GI Questions, Key terms and Points

38. The nurse caring for a patient with Crohn disease will closely monitor the urinary output to ensure that the patient is excreting at least _______mL/day.

ANS: 1500 The output of 1500 mL a day indicates good kidney perfusion. The disease allows such dramatic fluid loss that a constant watch on I&O is a major nursing intervention. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-91 OBJ: 7 TOP: Crohn disease KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

36. Flexible sigmoidoscopy should be performed every ________ years.

ANS: 5 Flexible sigmoidoscopy should be performed every 5 years. Endoscopy of the lower GI tract allows visualization and, if indicated, access to obtain biopsy specimens of tumors, polyps, or ulcerations of the anus, rectum, and sigmoid colon. The lower GI tract is difficult to visualize radiographically, but sigmoidoscopy allows direct visualization. Topic: Screening for colorectal cancer Nursing Process Step: Planning Objective: 3 Cognitive Level: Knowledge NCLEX: Physiological Integrity Text Reference: Page 5-119 PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1448, Health Promotion OBJ: 3 TOP: Screening for colorectal cancer KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

50. Arrange the normal process of protein metabolism. (Separate letters by a comma and space as follows: A, B, C, D) a. Protein enters the blood stream b. Excreted by kidney c. Portal vein delivers blood to the liver d. Conversion to urea e. Ammonia produced in the bowel

ANS: A, E, C, D, B Protein products enter the blood stream and are changed in the bowel to ammonia; the products then pass through the portal vein to the liver where the ammonia is converted to urea, which is then excreted by the kidneys. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1465 OBJ: 2 TOP: Protein metabolism KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

41. The nurse uses a poster to show the process of bowel obstruction from diverticulitis. Arrange the pathophysiologic event in order. (Separate letters by a comma and space as follows: A, B, C, D) a. Increase in intra-abdominal pressure b. Weakened wall of sigmoid c. Pouch fills with fecal matter d. Pouch protrudes through smooth muscle e. Narrowing of bowel lumen f. Inflammation of diverticula

ANS: B, A, D, C, F, E Bowel obstruction from diverticulitis follows a sequential path: The wall of the bowel is weakened (usually the sigmoid), increase in abdominal pressure from such activities as bending and carrying heavy loads causes a pouch to protrude through the smooth muscle of the colon, the pouch fills with fecal matter, becomes inflamed, and narrows the lumen of the bowel causing obstruction. Topic: Bowel Obstruction Nursing Process Step: Planning Objective: 9 Cognitive Analysis NCLEX: Health Promotion and Maintenance Text Reference: Pages 5-97, 5-98 PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1440 OBJ: 9 TOP: Bowel Obstruction KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

39. The nurse takes into consideration that long-term use of antibiotics can cause an antibiotic-associated pseudomembranous colitis from the organism________.

ANS: C. difficile C. difficile causes a type of colitis from long-term antibiotic use to which older adults are extremely susceptible. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-65 OBJ: 4 TOP: C. difficile KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

46. The tumor marker that is elevated in patients with pancreatic cancer is______.

ANS: CA19-9 The tumor marker CA19-9 is elevated in the presence of pancreatic cancer. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1484 OBJ: 1 TOP: CA19-9 KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

49. The nurse clarifies that deterioration progresses through stages before presenting with liver disease. Place the stages in order. (Separate letters by a comma and space as follows: A, B, C, D) a. Liver disease b. Inflammation c. Hepatic insufficiency d. Destruction e. Fibrotic regeneration

ANS: D, B, E, C, A Liver deterioration follows a pattern of stages: destruction, inflammation, fibrotic regeneration; hepatic insufficiency then presents as liver disease. Topic: Liver destruction Nursing Process Step: Implementation PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1465 OBJ: 2 TOP: Liver destruction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

42. Celiac sprue in the adult can lead to systemic problems. Arrange the pathophysical events of this in order of their appearance. (Separate letters by a comma and space as follows: A, B, C, D) a. Malabsorption b. Weight loss/vitamin deficiency c. Systemic involvement d. Diarrhea e. Ingestion of gluten f. Destruction of villi in the small intestine

ANS: E, F, A, D, B, C The ingestion of gluten in the small intestine damages the villi, which leads to malabsorption and diarrhea. Weight loss and vitamin deficiency, which occur from altered nutrition, can expand into systemic involvement. Topic: Celiac sprue Nursing Process Step: Planning Objective: 4 Cognitive Analysis NCLEX: Physiological Integrity Text Reference: Pages 5-70, 5-71 PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1430 OBJ: 4 TOP: Celiac sprue KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

44. ___________ is a condition characterized by yellowing of the sclera and the skin.

ANS: Jaundice Jaundice is the discoloration of body tissues caused by abnormally high blood levels of bilirubin. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1466 OBJ: 4 TOP: Jaundice KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

40. Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident for ulceration of the anus, called __________________.

ANS: anal fissure Ulceration and laceration of the anal skin can occur because of overstretching with the passing of constipated stool. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-131 OBJ: N/A TOP: Anal fissure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

47. Hepatitis D is usually seen as a co-infection with __________.

ANS: hepatitis B Hepatitis D is usually seen as a coinfection with hepatitis B. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1473, Box 54-1 OBJ: 6 TOP: Hepatitis KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

45. The disease that is on the increase because of the growing obesity population and is associated with coronary artery disease and use of corticosteroids is_______________.

