Digestive System
Another name for the (Billroth I)procedure is a ________. A. Gastrojejunostomy B. Gastroduodenostomy C. Cholangiogram D. Cholecystogram
B
How about ulcerative colitis, which of the following factors is believed to cause it? a. Acidic diet b. Altered immunity c. Chronic constipation d. Emotional stress
B
sequence for examining the abdomen
inspection, auscultation, percussion, and palpation
Hiatal hernias are diagnosed by?
barium swallow
A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which of the following factors was most likely of greatest significance in causing an exacerbation of ulcerative colitis? 1. A demanding and stressful job. 2. Changing to a modified vegetarian diet. 3. Beginning a weight-training program. 4. Walking 2 miles every day.
1. Stressful and emotional events have been clearly linked to exacerbations of ulcerative colitis, although their role in the etiology of the disease has been disproved. A modifi ed vegetarian diet or an exercise program is an unlikely cause of the exacerbation.
Which of the following should be a priority focus of care for a client experiencing an exacerba-tion of Crohn's disease? 1. Encouraging regular ambulation. 2. Promoting bowel rest. 3. Maintaining current weight. 4. Decreasing episodes of rectal bleeding.
2. A priority goal of care during an acute exacerbation of Crohn's disease is to promote bowel rest. This is accomplished through decreas-ing activity, encouraging rest, and initially placing client on nothing-by-mouth status while maintain-ing nutritional needs parenterally. Regular ambula-tion is important, but the priority is bowel rest. The client will probably lose some weight during the acute phase of the illness. Diarrhea is nonbloody in Crohn's disease,
A client has been placed on long-term sul-fasalazine (Azulfi dine) therapy for treatment of his ulcerative colitis. The nurse should encourage the client to eat which of the following foods to help avoid the nutrient defi ciencies that may develop as a result of this medication? 1. Citrus fruits. 2. Green, leafy vegetables. 3. Eggs. 4. Milk products.
2. In long-term sulfasalazine therapy, the cli-ent may develop folic acid defi ciency. The client can take folic acid supplements, but the nurse should also encourage the client to increase the intake of folic acid in his diet. Green, leafy vegetables are a good source of folic acid. Citrus fruits, eggs, and milk products are not good sources of folic acid.
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.
3, 4, 5. Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to com-plain about pain that occurs during the night and is frequently relieved by eating.
Another name for the (Billroth II)procedure is a ________. A. Gastrojejunostomy B. Gastroduodenostomy C. Cholangiogram D. Cholecystogram
A
Neoplasms of the salivary glands usually arise from which gland? A. Parotid B. Submandibular C. Saliva D. Adrenal E. Thyroid
A
Helicobacter pylori gastritis has a prevalence in more than 50% of American adults older than 50 years and is believed to be caused by a previous infection when the patient was younger. What can chronic gastritis caused by H. pylori cause? A. Decreased risk of gastric adenocarcinoma B. Decreased risk of low-grade B-cell gastric lymphoma C. Duodenal ulcer D. Gastric atrophy
B
Hydrochloric acid in the stomach functions primarily to: a. facilitate carbohydrate digestion b. facilitate lipid digestion c. hydrolyze peptide bonds d. facilitate protein digestion
B
Formation of bulging pouches throughout the colon, but most commonly in the lower portion of the colon, is called: A. Fistula B. GERD C. Diverticular disease D. Hemorrhoid
C
Hiatal hernias can cause severe pain if the hernia is large. Gastroesophageal reflux is a common comorbidity of hiatal hernia, and when this occurs, what might the hernia do? A. Increase esophageal acid clearance B. Retard esophageal acid clearance C. Decrease esophageal acid clearance D. Accelerate esophageal acid clearance
C
Oral Squamous Cell Carcinomas metastasize mainly to the A. parotid glands B. posterior and anterior cervical lymph nodes C. submandibular, superficial, and deep cervical lymph nodes. D. genitalia E. tonsilar lymph nodes and stensons duct
C
PUD is best described as: A. Gastric and Peptic Ulcers B. Pelvic Inflammatory Disease C. Breaks in the mucosa of the stomach and proximal duodenum that are produced by the action of gastric secretions. D. a condition that only affects Jewish people E. Caused by excessive consumption of alcohol, cigarette smoking nitrosamines and diets lacking in fresh fruits, vegetables
C
What is the function of the villi in the small intestine? A) to decrease the amount of exposed surface B) to facilitate enzyme retention and dispersal C) to increase the surface area for absorption and secretion D) to sweep particles across the surface with wavelike actions
C
What pancreatic enzyme aids in the digestion of carbohydrates? a. Lipase b. Trypsin c. Amylase d. Chymotrypsin
C Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.
What other symptoms will validate the diagnosis of gastric ulcer? a. right epigastric pain b. pain occurs when stomach is empty c. pain occurs immediately after meal d. pain not relieved by vomiting
C In gastric ulcer food intake aggravates pain which usually occur ½ - 1 hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.
Crohn's disease is different from ulcerative colitis in that it has ____ inflammation, _______, and ______ cobblestone appearance
Crohn's disease has intermittent inflammation, granulomas, and a cobblestone appearance
Bile entering the gallbladder must pass through the: a. common hepatic duct b. common bile duct c. duodenal papilla d. cystic duct
D
Bloody diarrhea with mucous is a primary symptom of a. peritonitis b. peptic ulcer disease c. paralytic ileus d. ulcerative colitis
D
Nausea, dizziness/syncope, diaphoresis, cramping (increased peristalsis), and diarrhea are vague symptoms, but can be indicative of what following abd surgery?
Dumping syndrome
The nurse is performing an assessment on a client who has developed a paralytic ileus. The client's bowel sounds will be:
If a paralytic ileus occurs, bowel sounds will be hypoactive or absent. Hyperactive bowel sounds may signify hunger, intestinal obstruction, or diarrhea.
What stimulates the esophagus?
Liquid, sitting up, food
Action of antacids
action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity
Age related change that increases the risk for amemia
atrophy of gastric mucosa reduces HCl sectrection, which impairs absorption of iron and Vitamin B-12
The nurse is aware that the diagnostic tests typically ordered for acute diverticulitis do not include a barium enema. The reason for this is that a barium enema: 1. Can perforate an intestinal abscess. 2. Would greatly increase the client's pain. 3. Is of minimal diagnostic value in diverticulitis. 4. Is too lengthy a procedure for the client to tolerate.
1. Barium enemas and colonoscopies are contraindicated in clients with acute diverticulitis because they can lead to perforation of the colon and peritonitis. A barium enema may be ordered after the client has been treated with antibiotic therapy and the infl ammation has subsided. A bar-ium enema is diagnostic in diverticulitis. A barium enema could increase the client's pain; however, that is not a reason for excluding this test. The client may be able to tolerate the procedure but the con-cern is the potential for perforation of the intestine.
The physician prescribes metoclopramide hydrochloride (Reglan) for the client with hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.
