GI system (3rd semester)
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority? 1 Weigh the client daily. 2 Restrict the client's oral fluid intake. 3 Measure the client's urine specific gravity. 4 Observe the client for increasing confusion.
Observe the client for increasing confusion.
The patient has a prescription for amoxicillin 750 mg by mouth. Available is 125 mg/5 mL. How many milliliters should the nurse administer? 1 3 mL 2 13 mL 3 30 mL 4 0.3 mL
30 mL
A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question? 1 Blood clotting 2 Bone formation 3 Muscle contraction 4 Cellular membranes
Cellular membranes
Which assessment data noted by the nurse indicate that bisacodyl has not been effective? 1 Pulse 108 beats/minute 2 Recurrent chest pain 3 Constipation 4 Blood pressure 156/82 mm Hg
Constipation
The nurse recognizes that which treatment strategy is beneficial for patients with stage I colorectal tumors? 1 Resection 2 Reanastomosis 3 Chemotherapy 4 Laparoscopic surgery
Laparoscopic surgery
A client who recently has had an abdominoperineal resection and colostomy accuses the nurse of being uncomfortable during a dressing change because the "wound looks terrible." The nurse identifies the client as using which defense mechanism? 1 Projection 2 Sublimation 3 Compensation 4 Intellectualization
Projection
A patient with stomach cancer presents with weight loss, dumping syndrome, and impaired wound healing. The nurse suspects that which surgical treatment may have caused the patient's symptoms? 1 Pyloroplasty 2 Total gastrectomy 3 Partial gastrectomy 4 Esophagojejunostomy
Total gastrectomy
A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery? 1 Vitamins 2 Whole bran 3 Cod liver oil 4 Amino acids
Whole bran
Which is the oral active cannabinoid used in the prevention of chemotherapy-induced emesis? 1 Aprepitant 2 Droperidol 3 Dronabinol 4 Dexamethasone
Dronabinol
Which medication can decrease intestinal motility? 1 Corticosteroids 2 Opioid antidiarrheals 3 Bile acid sequestrants 4 Tyrosine kinase inhibitors
Opioid antidiarrheals
Which technique should the nurse use to effectively administer a dose of promethazine by the intramuscular (IM) route? 1 Use the Z-track technique. 2 Inject at a 45-degree angle. 3 Numb the area with ice before injection. 4 Administer in the flank area to increase absorption.
Use the Z-track technique.
After administering a dose of metoclopramide to the patient, the nurse determines that the medication has not been effective when which symptom is noted? 1 Vertigo 2 Vomiting 3 Diarrhea 4 Migraine headache
Vomiting
A client is admitted to the hospital with a diagnosis of intestinal obstruction. The healthcare provider prescribes intestinal suction via a nasoenteric decompression tube. The loss of which constituents associated with intestinal suctioning is most important to consider when caring for this client? 1 Protein enzymes 2 Energy carbohydrates 3 Vitamins and minerals 4 Water and electrolytes
Water and electrolytes
The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that a manifestation of an obstruction in the large intestine is (select all that apply) :A. a largely distended abdomen B. diarrhea that is loose or liquid C. persistent, colicky abdominal pain D. profuse vomiting that relieves abdominal pain
:A. a largely distended abdomen C. persistent, colicky abdominal pain
The nurse explains to the patient undergoing ostomy surgery that the procedure that maintain the most normal functioning of the bowel is: A. a sigmoid colostomy B. a transverse colostom yC. a descending colostomy D. an ascending colostomy
A. a sigmoid colostomy
A client has surgery for an incarcerated hernia. The healthcare provider returns the incarcerated tissue to the abdominal cavity and uses a mesh to reinforce the muscle wall. What specific instructions should be included in the discharge instructions? Reduce dietary roughage. 2 Avoid lifting heavy items. 3 Increase dietary potassium intake. 4 Keep the head of the bed elevated.
Avoid lifting heavy items.
hich condition is a common manifestation associated with protein deficiency? 1 Paresthesia 2 Hypotension 3 Hair thinning 4 Peripheral neuropathy
Hair thinning
Which medication is prescribed for cytoprotective drug therapy? 1 Tofranil 2 Sucralfate 3 Cimetidine 4 Misoprostol
Sucralfate
Which medication does the nurse expect to be beneficial to the patient who reports difficulty swallowing and is diagnosed with achalasia? 1 Cisplatin 2 Nifedipine 3 Prednisone 4 Porfimer sodium
Nifedipine
Which diagnostic test detects reflux of gastric contents? 1 Biopsy 2 Endoscopy 3 Radionuclide test 4 Manometric studies
Radionuclide test
A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan? 1 A 2 C 3 D 4 E
Hepatitis C
A client is to have gastric lavage following an overdose of acetaminophen. In which position should the nurse place the client when the nasogastric tube is being inserted? 1 Supine 2 Mid-Fowler 3 High-Fowler 4 Trendelenburg
High-Fowler
In assessing the vital signs of a patient with an upper gastrointestinal (GI) bleed, it is important to determine whether the patient is in which kind of shock? 1 Septic 2 Neurogenic 3 Cardiogenic 4 Hypovolemic
Hypovolemic
Which neurologic condition causes constipation? 1 Dementia 2 Spina bifida 3 Parkinson's disease 4 Myelomeningocele
Parkinson's disease
A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of what symptom?