ANS: nonalcoholic fatty liver disease (NAFLD) nonalcoholic fatty liver disease NAFLD NAFLD is a disease that is on the rise due to the increasing population of obese persons. The disease is also associated with CAD and the use of corticosteroids. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1465 OBJ: 2 TOP: NAFLD KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

48. A ___________occurs when the body encapsulates the autodigestive debris in the pancreatic tissue, frequently becoming an abscess.

ANS: pseudocyst A pseudocyst occurs when the body encapsulates the autodigestive debris in the pancreatic tissue. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1482 OBJ: 2 TOP: Pseudocyst KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

25. The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (.02 mL/kg) be? a. 0.9 mL b. 1.4 mL c. 1.6 mL d. 1.8 mL

ANS: A 100 lb/2.2 = 45.4. 45.4 × 0.02 = 0.90 PTS: 1 DIF: Cognitive Level: Application REF: Page 1473 OBJ: 2 TOP: Immune serum globulin KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

20. The nurse points out which of the following as an example of a nonmechanical bowel obstruction? a. A paralytic ileus b. Narrowed bowel lumen from an inflammatory process c. Tumor of the bowel d. Fecal impaction

ANS: A A nonmechanical bowel obstruction can be caused by a paralytic ileus. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-111 OBJ: 4 TOP: Cancer KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

9. Which patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography? a. "Right after the test, I want breakfast with black coffee." b. "The instrument will be put down my throat." c. "I haven't had anything to eat or drink since 9 PM last night." d. "My doctor said I could have medicine to relax me before the test."

ANS: A After the procedure, keep the patient NPO until the gag reflex returns. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1464 OBJ: 1 TOP: Diagnostic procedures KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

24. The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as _____ after the onset of pancreatic disease. a. 2 hours b. 8 hours c. 24 hours d. 36 hours

ANS: A An increase in the serum amylase can be detected as early as 2 hours after the onset of pancreatic disease. In simple acute pancreatitis, the level returns to normal in about 36 hours. In chronic disease it remains elevated. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1462 OBJ: 1 TOP: Serum amylase KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

28. Which of the following is the purpose of antibiotic therapy in treating peptic ulcers? a. It eradicates H. pylori b. It inhibits gastric acid secretion c. It protects the gastric mucosa d. It neutralizes or reduces the acidity of stomach contents

ANS: A Antibiotic therapy eradicates H. pylori. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-49, 5-50 OBJ: 4 TOP: Peptic ulcers KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

24. Which of the following would be the most helpful nursing intervention to increase the comfort of a patient with appendicitis? a. Application of ice bag b. Administration of small tap water enema c. Warm compress over entire abdomen d. Ambulate for short periods in the room

ANS: A Application of an ice bag will decrease the flow of blood to the area and impede the inflammatory process. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-95 OBJ: 9 TOP: Appendicitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

22. The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate (Pepto-Bismol) to combat H. pylori. What color will this drug turn the stool? a. Gray-black b. Dark green c. Red-orange d. Yellow

ANS: A Bismuth products turn the stool gray-black. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-49, Table 5-1 OBJ: 4 TOP: Shock KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

13. The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of: a. esophageal varices. b. diverticulosis. c. Crohn disease. d. esophageal reflux (GERD).

ANS: A Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1467 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

19. What should the nurse avoid contamination from to prevent the transmission of hepatitis A? a. Food or water b. Blood transfusion c. Needles d. Sexual contact

ANS: A Hepatitis A virus is transmitted when a person puts something in his or her mouth that is contaminated with fecal material (called fecal-oral transmission). Teach patients the importance of good handwashing after the bathroom or changing a diaper, as well as proper food preparation, to prevent the spread of HAV. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1472, Box 54-1 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

27. The nurse takes into consideration that a proton pump inhibitor drug, such as ______________, will completely eradicate gastric acid production. a. omeprazole (Prilosec) b. ranitidine (Zantac) c. sucralfate (Carafate) d. olsalazine (Dipentum)

ANS: A Omeprazole (Prilosec) is a proton pump inhibitor that interferes with the production of gastric acid. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5- 32 OBJ: 4 TOP: Disorders of the stomach KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

1. A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient? a. Prokinetic drugs, such as metoclopramide (Reglan) b. Serotonin blockers, such as ondansetron (Zofran) c. Anticholinergic drugs, such as scopolamine (Scopace) d. Neuroleptic drugs, such as chlorpromazine (Thorazine)

ANS: A Prokinetic drugs promote the movement of substances through the gastrointestinal tract and increase gastrointestinal motility. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 850 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

20. What is the most appropriate method used by high-risk health workers to prevent hepatitis B? a. Hepatitis B vaccine b. Diligent handwashing c. Wearing protective gear d. Hb immune globulin injections

ANS: A The best preventative measure against the contraction of hepatitis B is HBV vaccine. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1472, Safety OBJ: 5 TOP: Hepatitis B KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

15. A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse recognizes these as indicators of which type of hernia? a. Strangulated b. Hiatal c. Ventral d. Umbilical