1. Metoclopramide hydrochloride (Reglan) increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control reflux and esophagitis and to decrease or neutralize gastric secretions. Reglan is not effective in decreasing or neutralizing gastric secretions.
As a result of a gastric resection, the client is at risk for development of dumping syndrome. The nurse should prepare a plan of care for this client based on knowledge that this problem stems primarily from which of the following gastrointestinal changes? 1. Excess secretion of digestive enzymes in the intestines. 2. Rapid emptying of stomach contents into the small intestine. 3. Excess glycogen production by the liver. 4. Loss of gastric enzymes.
2. After a gastric resection, ingested food moves rapidly from the remaining stomach into the duodenum or jejunum. The food has not undergone adequate preliminary digestion in the stomach. It is concentrated (hypertonic), distends the intestine, and stimulates significant secretion of insulin by the pancreas, as well as a shift of fluid into the bowel. T he dumping syndrome results from these factors, which are initiated by the rapid movement of food out of the stomach. After gastric resection, excess digestive enzymes are not secreted and the liver does not produce glycogen. Dumping syndrome is not caused by loss of gastric secretions.
reports of gnawing epigastric pain following meals and heartburn; pain occurs when stomach is empty and is relieved by eating
duodenal ulcers
A client is admitted through the emergency department for a strangulated intestinal obstruction with perforation. What interventions do you anticipate for this emergency condition? (Choose all that apply.) a. Preparation for surgery b. Barium enema c. NG tube insertion d. Abdominal x-ray e. IV fluids
...
What are some characteristics of Carcinoma of the Esophagus? A. More common in Females B. Caused by excessive alcohol use, nitroglycerine and HPV infection C. Caused by excessively high protein diets D. Caused by excessive consumption of alcohol, cigarette smoking nitrosamines and diets lacking in fresh fruits, vegetable E. weight loss, bright shiny white teeth and fresh smelling breath
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A client with diverticulitis has developed peritonitis following diverticular rupture. The nurse should assess the client to determine which of the following? Select all that apply. 1. Percuss the abdomen to note resonance and tympany. 2. Percuss the liver to note lack of dullness. 3. Monitor the vital signs for fever, tachypnea, and bradycardia. 4. Assess presence of polyphagia and polydipsia. 5. Auscultate bowel sounds to note frequency.
1, 2, 5. Assessment during peritonitis will reveal fever, tachypnea, and tachycardia. The abdo-men becomes rigid with rebound tenderness and there will be absent bowel sounds. Percussion will show resonance and tympany indicating paralytic ileus; loss of liver dullness may indicate free air in the abdomen. There is anorexia, nausea, and vomit-ing as peristalsis decreases.
A progressive condition resulting from the erosion of the connection b\w the necks of the teeth and the gingiva is: a. peritonitis b. peridontal disease c. plaque d. periapical abscess
B
An open sore that may result from a perforation or lesion of the skin or mucous membrane accompanied by sloughing of inflamed necrotic tissue is called a. fistula b. ulcer c. hemorrhoid d. volvus e. hernia
B
The hormone gastrin: a. inhibits the activity of the muscularis externa of the stomach b. increases the activity of parietal and chief cells c.is secreted by the pancreatic islets d. is produced in response to sympathetic stimulation
B
The primary effect of secretin is to cause a(n): a. increase in release of bile from the gallbladder into the duodenum b. increase in secretion of water and buffers by the pancreas and the liver c. increase in gastric motility and secretory rates d. decrease in duodenal submucosal secretions b. c. d.
B
The two factors that play an important part in the movement of chyme from the stomach to the small intestine are: a. CNS and ANS regulation b. stomach distension and gastrin release c. release of HCl and gastric juice d. sympathetic and parasympathetic stimulation
B
A client who has a history of Crohn's dis-ease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for: 1. Hyperalbuminemia. 2. Thrombocytopenia. 3. Hypokalemia. 4. Hypercalcemia.
3. Hypokalemia is the most expected labora-tory fi nding owing to the diarrhea. Hypoalbumin-emia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.
What best describes a duodenal ulcer? A. Burning epigastric pain that is relieved with milk and cookies. B. Burning epigastric pain that is experienced 1-3 hours after a meal or that awakens the patient at night C. RUQ pain that yields a + psoas sign D. Pain that subsides when fasting, patients appear to be cachectic E. Frank blood in the stool
B
Which of the following disorders is caused by inflammation of a blind pouch located near the ileocecal valve in the right lower quadrant of the abdomen a. crohn's disease b. appendicitis c. diverticulitis disease d. peritonitis
B
A client is receiving Total Parenteral Nutri-tion (TPN) soulution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which of the following signs? 1. Tachycardia. 2. Hypertension. 3. Elevated blood urea nitrogen concentration. 4. Hyperglycemia.
4. During TPN administration, the client should be monitored regularly for hyperglycemia. The client may require small amounts of insulin to improve glucose metabolism. The client should also be observed for signs and symptoms of hypogly-cemia, which may occur if the body overproduces insulin in response to a high glucose intake or if too much insulin is administered to help improve glu-cose metabolism. Tachycardia or hypertension is not indicative of the client's ability to metabolize the solution. An elevated blood urea nitrogen concentra-tion is indicative of renal status and fl uid balance.
Which of the following is secreted by the stomach? a. secretin b. gastrin c. pytalin d. galactase
B
Which of the following statements about peritonitis is false? a. It could be caused by a burst appendix. b. It leads to inflammation of the digestive mucosa. c. It is an inflammation of the peritoneal membrane. d. It can be caused by bacteria entering the abdominal cavity during a surgical procedure.
B
Which organism is associated with both gastric and duodenal ulcers? A. MRSA B. Helicobacter pylori C. Pseudomonas D. E. Coli E. tapeworm
B
Which of the following definitions best describes diverticulosis? a. An inflamed outpouching of the intestine b. A non - inflamed outpouching of the intestine c. The partial impairment of the forward flow of instestinal contents d. An abnormal protrusions of an oxygen through the structure that usually holds it
B An increase intraluminal pressure causes the outpouching of the colon wall resulting to diverticulosis. Option a suggests diverticulitis. Test taking skill: one of the opposite is the correct answer.
A nurse is providing wound care to a client 1 day after the client underwent an appendectomy. A drain was inserted into the incisional site dur-ing surgery. Which action should the nurse perform when providing wound care? 1. Remove the dressing and leave the incision open to air. 2. Remove the drain if wound drainage is minimal. 3. Gently irrigate the drain to remove exudate. 4. Clean the area around the drain moving away from the drain.
4. The nurse should gently clean the area around the drain by moving in a circular motion away from the drain. Doing so prevents the intro-duction of microorganisms to the wound and drain site. The incision cannot be left open to air as long as the drain is intact. The nurse should note the amount and character of wound drainage, but the surgeon will determine when the drain should be removed. Surgical wound drains are not irrigated.