Pruritus
A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? Select all that apply. 1 Rye 2 Oats 3 Rice 4 Corn 5 Wheat
Rye Oats Wheat
Which antiemetic medication causes xerostomia as a side effect? 1 Granisetron 2 Scopolamine 3 Perphenazine 4 Domperidone
Scopolamine
What is the main manifestation of short bowel syndrome? 1 Nocturia 2 Polyphagia 3 Steatorrhea 4 Urinary retention
Steatorrhea
Which part of the gastrointestinal tract has the highest percentage of gastrointestinal stromal tumors? 1 Rectum 2 Stomach 3 Esophagus 4 Small Intestine
Stomach
A client is being prepared for surgery to have placement of a percutaneous endoscopic gastrostomy (PEG) tube. The client asks why the PEG tube is preferred over the existing nasogastric tube that is being used for feedings. What explanation does the nurse give for why a PEG tube is preferred for administering a tube feeding? 1 There is less chance of aspiration. 2 This procedure does not require a pump. 3 Self-administration of the feeding is possible. 4 More tube feeding mixture can be given each time
There is less chance of aspiration.
on the third postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action? 1 Assist the client to ambulate. 2 Obtain the client's vital signs. 3 Administer the prescribed analgesic. 4 Encourage using the incentive spirometer.
Obtain the client's vital signs
The nurse is discussing dietary sources of protein for a patient with inflammatory bowel disease (IBD) who is lactose intolerant. Which instruction is most beneficial to the patient? 1 "Include Greek yogurt in your diet." 2 "Include cold foods in your diet." 3 "Include cereals with bran in your diet." 4 "Include milk and milk products in your diet."
"Include Greek yogurt in your diet."
The nurse is caring for a patient treated with intravenous (IV) fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, the nurse understands that which food choice would be most appropriate? 1 Iced tea 2 Dry toast 3 Hot coffee 4 Plain hamburger
Dry toast
The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? 1 Maintain a high intake of fluid and fiber in the diet. 2 Reduce intake of medications causing constipation. 3 Eat several small meals per day to maintain bowel motility. 4 Sit upright during meals to increase bowel motility by gravity.
Maintain a high intake of fluid and fiber in the diet.
A client with colitis has had a hemicolectomy. Three days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green viscous fluid. The nurse contacts the primary healthcare provider and recommends which intervention? 1 Nasogastric tube for decompression 2 Antiemetic for nausea/vomiting 3 Intravenous (IV) lactated Ringer for fluid replacement 4 Stat electrolytes to assess for probable electrolyte imbalance
Nasogastric tube for decompression
Which complications does the nurse expect due to progression of Clostridium difficile infection in a patient? Select all that apply. 1 Hemorrhoids 2 Diverticulosis 3 Fulminant colitis 4 Toxic megacolon 5 Intestinal perforation
Fulminant colitis Intestinal perforation
During change of shift report the night nurse indicates that a client cannot tolerate the prescribed intermittent tube feedings. Which action should the receiving nurse take first? 1 Suggest that an antiemetic be prescribed 2 Change the feeding schedule to omit nights 3 Request that the type of solution be changed 4 Gather more data from the night nurse about the technique used
Gather more data from the night nurse about the technique used
A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care? 1 Empty feeding bag stays attached to the tubing. 2 Tube is flushed with air after medication is given. 3 Replacement of the tube is done on a weekly basis. 4 Head of the bed remains elevated after the feeding.
Head of the bed remains elevated after the feeding.