ANS: A The hernia is strangulated when the blood supply and intestinal flow are occluded, which results in pain and distention. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-105 OBJ: 10 TOP: Inguinal hernia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

29. What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy? a. High placement of incision b. Excessive nausea c. Weakened abdominal muscles d. Poor oxygenation

ANS: A The high placement of the incision of the cholecystectomy makes the patient reluctant to cough. Splinting the incision is beneficial. PTS: 1 DIF: Cognitive Level: Application REF: Page 1480 OBJ: 2 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

16. A patient with a ruptured diverticulum in the descending colon has undergone a transverse loop colostomy. The patient is upset and says, "I didn't know it was going to be this awful. I hate this!" Which response made by the nurse would be most helpful? a. "This is a temporary solution. It will be closed in 6 weeks." b. "This seems awful now, but you won't have the problems you had before." c. "If everything goes well the surgeon can close this colostomy in about a year." d. "With the appropriate pouch and loose clothing, no one will notice a thing."

ANS: A The loop colostomy is a temporary colostomy that allows for complete bowel rest. It can be closed in as short a time as 6 weeks. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-100 OBJ: 8 TOP: Diverticulum KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

16. What is the most common procedure for the removal of the gallbladder? a. Laparoscopic cholecystectomy b. Cholangiography c. Open cholecystectomy d. Choledochostomy

ANS: A The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1479 OBJ: 8 TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

26. A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet? a. "The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system." b. "The liver heals better with a high-carbohydrate diet rather than with a diet high in protein." c. "Most people have too much protein in their diets. The amount in this diet is better for liver healing." d. "Because of portal hypertension, the blood flows around the liver, and ammonia made from protein collects in the brain, causing hallucinations."

ANS: A The patient with hepatic encephalopathy is on a very low-protein to no-protein diet. The goal of management of hepatic encephalopathy is the reduction of ammonia formation in the intestines. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1461 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

4. The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that the family provide: a. a tablet and pencil as a communication aid. b. a TV for diversion. c. a bell to summon help. d. a walkie-talkie.

ANS: A The provision of an alternative method of communicating will lessen the frustration of the patient who has trouble speaking understandably. The call bell would be helpful also, but without a way to communicate, the bell is not as essential as a method of communication. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-28 OBJ: 5 TOP: Cancer of esophagus KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

8. The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the most appropriate suggestion to lessen these symptoms? a. Eat a diet high in fiber content b. Increase dietary fat intake c. Exercise to increase intra-abdominal pressure d. Take daily laxatives

ANS: A The symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet, reduction of meat and fats in the diet, and avoiding activities that increase intra-abdominal pressure. Although laxatives might be prescribed sparingly, daily laxatives are not recommended. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-99 OBJ: 9 TOP: Diverticulitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

14. The nurse explains to the patient with Crohn disease that the tube feedings allow for: a. Rapid absorption in the upper GI tract b. Decompression of the stomach c. Reduction of diarrheic episodes d. A permanent nutritional support

ANS: A The tube feedings allow for rapid absorption of the nutrients in the upper GI tract. The tube feedings are not permanent and will be followed by oral intake of a low-residue, high-protein, high-calorie diet. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-91 OBJ: 7 TOP: Crohn disease KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

4. A patient who has severe nausea and vomiting following a case of food poisoning comes to the urgent care center. When reviewing his medication history, the nurse notes that he has an allergy to procaine. The nurse would question an order for which antiemetic drug if ordered for this patient? a. metoclopramide (Reglan) b. promethazine (Phenergan) c. phosphorated carbohydrate solution (Emetrol) d. palonosetron (Aloxi)

ANS: A The use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 850 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

17. A male patient complains that he will never adjust to his colostomy. Which is the best action for the nurse in this situation? a. Encourage him to express his concern b. Suggest that he discuss his concerns with his physician c. Counsel him that everything will be all right d. Assure him that his concerns will diminish when he is able to care for his colostomy

ANS: A When a colostomy is performed, the patient or significant other should be able to verbalize and demonstrate understanding of ostomy care to the nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-137 OBJ: 8 TOP: Colostomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

38. What are the indications for a liver transplant? (Select all that apply.) a. Congenital biliary abnormalities b. Hepatic malignancy c. Chronic hepatitis d. Cirrhosis due to alcoholism e. Gallbladder disease

ANS: A, B, C Indications for liver transplantation include congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy (confined to the liver), sclerosing cholangitis, and chronic end-stage liver disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1474 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

34. Which activities should the home health nurse suggest to an elderly patient to avoid constipation? (Select all that apply.) a. Increasing physical activity b. Taking bulk-forming laxatives c. Increasing fiber intake d. Drinking at least 1000 mL fluid e. Taking a daily stool softener f. Using tap water enemas for persons with altered mobility

ANS: A, B, C, D Inactivity and changes in diet and fluid intake can contribute to constipation. A nutritional diet high in fiber and bulk-forming foods can promote normal elimination. Increasing fluids to 8 to 10 glasses per day will be beneficial in preventing constipation. A daily bowel routine will also benefit elimination. Use of daily stool softeners is no longer recommended for the older adult. Tap water enemas for persons with altered mobility are is helpful. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5- 129 OBJ: 4 TOP: Disorders of intestine KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

33. In designing a teaching plan to present to a group of older adults regarding the prevention of esophageal cancer, the nurse would include information about the significance of (select all that apply): a. cessation of smoking. b. good oral care. c. regular checkups if dysphagia is present. d. reducing excessive weight. e. limiting alcohol consumption. f. reduction of consumption of citrus fruits.