Diverticulitis is the herniation of tissue of the large intestine through the muscularis layer of the colon. It is often asymptomatic and is found in approximately 80% of people older than 85 years old. Diverticulitis is often asymptomatic, but when symptoms do occur, what is the patient's most common complaint? A. Lower left quadrant pain with nausea and vomiting B. Right lower quadrant pain with nausea and vomiting C. Midepigastric pain with nausea and vomiting D. Right lower quadrant pain with rebound tenderness on the left
A
The active process that occurs when materials enter the digestive tract via the mouth is: a.ingestion b.secretion c.absorption d.excretion
A
The hormone that promotes the flow of bile and of pancreatic juice containing enzymes is: a. cholecystokinin b. gastrin c. secretin d. enterogasterone
A
Which of the following drugs aids in gastric emptying? A. Cisapride (Propulsid) B. Ranitidine (Zantac) C. Famotidine (Pepcid) D. Tranylcypromine sulfate (Parnate)
A
Which of the following is not a specific element of duodenal ulcers? A. Primarily affects males B. Occasional malignancy C. Can lead to weight gain D. Affects people over 65
A
Which of the following microorganisms has been linked to Parotitis? A. Staphylococcus aureus B. Schistosoma C. Wucheria bancrofti D. Trypanosoma cruzi
A
In gastritis, what are three possible causes of the inflammation?
Atrophy of cells, less acid production, or thining of the walls
A 72-year-old client seeks help for chronic constipation. This is a common problem for elderly clients due to several factors related to aging. Which is one such factor? A. Increased intestinal motility B. Decreased abdominal strength C. Increased gastric aid production D. hyperactive bowel sounds
B Decreased abdominal strength, muscle tone of the intestinal wall, and motility all contribute to chronic constipation in the elderly.
Diarrhea is believed to be caused by all of the following except a. increase intestinal secretions b. altered immunity c. decrease mucosal absorption d. altered motility
B Diarrhea is an intestinal disorder that is self - limiting. Options a, c and d are etiological factors of diarrhea.
A client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? A. Lying on the right side with legs straight B. Lying on the left side with knees bent C. Prone with the torso elevated D. Bent over with hands touching the floor
B For a colonoscopy, the nurse initially should position the client on the left side with knees bent to allow proper visualization of the large intestine.
chronic gastritis has a deficiency in which Vitamin
B-12
A lesion located in the anterior or posterior wall of the duodenum near the pylorus is known as: A. Gastric Ulcer B. Duodenal Ulcer C. Peptic Ulcer D. peptic ulcer disease E. IBS
B.
Which of the following assessment findings suggests early appendicitis? A. N&V B. periumbilical pain C. tense positioning D. abdominal rigdity
B. Periumbilical pain is the initial symptom, followed by nausea and vomiting.
Peritonitis is an inflammatory condition of the lining of the abdominal cavity. What is one of the most important signs of peritonitis? A. Vomiting of bloody emesis B. Vomiting of coffee ground-appearing emesis C. Translocation of extracellular fluid into the peritoneal cavity D. Translocation of intracellular fluid into the peritoneal cavity
C
In planning a treatment and prevention program of chronic fecal incontinence for an elderly client, which intervention should you try first? a. Administer a glycerin suppository 15 minutes before evacuation time. b. Insert a rectal tube at specified intervals each day. c. Assist the client to the bedpan or toilet 30 minutes after meals. d. Use incontinence briefs or adult-sized diapers.
C The goal of bowel training is to establish a pattern that mimics normal defecation, and many people have the urge to defecate after a meal. If this is not successful, a suppository can be used to stimulate the urge. Incontinence briefs are embarrassing for the client and must be changed frequently to prevent skin breakdown. Routine use of rectal tubes is not recommended because of damage to the mucosa and sphincter tone.
A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? a. Halts stress reactions b. Heals the gastric mucosa c. Reduces the stimulus to acid secretions d. Decreases food absorption in the stomach
C. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect descriptions of a vagotomy.
Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate T-cell-mediated immune response, and there is no cure for it. What is the treatment of choice for celiac disease? A. Removal of protein from the diet B. Removal of fat from the diet C. Removal of sugar from the diet D. Removal of gluten from the diet
D
Gastric Ulcers can be described as A. a large growth that has sharply demarcated edges B. an ulcer that is located on the anterior or posterior wall of the first part of the duodenum C. kissing ulcers D. A single 2-10 cm ulcer that has edges that tend to be sharply punched out, with overhanging margins E. ulcers that give you flatulence
D
Hypersecretion of HCl can lead to A. pyrosis B. choleolithasis C. Mallory-Weiss Tears D. duodenal ulcers E. fatty liver disease
D
The "doorway to the liver" (porta hepatis) is a complex that includes the: a. caudate lobe, quadrate lobe, and hepatic duct b. hilus, bile duct, and cystic duct c. left lobe, right lobe, and round ligament d. bile duct, hepatic portal vein, and hepatic artery
D
The primary function(s) of the gastrointestinal juice is (are) to: a. moisten the chyme b. assist in buffering acids c. dissolve digestive enzymes and products of digestion d. all of the above
D
The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen
D. Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.
What is the most common malignant tumor of the oral mucosa? A. Mucoepidermoid Carcinoma B. Buccal Carcinoma C. Pleomorphic Adenoma D. Neoplasms of the Salivary Glands E. Sqamous Cell Carcinoma
E
Nursing care for a hiatal hernia revolves around?
Education: Eat smaller meals, do not lay down after eating, sleep with the head of the bed up
Dysphagia: what cranial nerve has been affected?
Glossopharyngeal nerve
What values would be important to monitor in patients with a peptic ulcer?
H&H - any bleeding Occult blood/melena - any bleeding Dizziness, decreased BP, tachycardia, confusion - losing blood
In toxic megacolon, what is the problem?
Happens in ulcerative colitis. The colon is dilated so much it becomes paralyzed - risk for perforation
What a S/Sx of a hiatial hernia?
Heartburn about 30-40 min after meal (dilated LES) - better with food
Triple therapy is Tx for what?
Peptic ulcer disease. On board will be antacids, antibiotics, and PPIs/h2 antagonists
What is caffeine's role in GI disorders?
Promotes gastrin and HCL
With Crohn's disease, 1/3 of the patients will develop?
fistulas
Peptic ulcers are concerning because they increase the chance of stomach cancer. Why might this be?
The malfunction of cells destroyed by the peptic ulcer will stimulate more cells
A key diagnostic test for peptic ulcers (H. pylori) is: A) What is a VITAL nursing intervention for this test?
