GI/ GU

The mother of a child with celiac disease asks, "How long must he stay on this diet?" Which response by the nurse is best? a) "For the rest of his life." b) "Until his stools appear normal." c) "For the next 6 months." d) "Until the jejunal biopsy is normal."

"For the rest of his life." xplanation:Most children with celiac disease have a lifelong sensitivity to gluten, which requires that they maintain some type of diet restriction for the rest of their lives

After teaching the mother of a child with celiac disease about dietary management, which of the following statements by the mother indicates successful teaching? a) "I will be sure to give my child lots of milk." b) "I will plan to feed my child foods that contain rice." c) "I will feed my child foods that contain wheat products." d) "I will be sure my child gets oatmeal every day."

"I will plan to feed my child foods that contain rice." Explanation:Damage to intestinal mucosa in celiac disease is caused by gliadin, a part of the protein found in wheat, rye, barley, and oats. Foods containing these grains must be eliminated entirely from the diet of children with celiac disease. Foods containing rice and corn are a good substitute. Although an adequate intake of milk is important for any child, children with celiac disease do not need an increased milk intake.

IBD

-regional (chrons and granulomatous colitis) -ulcerative colitis

a home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. which statement by the client indicates an understanding of the test? 1. Ill avoid eating or drinking 6-8 hr before test 2. ill drink full fluids a day before the test 3. there is no need for special prep before 4. ill take a laxative to clear bowels before the test.

1. avoid eating or drinking 6-8 hrs no other prep is needing. ( low residue or clear with laxative for lower gi series )

Client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to 1. auscultate bowel sounds 2. palpate abdomen 3. change clients position 4. insert a rectal tube

1. is not present may be gastric or small intestine dilation- don't palpate post op with distention

a client with a history of bladder retention has not voided in 8 hours a nurse concerned the client is retaining urine notifies the MD he orders a bladder scan and placement of an indwelling cath is residual is greater than 350 ml the nurse knows using the bladder scan to measure residual urine instead od a straight cath reduces the risk of 1. microorganism transfer 2. prostate irritation 3. client discomfort 4. incorrect urine output values

1. non invasive and reduce microorganism risk

client admitted to rule our colorectal cancer. which intervention should the nurse include in plan of care? 1. test all stool for occult blood 2. administer topical ointment to decrease bleeding 3. prepare for gastrostomy 4. administer morphine as ordered

1. test all stool for occult blood- one of warning sign of colorectal cancer

A client presents to ED with complaints of acute GI distress, bloody diarrhea, weight loss, fever. Which condition in family history is most pertinent to clients health problem. 1. ulcerative colitis 2. hypertension 3. GERD 4. appendicitis

1. ulcerative colitis- esp if 1st degree increases client risk of having UC

nurse is monitoring a client recovering from moderate sedation administered during a colonoscopy. which finding requires immediate attention? 1. HR 84 BPM 2. o2 sat 85% 3. decreased cough and gag reflex 4. blood tinges stool

2 o2 sat 85- may be from moderate sedation. normal is 95-100

A client with renal dysfunction of acute onset comes to the ED complaining of fatigue oliguria and coffee colored urine. When obtaining history the nurse should ask about 1. chronic acetaminophen use 2. recent strep infection 3. childhood asthma 4. family history of pernicious anemia

2 recent strep- upper resp. infection of strep can lead to acute glomerular nephritis

a client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the post op period. Nurse informs the client that many members of the health care team will see him (including mental health) a mental health practitioner should be involved bc 1. assess if they are a good candidate for surgery 2. help the client cope with the anxiety associated with body changes 3. assess suicide risk

2. Help the client cope with anxiety associated with body image changes. may have anxiety associated in body image change .

After having transurethral resection for the prostate TURP a client returns to the unit with a three way indwelling cath. and CBI. which finding suggests the cath. is occluded 1. urine appears red to pink 2. client reports bladder spasms and the urge to void 3. the normal saline is infusing at a rate of 50 drops per minute 4. 1000ml irrigant instilled and 1200ml drainage returned

2. bladder spasms and urge to void. suggest blood clot may be occluding the cath.

During a rectal exam which finding is evidence of a urethral injury 1 low riding prostate 2. boggy mass 3. absent sphincter tone 4. pos. hemoccult

2. boggy mass -hematoma may feel like a mass

Client is diagnosed with crohns after undergoing weeks of testing. The clients boss calls the med surg floor requesting to speak with the nurse manager. he expresses concern that he must know the diagnosis for insurance. which response is the best? 1. sure I understand how demanding insurance is 2. I appreciate your concern I cannot give out info 3. why don't you come in and we can discuss

2. cant give out info

a client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. while changing the clients pouch the nurse observes the area around the stoma is red, weeping and painful. what should the nurse conclude. 1. the skin was not lubricated before pouch applied 2. the pouch faceplate does not fit the stoma 3. a skin barrier was applied properly 4. the stoma dilation was not performed.

2. faceplate doesn't fit stoma. if not fitting it is exposed to urine causing excoriation.

a nurse is caring for a client acute pyelonephritis which nursing intervention is the most important? 1. administer sitz bath twice a day 2. increase fluid to 3 L a day 3. using an indwelling urinary cath to measure urine accurately 4. encourage client to drink cranberry juice to acidify the urine

2. increase fluid to 3L- sudden inflammation. may result from cath, cystoscopy and urologic surgery. Help prevent calculi and flush contaminated urine out of the bladder.

Which condition is most likely to have a diagnosis of fluid volume deficit? 1. appendicitis 2. pancreatitis 3. cholecystitis 4. gastric ulcer

2. pancreatitis- hypovolemic shock from fluid shift is a factor in acute pancreatitis

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "finally! ill be thin and able to eat without much concern." How should the nurse intervene? 1. rejoice with the client 2. notify the dr the client is eager to sign the consent 3. evaluate the clients understanding of the procedure 4. ask the client what her plans are after surgery

3. evaluate the clients understanding of the procedure. it is not a cure for obesity

a client received inhalation anesthetic during GI surgery experiences shivering post op. in addition to giving blankets, the nurse should 1. notify the DR 2. increase IV infusion 3. provide 02 as ordered 4. monitor I/O

3. hypothermia is a common side effect- shivering is normal during post op recovery. give 02 for increase 02 demand from shivering

A client is being admitted to the hospital with abdominal pain, anemia, bloody stool. He complains feeling weak and dizzy. He has rectal pressure and needs to urinate and move bowels. The nurse should help him 1. to the bathroom 2. to commode 3. on bedpan 4. standing position so he can urinate

3. on bedpan due to risk for injury being dizzy

During rounds, a client admitted with hematuria asks the nurse about the DR diagnosis. To facilitate communication what should the nurse do? 1. ask why they are concerned about the diagnosis 2. change the subject to something more pleasant 3. provide privacy 4. give the client good advice

3. providing privacy is an active form of listening- why blocks therapeutic communication

which client requires immediate intervention? 1. complaint of epigastric pain after eating 2. anorexia and preumbilical pain 3. rigid board like abdomen 4. present with ribbonlike stools

3. sign of peritonitis- possibly life threatening condition. (epigastric is 90-3hr after pain)

during clindamycin (cleocin) therapy, a nurse monitors for pseudomembranous colitis. The serious adverse reaction to clindamycin results from superinfection of which organism. 1. staph aureus 2. bacteroides fragilis 3. e-coli 4. C-Diff

4. C-Diff

A nurse is assigning the care of a client with appendicitis. she should assign this clients care to a 1. nursing assistant 2. clinical nurse specialist 3. LPN 4. RN

4. RN requires frequent assessment and monitoring

MEDS oral fluid, low residue, high protein, high calorie, vitamins, iron, avoid cold food, sedative/antiiarrheal, rest bowel

5-aminosalicylates asulfodine- sulfasalazine (Folic acid deficit with long term use. Increase green leafy vegetables. Take with food to prolong effect of Med. Increase fluids and avoid sun, don't give to patient with sulfa allergies.) orange pee corticosteroids in exac- moon face, cataracts, mood swings, osteoporosis, skin issues prednisone, solumedrol, entocourt (metabolize in the liver) demeral for pain (morphine=segmentation) antisecretory- Zofran, eloxy (36hr) bulk forming laxative pouchitis- flagyll prevent, Cipro don't stop steroids fast be adrenal insufficiency

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: a) Absent. b) High-pitched. c) Mild. d) Hyperactive.

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

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? a) Black b) Red c) Dark brown d) Green

A) Black Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see? a) Constipation b) Hypoglycemia c) Lactic acidosis d) Hyperkalemia

A) Constipation Orthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? a) Encourage plenty of fluids. b) Order a high-fiber diet. c) Serve dairy products. d) Serve the client his usual diet.

A) Encourage plenty of fluids The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

A physician plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which of the following medications while collecting stool for the test? a) ibuprofen (Advil) b) ciprofloxacin (Cipro XR) c) docusate sodium (Colace) d) acetaminophen (Tylenol)

A) Ibprofen (Advil) Fecal occult blood testing (FOBT) is one of the most commonly performed stool tests. FOBT can be done at the bedside, in the physician's office, or at home. The client is taught to avoid aspirin, red meats, nonsteroidal antiinflammatory agents, and horseradish for 72 hours prior to the examination. Advil is an anti-inflammatory drug and should be avoided with FOBT.

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

A) Polyps Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care? a) Provide frequent mouth care. b) Keep the feeding formula refrigerated. c) Ensure adequate hydration with additional water. d) Flush the tube with water before adding the feedings.

A) Provide frequent mouth care Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

Which of the following medications used for the treatment of obesity prevents the reuptake of serotonin and norepinephrine? a) Sibutramine hydrochloride (Meridia) b) Orlistat (Xenical) c) Bupropion hydrochloride (Wellbutrin) d) Fluoxetine hydrochloride (Prozac)

A) Sibutramine hydrochloride (Meridia) Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephrine. Meridia decreases appetite. Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. Bupropion hydrochloride (Wellbutrin) is an antidepressant medication. Fluoxetine hydrochloride (Prozac) has not been approved by the FDA for use in the treatment of obesity.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a) The client is free from esophagitis and achalasia. b) The client reports diminished duodenal inflammation. c) The client has normal gastric structures. d) The client doesn't exhibit rectal tenesmus.

A) The client is free from esophagitis and achalasia. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

Which outcome indicates effective client teaching to prevent constipation? a) The client reports engaging in a regular exercise regimen. b) The client limits water intake to three glasses per day. c) The client verbalizes consumption of low-fiber foods. d) The client maintains a sedentary lifestyle.

A) The client reports engaging in a regular exercise regimen. The client having a regular exercise program indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet, a sedentary lifestyle, and limited water intake would predispose the client to constipation.

Dull, constant ache along right costovertebral angle with nausea and vomiting. Most likely cause of S&S is: A. Renal calculi B. Over-distended bladder C. Being a ****-head D. Acute prostitis

A. Renal calculi

The home care nurse is making a visit with a client who had a double barrel colostomy created after bowel surgery. While the nurse is changing the client's appliance there is a knock on the door. The nurse answers the door. The client's next-door neighbor wants to visit with the client. Which intervention by the nurse is most appropriate?

Ask the neighbor to come back in 20 minutes.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a) "Lie down after meals to promote digestion." b) "Avoid coffee and alcoholic beverages." c) "Limit fluid intake with meals." d) "Take antacids with meals."

B) Avoid coffee and alcoholic beverages To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? a) The ostomy bag should be adjusted. b) Blood supply to the stoma has been interrupted. c) An intestinal obstruction has occurred. d) This is a normal finding 1 day after surgery.

B) Blood supply to the stoma has been interrupted. An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.

Which of the follow statements provide accurate information regarding cancer of the colon and rectum? a) There is no hereditary component to colon cancer. b) Cancer of the colon and rectum is the second most common type of internal cancer in the United States. c) Rectal cancer affects more than twice as many people as colon cancer. d) The incidence of colon and rectal cancer decreases with age.

B) Cancer of the colon and rectum is the second most common type of internal cancer in the US Cancer of the colon and rectum is the second most common type of internal cancer in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

A client comes into the emergency department with complaints of abdominal pain. Which of the following should the nurse ask first? a) Family history of ruptured appendix b) Characteristics and duration of pain c) Concerns about impending hospital stay d) Medications taken in the last 8 hours

B) Characteristics and duration of pain A focused abdominal assessment begins with a complete history. The nurse must obtain information about abdominal pain. Pain can be a major symptom of gastrointestinal disease. The character, duration, pattern, frequency, location, distribution, and timing of the pain vary but require investigation immediately.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a) restrict fluid intake to 1 qt (1,000 ml)/day. b) drink liquids only between meals. c) don't drink liquids 2 hours before meals. d) drink liquids only with meals.

B) Drink liquids only between meals. A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? a) Maintaining wrinkles in the faceplate so it doesn't irritate the skin b) Gently washing the area surrounding the stoma using a facecloth and mild soap c) Scrubbing fecal material from the skin surrounding the stoma d) Cutting the faceplate opening no more than 2? larger than the stoma

B) Gently washing the area surrounding the stoma using a facecloth and mild soap For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A nurse is providing postprocedure instructions for a client who had an esophagogastroduodenoscopy. The nurse should perform which action? a) Tell the client to call back in the morning so she can give him instructions over the phone. b) Review the instructions with the person accompanying the client home. c) Tell the client there aren't specific instructions for after the procedure. d) Give instructions to the client immediately before discharge.

B) Review the instructions with the person accompanying the client home A client who undergoes esophagogastroduodenoscopy receives sedation during the procedure, and his memory becomes impaired. Clients tend not to remember instructions provided after the procedure. The nurse's best course of action is to give the instructions to the person who is accompanying the client home. It isn't appropriate for the nurse to tell the client to call back in the morning for instructions. The client needs to be aware at discharge of potential complications and signs and symptoms to report to the physician.

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

B) Severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

The nurse is preparing to examine the abdomen of a client complaining of a change in his bowel pattern. The nurse would place the client in which position? a) Lithotomy b) Supine with knees flexed c) Knee-chest d) Left Sim's lateral

B) Supine with knees flexed When examining the abdomen, the client lies supine with his knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a) The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns c) The client should be monitored for cramping or abdominal distention d) The client's fluid output should be measured for at least 24 hours after the procedure

B) The client should not be given any food and fluids until the gag reflex returns. For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns.

Which patient teaching component is important for the nurse to communicate regarding pain management prior to or during diagnostic testing for a disorder of the GI system? a) The patient should not expel gas and test fluids from the bowel when he or she experiences the urge during the procedure. b) The patient should inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. c) The patient should take a sedative before the procedure to avoid the possibility of experiencing any discomfort. d) The patient should lie down in a supine position for at least 3 hours before the test to reduce any discomfort during the test.

B) The patient should inform the test personnel if he or she experiences pressure or cramping during instillation of test fluids To ensure that a patient who is to undergo a diagnostic test for a disorder of the gastrointestinal system experiences no or minimal discomfort during the test, the patient should be instructed to inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. The test personnel can slow the instillation or take other measures to relieve discomfort. The patient should also be advised to expel gas and test fluids from the bowel when he or she experiences the urge. Ignoring the urge to expel the bowel contents increases pain and discomfort. The patient should be advised not to take any sedative or analgesic before the test, unless prescribed. Lying down in a supine position is not known to have any consequence on the level of discomfort experienced by a patient during a diagnostic test for a GI disorder.

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The physician has ordered a visualization of the small intestine via a capsule endoscopy. Which of the following will the nurse include in the client education about this procedure? a) "An x-ray machine will use a capsule ray to follow your intestinal tract." b) "You will need to swallow a capsule." c) "The physician will use a scope called a capsule to view your intestine." d) "A capsule will be inserted into your rectum."

B) You will need to swallow a capsule A capsule endoscopy allows for noninvasive visualization of the small intestinal mucosa. The technique consists of the client swallowing a capsule that is embedded with a wireless miniature camera, which is propelled through the intestine by peristalsis. The capsule passes from the rectum in 1 to 2 days.

A nurse is teaching an elderly client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? a) "I need to drink 2 to 3 liters of fluids every day." b) "I should exercise four times per week." c) "I need to use laxatives regularly to prevent constipation." d) "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

C) "I need to use laxatives regularly to prevent constipation." The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

A 24-year-old athlete is admitted to the trauma unit following a motor-vehicle collision. The client is comatose and has developed ascites as a result of the accident. You are explaining the client's condition to his parents. In your education, what do you indicate is the primary function of the small intestine? a) Digest proteins b) Digest fats c) Absorb nutrients d) Absorb water

C) Absorb nutrients The primary function of the small intestine is to absorb nutrients from the chyme.

A longitudinal tear or ulceration in the lining of the anal canal is termed a (an) a) hemorrhoid. b) anorectal abscess. c) anal fissure. d) anal fistula.

C) Anal fissure Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure? a) At the lower border of the liver b) In the right upper quadrant c) At the umbilicus d) Just below the last rib

C) At the umbilicus Measurement of abdominal girth is done at the widest point, which is usually the umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib would be inappropriate sites for abdominal girth measurement.

Which of the following terms is used to refer to intestinal rumbling? a) Diverticulitis b) Tenesmus c) Borborygmus d) Azotorrhea

C) Borborygmus Borborygmus is the intestinal rumbling that accompanies diarrhea. Tenesmus is the term used to refer to ineffectual straining at stool. Azotorrhea is the term used to refer to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure? a) Signs of perforation b) Gag reflex c) Client's tolerance for pain and discomfort d) Client's ability to retain the barium

C) Client's tolerance for pain and discomfort The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? a) Computer tomography b) Small bowel series c) Colonoscopy d) Upper GI series

C) Colonoscopy A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? a) Slowed heart beat b) Hyperglycemia c) Diarrhea d) Dry skin

C) Diarrhea Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Measurement of abdominal girth b) Palpation of abdomen for a fluid shift c) Foul-smelling breath d) Weight

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

Which of the following is a protrusion of the intestine through a weakened area in the abdominal wall? a) Tumor b) Adhesion c) Hernia d) Volvulus

C) Hernia A hernia is a protrusion of intestine through a weakened area in the abdominal muscle or wall. A tumor that extends into the intestinal lumen, or a tumor outside the intestine causes pressure on the wall of the intestine. Volvulus occurs when the bowel twists and turns on itself. An adhesion occurs when loops of intestine become adherent to areas that heal slowly or scar after abdominal surgery.

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? a) Gastric resection b) Infectious disease c) Inflammation of all layers of intestinal mucosa d) Disaccharidase deficiency

C) Inflammation of all layers of intestinal mucosa Crohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are a) absent. b) hypoactive. c) normal. d) sluggish.

C) Normal Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

The nurse asks a client to point to where she feels pain. The client asks why this is important. The nurse's best response would be which of the following? a) "This determines the pain medication to be ordered." b) "If the doctor massages over the exact painful area, the pain will disappear." c) "Often the area of pain is referred from another area." d) "The area may determine the severity of the pain."

C) Often the area of pain is referred from another area Pain can be a major symptom of disease. The location and distribution of pain can be referred from a different area. If a client points to an area of pain and has other symptoms associated with a certain disease, this is valuable information for treatment.

A client is being treated for prolonged diarrhea. Which of the following foods should the nurse encourage the client to consume? a) Protein-rich foods b) High-fiber foods c) Potassium-rich foods d) High-fat foods

C) Potassium rich foods The nurse should encourage the client with diarrhea to consume potassium-rich foods. Excessive diarrhea causes severe loss of potassium. The nurse should also instruct the client to avoid high-fiber or fatty foods because these foods stimulate gastrointestinal motility. The intake of protein foods may or may not be appropriate depending on the client's status.

A client presents with complaints of blood in her stools. Upon inspection, the nurse notes streaks of bright red blood visible on the outer surface of formed stool. Which of the following will the nurse further investigate with this client? a) Ingestion of cherry soda b) Ingestion of cocoa c) Presence or history of hemorrhoids d) Recent barium studies

C) Presence or history of hemorrhoids Stool is normally light to dark brown. Blood in the stool can present in various ways and must be investigated. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or blood is noted on toilet tissue.

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient? a) Instruct the patient to keep a record of food intake b) Instruct the patient to avoid prune or apple juice c) Suggest fluid intake of at least 2 L per day d) Assist the patient regarding the correct diet or to minimize food intake

C) Suggest fluid intake of at least 2 L per day For constipation the nurse should suggest a fluid intake of at least 2L per day. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the patient to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the patient to keep a record of food intake in case of diarrhea because this helps identify specific foods that irritate the GI tract.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make? a) Administer a tap-water enema weekly. b) Take a mild laxative such as magnesium citrate when necessary. c) Take a stool softener such as docusate sodium (Colace) daily. d) Administer a phospho-soda (Fleet) enema when necessary.

C) Take a stool softener such as docusate sodium (Colace) daily Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing a dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation.

After teaching the parents of a child with celiac disease about diet, which of the following, if stated by the parents to be avoided, indicates effective teaching? Select all that apply. a) Chocolate candy. b) Corn tortillas. c) Bologna on rye sandwich. d) White rice. e) Hot dogs.

Chocolate candy. • Hot dogs. • Bologna on rye sandwich. Explanation:Children with celiac disease should avoid foods containing the protein gluten, which is found in wheat, oats, rye, and barley grains. Children are allowed to eat foods containing rice or corn. Labels need to be read carefully since these glutens are used as fillers in many food items including many types of chocolate candy and hot dogs.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Anxiety related to unknown outcome of hospitalization c) Deficient knowledge related to prevention of disease recurrence d) Acute pain related to biliary spasms

D) Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

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

D) Board-like abdomen The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

What kind of feeding should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions? a) Bolus feeding b) Intermittent feeding c) Cyclic feeding d) Continuous feedings

D) Continuous feedings. Continuous feedings should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions.

A nurse is preparing a client for a protcosigmoidoscopy. Identify the quadrant on which this diagnostic test will focus. A) RUQ B) RLQ C) LUQ D) LLQ

D) LLQ The sigmoid colon is in the left lower quadrant. Proctosigmoidoscopy is examination of the rectum and sigmoid colon using a rigid endoscope inserted anally about 10 inches.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has: a) diverticulitis. b) peptic ulcer disease. c) appendicitis. d) ulcerative colitis.

D) Peptic Ulcer Disease Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? a) Left lower quadrant b) Left upper quadrant c) Right upper quadrant d) Right lower quadrant

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

Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis? a) Such clients can digest high-fat foods. b) Such clients are at risk for hepatic encephalopathy. c) Such clients are at risk for gallbladder contraction. d) Such clients cannot tolerate high-glucose concentration.

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

A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? a) Insulin has an adverse effect of constipation. b) The nerve fibers of the intestinal lining are experiencing neuropathy. c) Elevated glucose levels cause bacteria overgrowth in the large intestine. d) The pancreas secretes digestive enzymes.

D) The pancreas secretes digestive enzymes While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as foundi with diabetes, the digestive functioning may be impaired.

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

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

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) black, tarry stools. b) circumoral pallor. c) light amber urine. d) yellow sclerae.

D) Yellow sclerae Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

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

Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic,

In a client with enteritis and frequent diarrhea, the nurse should anticipate an acid-base imbalance of:

Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates leading to (Ans.metabolic acidosis).

The nurse is teaching a client how to irrigate his stoma. Which action indicates that the client needs more teaching?

Hanging the irrigation bag 24″ to 36″ (60 to 90 cm) above the stoma

Which of the following statements by a mother about her child would suggest to the nurse that the child may have celiac disease and should be referred to a health care provider? a) "He is so short." b) "His stools are large and smelly." c) "His urine is so dark in color." d) "His belly is so small."

His stools are large and smelly." Explanation:Celiac disease is a disorder involving intolerance to the protein gluten, which is found in wheat, rye, oats, and barley. The stools of a child with celiac disease are characteristically malodorous, pale, large (bulky), and soft (loose). Excessive flatus is common, and bouts of diarrhea may occur. Dark urine is commonly associated with concentrated urine, such as when a child has dehydration. The belly of a child with celiac disease, a malabsorption disorder, typically is protuberant. A small belly may be associated with a child who is thin. Short stature is not associated with this malabsorption disorder. (

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?

In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus

The nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?

Maintain a high-carbohydrate, low-fat diet."

A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? a) Metabolic alkalosis and hyperkalemia b) Metabolic acidosis and hypokalemia c) Metabolic alkalosis and hypokalemia d) Metabolic acidosis and hyperkalemia

Metabolic alkalosis and hypokalemia Explanation: Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.

A nurse is caring for a child with celiac disease. How should the nurse evaluate the effectiveness of nutritional therapy? a) Measure intake and output. b) Measure blood urea nitrogen and serum creatinine levels. c) Monitor the appearance, size, and number of stools. d) Monitor vital signs every 4 hours.

Monitor the appearance, size, and number of stools. Explanation:A gluten-free diet should eliminate fat, bulky, foul-smelling stools in a child with celiac disease. This finding indicates that the disease is controlled and the child is using nutrients effectively. Taking vital signs, measuring blood urea nitrogen and serum creatinine levels, and measuring intake and output don't indicate the effectiveness of nutritional therapy

A nurse is giving nutritional counseling to the mother of a child with celiac disease. Which statement by the mother indicates understanding? a) "My son can safely eat frozen and packaged foods." b) "My son needs a gluten-rich diet." c) "My son can't eat wheat, rye, oats, or barley." d) "My son must avoid potatoes, rice, and cornstarch."

My son can't eat wheat, rye, oats, or barley." Explanation:A child with celiac disease must follow a gluten-free diet. If the child eats foods containing gluten, changes in the intestinal mucosa will prevent the absorption of fats and other foods. Therefore, all foods containing wheat, rye, oats, and barley must be eliminated from the diet. Such foods as potatoes, rice, and cornstarch may be included in a gluten-free diet. Frozen and packaged foods, which may contain gluten fillers, should be avoided.

A client with acute diarrhea is prescribed paregoric, 5 ml by mouth up to four times daily, until acute diarrhea subsides. The client asks the nurse how soon the medication will start to work after the first dose is taken. How should the nurse respond?

Paregoric starts to act within 1 hour after administration. Onset of action isn't as rapid as 5 or 20 minutes or as slow as 2 to 4 hours.

The nurse is teaching an adolescent with celiac disease about dietary changes that will help maintain a healthy lifestyle. Which of the following foods can the nurse safely recommend as part of the adolescent's diet? Select all that apply. a) Apples b) Pizza c) Corn d) Potatoes e) Bagels

Potatoes • Apples • Corn Explanation: Celiac disease is an intolerance to the gluten factor of protein found in grains. Specific grains to be removed from the diet include wheat, rye, oats, and barley. Clients with a diagnosis of celiac disease can tolerate corn, fruits, and vegetables

A client who has been treated for diverticulitis is being discharged on oral propantheline bromide (Pro-Banthine). The nurse should instruct the client to take the drug at which times?

Propantheline bromide is used to reduce secretions and spasms of the GI tract in clients with diverticulitis, a condition characterized by bowel inflammation and colonic irritability and spasticity. The nurse should instruct the client to take the drug 30 minutes before meals and at bedtime to reduce GI motility, thus relieving spasticity

During assessment of a child with celiac disease, the nurse should most likely note which of the following physical findings? a) Tender inguinal lymph nodes. b) Enlarged liver. c) Periorbital edema. d) Protuberant abdomen.

Protuberant abdomen. Explanation:The intestines of a child with celiac disease fill with accumulated undigested food and flatus, causing the characteristic protuberant abdomen. Celiac disease is not usually associated with any liver dysfunction, including poor liver functioning leading to liver enlargement. Tender inguinal lymph nodes are often associated with an infection. Periorbital edema, swelling around the eyes, is associated with nephritis.

A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase?

Related to the presence of bacteria at the surgical site

A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase? a) Related to the presence of bacteria at the surgical site b) Related to malnutrition secondary to bowel resection with anastomosis c) Related to major surgery required by bowel resection d) Related to the presence of a nasogastric (NG) tube postoperatively

Related to the presence of bacteria at the surgical site Explanation: The nurse should add "Related to the presence of bacteria at the surgical site" to the diagnosis of Risk for infection. The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli, Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium, and chloride) is completed in the small intestine. An NG tube is placed through a natural opening, not a wound, and therefore doesn't increase the client's risk of infection.

Nursing assessment of a client with peritonitis (acute or chronic inflammation of the peritoneum) reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

Severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction).

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

The nurse should address the client's pain issues first by administering morphine I.V. as prescribed. The other interventions don't take priority over addressing the client's pain issues.

A client who had a colonoscopy with removal of a polyp is being prepared for discharge. Which of the following would the nurse include in the discharge instructions? a) "You might experience some nausea and vomiting for a day or so. This is normal." b) "Call your physician if there is even slight bleeding with your first bowel movement." c) "You might feel some cramping and gas but these usually go away in about a day." d) "Be sure to eat high fiber foods when you get home to help you move your bowels."

You might feel some cramping and gas but these usually go away in about a day." Explanation: After a colonoscopy, a client may experience mild cramping and flatulence which usually resolve within n 24 hours. If the client has a small growth or polyp removed, there may be a slight amount of bleeding that resolves on its own. The client should notify his physician if he experiences nausea, vomiting, fever, or excessive bleeding. The client also should avoid high-fat and high-fiber foods for at least 24 hours after the procedure.

Client has severe right flank pain, nausea, vomiting, diagnosed with renal calculi. What is the highest priority nursing diagnosis? a. Acute pain b. Risk for infection c. Impaired elimination d. Imbalanced nutrition

a. Acute pain

Client w/ renal insufficiency and pneumonia on gentamycin should have what monitored? a. BUN b. Na c. Alkaline Phosphatase d. WBC

a. BUN

Triple Lumen indwelling urinary catheter for cont. bladder irrigation following prostate resection. In addition to balloon inflation, function of the three lumens include: a. Continuous inflow and outflow of irrigation solution b. Intermittent inflow and continuous outflow of irrigation solution c. Continuous inflow and intermittent outflow of irrigation solution

a. Continuous inflow and outflow of irrigation solution

What is the most common renal calculi formation site? a. Kidney b. Ureter c. Bladder d. Urethra

a. Kidney

Acute glomerular-nephritis signs include: a. Periorbital edema b. Green-tinged urine c. Moderate to severe hypotension d. Polyuria

a. Periorbital edema

Elderly male client cannot pass urine. Bladder scan shows 600mL urine in bladder, cannot place catheter bc of resistance. A PSA test reveals 29g/L. Physician places catheter. Urine positive for nitrites, leukocytes, bacteriuria. What would nurse suspect? Select all that apply a. Prostate problems? b. UTI c. Acute renal failure d. Vit. K deficiency e. Liver Failure

a. Prostate problems? b. UTI

What is the most common prostate removal procedure? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of prostate

a. Transurethral resection of the prostate (TURP)

Client w/ chronic renal failure has hypocalcemia and hyperphosphatemia. When assessing the client nurse should be alert for what signs/ symptoms? Select all that apply: a. Trousseau's b. Arrhythmias c. Constipation d. Decreased clotting time e. Drowsiness and lethargy f. Fractures

a. Trousseau's b. Arrhythmias f. Fractures

kidney cancer

adenocarcinoma- aggressive asymptomatic until advanced vaccination to stimulate immune response renal artery may be occluded. post infarction syndrome

Nurse inserting catheter into a client who is nervous. She asks the client to: a. Initiate stream of urine b. Breathe deeply c. Turn to the side d. Hold the labia or shaft of the penis

b. Breathe deeply

Client has infection, SOB, fever, bilateral crackles, JVD, along with RBC, WBC, Protein in the urine. Dx: glomerulonephritis. Admitted to med-surge, what should nurse do? a. Place client on bed-rest b. High-protein, fluid-monitored diet c. Prepare to assist with insertion of Tenckhoff catheter for hemodialysis d. Place client on a sheepskin, and monitor for increasing edema

b. High-protein, fluid-monitored diet

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Increased serum calcium levels c) Elevated urine amylase levels d) Decreased liver enzyme levels

c) Elevated urine amylase levels Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

Therapeutic action of loop diuretics? a. Block reabsorption of potassium on collecting tubule b. Promote sodium secretion into distal tubule c. Block sodium reabsorption in ascending loop and dilate renal vessels

c. Block sodium reabsorption in ascending loop and dilate renal vessels

Client recovering from renal angiography in which a femoral puncture was used. When providing post-procedural care, nurse should: a. Keep client's knee on affected side bent 6 hours b. Apply pressure to puncture site 30 minutes c. Check pedal pulses frequently d. Remove dressing on site after VS stabilize

c. Check pedal pulses frequently

Client with decreased renal function needs antibiotic dose change. What lab value is that based on? a. GI absorption rate? b. Therapeutic index? c. Creatinine clearance d. Liver function studies

c. Creatinine clearance

Treat a UTI, client is ordered Bactrim. Most likely side effect is: a. Anxiety b. Headache c. Diarrhea d. Dizziness

c. Diarrhea

Client with chronic renal failure should be taught: a. Eat meat at every meal b. Eat plenty of bananas c. Increase your carbs. d. Drink plenty of fluids, use a salt substitute

c. Increase your carbs.

Client 3 days post-op for an ileo conduit. Nurse looks at stoma site decides to consult with ostomy nurse. Which finding indicates need for further consultation? a. Beefy red stoma site? b. Stoma site not sensitive to touch c. Red, sensitive skin around stoma site d. Clear mucous mixed with yellow urine drained from appliance bag

c. Red, sensitive skin around stoma site

urinary diverson keep urine below 6.5 ascorbic acid aspirin irritate stoma

cutaneous- stoma loop through abd continent- pouch and cath after 10-12 days remove stent risk- leak, peritonitis, ulcer, necrosis, prolapse, retraction don't limit fluids, can hook up to bedside drainage vinegar and warm water to heal

Pt. with UTI is put on Bactrim. Which added med is she given for pain? a. Nitrofurantoin b. Motrin c. Acetaminophen with codeine d. Pyridium

d. Pyridium

For a client who must undergo colon surgery, the physician orders preoperative cleansing enemas and neomycin sulfate (Mycifradin). The rationale for neomycin use in this client is to:

decrease the intestinal bacteria count.

The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin holes in the drainage bag to help relieve gas. The nurse should teach him that this action:

destroys the odor-proof seal.

colon cancer

fecal occult blood low HH, CEA, endoscopy, biopsy resect, chemo shrink then remove change in bowel pattern, blood in stool (melena), cramps, tenesmus (pain), distention, weak, fatigue, weight loss right side= pain and black stool left= obstruction, cramp, narrow stool with stoma high calorie, high protein, high carb, low residue full or clear liquid 24-48 hr diarrhea from fruit, fiber, soda, coffee, atropine, diphenoxlate descending = formed and less irritating

bladder cancer

genetic alteration n suppressor cells ciggs, exposure to toxins, recurrent UTI, stones, other cancer painless hematuria, dysuria (hard time), frequent pee, pain cystoscopy, UA pos for CA cells radiation, chemo, BCG (live TB) resect 50% change grows back radical cystectome=remove bladder and surrounding organs and create urinary diversion

polycystic kidney PKD

genetic, autosomal dominant (1 parent) genetic counseling abd or flank pain, hematuria, nocturia, renal US

diabetic nephropathy

hyperglycemia affect filtration protein leak in urine mon bun creatinine and glucose ACE and Arbs can delay progression avoid nephrotoxic, antibiotic, contrast medium, low na and low protein

assess GU lying supine

look at skin, scars, stretch marks, listen all four Q, light to deep palpation fat in stool steatoria borborugmus loud bowel sounds tenesmus = painful BM cdiff normal unless too much no barium if perf suspected endoscopy visualize rectum and sigmoid CBC- bleeding infection LYTES - small intestinal absorption CEA cancer CA 19-9 pancreatic cancer alkalosis vomiting acisosis ass in diarrhea avoid caffeine, veg and fruit pepto=black poop. usually iso or hypertonic

pyelonephritis

may have referred thigh pain. hematuria more in females. elderly confusion and children high fever. bacteria fever, chills. N/V, flank pain, headache, hematuria, malaise, lower uti pain meds, warm compress, diversion fluid- attn. to heart problems. flush as tolerated. probiotics with antibiotics

impeding GU flow

mechanical- intussusception, tumor, stenosis, adhesion, hernia, absess, volvulus, impaction, IBD functional- lack propulsion. amyloidosis, muscular dystrophy, DM, surgery small bowel =colicky pain- dehydration large=fecal vomiting cramping- may be undramatic if blood to colon not disrupted, dehydration more slow. constipation may be only sign for months above=high pitched sound below=none labs show dehydration, ng tube for decompression, NPO sit up, measure around belly button, manage pain, look for peritonitis (infection in peritoneal sac fever, inc WBC, inflamed =, rigid abd)

A client with amebiasis, an intestinal infection, is prescribed metronidazole (Flagyl). When teaching the client about adverse reactions to this drug, the nurse should mention:

metallic taste.

hydronephrosis

pain mgt, distended renal pelvis, treat cause nephrostomy to drain fluiss, stent from stones, tumor, polycystic, preggo flank pain, dec output water in kidney, obstruction, spasm, swelling, retention, scaring

renal assessment

personal and family HX genetics age (decreased thirst, mobility issues, renal disease, HF, BPH, dec filtration, Strep, impetigo) common S&S pain is biggest concern )Tylenol then Nsaid then opiod, voiding changes (oliguria, polyuria, hematuria) GI (N&V), unexplained anemia, fatigue anorexia. nutrition intake weight gain 1kg, 1l, 2.2lb sexual uti needs met? coping?

diverticulitis

sacs can accumulate food, bacteria in mucosa and sub mucosa- untreated- rupture, peritonitis, sepsis low fever, anorexia weight loss, weak, fatigue, constipation, some diarrhea, LLQ pain clear when progressing to high fiber and low fat antibiotic 7-10day bulk forming laxatives npo q8 after surgery, move, maintain fluids, intro food slow complications- bleeding (tachy, BP, HH) peritonitis - rigid ab abcess, obstruction, perf hartmans surgery antispasmodic= propantheline bromide and oxyphencyclamine bulk spyllum

nephrolithiasis/ urolithiasis (bladder)

stones calcium (oxalate - peanuts spinach, beeets, choc, sweet potato Calcium phosphate)- decrease sodium *** bc inc calcium, antacids, tumors, cancer, hyperparathyroid struvite- ammonia, protease, neurogenic bladder cysteine- inherited defect, low potein uric acid (gout or myoproliferative disease) pain, hematuria, cool moist skin, avoid shellfish/purines strain urine to collect avoid protein, limit salt, increase water opiod to prevent shock from pain nsaid to help stone pass, prostaglandin e reduce swell

glomerulonephritis- coke urine, autoimmune

strep, impetigo, body attacking glomeruli, hep b, hiv proteinuria, hematuria, axotemia(nitrogen), decreased GFR and NA, edema, HTN hyponatremia avoid hypotonic increased potassium - heart problem bolus fluis, restrict K, kexolate, k binding resin inc mag- whats the cause? antacids restrict protein, increase carb. add CA, Vit D, Fish oil *monitor BP monitor lytes corticosteroids- immune response plasmophoresis- stop antigen antibody response gravity 1.01 protein urine, metabolic acidosis, kidney not making bicarb increased serum phosphate decreased ca bc bind to phos to compensate protein

ulcerative colitis begin colon rectum

superficial not through wall no fistulas, colon, bleeding common and severe, more in jewish exacerbations and remission LLQ pain pallor, anemia oral, conjunctivitis, skin discolor, stones, thrombocytopenia, anemia, evaluate malnutrition diarrhea, mucous, pus 10-20 stool/day assess tachy, fever, pallor, HH, low albumin, neutrophils, lytes, megacolon, perf, bleeding

chrons GI

transmural inflammation usually ileum and colon fistula, fissure, absess ulcers, bowel wall thicken, lumen narrow, cobblestone string sign with barium prolonged course RLQ pain diarrhea, pain, steatorrhea (fatty poop) anorexia, weight loss, poor nutrition joint disorders, arthritis, lesion, eye issues

Choice Multiple question - Select all answer choices that apply. An examiner is performing the physical assessment of the rectum, perianal region, and anus. While this examination can be uncomfortable for many clients, health care providers must approach it in a prepared, confident manner. Which of the following considerations will help this examination flow smoothly and efficiently for both provider and client? Select all that apply. a) Position the client on the right side with the knees up to the chest. b) Dim the lights to decrease the client's embarrassment. c) Cleanse gloved fingers with water to allow for easy insertion. d) Ask the client to produce a bowel movement after the procedure. e) Ask the client to bear down for visual inspection.

• Position the client on the right side with the knees up to the chest. • Ask the client to bear down for visual inspection. Explanation: While examination of the rectum, perineum, and anus may be uncomfortable for the client, it is necessary for a thorough examination. The examiner will position the client on the right side with the knees up. He or she will use a gloved finger lubricated with a water-soluble lubricant for ease of insertion. The health care provider will encourage deep breathing during the procedure and ask the client to bear down while inspecting the anal area. The examination requires appropriate lighting for thorough inspection.