ANS: A, B, C, E Preventative measures include cessation of smoking and alcohol consumption, good oral care, and medical evaluation of dysphagia. Weight and reduction of citrus fruits are non-contributory to prevention of esophageal cancer. PTS: 1 DIF: Cognitive Level: Application REF: Pages 5-24, 5-25 OBJ: 6 TOP: Esophageal cancer KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

41. Viral hepatitis may be treated at home. What should be taught to the patient's family? (Select all that apply.) a. Clothes should be laundered separately with hot water. b. Personal items and drinking glasses should not be shared. c. Articles soiled with feces do not require extra care. d. Hands need to be thoroughly washed after toileting. e. Contaminated items may be disposed of with regular trash.

ANS: A, B, D For the patient with viral hepatitis being cared for in the home, the family needs to be taught necessary precautions. Clothes should be laundered separately with hot water. Personal items used by the patient should not be shared. Articles soiled with feces must be disinfected. Any contaminated items should be disposed of properly. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1473 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

35. The home health nurse is caring for a patient who has frequent abdominal pain and diarrhea. The nurse uses the Rome Criteria to direct assessment for irritable bowel syndrome. What is included in the Rome Criteria? (Select all that apply.) a. Discomfort at least 3 days a month b. Blood in stool c. Pain relieved by defecation d. Excessive flatulence e. Nausea and vomiting associated with onset f. Onset associated with change in stool consistency or frequency

ANS: A, C, F The Rome Criteria include that the patient experience discomfort at least 3 days a month within the last 3 months, pain relieved by defecation, onset associated with change in stool frequency, and onset in association with a change in stool appearance. Although increased flatus is associated with diverticulitis, it is not part of the Rome Criteria. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-74 OBJ: 5 TOP: Rome Criteria KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

40. Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.) a. Peanut butter b. Grilled chicken c. Rice and pasta d. Bananas, apples, oranges e. Whole milk f. Glazed chocolate doughnuts

ANS: A, E, F Peanut butter, nuts, chocolate, whole milk, fried foods, and cream and other fatty foods should be avoided. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1481 OBJ: 2 TOP: Cholecystitis and cholelithiasis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

31. Which factors are most commonly associated with pancreatitis? a. Coronary artery disease b. Alcoholism and biliary tract disease c. Cirrhosis d. History of myocardial infarction

ANS: B Alcoholism and biliary tract disease are the two factors most commonly associated with pancreatitis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1482 OBJ: 2 TOP: Pancreatitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this? a. As an attempt to get the nurse's attention b. As asterixis c. As an indication of respiratory obstruction from varices d. As spasticity

ANS: B Asterixis is the "flapping tremor" seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1469 OBJ: 3 TOP: Encephalopathy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

21. Bowel sound assessment on a patient with an obstruction who has distention, nausea, and visible peristaltic waves would be: a. loud and clearly audible. b. high pitched. c. hyperactive. d. absent.

ANS: B Because there are visible peristaltic waves, there will be bowel sounds that will be faint and high pitched. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-113 OBJ: 11 TOP: Bowel obstruction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. A patient on chemotherapy is using ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug? a. Dizziness b. Diarrhea c. Dry mouth d. Blurred vision

ANS: B Diarrhea is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 847 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite? a. metoclopramide (Reglan), a prokinetic drug b. dronabinol (Marinol), a tetrahydrocannabinoid c. ondansetron (Zofran), a serotonin blocker d. aprepitant (Emend), a substance P/NK1 receptor antagonist

ANS: B Dronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 851 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug? a. The patient may skip doses if the patient is feeling well. b. The patient will need to avoid driving because of possible drowsiness. c. The patient may experience occasional problems with taste. d. It is safe to take the medication with a glass of wine in the evening to help settle the stomach.

ANS: B Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs must not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped unless instructed to do so. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 854 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

32. A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response? a. "Diagnostic tests depend on you not eating anything." b. "The pancreas is stimulated whenever you eat or drink, and causes pain." c. "Eating causes the need for a bowel movement, which excretes your medication too rapidly." d. "Resting your GI tract will cure your pancreatitis."

ANS: B Food and fluids are withheld to avoid stimulating pancreatic activity, and IV fluids are administered. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1482 OBJ: 2 TOP: Pancreatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

22. A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A? a. Exposure to blood b. Recent ingestion of raw fish c. History of intravenous drug use d. Multiple sex partners

ANS: B Hepatitis A spreads by direct contact through the oral-fecal route, usually by food and water contaminated with feces. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1472, Box 54-1 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

18. In caring for a patient with gastric bleeding who has a nasogastric tube in place, the nurse should include in the plan of care to ensure that the NG tube is: a. Clamped for 10 minutes every hour b. Kept patent with irrigation c. Frequently repositioned to the opposite nostril d. Changed every 72 hours

ANS: B Irrigating the NG tube PRN will keep the tube patent and ensure effective decompression. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-52, Nursing care plan 5-1 OBJ: 4 TOP: NG tube KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

7. The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental: a. protein due to the loss of some of the digestive processes. b. vitamin B12 due to the loss of the intrinsic factor. c. bulk to prevent constipation. d. vitamin A due to the loss of the gastric lining.