Urea breath testing. Exhales for baseline, drinks carbon-enriched urea solution, then exhales again. If H pylori present, will have increase the co2 (breakdown of urea.) NPO status
Gastric Phase:
begins when food reaches stomach. Gastrin secreted which stimulates gastric juice which contain hydrochloric acid and pepsinogen
Pt with a bleeding gastric ulcer would have stools
black and tarry
Which of the following salivary glands produce salivary amylase, a carbohydrate-digesting enzyme? a. b. c. d.
both a and c
RUQ contains
liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of ascending and descending colon, portion of right kidney
Ulcerative colitis affects what part of the bowel?
lower bowel
What will be seen on the microscopic examination of PUD? A. The edges tend to be sharply punched out, with overhanging margins. The flat base is gray and indurated. (Your Answer) B. Fibrotic tissue covered by Necrotic tissue C. From the lumen outward: 1. Granulation tissue 2. Necrotic tissue 3. Fibrotic tissue D. whiskey for my men and beer for my horses E. From the lumen outward: 1. A superficial zone of fibrinopurulent exudate; 2. Necrotic tissue; 3. Granulation tissue; 4. Fibrotic tissue at the base of the ulcer(Missed)
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Which foods should the nurse encourage a client with diverticulosis to incorporate into the diet? Select all that apply. 1. Bran cereal. 2. Broccoli. 3. Tomato juice. 4. Navy beans. 5. Cheese.
1, 2, 4. Clients with diverticulosis are encour-aged to follow a high-fi ber diet. Bran, broccoli, and navy beans are foods high in fi ber. Tomato juice and cheese are low-residue foods.
The nurse instructs the client who has had a hemorrhoidectomy not to use sitz baths until at least 12 hours postoperatively to avoid inducing which of the following complications? 1. Hemorrhage. 2. Rectal spasm. 3. Urine retention. 4. Constipation
1. Applying heat during the immediate post-operative period may cause hemorrhage at the surgi-cal site. Moist heat may relieve rectal spasms after bowel movements. Urine retention caused by refl ex spasm may also be relieved by moist heat. Increas-ing fi ber and fl uid in the diet can help prevent constipation.
After a subtotal gastrectomy, the nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? 1. Dark brown. 2. Bile green. 3. Bright red. 4. Cloudy white.
1. About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood, but large amounts of blood or excessive bloody drainage should be reported to the physician promptly.
A client with diverticular disease is receiv-ing psyllium hydrophilic mucilloid (Metamucil). The drug has been effective when the client tells the nurse that he: 1. Passes stool without cramping. 2. Does not have diarrhea any longer. 3. Is not as anxious as he was. 4. Does not expel gas like he used to
1. Diverticular disease is treated with a high-fi ber diet and bulk laxatives such as psyllium hydro-philic mucilloid (Metamucil). Fiber decreases the intraluminal pressure and makes it easier for stool to pass through the colon. Bulk laxatives do not manage diarrhea, anxiety or relieve gas formation.
A nurse is admitting a client who has been admitted with a diagnosis of upper GI bleeding to the hospital. The nurse should assess the client for which of the following? Select all that apply. 1. Dry, flushed skin. 2. Decreased urine output. 3. Tachycardia. 4. Widening pulse pressure. 5. Rapid respiration's. 6. Thirst.
2, 3, 5, 6. The client who is experiencing upper GI bleeding is at risk for developing hypovolemic shock from blood loss. Therefore, the signs and symptoms the nurse should expect to find are those related to hypovolemia, including decreased urine output, tachycardia, rapid respirations, and thirst. The client's skin would be cool and clammy, not dry and flushed. The client would also be likely to develop hypotension, which would lead to a narrowing pulse pressure, not a widening pulse pressure.
The nurse is developing a plan of care for a client with Crohn's disease who is receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include? Select all that apply. 1. Monitoring vital signs once a shift. 2. Weighing the client daily. 3. Changing the central venous line dressing daily. 4. Monitoring the I.V. infusion rate hourly. 5. Taping all I.V. tubing connections securely.
2, 4, 5. When caring for a client who is receiving TPN, the nurse should plan to weigh the client daily, monitor the I.V. fl uid infusion rate hourly (even when using an I.V. fl uid pump), and securely tape all I.V. tubing connections to prevent disconnections. Vital signs should be monitored at least every 4 hours to facilitate early detection of complications. It is recommended that the I.V. dress-ing be changed once or twice per week or when it becomes soiled, loose, or wet.
A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During preoperative teaching, the nurse is reinforcing information about the surgical procedure. Which of the following explanations is most accurate? 1. The procedure will result in enlargement of the pyloric sphincter. 2. The procedure will result in anastomosis of the gastric stump to the jejunum. 3. The procedure will result in removal of the duodenum. 4. The procedure will result in re-positioning of the vagus nerve.
2. A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1. Having a sedentary desk job. 2. Being 5 feet, 3 inches tall and weighing 190 lb. 3. Using laxatives frequently. 4. Being 40 years old.
2. Any factor that increases intraabdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is not likely to be a contributing factor in development of a hiatal hernia.
Following a gastrectomy, the nurse should position the client in which of the following positions? 1. Prone. 2. Supine. 3. Low Fowler's. 4. Right or left Sims.
3. A client who has had abdominal surgery is best placed in a low Fowler's position postoperatively. This positioning relaxes abdominal muscles and provides for maximum respiratory and cardiovascular function. The prone, supine, or Sims position would not be tolerated by a client who has had abdominal surgery, nor do those positions support respiratory or cardiovascular functioning.
After a subtotal gastrectomy, care of the client's nasogastric (NG) tube and drainage system should include which of the following nursing interventions? 1. Irrigate the tube with 30 mL of sterile water every hour, if needed. 2. Re-position the tube if it is not draining well. 3. Monitor the client for nausea, vomiting, and abdominal distention. 4. Turn the machine to high suction if the drain-age is sluggish on low suction.
3. Nausea, vomiting, or abdominal distention indicates that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate NG tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician's order is needed to irrigate the NG tube because this procedure could disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.
3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.
he client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids? 1. Anorexia. 2. Weight gain. 3. Diarrhea. 4. Constipation.
3. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain.
A client who has had her jaws wired begins to vomit. What should be the nurse's first action? 1. Insert a nasogastric (NG) tube and connect it to suction. 2. Use wire cutters to cut the wire. 3. Suction the client's airway as needed. 4. Administer an antiemetic intravenously.
3. The nurse's first action is to clear the client's airway as necessary. Inserting an NG tube or administering an antiemetic may prevent future vomiting episodes, but these procedures are not helpful when the client is actually vomiting. Cutting the wires is done only as a last resort or in case of respiratory or cardiac arrest.
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? 1. An intestinal obstruction has developed. 2. Additional ulcers have developed. 3. The esophagus has become inflamed. 4. The ulcer has perforated.
4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.
To reduce the risk of dumping syndrome, the nurse should teach the client to do which of the following? 1. Sit upright for 30 minutes after meals. 2. Drink liquids with meals, avoiding caffeine. 3. Avoid milk and other dairy products. 4. Decrease the carbohydrate content of meals.
4. Carbohydrates are restricted, but protein, including meat and dairy products, is recommended because it is digested more slowly. Lying down for 30 minutes after a meal is encouraged to slow movement of the food bolus. Fluids are restricted to reduce the bulk of food. There is no need to avoid caffeine.
Which of the following interventions is most appropriate for a client who has stomatitis? 1. Drinking hot tea at frequent intervals. 2. Gargling with antiseptic mouthwash. 3. Using an electric toothbrush. 4. Eating a soft, bland diet.
4. Clients with stomatitis (inflammation of the mouth) have significant discomfort, which impacts their ability to eat and drink. They will be most comfortable eating soft, bland foods, and avoiding temperature extremes in their food and liquids. Gargling with an antiseptic mouthwash will be irritating to the mucosa. Mouth care should include gentle brushing with a soft toothbrush and flossing.
A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.
4. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.
The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 1. Antacids. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.
4. Metoclopramide hydrochloride (Reglan) can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug. Clients may take antacids, antihypertensives, and anticoagulants while on metoclopramide.
After an inguinal herniorrhaphy, the nurse should assess the client carefully for which of the following likely complications? 1. Hypostatic pneumonia. 2. Deep vein thrombosis. 3. Paralytic ileus. 4. Urine retention.
4. The most common complication after an inguinal hernia repair is the inability to void, espe-cially in men. The nurse should evaluate the client carefully for urine retention. Hypostatic pneumonia, deep vein thrombosis, and paralytic ileus are poten-tial postoperative problems with any surgical client but are not as likely to occur after an inguinal hernia repair as is urine retention.
What is the most common complication of PUD? A. Hemorrhage B. Perforations C. Malignant transformation D. Pyloric Obstruction E. SBO
A
Which is the least likely to cause constipation? A. high fiber intake B. being over 75 C. overuse of laxatives D. immobilization
A
To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air into the tube with a syringe and listening with a stethoscope for air passing into the stomach. Which is another test method? A. Aspiration of gastric contents and testing for a pH less than 6 B. Instillation of 30 ml of water while listening with a stethoscope C. Cessation of reflex gagging D. Ensuring proper measurement of the tube before insertion
A Aspiration of gastric secretions with a pH less than 6 indicates placement in the stomach.
What are the functions of HCl in the stomach a. kills microorganisms b. lowers the pH of gastric juice c. breaks down cell walls in food d. activates secretions of the chief cells
A,B,C,D
Which of the following are goals of drug therapy in the treatment of PUD (multiple answers)? A. provide pain relief B. prevent recurrence C. heal ulceration D. eradicate H. pylori infection
A,B,C,D are all goals
Which medication should the nurse expect to administer to a client with constipation?
A. Docusate sodium, a laxative, is used to treat constipation. It softens the stool by stimulating the secretion of intestinal fluid into the stool.
In regards to appendicitis, the location of pain in the lower, right abdominal quadrant is called: A. Kernig's sign B. Mc Burney's point C. Brudzinski's point D. Schrute's point
B
The most common presenting symptom in Cancer of the Esophagus is: A. menstruation B. dysphagia C. dyspepsia D. regurgitation E. constipation
B
A 28-year-old client is admitted with inflammatory bowel syndrome (Crohn's disease). Which therapies should the nurse expect to be part of the care plan? Check all that apply A. Lactulose therapy B. High-fiber diet C. High-protein milkshakes D. Corticosteroid therapy E. Antidiarrheal medications
D&E Corticosteroids, such as prednisone, reduce the signs and symptoms of diarrhea, pain, and bleeding by decreasing inflammation. Antidiarrheals, such as diphenoxylate (Lomotil), combat diarrhea by decreasing peristalsis.
Which GI hormone stimulates gallbladder contraction and secretion of enzyme-rich pancreatic fluid? a. gastrin b. secretin c. cholecystokinin d. gastric inhibitory peptides
C
A client who underwent abdominal surgery who has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first? A. Measure abdominal girth B. Auscultate bowel sounds C. Assess patency of the NG tube D. Assess vital signs
C When an NG tube is no longer patent, stomach contents collect in the stomach giving the client a sensation of fullness
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Endoscopy B. Upper GI series C. Hemoglobin (Hb) levels and hematocrit (HCT D. Arteriography
C. Hemoglobin and hematocrit are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss.
Which of the following isn't a complication of peptic ulcer disease? A. perforation B. GI bleeding C. pyloric obstruction D. pain
D. Pain is a symptom of PUD, not a complication
A chronic intestine inflammatin that usually affectsteh ileum and whose inflammatory patterns tend to be patchy or segmnetedis called
Crohn's Disease AKA Regional colitis
Which GI hormone stimulates gastric secretion and motility? a. secretin b. cholecystokinin c. gastric inhibitory peptides d. gastrin
D
Hiatal Hernia beverages to avoid
coffee and alcohol
Crohn's Disease therapies
corticosteroid therapy antidiarrheal medications
A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for? Select all that apply. 1. Projectile vomiting. 2. Significant abdominal distention. 3. Copious diarrhea. 4. Rapid onset of dehydration. 5. Increased bowel sounds.
1, 4, 5. Signs and symptoms of intestinal obstructions in the small intestine may include pro-jectile vomiting and rapidly developing dehydration and electrolyte imbalances. The client will also have increased bowel sounds, usually high-pitched and tinkling. The client would not normally have diar-rhea and would have minimal abdominal distention. Pain is intermittent, being relieved by vomiting. Intestinal obstructions in the large intestine usually evolve slowly, produce persistent pain, and vomit-ing is less common. Clients with a large-intestine obstruction may develop obstipation and signifi cant abdominal distention.
The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1. Heartburn. 2. Jaundice. 3. Anorexia. 4. Stomatitis.
1. Heartburn, the most common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, which results from a high concentration of bilirubin in the blood, is not associated with hiatal hernia. Anorexia is not a typical symptom of hiatal hernia. Stomatitis is inflammation of the mouth.
The physician orders intestinal decompres-sion with a Cantor tube for a client with an intesti-nal obstruction. In order to determine effectiveness of intestinal decompression the nurse should evalu-ate the client to determine if: 1. Fluid and gas have been removed from the intestine. 2. The client has had a bowel movement. 3. The client's urinary output is adequate. 4. The client can sit up without pain.
1. Intestinal decompression is accomplished with a Cantor, Harris, or Miller-Abbott tube. These 6- to 10-foot tubes are passed into the small intes-tine to the obstruction. They remove accumulated fl uid and gas, relieving the pressure. The client will not have an adequate bowel movement until the obstruction is removed. The pressure from the dis-tended intestine should not obstruct urinary output. While the client may be able to more easily sit up, and the pain caused by the intestinal pressure will be less, these are not the primary indicators for suc-cessful intestinal decompression.
In ulcerative colitis, the patient would exhibit diarrhea and rectal bleeding. The other S/Sx are due to increased peristalsis and loss of E-lytes/vitamins. What are the rest?
Abd pain & fever Wt - & vomiting Tenesumus/cramping Hypocalcemia & iron deficiency
The nurse administers fat emulsion solution during TPN as ordered based on the understanding that this type of solution: 1. Provides essential fatty acids. 2. Provides extra carbohydrates. 3. Promotes effective metabolism of glucose. 4. Maintains a normal body weight.
1. The administration of fat emulsion solu-tion provides additional calories and essential fatty acids to meet the body's energy needs. Fatty acids are lipids, not carbohydrates. Fatty acids do not aid in the metabolism of glucose. Although they are nec-essary for meeting the complete nutritional needs of the client, fatty acids do not necessarily help a client maintain normal body weight.
TPN is ordered for a client with Crohn's disease. Which of the following indicate the TPN soloution is having an intended outcome? 1. There is increased cell nutrition. 2. The client does not have metabolic acidosis. 3. The client is hydrated. 4. The client is in a negative nitrogen balance.
1. The goal of TPN is to meet the client's nutritional needs. TPN is not used to treat meta-bolic acidosis; ketoacidosis can actually develop as a result of administering TPN. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins. It is not used to meet the hydration needs of clients. TPN is administered to provide a positive nitrogen balance.
Which of the following diets would be most appropriate for the client with ulcerative colitis? 1. High-calorie, low-protein. 2. High-protein, low-residue. 3. Low-fat, high-fi ber. 4. Low-sodium, high-carbohydrate.
2. Clients with ulcerative colitis should follow a well-balanced high-protein, high-calorie, low-residue diet, avoiding such high-residue foods as whole-wheat grains, nuts, and raw fruits and vegetables. Clients with ulcerative colitis need more protein for tissue healing and should avoid excess roughage. There is no need for clients with ulcer-ative colitis to follow low-sodium diets.
A client who had an appendectomy for a perforated appendix returns from surgery with a drain inserted in the incisional site. The purpose of the drain is to: 1. Provide access for wound irrigation. 2. Promote drainage of wound exudates. 3. Minimize development of scar tissue. 4. Decrease postoperative discomfort.
2. Drains are inserted postoperatively in appendectomies when an abscess was present or the appendix was perforated. The purpose is to promote drainage of exudate from the wound and facilitate healing. A drain is not used for irrigation of the wound. The drain will not minimize scar tissue development or decrease postoperative discomfort.
A client with Crohn's disease has concen-trated urine, decreased urinary output, dry skin with decreased turgor, hypotension, and weak, thready pulses. The nurse should do which of the following fi rst? 1. Encourage the client to drink at least 1,000 mL per day. 2. Provide parenteral rehydration therapy ordered by the physician. 3. Turn and reposition every 2 hours. 4. Monitor vital signs every shift.
2. Initially, the extracellular fl uid (ECF) volume with isotonic I.V. fl uids until adequate circulating blood volume and renal perfusion are achieved. Vital signs should be monitored as paren-teral and oral rehydration are achieved. Oral fl uid intake should be greater than 1,000 mL/day. Turning and repositioning the client at regular intervals aids in the prevention of skin breakdown, but it is fi rst necessary to rehydrate this client.
A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse shuld tell the client? 1. "Ulcerative colitis can be cured by the use of steroids." 2. "Steroids are used in severe fl are-ups because they can decrease the incidence of bleeding." 3. "Long-term use of steroids will prolong peri-ods of remission." 4. "The side effects of steroids outweigh their benefi ts to clients with ulcerative colitis."
2. Steroids are effective in management of the acute symptoms of ulcerative colitis. Steroids do not cure ulcerative colitis, which is a chronic disease. Long-term use is not effective in prolonging the remission and is not advocated. Clients should be assessed carefully for side effects related to ste-roid therapy, but the benefi ts of short-term steroid therapy usually outweigh the potential adverse effects.
A client with infl ammatory bowel disease is receiving total parenteral nutrition (TPN). The basic component of the client's TPN solution is most likely to be: 1. An isotonic dextrose solution. 2. A hypertonic dextrose solution. 3. A hypotonic dextrose solution. 4. A colloidal dextrose solution.
2. The TPN solution is usually a hypertonic dextrose solution. The greater the concentration of dextrose in solution, the greater the tonicity. Hyper-tonic dextrose solutions are used to meet the body's calorie demands in a volume of fl uid that will not overload the cardiovascular system. An isotonic dextrose solution (e.g., 5% dextrose in water) or a hypotonic dextrose solution will not provide enough calories to meet metabolic needs. Colloids are plasma expanders and blood products and are not used in TPN.
After insertion of a nasoenteric tube, the nurse should place the client in which position? 1. Supine. 2. Right side-lying. 3. Semi-Fowler's. 4. Upright in a bedside chair.
2. The client is placed in a right side-lying position to facilitate movement of the mercury-weighted tube through the pyloric sphincter. After the tube is in the intestine, the client is turned from side to side or encouraged to ambulate to facilitate tube movement through the intestinal loops. Placing the client in the supine or semi-Fowler's position, or having the client sitting out of bed in a chair will not facilitate tube progression.
Which of the following adverse effects would the nurse expect the client to exhibit in the event of too rapid an infusion of TPN solution? 1. Negative nitrogen balance. 2. Circulatory overload. 3. Hypoglycemia. 4. Hypokalemia.
2. Too rapid infusion of a TPN solution can lead to circulatory overload. The client should be assessed carefully for indications of excessive fl uid volume. A negative nitrogen balance occurs in nutri-tionally depleted individuals, not when TPN fl uids are administered in excess. When TPN is adminis-tered too rapidly the client is at risk for receiving an excess of dextrose and electrolytes. Therefore, the client is at risk for hyperglycemia and hyperkalemia.
The nurse teaches the client who has had rectal surgery the proper timing for sitz baths. The nurse knows that the client has understood the teaching when the client states that it is most impor-tant to take a sitz bath: 1. First thing each morning. 2. As needed for discomfort. 3. After a bowel movement. 4. At bedtime.
3. Adequate cleaning of the anal area is dif-fi cult but essential. After rectal surgery, sitz baths assist in this process, so the client should take a sitz bath after a bowel movement. Other times are dictated by client comfort.
Which of the following laboratory fi ndings would the nurse expect to fi nd in a client with diverticulitis? 1. Elevated red blood cell count. 2. Decreased platelet count. 3. Elevated white blood cell count. 4. Elevated
3. Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis. Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit. Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions. Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.
Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? 1. Esophageal reflux. 2. Dysphagia. 3. Esophagitis. 4. Ulcer formation.
3. Cimetidine (Tagamet) is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux. Cimetidine is not used to prevent reflux, dysphagia, or ulcer development.
A client's ulcerative colitis signs and symptoms have been present for longer than 1 week. The nurse should assess the client for signs and symptoms of which of the following complications? 1. Heart failure. 2. Deep vein thrombosis. 3. Hypokalemia. 4. Hypocalcemia.
3. Excessive diarrhea causes signifi cant depletion of the body's stores of sodium and potassium as well as fl uid. The client should be closely monitored for hypokalemia and hypona-tremia. Ulcerative colitis does not place the client at risk for heart failure, deep vein thrombosis, or hypocalcemia.
A client who has ulcerative colitis has persis-tent diarrhea. He is thin and has lost 12 lb since the exacerbation of his ulcerative colitis. Which of the following will be most effective in helping the client meet his nutritional needs? 1. Continuous enteral feedings. 2. Following a high-calorie, high-protein diet. 3. Total parenteral nutrition (TPN). 4. Eating six small meals a day.
3. Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional sta-tus, the client will be started on TPN. Enteral feed-ings or dividing the diet into six small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.
The nurse is admitting a client with acute appendicitis to the emergency department. The client has abdominal pain of 10 on a pain scale of 1 to 10. The client will be going to surgery as soon as possible. The nurse should: 1. Contact the surgeon to request an order for a narcotic for the pain. 2. Maintain the client in a recumbent position. 3. Place the client on nothing-by-mouth (NPO) status. 4. Apply heat to the abdomen in the area of the pain.
3. The nurse should place the client on NPO status in anticipation of surgery. The nurse can initiate pain relief strategies, such as relaxation techniques, but the surgeon will likely not order narcotic medication prior to surgery. The nurse can place the client in a position that is most comfort-able for the client. Heat is contraindicated because it may lead to perforation of the appendix.
Which of the following should the nurse interpret as an indication of a complication after the fi rst few days of TPN therapy? 1. Glycosuria. 2. A 1- to 2-pound weight gain. 3. Decreased appetite. 4. Elevated temperature.
4. An elevated temperature can be an indi-cation of an infection at the insertion site or in the catheter. Vital signs should be taken every 2 to 4 hours after initiation of TPN therapy to detect early signs of complications. Glycosuria is to be expected during the fi rst few days of therapy until the pan-creas adjusts by secreting more insulin. A gradual weight gain is to be expected as the client's nutri-tional status improves. Some clients experience a decreased appetite during TPN therapy.
A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these assessment findings, the nurse should further assess the client for which of the following complications? 1. Deficient fluid volume. 2. Intestinal obstruction. 3. Bowel ischemia. 4. Peritonitis.
4. Complications of acute appendicitis are perforation, peritonitis, and abscess development. Signs of the development of peritonitis include abdominal pain and distention, tachycardia, tachyp-nea, nausea, vomiting, and fever. Because peritonitis can cause hypovolemic shock, hypotension can develop. Defi cient fl uid volume would not cause a fever. Intestinal obstruction would cause abdomi-nal distention, diminished or absent bowel sounds, and abdominal pain. Bowel ischemia has signs and symptoms similar to those found with intestinal obstruction.
The muscular sphincter that guards the entrance between the ileum and the cecum is the: a. ileocecal valve b. gastrointestinal sphincter c. taenia coli d. pyloric sphincter
A
Nurse Nico instructs her client who has had a hemorrhoidectomy not to used sitz bath until at least 12 hours postoperatively to avoid which of the following complications? a. Hemorrhage b. Rectal Spasm c. Urinary retention d. Constipation
A Applying heat during the immediate postoperative period may cause hemorrhage at the surgical site. Moist heat may relieve rectal spasms after bowel movements. Urinary retention caused by reflex spasm may also be relieved by moist heat. Increasing fiber and fluid in the diet can help constipation.
What is dumping syndrome?
A vasomotor response d/t rapid emptying of the stomach into the SI. This influx of hypertonic fluids drastically draws in fluid from the vessels, decreasing circulating volume. Typically occurs after surgery (Billroth II) because the reduced stomach is wacked out and cannot control amount and rate of chyme that enters the SI.
The stomach secretes acid to begin the digestive process on the food that we eat. The gastric mucosal barrier works to prevent acids secreted by the stomach from actually damaging the wall of the stomach. What are the factors that make up the gastric mucosal barrier? Mark all that apply. A. Impermeable epithelial cell surface covering B. Mechanisms for selective transport of bicarbonate and potassium ions C. Characteristics of gastric mucus D. Cell coverings that act as antacids E. Mechanisms for selective transport of hydrogen and bicarbonate ions
A, C, D
The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record? a. Diarrhea b. Chronic constipation c. Constipation alternating with diarrhea d. Stools constantly oozing form the rectum
A. Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options B, C, and D are not characteristics of Crohn's disease.
The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? a. Sweating and pallor b. Bradycardia and indigestion c. Double vision and chest pain d. Abdominal cramping and pain
A. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
Mrs. R.B will likely be prescribed _____ to neutralize acid and protect the mucosa, ____ to irreversibly decrease the amount of acid available, _____ to selectively block the h2 receptors, and ____ to promote motility.
Antacids to neutralize, Protonix (PPI) to irreversibly stop, Zantac or Prilosec to selectively inhibit, and Reglan to increase
Which of the following digestive regions is responsible for the propulsion of materials into the esophagus? a. gall bladder b. pharynx c. salivary glands d. stomach
B
Which of the following drugs is a dopamine antagonist? A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox)
B
he nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? a. Irrigating the drain b. Avoiding coughing c. Maintaining bed rest d. Restricting pain medication
B. Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure. Bed rest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure, although the client may be instructed in simple dressing changes.
The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? a. Limit oral fluid b. Elevate the scrotum c. Apply heat to the abdomen d. Remain in a low-fiber diet
B. Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed. Heat will increase swelling. Limiting oral fluids and a low-fiber diet can cause constipation.
Which hormones stimulate the production of pancreatic juice and bicarbonate? A) angiotensin and epinephrine B) gastrin and insulin C) cholecystokinin and secretin D) insulin and glucagon
C
Which of the following disorders involves small out-pouchings developing along the intestinal tract a. crohn's disease b. appendicitis c. diverticulitis disease d. peritonitis
C
Which of the following disorders is a non-continous inflammatory disease that can affect any point from the mouth to the anus a. appendicitis b. gastric ulcer c. cronhn's disease d. diverticulitis disease
C
Which of the following drugs is a histamine blocker and reduces levels of gastric acid? A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox
C
Which of the following factors is believed to be linked to Chron's disease? a. Diet b. Constipation c. Heredity d. Lack of exercise
C The cause is unknown but is thought to be multifactorial. Heredity, infectious agents, altered immunity or autoimmune and environmental are factors to be considered. Test taking skill: which does not belong? Options a, b, and d are all modifiable factors.
The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? a. Ambulate following a meal b. Eat high carbohydrate foods c. Limit the fluid taken with meal d. Sit in a high-Fowler's position during meals
C. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.
The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal)
C. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.
What kind of inflammation will there be with Ulcerative Colitis?
Chronic inflammation but no granulomas
Intestinal Phase:
Chyme passes through pyloric sphincter. Gastric juices inhibited but once chyme passes duodenum juices stimulated again. Regulates entry into small intestine
How are ulcerative colitis and Chron's disease definitively diagnosed? A. EGD B. CBC C. stool sample D. colonoscopy
D
The contractions of the stomach are inhibited by: a. gastrin b. pepsinogen c. trypsin d. secretin
D
The enzyme lactase, which digests lactose to glucose and galactose, is synthesized by: a. the stomach b. the pancreas c. epithelial cells lining the small intestine d. Brunner's glands
D
Which of the following disorders involve inflammation of the abdominal cavity? a. intestinal obstruction b. paralytic ileus c. hiatal hernia d. peritonitis
D
Which of the following drugs is an antacid? A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox)
D
Your Answer: Incorrect Irritable bowel syndrome is believed to be present in 10% to 15% of the population in the United States. What is the hallmark symptom? A. Abdominal pain relieved by defecation and bowel impaction B. Nausea and abdominal pain unrelieved by defecation C. Diarrhea and abdominal pain unrelieved by defecation D. Abdominal pain relieved by defecation with a change in consistency or frequency of stools
D
You would be most concerned about which client having an order for TPN (total parental nutrition) fat emulsion? a. A client with gastrointestinal obstruction b. A client with severe anorexia nervosa c. A client with chronic diarrhea and vomiting d. A client with a fractured femur
D A client with fractured femur is at risk for fat embolism, so fat emulsion should be used with caution. Vomiting may be a problem if the emulsion is infused too rapidly. TPN is commonly used for gastrointestinal obstruction, severe anorexia nervosa, and chronic diarrhea or vomiting.
Which of the following alimentary canal is the most common location for Chron's disease? a. Descending colon b. Jejunum c. Sigmoid Colon d. Terminal Ileum
D Chronic inflammatory of GI mucosa occurs anywhere from the mouth to anus but most often in terminal ileum. Inflammatory lesions are local and involve all layers of the intestinal wall.
You are caring for a client with peptic ulcer disease. Which assessment finding is the most serious? a. Projectile vomiting b. Burning sensation 2 hours after eating c. Coffee-grounded emesis d. Board-like abdomen with shoulder pain
D A board-like abdomen with shoulder pain is a symptom of a perforation, which is most lethal complication of peptic ulcer disease. A burning sensation is a typical complaint, which can be controlled with medications. Projectile vomiting can signal an obstruction. Coffee-ground emesis is typical of slower bleeding and will require diagnostic testing.
Which ulcer will have pain 1.5-3 HOURS after a meal, often occur at night, and be relived by food?
Duodenal
A disorder that causes inflammation of the intestines is called: A. HERNIA B. CROHN DISEASE C. ULCERATIVE COLITIS D. IRRITABLE BOWEL SYNDROME E. INFLAMMATORY BOWEL DISEASE
E
Gastric glands, which produce most of the gastric juice, are abundant in which of the following regions of the stomach? a. cardia b. fundus c. body d. both a & d e. both b & c
E
T/F: Both Ulcerative Colitis and Crohn's disease will have bloody diarrhea
False: Crohn's disease will NOT have bloody diarrhea
Which ulcer will have pain 30-60 min after a meal, rarely occur at night, and worsen after food?
Gastric ulcer
Segmentation consists of waves of muscular contractions that move a bolus along the length of the digestive tract. True or False
Peristalsis consists of waves of muscular contractions Segmentation is muscle contractions that mix up the contents with intestinal secretions
Duodenal ulcers tend to be deeper, penetrating through the mucousa to the muscular layer True or False
True
Gastric Ulcers favor the less curvature of the stomach True or False
True
T/F: Peptic ulcers are an erosion of the stomach wall
True
inflammatory bowel disease is an umbrella term encompassing which three diseases?
Ulcerative colitis Crohn's disease Peritonitis
The nurse is assisting with a colonoscopy. Which medication should she anticipate administering if one is needed?
Versed (conscious sedation) or Valium for anxiety
Aphthous stomatitis is best described as
a canker sore of the oral soft tissues
Cephalic Phase:
thoughts about food, sees, smells, tastes. Stimulates medulla oblongata which increase gastric juice secretion and increases hormone gastrin to stimulate gastric glands
Before abdominal surgery for an intestinal obstruction, the nurse monitors the client's urine output and fi nds that the total output for the past 2 hours was 35 mL. The nurse then assesses the client's total intake and output over the last 24 hours and notes that he had 2,000 mL of I.V. fl uid for intake, 500 mL of drainage from the naso-gastric tube, and 700 mL of urine for a total output of 1,200 mL. This would indicate which of the following? 1. Decreased renal function. 2. Inadequate pain relief. 3. Extension of the obstruction. 4. Inadequate fl uid replacement.
4. Considering that there is usually 1 L of insensible fl uid loss, this client's output exceeds his intake (intake, 2,000 mL; output, 2,200 mL), indicating defi cient fl uid volume. The kidneys are concentrating urine in response to low circulat-ing volume, as evidenced by a urine output of less than 30 mL/hour. This indicates that increased fl uid replacement is needed. Decreasing urine output can be a sign of decreased renal function, but the data provided suggest that the client is dehydrated. Pain does not affect urine output. There are no data to suggest that the obstruction has worsened.
A 36-year-old female client has been diagnosed with hemorrhoids. Which of the following factors in the client's history would most likely be a primary cause of her hemorrhoids? 1. Her age. 2. Three vaginal delivery pregnancies. 3. Her job as a schoolteacher. 4. Varicosities in her legs.
2. Hemorrhoids are associated with prolonged sitting or standing, portal hypertension, chronic constipation, and prolonged increased intra-abdom-inal pressure, as associated with pregnancy and the strain of vaginal delivery. Her job as a schoolteacher does not require prolonged sitting or standing. Age and leg varicosities are not related to the develop-ment of hemorrhoids.
Postoperative nursing care for a client after an appendectomy should include which of the fol-lowing? 1. Administering sitz baths four times a day. 2. Noting the fi rst bowel movement after sur-gery. 3. Limiting the client's activity to bathroom privileges. 4. Measuring abdominal girth every 2 hours.
2. Noting the client's fi rst bowel movement after surgery is important because this indicates that normal peristalsis has returned. Sitz baths are used after rectal surgery, not appendectomy. Ambulation is started the day of surgery and is not confi ned to bathroom privileges. The abdomen should be auscul-tated for bowel sounds and palpated for softness, but there is no need to measure the girth every 2 hours.
A client who has a history of an inguinal her-nia is admitted to the hospital with sudden, severe abdominal pain, vomiting, and abdominal disten-tion. The nurse should assess the client further for which of the following complications? 1. Peritonitis. 2. Incarcerated hernia. 3. Strangulated hernia. 4. Intestinal perforation.
3. The symptoms are indicative of a stran-gulated hernia. In a strangulated hernia, the hernia cannot be reduced back into the abdominal cavity. The intestinal lumen and the blood supply to the intestine are obstructed, causing an acute intestinal obstruction. Without immediate intervention, necro-sis and gangrene may develop. Surgery is required to release the strangulation. Although many of these signs and symptoms are present with peritonitis or perforated bowel, abdominal rigidity, a cardinal sign of peritonitis and perforated bowel, is not mentioned. Therefore, the nurse would not immediately suspect these conditions. An incarcerated hernia refers to a hernia that is irreducible but has not necessarily resulted in an obstruction.
Adenocarcinoma of the stomach will most likely occur ..... A. on the anterior wall of the pyloric sphincter B. in the duodenum C. in the distal stomach, on the lesser curvature of the antrum, D. in the GE junction E. in the fundus of the stomach
C