A client reports experiencing nausea, dyspnea, and right upper quadrant pain unrelieved by antacids. The pain occurs most often after eating in fast-food restaurants. Which diet should the nurse instruct the client to follow? 1 Low fat 2 Low carbohydrate 3 Soft-textured and bland 4 High protein and kilocalories
Low fat
A patient had taken a broad spectrum oral antibiotic for 10 days for a wound infection. Soon after the infection subsides, the patient develops diarrhea. The nurse expects that what medication will be prescribed? 1 Probiotic 2 Antibiotic 3 Antiviral 4 Antifungal
Probiotic
A client who had a choledochostomy to explore the common bile duct is returned to the surgical unit with a T-tube in place. What is the priority intervention when caring for this client? 1 Irrigate the T-tube as necessary 2 Protect the abdominal skin from bile drainage 3 Have the client wear a binder when out of bed 4 Empty the T-tube drainage bag every two hours
Protect the abdominal skin from bile drainage
A client is admitted to the hospital with suspected liver disease, and a needle biopsy of the liver is performed. After the procedure, the nurse should maintain the client in what position? 1 Supine 2 Semi-Fowler 3 Right side-lying 4 Dorsal recumbent
Right side-lying
When teaching a client how to prevent constipation, the nurse evaluates that the dietary teaching is understood when the client chooses which breakfast cereal? 1 Froot Loops 2 Cornflakes 3 Cap'n Crunch 4 Shredded wheat
Shredded wheat
Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)? A. Restricted to rectum B. Strictures are common .C. Bloody, diarrhea stools D. Cramping abdominal painE. Lesions penetrate intestine.
C, D Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease
Which statement is true regarding celiac disease? 1 It occurs due to lactose ingestion. 2 It is not related to bacterial overgrowth. 3 It does not occur due to genetic predisposition. 4 It occurs due to an immune-mediated response
It occurs due to an immune-mediated response
The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority? 1 Ask the patient about the timing of the last meal. 2 Offer the patient sips of water to prevent dehydration. 3 Monitor the patient for any further episodes of nausea and vomiting. 4 Notify the primary health care provider about the patient's condition
Notify the primary health care provider about the patient's condition
A nurse is caring for a client who is positive for hepatitis A. Which precautions should the nurse take? 1 Wear a gown when entering the client's room. 2 Use caution when bringing in the client's food. 3 Use gloves when removing the client's bedpan. 4 Wear a protective mask when entering the client's room.
Use gloves when removing the client's bedpan.
Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? A. Notify the physician .B. Auscultate for bowel sounds .C. Reposition the tube and check for placement .D. Remove the tube and replace it with a new one.
C. The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.
The nurse understands that research demonstrates that malnutrition occurs in as many as 50% of hospitalized clients. The nurse should assess a postoperative client with anorexia for what sign of malnutrition 1 Dependent edema 2 Spoon-shaped nails 3 Loose, decayed teeth 4 Delayed wound healing
Delayed wound healing
A healthcare provider prescribes dietary and medication therapy for a client with the diagnosis of gastroesophageal reflux disease (GERD). What is most appropriate for the nurse to teach the client about meal management? 1 Snack daily in the evenings 2 Divide food into four to six meals a day 3 Eat the last of three daily meals by 8:00 PM 4 Suck a peppermint candy after each meal
Divide food into four to six meals a day
The nurse is caring for a patient experiencing diarrhea caused by clostridium difficile. What action should the nurse take? 1 Handwashing 2 Providing antidiarrheal medication 3 Administering of mineral oil enemas 4 Placing the patient on airborne isolation
Handwashing
A patient has a prescription to receive famotidine (Pepcid) 30 mg intravenous piggyback (IVPB) or intravenous push (IVP) q12hr. Available is a vial containing 10 mg/mL. How many milliliters should the nurse draw up to administer this dose? 1 0.2 mL 2 0.75 mL 3 3 mL 4 5 mL
3 mL
The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate? A. "This will prevent air from accumulating in the stomach, causing gas pains. "B. "This will prevent the heartburn that occurs as a side effect of general anesthesia ."C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it. "D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again
D. Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.
