality rate is not related to surgical complications, late diagnosis, or the development of brain tumors. PTS: 1 REF: p. 1236 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 15. A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. What would be the nursing care most needed by the client at this time? A. Teaching the client about necessary nutritional modification B. Helping the client weigh treatment options C. Teaching the client about the etiology of gastritis D. Providing the client with physical and emotional support

D Rationale: For acute gastritis, the nurse provides physical and emotional support and helps the client manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time. PTS: 1 REF: p. 1268 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 11. An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body? A. Haloperidol B. Prostigmine C. Epinephrine D. Glucagon

D Rationale: Glucagon is given prior to removal of a foreign body because it relaxes the smooth muscle of the esophagus, facilitating insertion of the endoscope. Haloperidol is an antipsychotic drug and is not indicated. Prostigmine is prescribed for clients with myasthenia gravis. It increases muscular contraction, an effect opposite that which is desired to facilitate removal of the foreign body. Epinephrine is indicated in asthma attack and bronchospasm. PTS: 1 REF: p. 1256 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 5. A nurse is caring for a client with recurrent hematemesis who is scheduled for upper gastrointestinal fibroscopy. How should the nurse in the radiology department prepare this client? A. Insert a nasogastric tube. B. Administer a micro Fleet enema at least 3 hours before the procedure. C. Have the client lie in a supine position for the procedure. D. Apply local anesthetic to the back of the client's throat.

D Rationale: Preparation includes spraying or gargling with a local anesthetic. A nasogastric tube or a micro Fleet enema is not required for this procedure. The client should be positioned in a side-lying position in case of emesis. PTS: 1 REF: p. 1222 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 17. A nurse is caring for a client who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the client and notes the presence of high-pitched adventitious sounds over the client's trachea on auscultation. The client's oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurse's most appropriate action? A. Encourage the client to perform deep breathing and coughing exercises hourly. B. Reposition the client into a prone or semi-Fowler position and apply supplementary oxygen by nasal cannula. C. Activate the emergency response system. D. Report this finding promptly to the health care provider and remain with the client.

D Rationale: In the immediate postoperative period, the nurse assesses for stridor (coarse, high-pitched sound on inspiration) by listening frequently over the trachea with a stethoscope. This finding must be reported immediately because it indicates obstruction of the airway. The client's current status does not warrant activation of the emergency response system, and encouraging deep breathing and repositioning the client are inadequate responses. PTS: 1 REF: p. 1240 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. A client seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education? A. "Drinking beverages after your meal, rather than with your meal, may bring some relief." B. "It's best to avoid dry foods, such as rice and chicken, because they're harder to swallow." C. "Many clients obtain relief by taking over-the-counter antacids 30 minutes before eating." D. "Instead of eating three meals a day, try eating smaller amounts more often."

D Rationale: Management for a hiatal hernia includes frequent, small feedings that can pass easily through the esophagus. Avoiding beverages and particular foods or taking OTC antacids are not noted to be beneficial. PTS: 1 REF: p. 1255 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 5. A nurse is caring for a client who is acutely ill and has included vigilant oral care in the client's plan of care. What factor increases this client's risk for dental caries? A. Hormonal changes brought on by the stress response cause an acidic oral environment B. Systemic infections frequently migrate to the teeth C. Hydration that is received intravenously lacks fluoride D. Inadequate nutrition and decreased saliva production can cause cavities

D Rationale: Many ill clients do not eat adequate amounts of food and therefore produce less saliva, which in turn reduces the natural cleaning of the teeth. Stress response is not a factor, infections generally do not attack the enamel of the teeth, and the fluoride level of the client is not significant in the development of dental caries in the ill client. PTS: 1 REF: p. 1232 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 22. A nurse is caring for a client hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize? A. Strategies for maintaining an alkaline gastric environment B. Safe technique for self-suctioning C. Techniques for positioning correctly to promote gastric healing D. Strategies for avoiding irritating foods and beverages

D Rationale: Measures to help relieve pain include instructing the client to avoid foods and beverages that may be irritating to the gastric mucosa and instructing the client about the correct use of medications to relieve chronic gastritis. An alkaline gastric environment is neither possible nor desirable. There is no plausible need for self-suctioning. Positioning does not have a significant effect on the presence or absence of gastric healing. PTS: 1 REF: p. 1277 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Select 19. A nurse is performing an abdominal assessment of an older adult client. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function? A. Increased gastric motility B. Decreased gastric pH C. Increased gag reflex D. Decreased mucus secretion

D Rationale: Older adults tend to secrete less mucus than younger adults. Gastric motility slows with age and gastric pH rises due to decreased secretion of gastric acids. Older adults tend to have a blunted gag reflex compared to younger adults. PTS: 1 REF: p. 1213 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 37. A nasogastric tube is being inserted in a client with the COVID virus. Which action should the nurse take? A. Place the client in a prone position. B. Administer bolus feedings. C. Place a mask over the client's nose. D. Wear personal protective equipment.

D Rationale: Personal protective equipment must be worn when placing a nasogastric tube in a client with COVID since it is considered an aerosol-generating procedure as tube placement often generates a cough. The client should be placed in a supine position for the placement of the nasogastric tube to assure proper visualization, assessment, and advancement of the tube. If possible, a mask should be placed over the client's mouth to avoid transmission of the virus if the client coughs. The mask cannot be placed over the client's nose since the tube will be placed through the nares. The feedings should be administered as a continuous feeding, rather than a bolus, to reduce the risk of contact with bodily fluids and aerosolized droplets. PTS: 1 REF: p. 1246 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 16. A The client is experiencing painful oral lesions following radiation for oropharyngeal cancer. Which instruction should the nurse give this client? A. Spicy foods stimulate salivation and are soothing. B. Eat food while it is hot to enhance flavor. C. Avoid brushing teeth while lesions are present. D. Eat soft or liquid foods.

D Rationale: Since oral lesions can be painful, a soft or liquid diet may be preferred and easier to ingest. Other strategies to reduce pain and discomfort include avoiding spicy and hot foods. The client should continue with mouth care and brushing teeth with a soft toothbrush to keep the oral cavity clean. PTS: 1 REF: p. 1237 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 5. A community health nurse is preparing for an initial home visit to a client discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include? A. Enteral feeding via gastrostomy tube (G tube) B. Gastrointestinal decompression by nasogastric tube C. Periodic assessment for esophageal distension D. Administration of injections of vitamin B12

D Rationale: Since vitamin B12 is absorbed in the stomach, the client requires vitamin B12 replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is absent, a nasogastric tube would not be indicated. As well, this is not possible in the home setting. Since there is no stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension is unlikely. PTS: 1 REF: p. 1270 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 33. A client will be undergoing a urea breath test for the detection of Helicobacter pylori. Which instruction should the nurse give to the client to prepare for this test? A. Ingest a capsule of carbon-labeled urea ingested three days before the test. B. Take prescribed antibiotics one month before the test. C. Fast for 12 hours before the test. D. Avoid taking cimetidine 24 hours before the test.

D Rationale: The client undergoing a urea breath test should avoid taking cimetidine for 24 hours before the test. The capsule with the carbon-labeled urea is ingested at the time of the test and a breath sample is obtained 10 to 20 minutes later. Antibiotics should be avoided for one month before the test. There is no need to fast for this test. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 21. A nurse is caring for a client who has a diagnosis of GI bleed. During shift assessment, the nurse finds the client to be tachycardic and hypotensive, and the client has an episode of hematemesis while the nurse is in the room. In addition to monitoring the client's vital signs and level of conscious, what would be a priority nursing action for this client? A. Place the client in a prone position. B. Provide the client with ice water to slow any GI bleeding. C. Prepare for the insertion of an NG tube. D. Notify the health care provider.

D Rationale: The nurse must always be alert for any indicators of hemorrhagic gastritis, which include hematemesis (vomiting of blood), tachycardia, and hypotension. If these occur, the health care provider is notified and the client's vital signs are monitored as the client's condition warrants. Putting the client in a prone position could lead to aspiration. Giving ice water is contraindicated as it would stimulate more vomiting. PTS: 1 REF: p. 1270 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 16. A client is recovering in the hospital following gastrectomy. The nurse notes that the client has become increasingly difficult to engage and has had several angry outbursts at staff members in recent days. The nurse's attempts at therapeutic dialogue have been rebuffed. What is the nurse's most appropriate action? A. Ask the client's primary provider to liaise between the nurse and the client. B. Delegate care of the client to a colleague. C. Limit contact with the client in order to provide privacy. D. Make appropriate referrals to services that provide psychosocial support.

D Rationale: The nurse should enlist the services of clergy, psychiatric clinical nurse specialists, psychologists, social workers, and psychiatrists, if needed. This is preferable to delegating care, since the client has become angry with other care providers as well. It is impractical and inappropriate to expect the primary provider to act as a liaison. It would be inappropriate and unsafe to simply limit contact with the client. PTS: 1 REF: p. 1283 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Select 38. The nurse is caring for a client who has a diagnosis of AIDS. Inspection of the client's mouth reveals the new presence of white lesions on the client's oral mucosa. What is the nurse's most appropriate response? A. Encourage the client to gargle with salt water twice daily. B. Attempt to remove the lesions with a tongue depressor. C. Make a referral to the unit's dietitian. D. Inform the primary provider of this finding.

D Rationale: The nurse should inform the primary provider of this abnormal finding in the client's oral cavity, since it necessitates medical treatment. It would be inappropriate to try to remove skin lesions from a client's mouth and salt water will not resolve this problem, which is likely due to candidiasis. A dietitian referral is unnecessary. PTS: 1 REF: p. 1215 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. The nurse is providing a client with the supplies necessary to perform two hemoccult tests on the client's stool. What instruction should the nurse give this client? A. "If possible, fast for 12 hours before collecting a sample." B. "Take all your medications except the antihypertensive ones." C. "Don't eat highly acidic foods 72 hours before you start the test." D. "Mail the paper slides to the clinic once you've collected the samples."

D Rationale: In the past, clients were advised to avoid ingesting red meat, aspirin, nonsteroidal anti-inflammatory drugs, turnips, and horseradish for 72 hours prior to the study because it was thought that these were associated with false-positive results; likewise, clients were advised to avoid ingesting vitamin C from supplements or foods as it was believed that this was associated with false-negative results. However, these restrictions are no longer advised as their actual effects on test results have not been established; plus, they unnecessarily restrict participation in screening. Fasting is unnecessary and samples are mailed in after they have been collected. PTS: 1 REF: p. 1217 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 2. A nurse is admitting a client diagnosed with late-stage gastric cancer. The client's family is distraught and angry that the client was not diagnosed earlier in the course of her disease. What factor most likely contributed to the client's late diagnosis? A. Gastric cancer does not cause signs or symptoms until metastasis has occurred. B. Adherence to screening recommendations for gastric cancer is exceptionally low. C. Early symptoms of gastric cancer are usually attributed to constipation. D. The early symptoms of gastric cancer are usually not alarming or highly unusual.

D Rationale: Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing. Symptoms precede metastasis, however, and do not include constipation. PTS: 1 REF: p. 1278 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze