Gastrointestinal System quiz
A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? a. Offering the patient a pitcher of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with a wet cloth
A
A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching? a."Formulations for the treatment of diarrhea have very short half-lives." b."Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses." c."Some opioid antidiarrheal drugs do not cross the blood-brain barrier." d."Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally."
A
A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct? a."Aprepitant [Emend] will be necessary to treat CINV caused by cisplatin." b."Antiemetics are most effective if given just as the chemotherapy is finished." c."Lorazepam probably would not be helpful for this patient." d."This patient will need intravenous antiemetics for best effects."
A
A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to a. place the patient on NPO status. b. administer Cobalamin (vitamin B12) injections. c. start bowel preparation for colonoscopy. d. administer IV metoclopramide (Reglan).
A
A patient is admitted to the emergency department with severe abdominal pain with rebound tenderness, anorexia, and chills. The vital signs include temperature 101° F (38.3° C), pulse 130, respirations 34, and blood pressure (BP) 82/50. Of the following collaborative interventions, which one should the nurse implement first? a. Infuse 1000 ml of lactated Ringer's solution over 30 minutes. b. Administer IV ketorolac (Toradol) 15 mg. c. Give IV ceftriaxone (Rocephin) 1 g. d. Obtain a computed tomography (CT) scan of the abdomen with and without contrast.
A
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.
A
A patient is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the patient, it is important for the nurse to a. assess the BP and pulse. b. remove the knife to assess the wound. c. determine the presence of Rovsing's sign. d. insert a urinary catheter and assess for hematuria.
A
A patient newly diagnosed with Crohn's disease asks the nurse what to expect in the future. The best response by the nurse is, a. "You need to know that there is the probability of lifelong, unpredictable periods of remissions and recurrences." b. "You can expect to lead a normal life and may have long periods without episodes of diarrhea or other symptoms." c. "Most patients with Crohn's disease require an ostomy to control the disease, but you can adjust to that." d. "After about 10 years, patients with Crohn's disease have a high risk for colon cancer unless the colon is removed."
A
A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest? a.Avoiding fatty and spicy foods b.Consuming extra clear fluids c.Eating three meals daily d.Taking foods later in the day
A
A patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as illustrated. The nurse explains to the patient that a. this type of colostomy is usually temporary. b. soft, formed stool can be expected as drainage. c. the drainage is liquid at this site but less odorous than at higher sites. d. colostomy irrigations can help regulate the drainage from the proximal stoma.
A
A patient with acute diarrhea of 24 hours' duration calls the clinic to ask for directions for care. In talking with the patient, the nurse should a. ask the patient to describe the character of the stools and any associated symptoms. b. advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility. c. inform the patient that laboratory testing of blood and stool specimens will be necessary. d. advise the patient to drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.
A
A recent colonoscopy revealed an increased number of polyps in a 22-year-old patient with a history of moderately severe familial adenomatous polyposis (FAP). In planning care for the patient, the nurse recognizes that the medical recommendation for patients with familial adenomatous polyposis includes a. a total colectomy with ileostomy. b. annual colonoscopy until age 40. c. routine periodic polypectomies via colonoscope to remove these abnormal growths. d. biannual colonoscopy for life because of a 50% chance of developing colon cancer.
A
After teaching a patient to irrigate a new colostomy, the nurse will determine that the teaching has been effective if the patient a. hangs the irrigating container about 18 inches above the stoma. b. stops the irrigation and removes the irrigating cone if cramping occurs. c. fills the irrigating container with 1000 to 2000 ml of lukewarm tap water. d. inserts the irrigation tubing no further than 4 to 6 inches into the stoma.
A
During the initial postoperative assessment of a patient's stoma formed with a transverse colostomy, the nurse finds it to be red with moderate edema and a small amount of bleeding. The nurse should a. document the stoma assessment. b. notify the surgeon about the stoma appearance. c. monitor the stoma every 30 minutes. d. place an ice pack on the stoma to reduce swelling.
A
In providing discharge teaching for a patient who has undergone a hemorrhoidectomy at an outpatient surgical center, the nurse instructs the patient to a. take prescribed pain medications before a bowel movement is expected. b. delay having a bowel movement for several days until healing has occurred. c. maintain a low-residue diet until the surgical area is healed. d. use ice packs on the perianal area to relieve pain and swelling.
A
To palpate the liver during a head-to-toe physical assessment, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.
A
Two days following an exploratory laparotomy with a resection of a short segment of small bowel, the patient complains of gas pains and abdominal distention. Which nursing action is most appropriate to take at this time? a. Assisting the patient to ambulate b. Administering the ordered IV morphine sulfate c. Giving a return-flow enema d. Inserting the ordered promethazine (Phenergan) suppository
A
What problem should the nurse assess the patient for if the patient was on prolonged antibiotic therapy? a. Coagulation problems b. Elevated serum ammonia levels c. Impaired absorption of amino acids d. Increased mucus and bicarbonate secretion
A
When implementing the initial plan of care for a patient admitted with acute diverticulitis, the nurse will a. administer IV fluids. b. order a diet high in fiber and fluids. c. give stool softeners. d. prepare the patient for colonoscopy.
A
Which types of drugs are used to treat inflammatory bowel disease (IBD)? (Select all that apply.) a.Aminosalicylates b.Glucocorticoids c.Immunomodulators d.Opioid antidiarrheals e.Sulfonamide antibiotics
A, B, C
A 23-year-old woman is being evaluated in the emergency department for acute lower abdominal pain and vomiting. During the nursing history, the most helpful question by the nurse to obtain information regarding the patient's condition is a. "What type of foods do you usually eat?" b. "Can you tell me about your pain?" c. "What is your usual elimination pattern?" d. "Is it possible that you are pregnant?"
B
A 30-yr-old male patient with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding is important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area
B
A 42-year-old patient recently developed abdominal distention, weight loss, steatorrhea, and flatulence. A diagnosis of adult celiac disease is made, and treatment is initiated. The nurse determines that teaching about the treatment of the disease has been effective when the patient says, a. "I must take folic acid for the rest of my life." b. "I will avoid dietary wheat, rye, barley, and oats." c. "I will be sure to take all of the ordered antibiotics." d. "I should eat only very low-fat or fat-free foods."
B
A 62 yr old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.
B
A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching? a."Azathioprine [Imuran] helps induce rapid remission of IBD." b."Cyclosporine [Sandimmune] can be used to induce remission of IBD." c."Cyclosporine [Sandimmune] does not have serious adverse effects." d."Methotrexate is used long term to maintain remission of IBD."
B
A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron [Lotronex]. Which statement by the student indicates a need for further teaching? a."I should evaluate the patient's abdomen for distension and bowel sounds." b."Patients with diverticulitis and IBS-C may take this drug." c."This drug can cause ischemic colitis in some patients." d."This drug is given only to women with severe IBS-D."
B
A patient is admitted to the emergency department for evaluation of right lower-quadrant abdominal pain with nausea and vomiting. The patient has a white blood cell count (WBC) of 14,000/l with a shift to the left. Which of these actions is appropriate for the nurse to take? a. Encouraging the patient to take sips of clear liquids b. Applying an ice pack to the right lower quadrant c. Checking for rebound tenderness every 30 minutes d. Teaching the patient how to cough and deep breathe
B
A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do? a.Assess further for signs of gastrointestinal (GI) bleeding. b.Reassure the patient that this is an expected side effect of this drug. c.Request an order for liver function tests to evaluate for hepatotoxicity. d.Withhold the drug, because this is a sign of bismuth overdose.
B
A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a.can be applied as needed at the first sign of nausea. b.has less intense anticholinergic effects than the oral form. c.is less sedating than the oral preparation. d.provides direct effects, because it is placed close to the vestibular apparatus of the ear.
B
A patient who is hospitalized with abdominal pain and watery, incontinent diarrhea is diagnosed with Clostridium difficile. In planning care for the patient, the nurse will a. order a diet with no dairy products for the patient. b. place the patient in a private room with contact isolation. c. explain to the patient why antibiotics are not being used. d. teach the patient about proper food handling and storage.
B
A patient with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, foul-smelling urine. The nurse will teach the patient a. to clean the perianal carefully after any stools. b. about fistula formation between the bowel and bladder. c. to empty the bladder before and after sexual intercourse. d. about the effects of corticosteroid use on immune function.
B
A patient with Crohn's disease has a megaloblastic anemia. The nurse will anticipate teaching the patient about the ongoing need for a. oral ferrous sulfate tablets. b. cobalamin (B12) injections. c. iron dextran (Imferon) injections. d. regular blood transfusions.
B
A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? a.It is not safe to take this drug during pregnancy. b.These are common side effects of ondansetron. c.She should stop taking the ondansetron immediately. d.She should report these adverse effects to her provider.
B
A total proctocolectomy with a permanent ileostomy is performed for a patient with ulcerative colitis. The patient is very upset and tells the nurse, "I can not bear to even look at the stoma. I do not think I can manage all these changes." The nurse's best approach to the patient's remarks is to a. reassure the patient that care for the ileostomy will become easier. b. ask the patient if a member of an ostomy support group may visit. c. develop a detailed written plan for ostomy care for the patient. d. wait to intervene until the patient adjusts to the body image change.
B
Psyllium (Metamucil) is prescribed for a patient with chronic constipation. In teaching the patient about the use of the drug, the nurse stresses that a. the use of this type of laxative is safe and adverse effects are very minimal. b. large amounts of fluid should be taken to prevent impaction or bowel obstruction. c. dietary sources of fiber should be eliminated to prevent excessive gas formation. d. fat-soluble vitamins must be taken because the drug blocks absorption of these vitamins.
B
Sulfasalazine (Azulfidine) is prescribed for a patient who has been diagnosed with ulcerative colitis. The nurse recognizes that teaching about this drug has been effective when the patient says, a. "The medication will prevent infections that cause the diarrhea." b. "The medication suppresses the inflammation in my large intestine." c. "I will need lab tests to be sure that I can still fight infections." d. "I will take the sulfasalazine as an enema or suppository."
B
The nurse explains to a patient with a new ileostomy that after the bowel adjusts to the ileostomy, the usual drainage will be about a. 1 cup. b. 2 cups. c. 3 cups. d. 1 quart.
B
The nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements for a patient who is hospitalized with an acute exacerbation of Crohn's disease, based on the finding of a. complaints of fatigue and weakness. b. hemoglobin of 10 g/dl (120 g/L). c. weight loss of 2 pounds (0.9 kg) in 2 days. d. a 1500-calorie intake over the last day.
B
The nurse is assessing an alert and independent 78-yr-old patient for malnutrition risk. Which is the most appropriate initial question? a. "How do you get to the store to buy your food?" b. "Can you tell me the food that you ate yesterday?" c. "Do you have any difficulty in preparing or eating food?" d. "Are you taking any medications that alter your taste for food?
B
The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine [Azulfidine]. What statement by the patient best demonstrates understanding of the action of sulfasalazine? a."It treats the infection that triggers the condition." b."It reduces the inflammation." c."It enhances the immune response." d."It increases the reabsorption of fluid."
B
The nurse will plan to monitor a patient with an obstructed common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol level. d. increased serum indirect bilirubin level.
B
Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse? a. Decreased appetite b. Unintended weight loss c. Difficulty chewing food d. Complaints of indigestion
B
While obtaining a nursing history from a patient with IBD, the nurse recognizes that the patient most likely has ulcerative colitis rather than Crohn's disease when the patient reports experiencing a. weight loss. b. bloody stools. c. abdominal pain and cramping. d. disease onset at age 20.
B
Which patients would be candidates for the use of dronabinol [Marinol] to treat nausea and vomiting? (Select all that apply.) a.A patient with a history of a psychiatric disorder b.A patient with acquired immunodeficiency syndrome (AIDS)-induced anorexia c.A patient with chemotherapy-induced nausea and vomiting d.A patient with nausea who has used marijuana in the past e.A patient with postoperative nausea and vomiting
B, C, D
A 26-year-old patient is diagnosed with Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach the patient about a. activity restrictions. b. fluid restriction. c. oral corticosteroids. d. enteral feedings.
C
A 54 yr old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b. The patient reports a sore throat. c. The oral temperature is 101.4°F. d. The apical pulse is 100 beats/minute.
C
A 67-year-old patient tells the nurse, "I have problems with constipation now that I am older, so I use a suppository every morning." The most appropriate nursing action at this time is to a. encourage the patient to drink at least 3000 ml of fluid a day. b. inform the patient that a daily bowel movement is not necessary. c. perform a focused nursing assessment to identify risk factors for constipation. d. suggest that the patient increase dietary intake of foods that are high in fiber.
C
A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to: a.use antispasmodic medications. b.avoid food containing lactose and gluten. c.keep a food, stress, and symptom diary. d.use antidiarrheal drugs to manage symptoms
C
A patient has a newly formed ileostomy for treatment of ulcerative colitis. In teaching the patient about the care of the ileostomy, the nurse informs the patient about the need to a. restrict fluid intake to prevent constant liquid drainage from the stoma. b. change the pouch every day to prevent leakage of contents onto the skin. c. use care when eating high-fiber foods to avoid obstruction of the ileum. d. irrigate the ileostomy daily to avoid having to wear a drainage appliance.
C
A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a.Contact the provider to discuss increasing the dose of ondansetron. b.Suggest giving prolonged doses of dexamethasone. c.Suggest adding aprepitant [Emend] to the medication regimen. d.Tell the patient to ask the provider about changing the ondansetron to aprepitant.
C
A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug? a.Giving the dose as an IV push over 3 to 5 minutes b.Infusing the dose with microbore tubing and an infusion pump c.Observing the IV insertion site frequently for patency d.Telling the patient to report dry mouth and sedation
C
A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the GI tract by doing what? a. Increasing gastric emptying b. Relaxing pyloric and ileocecal sphincters c. Decreasing secretions and peristaltic action d. Stimulation the nervous system of the GI tract
C
A patient returns from surgery following an abdominal-perineal resection with a sigmoid colostomy and abdominal and perineal incisions. The colostomy is dressed with petroleum jelly gauze and dry gauze dressings. The perineal incision is partially closed and has two drains attached to Jackson-Pratt suction. On the first postoperative day, the nurse gives the highest priority to a. teaching about a low-residue diet. b. monitoring drainage from the stoma. c. assessing the perineal drainage and incision. d. encouraging acceptance of the colostomy site.
C
A patient with Crohn's disease will begin receiving an initial infusion of infliximab [Remicade]. The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching? a."I may have an increased risk of infections, such as tuberculosis, when taking infliximab." b."I should report chills, fever, itching, and shortness of breath while receiving the infusion." c."This drug sometimes provides a complete cure of inflammatory bowel disease." d."I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter."
C
After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.
C
After being treated for a respiratory tract infection with a 10-day course of antibiotics, a 69-year-old patient calls the clinic and tells the nurse about developing frequent, watery diarrhea. The nurse anticipates that the patient will need to a. prepare for colonoscopy by taking laxatives. b. have blood drawn for blood cultures. c. bring a stool specimen in to be tested for C. difficile. d. schedule a barium enema to check for inflammation.
C
Before undergoing a colon resection for cancer of the colon, a patient has an elevated carcinoembryonic antigen (CEA) test. The nurse explains that the test is used to a. identify the extent of cancer spread or metastasis. b. confirm the diagnosis of colon cancer. c. monitor the tumor status after surgery. d. determine the need for postoperative chemotherapy.
C
Following an exploratory laparotomy and bowel resection, a patient has an NG tube to suction but complains of nausea and stomach distention. The nurse irrigates the tube PRN as ordered, but the irrigating fluid does not return. The first action by the nurse should be to a. notify the patient's health care provider. b. auscultate for bowel sounds. c. reposition the tube and check for placement. d. remove the tube and replace it with a new one.
C
How will an obstruction at the ampulla of Vater affect the digestion of all nutrients? a. Bile is responsible for emulsification of all nutrients and vitamins. b. Intestinal digestive enzymes are released through the ampulla of Vater. c. Both bile and pancreatic enzymes enter the duodenum at the ampulla of Vater. d. Gastric contents can ply pass to the duodenum when the ampulla of Vater is open.
C
Surgery is recommended by the health care provider for a patient with severe ulcerative colitis. The patient asks the nurse for clarification about the various procedures and the associated advantages and disadvantages. In responding to the patient's concerns, the nurse explains that a. surgery for ulcerative colitis involves the formation of a temporary ileostomy to divert fecal contents until the large bowel heals. b. in a total proctocolectomy with a continent ileostomy, a pouch is created that holds bowel contents and is emptied once a day with the use of a catheter. c. a total colectomy and ileal reservoir provide the most normal elimination function, but this surgery consists of two procedures, requiring a temporary ileostomy for 8 to 12 weeks. d. any proposed surgery for treatment of ulcerative colitis should be given serious consideration because the disease often recurs in previously unaffected parts of the bowel.
C
The RN and nursing assistant (NA) are caring for a patient with a paralytic ileus. Which of these nursing activities is appropriate for the nurse to delegate to the NA? a. Irrigation of the NG tube with saline b. Retaping the NG tube c. Applying petroleum jelly to the lips d. Auscultation for bowel sounds
C
The nurse identifies a nursing diagnosis of acute pain related to edema and surgical incision for a patient who has had a herniorrhaphy performed for an incarcerated inguinal hernia. An appropriate nursing intervention for this problem is to a. administer stool softeners as ordered. b. provide warm sitz baths several times a day. c. apply a scrotal support with application of ice. d. apply moist heat to the abdomen.
C
The nurse identifies a nursing diagnosis of impaired skin integrity related to having 15 to 20 daily episodes of diarrhea for a patient with ulcerative colitis. The nurse recognizes that teaching regarding perianal care has been effective when the patient a. takes a sitz bath for 40 minutes following each stool. b. asks for antidiarrheal medication after each diarrhea stool. c. uses witch hazel compresses to provide relief from anal irritation. d. cleans the perianal area with soap and water after each stool.
C
The nurse identifies the collaborative problem of potential complication: hypovolemic shock related to loss of circulatory volume for a patient with bacterial peritonitis resulting from a ruptured appendix. The nurse recognizes that the major loss of circulating fluid volume occurs as a result of a. prolonged nasogastric (NG) suctioning. b. increased production of stress hormones. c. extracellular fluid shift into the peritoneal cavity. d. loss of purulent drainage into the peritoneal cavity.
C
What is a normal finding during physical assessment of the mouth? a. A red, slick appearance of the tongue b. Uvular deviation to the side on saying "Ahh" c. A thin, white coating of the dorsum of the tongue d. Scattered red, smooth areas on the dorsum of the tongue
C
When caring for a patient who has had most of the stomach surgically removed, what is important for the nurse to teach the patient? a. Extra iron will need to be taken to prevent anemia. b. Avoid foods with lactose to prevent bloating and diarrhea. c. Lifelong supplementation of cobalamin (vitamin B12) will be needed. d. Because of the absence of digestive enzymes, protein malnutrition is likely.
C
When performing an admission assessment for a patient with abdominal pain, the nurse palpates the left lower quadrant and the patient complains of right lower quadrant pain. The nurse will document this as a. McBurney's point. b. rebound pain. c. Rovsing's sign. d. Cullen's sign.
C
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds
C
Which statement to the nurse from a patient with jaundice indicates a need for teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I use acetaminophen (Tylenol) every 4 hours for back pain." d. "I need to take an antacid for indigestion several times a week"
C
While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about a. preventing noninfectious hepatitis. b. treating inflammatory bowel disease. c. risk for developing colorectal cancer. d. using antacids and proton pump inhibitors.
C
A 42-yr-old patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? a. The patient took a laxative the previous evening. b. The patient had a high-fat meal the previous evening. c. The patient has a permanent gastrostomy tube in place. d. The patient ate a low-fat bagel 4 hours ago for breakfast.
D
A 68-year-old patient is in the office for a physical. She notes that she no longer has regular bowel movements. Which suggestion by the nurse would be most helpful to the patient? a. Take an additional laxative to stimulate defecation. b. Eat less acidic foods to enable the gastrointestinal system to increase peristalsis. c. Eat less food at each meal to prevent feces from backing up related to slowed peristalsis. d. Attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time.
D
A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin [Kepivance]. Which is an appropriate nursing action when giving this drug? a.Administering the drug as a slow IV infusion b.Flushing the IV line with heparin before infusing the drug c.Giving the drug within 6 hours of the chemotherapy d.Warning the patient about the potential for distortion of taste
D
A patient diagnosed with irritable bowel syndrome (IBS) tells the nurse, "My friends tell me this problem is all in my head." In caring for the patient, the nurse should a. discuss the new medications that are available to treat the condition. b. inform the patient that IBS has a specific, identifiable cause. c. explain that modifications to increase dietary fiber can control the symptoms. d. encourage the patient to express feelings and ask questions about IBS.
D
A patient has a large bowel obstruction that occurred as a result of a fecal impaction. During nursing assessment of the patient, a finding by the nurse that is consistent with a large bowel obstruction includes a. metabolic alkalosis. b. referred pain to the back. c. bile colored vomiting. d. abdominal distension.
D
A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to a. sympathetic inhibition. b. mixing and propulsion. c. sympathetic stimulation. d. parasympathetic stimulation.
D
A patient is brought to the emergency department following an automobile accident in which blunt trauma to the abdomen occurred. The patient is splinting the abdomen and complaining of pain, and bowel sounds are decreased. Peritoneal lavage returns brown drainage. Based on the results of the lavage, the nurse plans for a. preparation for a paracentesis. b. administration of pain medications. c. continued monitoring of the patient's condition. d. immediate preparation of the patient for surgery.
D
A patient is hospitalized with severe vomiting and colicky abdominal pain that is somewhat relieved with the vomiting. The health care provider orders an IV infusion of lactated Ringer's solution and placement of an NG tube. An appropriate collaborative problem for the nurse to identify for the patient at this time is a. potential complication: volvulus. b. potential complication: thromboembolism. c. potential complication: renal insufficiency. d. potential complication: metabolic alkalosis.
D
A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do? a.Combine the antibiotic with an antidiarrheal medication, such as loperamide. b.Start taking the ciprofloxacin 1 week before traveling. c.Take 1 tablet of ciprofloxacin with each meal for best results. d.Use the drug if symptoms are severe or do not improve in a few days.
D
A patient who has traveler's diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug? a."Loperamide is used for moderate to severe symptoms only." b."This drug is useful as prophylaxis to prevent symptoms." c."This drug is only effective to treat certain infectious agents." d."Use of this drug may prolong symptoms by slowing peristalsis."
D
A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct? a."After 3 months, if the drug is not effective, you may need to increase the dose." b."Metoclopramide may cause hiccups, especially after meals." c."Serious side effects may occur but will stop when the drug is discontinued." d."You should take the drug 30 minutes before each meal and at bedtime."
D
After a patient with IBD has had dietary teaching, which food choice by the patient indicates that the teaching has been successful? a. Oatmeal with cream, whole wheat toast, and a banana b. Corn tortilla taco with chicken, lettuce, tomato, and cheese c. Roast beef, mashed potatoes, and a tossed green salad d. Chicken sandwich with mayonnaise on white bread
D
After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladder. What is the mechanism responsible for this action? a. Production of bile by the liver b. Production of secretin by the duodenum c. Release of gastrin from the stomach antrum d. Production of cholecystokinin by the duodenum
D
After teaching a patient with IBD about recommended dietary modifications, the nurse identifies a need for further instruction when the patient chooses from the menu a. spaghetti with tomato sauce. b. poached eggs and crisp bacon. c. boiled shrimp and white rice. d. ham hocks and beans.
D
During preoperative preparation for a patient scheduled for an abdominal-perineal resection, the nurse will a. give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria. b. teach the patient that activities such as sitting at the bedside will be started the first postoperative day. c. instruct the patient that another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. d. administer enemas and laxatives to ensure that the bowel is empty before the surgery.
D
The nurse receives the following information about a 51-yr-old female patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to both shellfish and iodine in the past. d. The patient refused to drink the prescribed polyethylene glycol (GoLYTELY)
D
What is a clinical manifestation of age-related changes in the GI system that the nurse may find in an older patient? a. Gastric hyperacidity b. Intolerance to fatty foods c. Yellowish tinge to the skin d. Reflux of gastric contents into the esophagus
D
When caring for a patient with a history of a total gastrectomy, the nurse will monitor for a. constipation. b. dehydration. c. elevated total serum cholesterol. d. cobalamin (vitamin B12) deficiency
D
While obtaining a nursing history from a 55-year-old patient scheduled for a colonoscopy, the nurse will be most concerned about a. lifelong constipation. b. nausea and vomiting. c. history of an appendectomy. d. recent blood in the stools.
D
A patient is jaundiced and her stools are clay colored (gray). This is most likely related to a. decreased bile flow into the intestine. b. increased production of urobilinogen. c. increased production of cholecystokinin. d. increased bile and bilirubin in the blood.
a
A normal physical assessment finding of the GI system is/are (select all that apply) a. nonpalpable liver and spleen. b. borborygmi in upper right quadrant. c. tympany on percussion of the abdomen. d. liver edge 2 to 4 cm below the costal margin. e. finding of a firm, nodular edge on the rectal examination.
a, c
A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that a. the gallbladder is unable to contract to release stored bile. b. bilirubin is not being conjugated and excreted into the bile by the liver. c. the Kupffer cells in the liver are unable to remove bilirubin from the blood. d. there is an obstruction in the biliary tract preventing flow of bile into the small intestine.
b
An 80-year-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult a. should not experience changes in taste. b. has a loss of taste buds, especially for sweet and salt. c. has some loss of taste but no difficulty chewing food. d. loses the sense of taste because the ability to smell is decreased.
b
As gastric contents move into the small intestine, the bowel is nor- mally protected from the acidity of gastric contents by the a. inhibition of secretin release. b. release of bicarbonate by the pancreas. c. release of pancreatic digestive enzymes. d. release of gastrin by the duodenal mucosa.
b
During an examination of the abdomen the nurse should a. position the patient in the supine position with the bed flat and knees straight. b. listen for bowel sounds in the epigastrium and all four quadrants for 2 minutes c. describe bowel sounds as absent if no sound is heard in the lower right quadrant after 2 minutes. d. use the following order of techniques: inspection, palpation, percussion, auscultation.
b
In preparing a patient for a colonoscopy, the nurse explains that a. a signed permit is not necessary. b. sedation may be used during the procedure. c. only one cleansing enema is necessary for preparation. d. a light meal should be eaten the day before the procedure.
b
Which digestive substances are active or activated in the stomach (select all that apply)? a. Bile b. Pepsin c. Gastrin d. Maltase e. Secretin f. Amylase
b, c
A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do? a.Administer the ondansetron at the same time as the chemotherapy. b.Contact the provider to suggest using high-dose intravenous dolasetron [Anzemet]. c.Request an order to administer dexamethasone with the ondansetron. d.Suggest to the provider that loperamide [Lomotil] be given with the ondansetron.
c
When the nurse is assessing the health perception-health mainte- nance pattern as related to GI function, an appropriate question to ask is a. "What is your usual bowel elimination pattern?" b. "What percentage of your income is spent on food?" c. "Have you traveled to a foreign country in the last year?" d. "Do you have diarrhea when you are under a lot of stress?"
c
A patient who is hospitalized with a diagnosis of Giardia lamblia infection frequently has uncontrollable explosive diarrhea. The patient closes the eyes and will not talk to the nurse when the linens are changed and skin care is performed. To help maintain the patient's self-esteem, the nurse should a. use incontinence briefs for the patient so that the cleaning is less cumbersome and embarrassing. b. request an order for an antidiarrheal drug from the health care provider to help control the diarrhea episodes. c. ensure the patient that the lack of control is temporary and will resolve after about a week of treatment. d. acknowledge the behavior as reflective of a difficult situation and provide privacy during hygiene.
d