The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? A. Ask family members whether they have discussed the surgical procedure with the physician. B. Have the patient sign the form and state the physician will visit to explain the procedure before surgery. C. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. D. Delay the patient's signature on the consent and notify the physician about the conversation with the patient
D. The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent
The nurse would administer a dose of magnesium hydroxide to a patient after evaluation of which assessment findings? 1 Poor oral intake over the past 3 days 2 Weight loss of two points in 24 hours 3 No bowel movement for 4 days 4 Irritability and tachycardia
No bowel movement for 4 days
A patient is scheduled to receive "docusate sodium 100 mg orally (PO)." The patient asks to take the medication in liquid form, and the nurse obtains a prescription for the interchange. Available is a syrup that contains 150 mg/15 mL. Calculate how many mL the nurse should administer. Fill in the blank using a whole number. _______ mL
10
A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 1 7:00 AM, 10:00 AM, and 1:00 PM 2 8:00 AM, 12:00 PM, and 4:00 PM 3 9:00 AM and 3:00 PM 4 9:00 AM, 12:00 PM, and 3:00 PM
8:00 AM, 12:00 PM, and 4:00 PM
The nurse assesses for which major complication in a client who has had a gastroscopy? 1 Difficulty swallowing 2 Increased gastrointestinal (GI) motility 3 Nausea with vomiting 4 Abdominal distention with pain
Abdominal distention with pain
A colectomy is scheduled for an 81-year-old man with an abdominal mass, suspected bowel obstruction, and a history of rectal polyps. The nurse should plan to include which prescribed measure in the preoperative preparation of this patient? 1 Rectal acetaminophen to reduce postoperative pain 2 Administration of intravenous (IV) anticoagulants to prevent blood clots 3 Strict adherence to a liquid diet for three days before surgery 4 Administration of a cleansing enema
Administration of a cleansing enema
Which antacid used in the treatment of gastrointestinal reflux disease (GERD) causes phosphorus depletion with chronic use? 1 Magnesium oxide 2 Calcium carbonate 3 Sodium bicarbonate 4 Aluminum hydroxide
Aluminum hydroxide
Which diagnostic study is used to assess alterations in mucosal integrity and inflammation in the small intestine? 1 D-xylose test 2 Capsule endoscopy 3 Bowel barium enema 4 Lactose tolerance test
Capsule endoscopy
Which represents appropriate nursing management of the client's nasogastric (NG) tube in the immediate postoperative period following gastroduodenostomy? 1 Advancing the tube to the original insertion depth if the tube becomes dislodged. 2 Obtaining a prescription to vigorously irrigate the nasogastric tube if clogging is noted. 3 Carefully monitoring the nasogastric tube to ensure that the tube is patent and the suction is working. 4 Reporting the presence of bright red gastric aspirant in the suction canister during the immediate postoperative period.
Carefully monitoring the nasogastric tube to ensure that the tube is patent and the suction is working.
The nurse is preparing to administer a nasogastric tube feeding to a client via infusion pump. What is the most important assessment the nurse needs to perform before beginning the pump? 1 Checking for the last bowel movement 2 Checking for residual stomach contents 3 Checking to determine time of last medication for nausea 4 Checking to make sure the head of bed is elevated at least 15 degrees
Checking for residual stomach contents
Which manifestation should be suspected in a patient with riboflavin deficiency? 1 Anemia 2 Cheilosis 3 Paresthesia 4 Peripheral neuropathy
Cheilosis
A client is diagnosed with hepatitis A. The nurse provides the client with information about untoward signs and symptoms related to hepatitis. The nurse instructs the client to contact the primary healthcare provider if the client develops what symptom? 1 Fatigue 2 Anorexia 3 Yellow urine 4 Clay-colored stools
Clay-colored stools
Which integumentary manifestation is associated with zinc deficiency? 1 Bruising 2 Dermatitis 3 Brittle nails 4 Hair thinning
Dermatitis
Which surgical therapy is used to treat pyloric obstruction? 1 Vagotomy 2 Endoscopy 3 Gastrojejunostomy 4 Gastroduodenostomy
Endoscopy
When assessing a client's abdomen, the nurse palpates the area directly above the umbilicus. By what term is this area known? 1 Iliac area 2 Epigastric area 3 Hypogastric area 4 Suprasternal area
Epigastric area
Which laboratory test is beneficial for diagnosing the presence of a small amount of blood in gastric secretions and stools? 1 Guaiac test 2 Liver enzyme studies 3 Complete blood count (CBC) 4 Serum amylase determination
Guaiac test
Which medication for peptic ulcer disease causes hallucinations? 1 Nizatidine 2 Sucralfate 3 Omeprazole 4 Metoclopramide
Metoclopramide
After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The client says, "What does it mean when the healthcare provider says that I am experiencing dumping syndrome?" What information should the nurse include in a response to this question? 1 Nausea resulting from a full stomach 2 Reflux of gastric contents into the esophagus 3 Buildup of flatulence within the large intestine 4 Rapid passage of concentrated fluid into the small intestine
Rapid passage of concentrated fluid into the small intestine
Which abnormal nutritional condition is treated with folic acid and tetracycline? 1 Celiac disease 2 Tropical sprue 3 Lactase deficiency 4 Short bowel syndrome
Tropical sprue
Which condition can be diagnosed by measuring fasting serum gastrin levels? 1 Acute gastritis 2 Pyloric obstruction 3 Gastric outlet obstruction 4 Zollinger-Ellison syndrome
Zollinger-Ellison syndrome
The home health nurse provides education to a client with cancer of the tongue who will begin gastrostomy feedings at home. Which statement by the client indicates teaching by the nurse is effective? 1 "Before I start the procedure, I will don sterile gloves." 2 "Before I start the procedure, I will obtain my body weight." 3 "Before I start the procedure, I will measure the residual volume." 4 "Before I start the procedure, I will instill one ounce (30 mL) of a carbonated liquid."
"Before I start the procedure, I will measure the residual volume."
The nurse provides discharge teaching to a client related to management of the client's new colostomy. The client states, "I hope I can handle all of this at home; it's a lot to remember." What is the nurse's best response? 1 "I'm sure you will be able to do it." 2 "Maybe a family member can do it for you." 3 "You seem to be nervous about going home." 4 "Perhaps you can stay in the hospital another day."
"You seem to be nervous about going home."
Where does Zenker's diverticulum occur? 1 At the wall of the esophagus 2 Near the esophageal midpoint 3 At the lower portion of the esophagus 4 Above the upper esophageal sphincter
Above the upper esophageal sphincter
A nurse teaching a community group about ways to reduce the risk for colorectal cancer includes decreasing the dietary intake of: 1 Beef and pork 2 Fish and poultry 3 Fresh and dried fruits 4 Green leafy vegetables
Beef and pork
Which medication has a side effect of milk-alkali syndrome? 1 Misoprostol 2 Metoclopramide 3 Calcium carbonate 4 Aluminum hydroxide
Calcium carbonate
What nursing diagnostic statement would be assigned the highest priority in the plan of care for a patient who has ulcerative colitis? 1 Activity intolerance 2 Deficient fluid volume 3 Impaired tissue integrity 4 Risk for impaired skin integrity
Deficient fluid volume
Which gastrointestinal manifestation is seen due to bacterial fermentation of unabsorbed carbohydrates? 1 Glossitis 2 Diarrhea 3 Flatulence 4 Weight loss
Flatulence
A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this client's ascites? 1 Impaired portal venous return 2 Impaired thoracic lymph channels 3 Excess production of serum albumin 4 Enhanced hepatic deactivation of aldosterone secretion
Impaired portal venous return
A client with a 20-year history of excessive alcohol use has developed jaundice and ascites and is admitted to the hospital. What is the priority nursing action during the first 48 hours after the client's admission? 1 Monitor vital signs 2 Increase fluid intake 3 Obtain a foam mattress 4 Improve nutritional status
Monitor vital signs
Which test indicates whether or not a patient has adequate absorption of vitamin K? 1 Fecal elastase testing 2 Bowel barium enema 3 Lactose tolerance test 4 Prothrombin time
Prothrombin time
A patient with gastroesophageal reflux disease reports to the nurse, "I feel like there is a hot, bitter liquid in my mouth." What does the nurse document in the patient's medical record? 1 Dysphagia 2 Regurgitation 3 Hypersalivation 4 Hyperchlorhydria
Regurgitation
What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy? A. How to care for the wound B. How to deep breathe and cough C. The location and care of drains after surgery D. Which medications will be used during surgery
B. Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.
The nurse is presenting information about gastroenteritis to a group of nursing students. What is appropriate for the nurse to include in the education? 1 It is caused by a norovirus. 2 It is often treated with sulfasalazine. 3 It is classified as an ulcerative colitis. 4 It is defined as the chronic inflammation of the gastrointestinal tract.
It is caused by a norovirus.
Which complications can occur due to long-term use of proton pump inhibitors in patients with gastroesophageal reflux disease (GERD)? Select all that apply. 1 Pneumonia 2 Renal calculi 3 Uterine rupture 4 Decreased bone density 5 Chronic hypochlorhydria
Pneumonia Decreased bone density Chronic hypochlorhydria
A patient reports abdominal pain, weight loss, indigestion, and a feeling of fullness in stomach. Diagnostic test results indicate atrophic gastritis. Based on the assessment findings, the nurse suspects which diagnosis? 1 Achalasia 2 Gastric ulcer 3 Stomach cancer 4 Upper gastrointestinal bleeding
Stomach cancer
A nurse is caring for a client on the second day after an abdominoperineal resection. Which finding does the nurse document as normal in the stoma? 1 Dry, pale pink, and even with the skin 2 Moist, skin-colored, and flush with the skin 3 Moist, red, and raised above the skin surface 4 Dry, purple, and depressed below the skin surface
Moist, red, and raised above the skin surface
Which is a manifestation of electrolyte depletion? 1 Flatulence 2 Steatorrhea 3 Muscle cramps 4 Night blindness
Muscle cramps
A nurse is caring for a client with a hiatal hernia. Which risk factor should the nurse assess for in this client? 1 Obesity 2 Alcoholism 3 Chronic bronchitis 4 Esophageal varices
Obesity
The patient receiving chemotherapy rings the call light and reports the onset of nausea. The nurse should prepare an as needed dose of which medication? 1 Morphine sulfate 2 Zolpidem 3 Ondansetron 4 Dexamethasone
Ondansetron
The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder? 1 Ham sandwich with cheese, whole milk, and potato chips 2 Penne pasta, spinach, banana, and decaffeinated iced tea 3 Baked lasagna with sausage, salad, and milkshake 4 Hamburger, french fries, and cola
Penne pasta, spinach, banana, and decaffeinated iced tea
The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? A. "The tube will help to drain the stomach contents and prevent further vomiting." B. "The tube will push past the area that is blocked and thus help to stop the vomiting. "C. "The tube is just a standard procedure before many types of surgery to the abdomen. "D. "The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best."
A. The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents
The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site? A. The patient must be able to see the site. B. Outside the rectus muscle area is the best site. C. It is easier to seal the drainage bag to a protruding area. D. The ostomy will need irrigation, so area should not be tender.
A.In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag.
A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient? A. Instruction on irrigating a colostomy B. Administration of a cleansing enema C. A high-fiber diet the day before surgery D. Administration of IV antibiotics for bowel preparation
B.Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. Instructions to irrigate the colostomy will be done postoperatively. Oral antibiotics are given preoperatively, and an IV antibiotic may be used in the OR. A clear liquid diet will be used the day before surgery with the bowel cleansing.
A client had a colon resection and formation of a colostomy two days ago. Which color indicates to the nurse the stoma is viable? 1 Blue 2 Gray 3 Brick red 4 Dark purple
Brick red
The nurse is aware that the primary symptoms of a sliding hiatal hernia are associated with reflux and should assess the patient for which symptoms? 1 Jaundice, ascites, and edema 2 Heartburn, regurgitation, and dysphagia 3 Abdominal cramps, diarrhea, and anorexia 4 Pelvic pain, fever, and board-like abdominal rigidity
Heartburn, regurgitation, and dysphagia
The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction
D. Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.
A client had a gastric bypass procedure to treat morbid obesity. After surgery the client reports weakness, sweating, palpitations, and dizziness after eating. What should the nurse encourage the client to do? 1 Reduce the intake of protein-rich foods 2 Drink 8 ounces (240 mL) of water with meals 3 Divide the daily caloric intake into six smaller meals 4 Remain in an upright position for one hour after eating
Divide the daily caloric intake into six smaller meals
A client is admitted to the hospital with jaundiced skin and acute abdominal pain. What is the nurse's most therapeutic response when the client refuses all visitors? 1 Listen to the client's fears 2 Encourage the client to socialize 3 Grant the client's request about visitors 4 Darken the client's room by pulling the drapes
Listen to the client's fears
Which patient statement indicates a need for further teaching regarding appropriate dietary choices for illness with vomiting? 1 "I should eat hard candy." 2 "I should eat plain baked potatoes." 3 "I should drink warm tea with crackers." 4 "I should drink carbonated beverages on ice."
"I should drink carbonated beverages on ice."
A patient requires a dose of promethazine for nausea. The prescription states to give 25 mg intravenous (IV) push q8hr as needed. On hand is a vial labeled "100 mg/mL." How many milliliters should the nurse administer? 1 0.15 mL 2 0.25 mL 3 0.5 mL 4 1 mL
0.25 mL
The nurse is caring for a client with a hiatal hernia. The client states that favorite beverages include ginger ale, apple juice, orange juice, and cola beverages. Of the four the client listed, which is the only beverage that should remain in the client's diet? 1 Ginger ale 2 Apple juice 3 Orange juice 4 Cola beverages
Apple juice
The nurse is caring for a client in the postanesthesia care unit immediately after the client had a subtotal gastrectomy. The nurse identifies small blood clots in the client's gastric drainage. What action should the nurse take? 1 Clamp the tube. 2 Consider this an expected event. 3 Instill the tube with iced normal saline. 4 Notify the surgeon immediately.
Consider this an expected event
The nurse is educating a patient about dietary fiber and the ways to incorporate it into the daily diet. What information should the nurse include while teaching this patient about fiber intake? 1 Drink at least 2 liters of water daily. 2 Avoid having prunes and prune juice. 3 Check flatulence formation in the case of dietary fiber intake. 4 Check for milk and milk products that are high in dietary fiber.
Drink at least 2 liters of water daily.
A client with advanced bone cancer is experiencing cachexia. The nurse discusses the nutritional aspect of palliative care with the family. What is the importance of the nurse explaining these nutritional interventions to the family? 1 Enhances the quality of the client's life 2 Reduces the likelihood of a respiratory infection 3 Prevents the malabsorption syndrome from occurring 4 Cures the cachexia that results from bone cancer and chemotherapy
Enhances the quality of the client's life
Which is the first indication of gastroesophageal reflux disease and a hiatal hernia in elderly patients? 1 Halitosis 2 Pernicious anemia 3 Esophageal bleeding 4 Epigastric tenderness
Esophageal bleeding
After surgery for creation of an ileostomy, a client is to be discharged. Before discharge, what is the primary nursing intervention? 1 Emphasizing that it is essential that the client can care for the ileostomy without assistance 2 Evaluating the client's ability to care for the ileostomy 3 Ensuring that the client understands the dietary limitations that must be followed 4 Ensuring that the client is competent at changing the dry sterile dressing on the incision
Evaluating the client's ability to care for the ileostomy
The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? 1 Osteoarthritis 2 History of colorectal polyps 3 History of lactose intolerance 4 Use of herbs as dietary supplements
History of colorectal polyps
On the second day after an abdominoperineal resection, the nurse anticipates that the colostomy stoma will have what appearance? 1 Dry, pale pink, and flush with the skin 2 Moist, red, and raised above the skin surface 3 Dry, purple, and depressed below the skin surface 4 Moist, pink, flush with the skin, and painful when touched
Moist, red, and raised above the skin surface
he nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history? 1 Acute gastritis 2 Diabetes mellitus 3 Partial gastrectomy 4 Unhealthy dietary habits
Partial gastrectomy
A nurse is reviewing preoperative instructions with a client who is scheduled for orthopedic surgery at 8:00 AM the next day. What advice does the nurse 1 "Have your dinner completed by 6:00 PM tonight and then no food or fluids after that." 2 "Drink whatever liquids you want tonight and then only clear liquids tomorrow morning." 3 "Consume a light evening meal tonight and then no food or fluids after midnight." 4 "Eat lunch today and then do not drink or eat anything until after your surgery. give the client?
"Consume a light evening meal tonight and then no food or fluids after midnight."
The nurse provides education to a patient about the management of constipation. Which statement made by the patient indicates the need for further teaching? 1 "I should drink fruit juice at least 3 times a day." 2 "I should include beans, metamucil, and citrucel in my diet." 3 "I should respond immediately to the urge to have a bowel movement." 4 "I should have laxatives readily available and use them whenever I have difficulty passing stools."
"I should have laxatives readily available and use them whenever I have difficulty passing stools."
The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. The patient has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? 1 "The tube will help to drain the stomach contents and prevent further vomiting." 2 "The tube will push past the area that is blocked and thus help to stop the vomiting." 3 "The tube is just a standard procedure before many types of surgery to the abdomen." 4 "The tube will let us measure your stomach contents so that we can plan what type of intravenous fluid replacement would be best."
"The tube will help to drain the stomach contents and prevent further vomiting."
A client is admitted to the hospital with ascites. The client reports drinking a quart (liter) of vodka mixed in orange juice every day for the past three months. To assess the potential for withdrawal symptoms, which question would be appropriate for the nurse to ask the client? 1 "When was your last drink of vodka?" 2 "What prompts your drinking episodes?" 3 "Do you also eat when you drink?" 4 "Why do you mix the vodka with orange juice?"
"When was your last drink of vodka?"
In planning care for a patient with fecal incontinence, the goal the nurse is likely to establish is that the patient will: 1 Eliminate once a day 2 Maintain perianal skin integrity 3 Cope with depression by having alone time 4 Alleviate all nonessential work and social activities
Maintain perianal skin integrity
The patient states that he or she has had an episode of loose stool and does not want to take the scheduled dose of docusate sodium. What is the appropriate action by the nurse? 1 File an incident report and notify the health care provider. 2 Chart the dose as not given and update the nursing note. 3 Ask the patient's spouse to try to convince the patient to take it. 4 Attempt to give the medication later in the morning.
Chart the dose as not given and update the nursing note.
Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of A. impaired peristalsis. B. irritation of the bowel .C. nasogastric suctioning. D. inflammation of the incision site.
A. Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.
A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment? 1 Platelet count 2 Amylase level 3 Red blood cell count 4 Erythrocyte sedimentation rate
Amylase level
The nurse is caring for a patient who is scheduled to receive a course of long-term broad spectrum antibiotic therapy. The nurse knows the patient will need instruction on actions to take to prevent infection with which organism? 1 Salmonella 2 Clostridium difficile 3 Rotavirus 4 Escherichia coli 0157:H7
Clostridium difficile
After administering a dose of promethazine, the nurse explains that which common temporary adverse effect may occur? 1 Tinnitus 2 Drowsiness 3 Urinary retention 4 Sensation of falling
Drowsiness
When teaching a patient about ways to prevent constipation, what instructions should the nurse include? Select all that apply. 1 Eat a high-fiber diet. 2 Use laxatives regularly. 3 Exercise occasionally. 4 Increase fluid intake. 5 Do not suppress the urge to defecate.
Eat a high-fiber diet. Increase fluid intake. Do not suppress the urge to defecate.
A client has surgery for an abdominal cholecystectomy and returns from surgery with a nasogastric tube to low continuous suction, a T-tube, and an indwelling catheter. Which intervention should the nurse perform first? 1 Fasten each tube to the bedsheets 2 Irrigate each tube with normal saline 3 Measure the drainage in the collection devices 4Ensure that all tubes are attached to collection devices
Ensure that all tubes are attached to collection devices
A nurse is reviewing a list of current medications with a client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the primary healthcare provider? 1 Digoxin 2 Ibuprofen 3 Famotidine 4 Atorvastatin
Ibuprofen
A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first? 1 Clamp the nasogastric tube. 2 Irrigate the tube gently with normal saline. 3 Record the observation and continue to monitor the drainage from the tube. 4 Reduce the pressure of the suction and record observations of the drainage characteristics.
Record the observation and continue to monitor the drainage from the tube.
A nurse is evaluating a client's response to receiving an intermittent gravity flow percutaneous endoscopic gastrostomy (PEG) tube feeding. Which clinical finding indicates that the client is unable to tolerate a continuation of the feeding? 1 Passage of flatus 2 Rise of formula in the tube 3 Rapid inflow of the feeding 4 Tenderness of epigastric area
Rise of formula in the tube
A client who is suspected of having salmonellosis asks the nurse how the diagnosis is confirmed. The nurse responds that the medical diagnosis is established with what laboratory test? Urinalysis 2 Stool culture 3 Febrile agglutinin test 4 Complete blood count
Stool culture
A client with achalasia is scheduled to have a bougienage to dilate the lower esophagus and cardiac sphincter. After the procedure the nurse assesses the client for what complications related to esophageal perforation? 1 Tachycardia and abdominal pain 2 Faintness and feelings of fullness 3 Diaphoresis and cardiac palpitations 4 Increased blood pressure and urinary output
Tachycardia and abdominal pain
A nurse is caring for a client who just had surgery for a parotid tumor. Which nursing intervention is the priority in the immediate postoperative period? 1 Offering psychological support 2 Monitoring the client's fluid balance 3 Keeping the client's respiratory passages patent 4 Providing a pad and pencil for writing messages
Keeping the client's respiratory passages patent
A client is scheduled for a colonoscopy, and the healthcare provider prescribes a tap water enema. In which position should the nurse place the client during the enema? 1 Left Sims 2 Back lying 3 Knee chest 4 Mid-Fowler
Left Sims
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? 1 Crackles 2 Hypovolemia 3 Gastric reflux 4 Jugular vein distention
Hypovolemia
A client with jaundice associated with hepatitis expresses concern over the change in skin color. What does the nurse explain is the cause of this color change? 1 Stimulation of the liver to produce an excess quantity of bile pigments 2 Inability of the liver to remove normal amounts of bilirubin from the blood 3 Increased destruction of red blood cells during the acute phase of the disease 4 Decreased prothrombin levels, leading to multiple sites of intradermal bleeding
Inability of the liver to remove normal amounts of bilirubin from the blood
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? 1 "You'll need to drink at least two to three glasses of milk daily." 2 "It would likely be beneficial for you to eliminate drinking alcohol." 3 "Many people find that a minced or pureed diet eases their symptoms of PUD." 4 "Your medications should allow you to maintain your present diet while minimizing symptoms."
"It would likely be beneficial for you to eliminate drinking alcohol."
The postoperative patient states that he or she has never taken pantoprazole in the past. The patient asks why he or she is getting this medication if the patient has never had heartburn. What is the best response by the nurse? 1 "This will prevent gas pains from the excess air in your small intestine." 2 "This will prevent the heartburn that occurs as a side effect of your diabetes." 3 "The stress of surgery is likely to cause stomach bleeding if you do not receive it." 4 "This will reduce the amount of acid in your stomach until you can eat a regular diet again."
"This will reduce the amount of acid in your stomach until you can eat a regular diet again."
In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease :A. frequently results in toxic megacolon B. causes fewer nutritional deficiencies than does ulcerative colitis C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy D. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis
C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy
A client who had an abdominoperineal resection and colostomy refuses to allow any family members to see the incision or stoma. The client is noncompliant with most of the dietary recommendations. The nurse concludes that the client is experiencing what response? 1 Reaction formation; this is related to the client's recent altered body image 2 Denial; the client is having difficulty accepting reality 3 Impotency resulting from the surgery; sexual counseling may be indicated 4 Suicidal thoughts; consultation with a psychiatrist should be prescribed
Denial; the client is having difficulty accepting reality
A client is scheduled for gastrointestinal surgery. What is the most important nursing action that should be implemented the evening before surgery? 1 Describing the specific surgical procedure 2 Ensuring the bowel preparation is initiated 3 Encouraging the client to socialize with other clients 4 Providing the client's food preferences for the evening meal
Ensuring the bowel preparation is initiated
A client is admitted to the hospital with a diagnosis of Crohn disease. What is most important for the nurse to include in the teaching plan for this client? 1 Controlling constipation 2 Meeting nutritional needs 3 Preventing increased weakness 4 Anticipating a sexual alteration
Meeting nutritional needs