ANS: B It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-61 OBJ: 6 TOP: Gastrectomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

23. When caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for in the plan of care? a. Encouraging consumption of a high-fat diet b. Skin care to relieve pruritus c. Offering foods rich in fat-soluble vitamins d. Meticulous foot care

ANS: B Jaundice causes pruritus and can lead to skin lesions and pressure ulcers. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1469 OBJ: 1 TOP: Cirrhosis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

7. Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy? a. Assisting to ambulate for the bathroom b. Keeping the patient on the right side for a minimum of 2 hours c. Taking vital signs every 4 hours d. Keeping the patient on the left side for a minimum of 4 hours

ANS: B Keep the patient lying on the right side for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours. PTS: 1 DIF: Cognitive Level: Application REF: Page 1461 OBJ: 2 TOP: Liver biopsy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

2. The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit? a. Jaundice b. Edema c. Copious urine output d. Pallor

ANS: B Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1459 OBJ: 1 TOP: Cirrhosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

26. What is the most lethal complication of a peptic ulcer? a. Bleeding b. Perforation c. Severe pain d. Gastric outlet obstruction

ANS: B Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur when the ulcer erodes into a blood vessel; however, perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum. Gastric outlet obstruction can occur at any time and can be relieved by NG aspiration of stomach contents. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-47 OBJ: 4 TOP: Disorders of the stomach KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

8. Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect? a. Peritonitis b. Pneumothorax c. Hemorrhage of the liver d. Pleural effusion

ANS: B Pneumothorax is a possible complication of paracentesis. The patient's head of the bed should be raised slightly, but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1461 OBJ: 1 TOP: Pneumothorax KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

6. A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs has proven most effective in preventing nausea and vomiting for patients receiving chemotherapy? a. Prokinetic drugs, such as metoclopramide (Reglan) b. Serotonin blockers, such a ondansetron (Zofran) c. Anticholinergic drugs, such as scopolamine d. Neuroleptic drugs, such as promethazine (Phenergan)

ANS: B Serotonin blockers have proven to be very effective in preventing chemotherapy-induced and postoperative nausea and vomiting. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 850 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5. A mother calls the pediatrician's office to report that her 18-month-old child has eaten half of a bottle of baby aspirin. She says, "I have a bottle of syrup of ipecac. Should I give it to him? He seems fine right now. What do I do?" What is the nurse's best response? a. "Go ahead and give him the ipecac, and then call 911." b. "Don't give him the ipecac. Call the Poison Control number immediately for instructions." c. "Please come to the office right away so that we can check him." d. "Go ahead and take him to the emergency room right now."

ANS: B The American Academy of Pediatrics no longer recommends the use of syrup of ipecac for home treatment for poisoning. Instructions state that if the poison has been ingested, first call the national poison control hotline at 800-222-1222. In all cases of poisoning, if the victim is conscious and alert, call the local poison control center. If the victim has collapsed or stopped breathing, call 911 for emergency transport to a hospital. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 845 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse caring for a patient who has had an open cholecystectomy with a T-Tube will: a. open the T-tube to the air so that it will drain freely. b. position and secure the drainage bag at the chest level. c. Place the collection bag so the tube is not kinked. d. Irrigate the T-tube with normal saline to ensure the free flow of bile.

ANS: B The T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated. PTS: 1 DIF: Cognitive Level: Application REF: Page 1480 OBJ: 8 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

35. Which assessment would indicate possible gallbladder disease in an older adult? a. Dull pain in the right upper quadrant region b. Changes in color of urine or stool c. Distention of veins in upper part of body d. Aching muscles and tenderness in the liver

ANS: B The incidence of cholelithiasis increases with aging. Assess older adults for history of changes in stool or urine color. Cirrhosis of the liver may cause distention in veins in the upper part of the body. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1482, Lifespan OBJ: 2 TOP: Age-related changes KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

1. The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the blood stream by the: a. gastric lining of the stomach. b. villi of the small intestine. c. bile of the liver in the large intestine. d. excretion from the cecum.

ANS: B The inner surface of the small intestine contains millions of tiny, fingerlike projections called villi, which contain small blood vessels. They are responsible for absorbing the products of digestion. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-6 OBJ: 2 TOP: Digestive KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. What should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)? a. Decompress the stomach b. Control esophageal varices bleeding c. A route for tube feedings d. Obtain specimen for gastric analysis

ANS: B The major purpose of the S/B tube is to control bleeding by pressure against the vessels in the esophagus. The two balloons of the tube are inflated to put direct pressure on the esophagus and are anchored by the inflated balloon in the stomach. The tube can suction blood from the stomach as well. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1467-1468, Figure 45-4 OBJ: 2 TOP: SB tube KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

1. The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is: a. stored in the gallbladder to make bile. b. water insoluble bilirubin that must be converted by the liver. c. a by-product which is excreted directly into the bowel for excretion. d. necessary for digestion of fats.

ANS: B Unconjugated bilirubin is a water-insoluble product that must be converted in the liver to conjugated bilirubin (water soluble) so that it may be excreted through the bowel. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1458 OBJ: 1 TOP: Bilirubin KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

37. A patient with a T-tube for an open cholecystectomy has resumed oral intake. The T-tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate? a. Notify the physician b. Unclamp the tube immediately c. Increase the IV fluids d. Change the T-tube dressing

ANS: B While the tube is clamped, the patient may show signs of abdominal pain, nausea, vomiting, etc. Unclamp the tube immediately to allow for drainage and relief of both nausea and pain. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1480 OBJ: 8 TOP: Cancer of the pancreas KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

32. How should the nurse counsel the 34-year-old woman who has been prescribed sulfasalazine (Azulfidine) for Crohn disease? (Select all that apply.) a. Expose her to sunlight at least 30 minutes a day for vitamin D synthesis b. Tell her to drink at least 1500 mL of fluid a day c. Advise assessing self for rash d. Use alternate birth control methods to oral contraception e. Take drug on an empty stomach

ANS: B, C, D Cautionary information about sulfasalazine (Azulfidine) would include having adequate fluid intake to prevent crystallization in the kidneys, avoiding exposure to the sun, and using alternate birth control methods as oral contraception is made unreliable by this drug. The drug should be taken with meals and the patient should be assessing for rash. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-49, Table 5-1, 5-82 OBJ: 7 TOP: Crohn disease KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

31. Which of the following are indicators of colorectal cancer? (Select all that apply.) a. Constant diarrhea b. Excessive flatulence c. Cachexia d. Cramps e. Rectal bleeding f. Anemia

ANS: B, C, D, E, F The indicators for colorectal cancer are changing bowel habits between diarrhea and constipation, flatulence, cachexia, cramps, rectal bleeding, and anemia. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-118 OBJ: 12 TOP: Colorectal cancer KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

39. Which medical interventions and management systems control the bleeding of esophageal varices? (Select all that apply.) a. Transfusions b. Sengstaken-Blakemore tube c. Band ligation d. Cryotherapy e. Portocaval shunt f. Large doses of vitamin B12

ANS: B, C, E Band ligation, insertion of the S/B tube, and various shunting surgeries are helpful in stopping the hemorrhage. Transfusions and water-soluble vitamins are not beneficial. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1467 OBJ: 3 TOP: Esophageal varices KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

43. What should the nurse do as part of the preparation for an endoscopic retrograde cholangiopancreatography (ERCP)? (Select all that apply.) a. Confirm that a recent chest x-ray is on file b. Confirm the presence of a consent form c. Warn patient that the procedure will take about 3 hours d. Confirm the presence of a prothrombin time/INR e. Withhold food and drink for 4 hours

ANS: B, D Before the ERCP the patient will be held NPO for 8 hours. It is necessary that a consent form be signed as well as evidence of a prothrombin time INR. PTS: 1 DIF: Cognitive Level: Application REF: Page 1463 OBJ: 1 TOP: ERCP KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

42. The nurse is aware that the liver synthesizes products essential to health. Which products are synthesized by the liver? (Select all that apply.) a. Intrinsic factor b. Protein c. Vitamin K d. Red blood cells e. Albumin

ANS: B, E The liver synthesizes protein and albumin. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1459 OBJ: N/A TOP: Products synthesized by liver KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

33. Why is morphine contraindicated in the patient with pancreatitis? a. Demerol (meperidine) is less expensive. b. Tylenol is more effective at managing this type of pain. c. Morphine may cause spasms of the sphincter of Oddi. d. These patients do not experience pain.

ANS: C A common complaint is constant, severe pain; in such cases, meperidine (Demerol) PCA is often administered. Morphine may cause spasms of the sphincter of Oddi. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1478 OBJ: 2 TOP: Pancreatitis KEY: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

27. The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent: a. fluid congestion. b. fatigue. c. infection. d. urinary retention.

ANS: C A critical aspect of nursing care following liver transplantation is monitoring for infection. The major postoperative complications of a liver transplant are rejection and infection. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1474 OBJ: 1 TOP: Liver transplant KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

30. Why is it advantageous for a live person to be a liver donor? a. Because the donor is not at risk for any complication b. Because the recipient is more likely to avoid rejection c. Because the donor donates only a part of the liver d. Because the blood supply is more dependable in the donated liver

ANS: C A live donor may donate only a portion of their liver and within weeks the donor's liver has grown to the size to meet the body's needs. The same is true for the recipient. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1474 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. What should a nurse do when obtaining a stool specimen to be examined for ova and parasites? a. Use an oil retention enema to facilitate collection b. Refrigerate the specimen immediately c. Obtain three different stool specimens on subsequent days d. Check the specimen for the presence of occult blood

ANS: C Diagnosing a parasitic infection requires three different stool specimens on subsequent days. Use only normal saline or tap water enemas to prevent alteration of results. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-18 OBJ: 3 TOP: Diagnostic studies KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

11. The patient has come to the PACU following an ileostomy for the treatment of ulcerative colitis. The patient is conscious and has a nasogastric tube in place and a pouch over the stoma. What should be the nurse's initial action? a. Turn patient to right side b. Give patient ice chips to moisten mouth c. Attach NG tube to suction d. Irrigate NG tube

ANS: C Initially, the NG tube should be attached to suction to decompress the stomach and prevent nausea. Assessing the tube for the need of future irrigation will be part of the postoperative care. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-85, Box 5-5 OBJ: 4 TOP: Appendicitis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

18. Which of the following is a classic symptom of cholecystitis? a. Substernal, radiating to the left shoulder and arm b. Epigastric, radiating to the back c. Right upper abdomen, radiating to the back or right scapula d. Left upper abdomen, radiating to the jaw and neck

ANS: C It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1477-1478 OBJ: 2 TOP: Cholecystitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

29. Why are peptic ulcers a common problem of aging? a. Because of overuse of antibiotics b. Because of overuse of antacids c. Because of overuse of NSAIDs d. Because of overuse of laxatives

ANS: C Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) taken for arthritis or degenerative joint conditions may contribute to ulcer formation. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-110 OBJ: 4 TOP: Disorders of the stomach KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube; the patient complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of? a. Hiatal hernia b. Gastritis c. Perforation d. Bowel obstruction

ANS: C Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the result of a perforation. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-47 OBJ: 5 TOP: Ulcer perforation KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

4. What should the nurse expect of a patient with a malabsorption of vitamin K? a. Lowered hemoglobin b. Elevated hematocrit c. Increased prothrombin time d. Diminished white blood cell count

ANS: C Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1465 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

15. How does the administration of neomycin (Mycifradin) reduce the production of ammonia? a. By assisting the hepatic cells to regenerate b. By reducing ascites c. By decreasing the bacteria in the gut d. By helping to digest fats and proteins

ANS: C The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced. PTS: 1 DIF: Cognitive Level: Application REF: Pages 1468, 1464, Table 54-1 OBJ: 3 TOP: Encephalopathy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

36. What should the nurse monitor in caring for the patient undergoing a paracentesis? a. The urinary output b. Hypervolemia c. Fluid removal over at least 30 minutes d. Seizure

ANS: C The fluid removed during a paracentesis is removed over a period of 30 to 90 minutes to prevent sudden changes in blood pressure leading to syncope. The bed should be in a high Fowler position. Food and fluid restriction is usually not necessary. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1467 OBJ: 1 TOP: Paracentesis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care? a. Evaluation and assessment of dietary intake of fiber b. Evaluation and assessment of patient cleanliness c. Evaluation and assessment of periostomal skin integrity d. Evaluation and assessment of the adequacy of the collection device

ANS: C The nurse should assess the periostomal skin for impairment of integrity. The fecal material is liquid and has a potential for severe skin excoriation from the digestive enzymes. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-5-84 OBJ: 8 TOP: Ulcerative colitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

17. What should the nurse do to prepare a patient for an oral cholecystography? a. Ensure that the patient drinks 500 mL of water before testing b. Give 4 Oragrafin (ipodate) 5 minutes apart starting at 6 AM c. Administer 6 Telepaque (iopanoic acid) tablets 5 minutes apart after the evening meal d. Give a fatty meal hour before the test is started

ANS: C The patient is held NPO and given 6 tablets 5 minutes apart the evening before the procedure after the evening meal. A fatty meal is given to the patient after the test is started to stimulate emptying of the gallbladder. PTS: 1 DIF: Cognitive Level: Application REF: Page 1459 OBJ: 1 TOP: Oral cholecystography KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

5. Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia? a. Consume only liquid b. Avoid fruit juices c. Drink 10 oz of fluid with each meal d. Lie down for 30 minutes after each meal

ANS: C The patient should drink fluid with each meal to increase lower esophageal pressure to push food into the stomach. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-41 OBJ: 5 TOP: Esophageal dilation KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

23. Which of the following should be included in the patient teaching of a patient with a peptic ulcer? a. Introducing irritating foods in minute amounts to desensitize the stomach b. Restricting fluid to 1000 mL per day c. Eating 6 small meals a day d. Drinking alcohol and caffeine in moderation

ANS: C The patient with a peptic ulcer should eat frequently to keep food in the stomach. Eating 6 small meals daily is helpful. Restriction of fluid is not necessary and irritating foods, alcohol, and caffeine should be discouraged. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-56 OBJ: 4 TOP: Peptic ulcer KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

2. A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of 102° F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock? a. Chest pain b. Seizure c. Tachycardia d. Massive diarrhea

ANS: C The patient with diverticulitis who has fever and an elevated white count has an infection that could lead to septic shock, which will present as tachycardia and hypotension. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-98 OBJ: 9 TOP: Diverticulitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

25. To assist a family with a bowel training program to reduce fecal incontinence, the nurse would suggest the use of a ___________ at an optimal time to stimulate defecation. a. Warm bath b. A tap water enema c. Glycerin suppository d. Large glass of warm lemonade

ANS: C The use of a glycerin suppository for fecal stimulation is a helpful aid in a bowel-training program. The suppository is administered at what the family and patient have determined is the optimal time for a bowel movement. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-124 OBJ: 13 TOP: Bowel training KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

30. The patient with irritable bowel syndrome tells the home health nurse she is going to an acupuncturist for therapy for her condition. Which of the following would be the best nursing response? a. "Go for it. Alternative medicine does great things." b. "YIKES! An acupuncturist?" c. "It may help, but there has been no clinical proof of its effectiveness." d. "You should confirm that the acupuncturist is licensed."

