Content Area: Med-Surg: Gastrointestinal System
Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopancreatography (ERCP)? 1 Urine output 2 Bilirubin level 3 Blood pressure 4 Serum glucose
Correct2 Bilirubin level
When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. For what response should the nurse critically assess this client? 1 Edema 2 Belching 3 Fluid deficit 4 Excessive salivation
Correct3 Fluid deficit
An older adult client who is accustomed to taking enemas periodically to avoid constipation is admitted to a long-term care facility. In addition to medications, the health care provider prescribes bed rest and a regular diet. Which action should be implemented to help prevent the client from developing constipation? 1 Arrange to have enemas prescribed for the client. 2 Obtain a prescription for a daily laxative for the client. 3 Place a commode by the bedside to facilitate defecation. 4 Offer a large glass of prune juice with warm water each morning.
Correct4 Offer a large glass of prune juice with warm water each morning.
Which client statement indicates to the nurse that a client who is receiving cyanocobalamin (vitamin B 12) therapy for an intrinsic factor deficiency understands the treatment? 1 "I should have a vitamin B 12 injection every month." 2 "I'll take my B 12 vitamin every morning with my breakfast." 3 "I'll have a salad every day because Vitamin B 12 is in green vegetables." 4 "I should feel better because my vitamin B 12 treatments will improve my aplastic anemia."
Correct1 "I should have a vitamin B 12 injection every month."
Before discharge, a client who had a colostomy for colorectal cancer questions the nurse about resuming activity. What should the nurse teach the client about activity? 1 "With guidance, a near-normal lifestyle, including complete sexual function, is possible." 2 "Activities of daily living should be resumed as quickly as possible so you avoid being depressed." 3 "Most sports activities, except for swimming, can be resumed based on your overall physical condition." 4 "After surgery, changes in activities must be made to accommodate for the physiological changes caused by the operation."
Correct1 "With guidance, a near-normal lifestyle, including complete sexual function, is possible."
A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. With this evidence of impending hepatic coma, which diet can the nurse expect will be prescribed for this client? 1 20 g of protein, 2000 calories 2 70 g of protein, 1200 calories 3 80 g of protein, 2500 calories 4 100 g of protein, 1500 calories
Correct1 20 g of protein, 2000 calories
A nurse is caring for a client with cirrhosis of the liver. Which laboratory test should the nurse monitor that, when abnormal, might identify a client who may benefit from neomycin enemas? 1 Ammonia level 2 Culture and sensitivity 3 White blood cell count 4 Alanine aminotransferase (ALT) level
Correct1 Ammonia level
A health care provider schedules a paracentesis. What should the nurse instruct the client to do to prepare for the procedure? 1 Empty the bladder before the procedure. 2 Take a laxative the evening before the procedure. 3 Ingest nothing by mouth for eight hours before the procedure. 4 Self-administer a low soapsuds enema two hours before the procedure.
Correct1 Empty the bladder before the procedure.
A pregnant client complains of constipation. Which strategies should the nurse recommend? Select all that apply. 1 Exercise regularly. 2 Take a mild laxative before breakfast. 3 Drink at least one caffeinated beverage daily. 4 Add a few tablespoons of wheat bran to cereal at breakfast. 5 Plan to have a bowel movement at the same time every day.
Correct1 Exercise regularly. Correct4 Add a few tablespoons of wheat bran to cereal at breakfast. Correct5 Plan to have a bowel movement at the same time every day.
A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for possible situations in which exposure may have occurred. Which event does the nurse determine is most likely the source of this infection? 1 Had a small tattoo on the arm three months ago 2 Assisted in the emergency birth of a baby two weeks ago 3 Worked for a month in an undeveloped area in Mexico four months ago 4 Attended an ecologic conference in a large urban center two months ago
Correct1 Had a small tattoo on the arm three months ago
After a subtotal gastrectomy, a client has a nasogastric (NG) tube to continuous low suction. Three hours after the surgery, the client complains of nausea and abdominal pain. The client's abdomen appears distended. What should the nurse do first? 1 Instill 30 mL of air into the NG tube 2 Administer the prescribed pain medication 3 Inform the client that abdominal pain is common with NG tubes 4 Notify the surgeon of the absence of bowel sounds
Correct1 Instill 30 mL of air into the NG tube
A client is diagnosed with tuberculosis associated with human immunodeficiency virus (HIV) infection. Before starting antitubercular pharmacotherapy, it is essential for the nurse to review what test results? 1 Liver function studies 2 Pulmonary function studies 3 Electrocardiogram and echocardiogram 4 White blood cell counts and sedimentation rate
Correct1 Liver function studies
The nurse is caring for an Asian client who had a laparoscopic cholecystectomy six hours ago. When asked whether there is pain, the client smiles and says, "No." What should the nurse do? 1 Monitor for nonverbal cues of pain 2 Check the pressure dressing for bleeding 3 Assist the client to ambulate around his room 4 Irrigate the client's nasogastric tube with sterile water
Correct1 Monitor for nonverbal cues of pain
Thiamine (vitamin B1) and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan? 1 Neuronal activity 2 Bowel elimination 3 Efficient circulation 4 Prothrombin development
Correct1 Neuronal activity
A nurse is caring for a client with a hiatal hernia. Which risk factor is associated most commonly with this diagnosis? 1 Obesity 2 Alcoholism 3 Chronic bronchitis 4 Esophageal varices
Correct1 Obesity
A client with achalasia is scheduled to have a bougienage to dilate the lower esophagus and cardiac sphincter. After the procedure the nurse assesses the client for what complications related to esophageal perforation? 1 Tachycardia and abdominal pain 2 Faintness and feelings of fullness 3 Diaphoresis and cardiac palpitations 4 Increased blood pressure and urinary output
Correct1 Tachycardia and abdominal pain
Which statement by a client who is scheduled for bariatric surgery indicates to the nurse that further preoperative teaching is necessary? 1 "I need to eat more high protein foods." 2 "I'm going to have a figure like a model in about a year." 3 "I'm going to be out of bed and sitting in a chair the first day after surgery." 4 "I will be limiting my intake to 600 to 800 calories a day once I start eating again."
Correct2 "I'm going to have a figure like a model in about a year."
A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for what purpose? 1 Stimulate production of gastrointestinal secretions 2 Enhance relaxation of the upper gastrointestinal tract 3 Prolong excretion of the chemotherapeutic medication 4 Increase absorption of the chemotherapeutic medication
Correct2 Enhance relaxation of the upper gastrointestinal tract
A client is admitted to the hospital with a diagnosis of peptic ulcer. The nurse should assess the client for which complication commonly associated with the diagnosis? 1 Perforation 2 Hemorrhage 3 Pyloric obstruction 4 Esophageal varices
Correct2 Hemorrhage
A nurse teaches a client that it is not recommended to take bicarbonate of soda regularly. What effect of bicarbonate of soda is the nurse trying to prevent? 1 Gastric distention 2 Metabolic alkalosis 3 Chronic constipation 4 Cardiac dysrhythmias
Correct2 Metabolic alkalosis
A nurse is teaching a client with an acute exacerbation of colitis about the most appropriate diet. Which food selected by the client indicates that the dietary teaching is effective? 1 Orange juice 2 Scrambled eggs 3 Vanilla milkshake 4 Creamed potato soup
Correct2 Scrambled eggs
A client has a permanent sigmoid colostomy as a result of cancer of the rectum. The primary health care provider prescribes daily colostomy irrigations. What does the nurse explain that the primary purpose of these irrigations is? 1 To prevent straining at passage of stool 2 To establish a regular elimination schedule 3 To decrease the amount of flatus in the bowel 4 To limit the amount of fluid lost from the intestine
Correct2 To establish a regular elimination schedule
A client is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver. The nurse suspects what type of toxicity? 1 Thiamine 2 Vitamin A 3 Vitamin C 4 Pyridoxine
Correct2 Vitamin A
A client has a fractured mandible that is immobilized with wires. For which life-threatening postoperative problem should the nurse monitor this client? 1 Infection 2 Vomiting 3 Osteomyelitis 4 Bronchospasm
Correct2 Vomiting
Which represents appropriate nursing management of the client's nasogastric (NG) tube in the immediate postoperative period following gastroduodenostomy? 1 Advancing the tube to the original insertion depth if the tube becomes dislodged 2 Obtaining a prescription to vigorously irrigate the nasogastric tube if clogging is noted 3 Carefully monitoring the nasogastric tube to ensure that the tube is patent and the suction is working 4 Reporting the presence of bright red gastric aspirant in the suction canister during the immediate postoperative period
Correct3 Carefully monitoring the nasogastric tube to ensure that the tube is patent and the suction is workin
Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is bright red. What should the nurse do first? 1 Notify the health care provider. 2 Clamp the nasogastric tube for one hour. 3 Determine that this is an expected finding. 4 Irrigate the nasogastric tube with iced saline.
Correct3 Determine that this is an expected finding.
A nurse reviews the plan of care for a client with less than adequate nutritional intake. The nurse should question which prescription? 1 Have client sit in a chair for meals 2 Provide six small feedings in 24 hours 3 Give one can of diet supplement at 8 am and 4 pm 4 Encourage the client's family members to bring food from home
Correct3 Give one can of diet supplement at 8 am and 4 pm
A client is admitted with a lesion in the descending colon. Which factor in the client's history is unrelated to a predisposition to cancer? 1 Colitis 2 Constipation 3 Hemorrhoids 4 Diverticulitis
Correct3 Hemorrhoids
A client has an excision of a thrombosed external hemorrhoid. What should the nurse teach the client to use when cleaning the anus after a bowel movement? 1 Betadine pads 2 Soft facial tissue 3 Medicated pads (Tucks) 4 Sterile 4 x 4-inch gauze pads
Correct3 Medicated pads (Tucks)
A client is admitted to the hospital with jaundice. After numerous diagnostic tests, the healthcare provider makes the diagnosis of cancer of the pancreas. What does the nurse conclude is the most likely cause of the client's jaundice? 1 Necrosis of the parenchyma caused by the neoplasm 2 Excessive serum bilirubin caused by red blood cell destruction 3 Obstruction of the common bile duct by the pancreatic neoplasm 4 Impaired liver function, resulting in incomplete bilirubin metabolism
Correct3 Obstruction of the common bile duct by the pancreatic neoplasm
A client has circumgastric banding, a bariatric surgical procedure. The nurse provides discharge teaching about signs and symptoms of dumping syndrome and mentions what physiological response? 1 Fever 2 Vomiting 3 Palpitations 4 Constipation
Correct3 Palpitations
A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the health care provider to explore with this client? 1 Intensive psychotherapy 2 Continued medical therapy 3 Surgical therapy (colectomy) 4 Diet therapy (low-residue, high-protein diet)
Correct3 Surgical therapy (colectomy)
When discussing a scheduled liver biopsy with a client, the nurse explains that for several hours after the biopsy the client will have to remain in what position? 1 The left side-lying position with the head of the bed elevated 2 A high-Fowler position with both arms supported on several pillows 3 The right side-lying position with pillows placed under the costal margin 4 Any comfortable recumbent position as long as the client remains immobile
Correct3 The right side-lying position with pillows placed under the costal margin
A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client? 1 Levin 2 Salem sump 3 Miller-Abbott 4 Blakemore-Sengstaken
Correct4 Blakemore-Sengstaken
A nurse is eliciting a health history from a client with ulcerative colitis. What factor does the nurse consider to be most likely associated with the client's colitis? 1 Food allergy 2 Infectious agent 3 Autoimmune response 4 Genetic predisposition
Correct4 Genetic predisposition
A client is diagnosed as having malabsorption syndrome secondary to celiac sprue. The client asks the nurse if there is anything that can help improve symptoms. What should the nurse encourage the client to incorporate into the diet for symptom improvement? 1 Folic acid 2 Vitamin B12 3 Corticosteroids 4 Gluten-free diet
Correct4 Gluten-free diet
A nurse is caring for a client who is learning how to take care of a newly created colostomy. When observing a return demonstration of the colostomy irrigation, the nurse evaluates that more teaching is required when the client does what? 1 Clamps off the flow of fluid when feeling uncomfortable 2 Lubricates the tip of the catheter before inserting it into the stoma 3 Discontinues the insertion of fluid after only a half a liter of fluid is instilled 4 Hangs the irrigation bag on the door clothes hook during fluid insertion
Correct4 Hangs the irrigation bag on the door clothes hook during fluid insertion
A nurse is planning education for a parent group related to procedures to be taken if accidental poisoning is suspected. What should the nurse include? Select all that apply. 1 Induce vomiting 2 Administer syrup of ipecac 3 Give a large volume of water 4 Identify the material ingested 5 Call the poison control center
Correct4 Identify the material ingested Correct5 Call the poison control center
Ranitidine (Zantac) has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by doing what? 1 Lowering the gastric pH 2 Promoting the release of gastrin 3 Regenerating the gastric mucosa 4 Inhibiting the histamine H 2 receptors
Correct4 Inhibiting the histamine H 2 receptors
A client who recently experienced a brain attack (CVA) and who has limited mobility complains of constipation. What is most important for the nurse to determine when collecting information about the constipation? 1 Presence of distention 2 Extent of weight gained 3 Amount of high-fiber food consumed 4 Length of time this problem has existed
Correct4 Length of time this problem has existed
A client with a history of ulcerative colitis has a large portion of the large intestine removed, and an ileostomy is created. For which potential life-threatening complication should the nurse assess the client after this surgery? 1 Infection caused by the excretion of feces 2 Injury caused by exposed intestinal mucosa 3 Altered bowel elimination caused by the ostomy 4 Limited water reabsorption caused by removal of intestine
Correct4 Limited water reabsorption caused by removal of intestine
A client appears depressed since the surgical creation of a colostomy five days ago. The nurse determines that there is some movement toward adaptation to the change in body image when the client does what? 1 Discusses the necessity of the colostomy 2 Requests the nurse to change the dressing 3 Looks at the face of the nurse during care 4 Stares at the stoma during dressing changes
Correct4 Stares at the stoma during dressing changes