GI prepU
A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action? A. Contact the health care provider B. Auscultate the bowel sounds C. Ask the client the last bowel movement date D. Prepare to insert a nasogastric tube to intermittent suction
A. Contact the health care provider
A client comes to the clinic reporting pain in the epigastric region. What statement by the client suggests the presence of a duodenal ulcer? A. "My pain resolves when I have something to eat." B. "The pain really interferes with my quality of life." C. "I know that my father and my grandfather both had ulcers." D. "I seem to have bowel movements more often than I usually do."
A. "My pain resolves when I have something to eat."
Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? A. 0.9% NS B. D5W C. D10W D. 0.45% of NS
A. 0.9% NS
A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply. A. Encourage bed rest to decrease the client's metabolic rate. B. Teach the client about the correlation between alcohol intake and pain. C. Allow the client to have sips of clear liquids. D. Withhold oral feedings to limit the release of secretin.
A. Encourage bed rest to decrease the client's metabolic rate. B. Teach the client about the correlation between alcohol intake and pain. D. Withhold oral feedings to limit the release of secretin.
A 35-year-old male client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary provider, what intervention should the nurse prioritize? A. Insertion of a nasogastric tube B. Insertion of a central venous catheter C. Administration of a mineral oil enema D. Administration of a glycerin suppository and an oral laxative
A. Insertion of a nasogastric tube
A nurse is preparing to provide care for a client whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the client's stools will have what characteristics? A. Watery with blood and mucus B. Hard and black or tarry C. Dry and streaked with blood D. Loose with visible fatty streaks
A. Watery with blood and mucus
What symptoms of perforation might the nurse observe in a client with an intestinal obstruction? Select all that apply. A. sudden, sustained abdominal pain B. abdominal distention C. sudden drop in body temperature D. intermittent, severe pain
A. sudden, sustained abdominal pain B. abdominal distention
A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement? A. "I should feel better in about 24 to 36 hours." B. "My appetite should come back tomorrow." C. "I should limit alcohol intake, at least until symptoms subside." D. "Once I can eat again, I should stick with bland foods."
B. "My appetite should come back tomorrow."
A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis? A. "I think the soda that I drank irritated my stomach." B. "The pain stopped so I stopped taking the medications." C. "I felt better but then just got really nauseated and threw up." D. "I only ate dinner yesterday and it gave me an upset stomach."
B. "The pain stopped so I stopped taking the medications."
A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain? A. Aspirin every 4 to 6 hours as prescribed B. Application of heat 15 to 20 minutes each hour C. Application of an ice pack for no more than 15 minutes D. Application of liniment rub to affected area
B. Application of heat 15 to 20 minutes each hour
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. A. Altered nutrition, more than body requirements, related to decreased activity and bed rest B. Risk for injury related to altered clotting mechanisms C. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort D. Urinary incontinence related to general debility and muscle wasting E. Disturbed body image related to changes in appearance, sexual dysfunction, and role function
B. Risk for injury related to altered clotting mechanisms C. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort E. Disturbed body image related to changes in appearance, sexual dysfunction, and role function
A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms? A. A pattern of distinct exacerbations and remissions B. Severe diarrhea C. An absence of blood in stool D. Involvement of the rectal mucosa
C. An absence of blood in stool
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Upper GI series B. Endoscopy C. Hemoglobin and hematocrit D. Arteriography
C. Hemoglobin and hematocrit
A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate? A. Reassure the client that the procedure is relatively low risk and that clients are usually successful in adjusting to an ostomy. B. Provide the client with educational materials that match the client's learning style. C. Encourage the client to write down these concerns and questions to bring forward to the surgeon. D. Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.
D. Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.
A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes? A. Preventing infection B. Maintaining skin and tissue integrity C. Preventing nausea and vomiting D. Maintaining fluid and electrolyte balance
D. Maintaining fluid and electrolyte balance
A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the client's most recent laboratory tests, the nurse should prioritize what finding? A. White blood cell level B. Creatinine level C. Hemoglobin level D. Potassium level
D. Potassium level
A client's large bowel obstruction has failed to resolve spontaneously and the client's worsening condition has warranted admission to the medical unit. Which of the following aspect of nursing care is most appropriate for this client? A. Administering bowel stimulants as prescribed B. Administering bulk-forming laxatives as prescribed C. Performing deep palpation as prescribed to promote peristalsis D. Preparing the client for surgical bowel resection
D. Preparing the client for surgical bowel resection
A client with acute pancreatitis is prescribed hydromorphone 2 mg intravenously every 4 hours as needed for severe pain. Which assessment will the nurse prioritize for this client? A. Heart sounds B. Bowel sounds C. Bleeding tendency D. Development of nausea
B. Bowel sounds
A client recovering from a cholecystectomy has decreased breath sounds bilaterally in the lower lobes. Which action(s) will the nurse take to improve the client's respiratory function? Select all that apply. A. Splint the affected area. B. Raise the head of the bed. C. Assist to ambulate as prescribed. D. Deep breathe and cough every hour. E. Use the incentive spirometer as instructed.
A. Splint the affected area. B. Raise the head of the bed. C. Assist to ambulate as prescribed. D. Deep breathe and cough every hour. E. Use the incentive spirometer as instructed.
A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client's coping after discharge? A. The family's ability to take care of the client's special diet needs B. The family's ability to monitor the client's changing health status C. The family's ability to provide emotional support D. The family's ability to manage the client's medication regimen
C. The family's ability to provide emotional support
The nurse is caring for a client who has a nasogastric tube that has been in place for 2 days. Before administering a scheduled feeding, the nurse should: A. ensure that the client has recently voided. B. administer 30 to 45 mL of water to confirm placement. C. position the client upright. D. perform a focused gastrointestinal assessment.
C. position the client upright.
A client with severe abdominal pain and an abnormal computed tomography (CT) scan, which shows an enlarged pancreas, has been admitted to a medical unit today. The nurse anticipates including which actions in the client's plan of care? Select all that apply. A. Use a pain scale throughout treatment. B. Provide oral hygiene and gargling solutions. C. Administer pain relief measures. D. Assess current nutrtional status. E. Encourage ambulation as tolerated. F. Maintain nothing by mouth (NPO) diet.
A. Use a pain scale throughout treatment. C. Administer pain relief measures. F. Maintain nothing by mouth (NPO) diet.
The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? A. Maintaining skin integrity B. Beginning a bowel program to establish continence C. Instituting a diet high in fiber and increase fluid intake D. Determining the need for surgical intervention to correct the problem
A. Maintaining skin integrity
Which of the following is considered a bulk-forming laxative? A. Metamucil B. Milk of Magnesia C. Mineral oil D. Dulcolax
A. Metamucil
The nurse is caring for a client with symptoms of gallbladder disease. Which diagnostic test will the nurse anticipate preparing the client for to confirm the diagnosis? A. Ultrasound B. Abdominal x-ray C. Cholescintigraphy D. Oral cholecystography
A. Ultrasound
The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem? A. Restrict dietary protein intake. B. Arrange for a low air loss bed. C. Perform passive range-of-motion exercises four times a day. D. Reposition the client every 4 hours.
B. Arrange for a low air loss bed.
A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's plan of care? A. Measurement of abdominal girth and body weight B. Assessment for variceal bleeding C. Assessment for signs and symptoms of jaundice D. Monitoring of results of liver function testing
B. Assessment for variceal bleeding
A client presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate which area? A. Between the umbilicus and the left iliac crest B. Between the umbilicus and the anterior superior iliac spine C. In the left periumbilical area D. In the upper right quadrant slightly below the diaphragm
B. Between the umbilicus and the anterior superior iliac spine
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) A. Encouraging bed rest to decrease the metabolic rate B. Assisting the patient into the prone position C. Withholding oral feedings to limit the release of secretin D. Administering parenteral opioid analgesics as ordered E. Administering prophylactic antibiotics
A. Encouraging bed rest to decrease the metabolic rate C. Withholding oral feedings to limit the release of secretin D. Administering parenteral opioid analgesics as ordered
Diagnostic imaging and physical assessment have revealed that a client with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? A. Peritonitis B. Gastritis C. Gastroesophageal reflux D. Acute pancreatitis
A. Peritonitis
Which term refers to the symptom of gastroesophageal reflux disease (GERD), which is characterized by a burning sensation in the esophagus? A. Pyrosis B. Dyspepsia C. Dysphagia D. Odynophagia
A. Pyrosis
A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________. A. Rovsing's sign; acute appendicitis B. McBurney's sign; acute appendicitis C. Rovsing's sign; perforation D. McBurney's sign; perforation
A. Rovsing's sign; acute appendicitis
The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. A. Alterations in mood B. Agitation C. Decreased deep tendon reflexes D. Report of headache E. Insomnia
A. Alterations in mood B. Agitation E. Insomnia
A client recovers from an episode of gallbladder inflammation and the client's diet is advanced from a low-fat liquid diet. Which meals will the nurse recommend to the client? Select all that apply. A. Roasted chicken, mashed potatoes, and green beans. B. Marinated lean steak, steamed rice, and roasted zucchini. C. Oatmeal with a cooked fruit compote and hot tea. D. Egg salad sandwich with low fat mayonnaise and a side salad with ranch dressing. E. Vegetable lasagna, bread sticks, and steamed broccoli.
A. Roasted chicken, mashed potatoes, and green beans. B. Marinated lean steak, steamed rice, and roasted zucchini. C. Oatmeal with a cooked fruit compote and hot tea.
A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. A. Tachycardia B. Hypotension C. Mild epigastric pain D. A rigid, board-like abdomen E. Diarrhea
A. Tachycardia B. Hypotension D. A rigid, board-like abdomen
Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. A. Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. B. Avoid beer, especially in the evening. C. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. D. Elevate the head of the bed on 6- to 8-inch blocks. E. Elevate the upper body on pillows.
B. Avoid beer, especially in the evening. D. Elevate the head of the bed on 6- to 8-inch blocks. E. Elevate the upper body on pillows.
A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.) A. Amber-colored urine B. Clay-colored feces C. Pruritus D. Jaundice E. Pain in the left upper abdominal quadrant
B. Clay-colored feces C. Pruritus D. Jaundice
A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply. A. Hypertension B. Diarrhea C. Decreased bowel sounds D. Tachycardia E. Diaphoresis
B. Diarrhea D. Tachycardia E. Diaphoresis
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: A. Serum calcium B. Serum lipase C. Serum bilirubin D. Serum amylase
B. Serum lipase
A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client's fluid volume excess? Select all that apply. A. Administering diuretics B. Administering calcium channel blockers C. Implementing fluid restrictions D. Implementing a 1500 kcal/day restriction E. Enhancing client positioning
A. Administering diuretics C. Implementing fluid restrictions E. Enhancing client positioning
A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments? A. Assessment of blood pressure and assessment for headaches and visual changes B. Assessments for signs and symptoms of venous thromboembolism C. Daily weights and abdominal girth measurement D. Blood glucose monitoring q4h
C. Daily weights and abdominal girth measurement
A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client states that she fell when transferring to the commode. The client's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action? A. Remove the client's commode and supply a bedpan. B. Complete an incident report and submit it to the unit supervisor. C. Have the client assessed by the primary provider due to the risk of internal bleeding. D. Perform a focused abdominal assessment in order to rule out injury.
C. Have the client assessed by the primary provider due to the risk of internal bleeding.
Which is a true statement regarding regional enteritis (Crohn's disease)? A. It has a progressive disease pattern. B. It is characterized by pain in the lower left abdominal quadrant. C. The clusters of ulcers take on a cobblestone appearance. D. The lesions are in continuous contact with one another.
C. The clusters of ulcers take on a cobblestone appearance.