ANS: C While it is true that some have found relief there is no evidence that these therapies relieve the symptoms of IBS. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-76 OBJ: 4 TOP: Alternative therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

6. A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition? a. Duodenal ulcer b. Gastritis c. Achalasia d. Peptic ulcer

ANS: D A significant subjective data assessment for a peptic ulcer is the patient report that pain is associated with eating, but not with an empty stomach, because there would be pain with a duodenal ulcer. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-46 OBJ: 5 TOP: Peptic ulcer KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. The home health nurse evaluates a patient being treated for a peptic ulcer with Riopan (antacid) and famotidine (histamine receptor blocker). Which statement made by the patient indicates a need for further instruction? a. "I know famotidine will not interfere with my Coumadin." b. "I take the Riopan at least 2 hours after any of my other drugs." c. "Boy! That Riopan keeps my stomach happy!" d. "I take both those meds at the same time every morning."

ANS: D Antacids should not be taken with other drugs, because the absorption of the other drugs may be affected. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-49, Table 5-1 OBJ: 4 TOP: Pharmacology KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

21. The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug: a. increases the rate of the regeneration of liver cells. b. can overcome complications presented by hepatitis C. c. increases blood supply to transplant. d. does not suppress bone marrow.

ANS: D Cyclosporine is an immunosuppressant that does not cause bone marrow suppression nor does it impede healing. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1474 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

5. A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. What is the purpose of the T-tube? a. To decompress the duct and relieve pain caused by stimulation of the sphincter of Oddi. b. To improve diaphragmatic expansion and prevention of atelectasis. c. To shorten postoperative recovery and hasten the healing process. d. To keep the duct open and allow drainage of the bile until edema resolves.

ANS: D If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1479, Figure 45-7 OBJ: 8 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

28. The nurse is aware that the hepatitis A immunization provides immunity in: a. 5 days. b. 10 days. c. 15 days. d. 30 days.

ANS: D Primary immunization with hepatitis A vaccine provides immunity within 30 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1473 OBJ: 8 TOP: Hepatitis A KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

19. What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce the frequency of heartburn? a. Drinking 10 oz of milk with every meal b. Lie down after eating c. Panting through mouth when symptoms begin d. Eating small meals

ANS: D Taking care not to overeat is the best defense again pyrosis (heartburn) for the person with a hiatal hernia. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-109 OBJ: 10 TOP: Hiatal hernia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

34. Which factors may increase a patient's risk of developing cancer of the pancreas? a. Diet high in carbohydrates and dairy products b. Cardiovascular disease and glaucoma c. Tea and cola consumption d. Cigarette smokers and people with diabetes mellitus

ANS: D The cause of cancer of the pancreas is unknown, but it is diagnosed more often in cigarette smokers, people exposed to chemical carcinogens, and people with diabetes mellitus and pancreatitis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1484 OBJ: 2 TOP: Cancer of the pancreas KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

11. What should the nurse point out as a significant advantage of the laparoscopic cholecystectomy? a. Slightly more invasive, but there is less pain b. Can be performed on all patients of any age c. Can be performed even when there are large stones present in the bile duct d. Less invasive procedure

ANS: D The laparoscopic cholecystectomy is less invasive and causes less pain and a quick recovery. If there are large stones present a sphincterotomy is done before the laparoscopic cholecystectomy. Persons with bleeding tendencies, pathologic conditions of the abdomen, stones in the bile duct, and extensive adhesions are not good candidates. PTS: 1 DIF: Cognitive Level: Application REF: Page 1479 OBJ: 2 TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

3. What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis? a. Have patient sign a permit b. Pad side rails c. Check for allergy to contrast media or to shellfish d. Have patient void immediately before procedure

ANS: D To prevent the puncturing of the bladder, the patient must void immediately before the procedure. A permit is required but it is not a safety precaution for the patient. There is no contrast media used in a paracentesis. PTS: 1 DIF: Cognitive Level: Application REF: Page 1467 OBJ: 2 TOP: Paracentesis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

10. Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. What would the nurse suggest to reduce the risk of dumping syndrome? a. Eating a high-carbohydrate diet b. Drinking 10 oz of fluids with meals c. Remaining upright for 2 hours after meals d. Eating six small daily meals high in protein and fat

ANS: D Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If possible, the patient should lie down for 1 hour after meals. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-60 OBJ: 4 TOP: Dumping syndrome KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

10. The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for: a. Muscular twitching/spasm b. Hematuria c. Macular rash on trunk and arms d. Evidence of cardiac ischemia

ANS: D Vasopressin is a strong vasoconstrictor given to try to stop the hemorrhage of the varices. Unfortunately it also constricts all vessels and may cause cardiac ischemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1467 OBJ: 3 TOP: Vasopressin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

37. The nurse explains that ___________, the chief enzyme of gastric juice, is activated by hydrochloric acid to begin digestion of protein.

ANS: pepsin Pepsin is activated by the hydrochloric acid to break down protein for digestion. Topic: Pepsin Nursing Process Step: Implementation Objective: 2 Cognitive Level: Knowledge NCLEX: Physiological Integrity Text Reference: Page 5-5 PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1403 OBJ: 2 TOP: Pepsin KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity