MED SURG (Nurselabs) GI
After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? A. Dark brown B. Bile green C. Bright red D. Cloudy white
A. Dark brown About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood, but large amounts of blood or excessively bloody drainage should be reported to the physician promptly.
A female client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? A. Fast for 8 hours before the test B. Eat a regular supper and breakfast C. Continue to take all oral medications as scheduled D. Monitor own bowel movement pattern for constipation
A. Fast for 8 hours before the test A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Most oral medications also are withheld before the test. After the procedure, the nurse must monitor for constipation, which can occur as a result of the presence of barium in the gastrointestinal tract.
A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: A. Reduce gastric acid output B. Protect the ulcer surface C. Inhibit the production of hydrochloric acid (HCl) D. Inhibit vagus nerve stimulation
A. Reduce gastric acid output These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A. Cancer of the stomach B. Peptic ulcer disease C. Chronic gastritis D. Pylorospasm
B. Peptic ulcer disease Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would not evidence pain or vomiting unless the pylorus was obstructed.
Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: A 45 units/L B 100 units/L C 300 units/L D 500 units/L
C 300 units/L The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? A. Before meals B. With meals C. At bedtime D. When pain occurs
C. At bedtime Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.
A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? A. Halts stress reactions B. Heals the gastric mucosa C. Reduces the stimulus to acid secretions D. Decreases food absorption in the stomach
C. Reduces the stimulus to acid secretions A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect descriptions of a vagotomy.
Which of the following tests is most commonly used to diagnose cholecystitis? A. Abdominal CT scan B. Abdominal ultrasound C. Barium swallow D. Endoscopy
B. Abdominal ultrasound An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn't necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply. A. Epigastric pain at night B. Relief of epigastric pain after eating C. Vomiting D. Weight loss
C. Vomiting D. Weight loss Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.
A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client? A. Tea B. Gelatin C. Custard D. Popsicle
C. Custard Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in options A, B, and D are clear liquids.
The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics? A. Early satiety B. Pain on eating C. Dull upper epigastric pain D. Pain on empty stomach
D. Pain on empty stomach Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.
Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D
A. Hepatitis A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A. yellow sclera B. light amber urine C. circumoral pallor D. black, tarry stools
A. yellow sclera Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? A. Lying on the right side with legs straight B. Lying on the left side with knees bent C. Prone with the torso elevated D. Bent over with hands touching the floor
B. Lying on the left side with knees bent For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.
Which of the following factors can cause hepatitis A? A. Contact with infected blood B. Blood transfusions with infected blood C. Eating contaminated shellfish D. Sexual contact with an infected person
C. Eating contaminated shellfish Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.
The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? A. "The cimetidine (Tagamet) will cause me to produce less stomach acid." B. "Sucralfate (Carafate) will change the fluid in my stomach." C. "Antacids will coat my stomach." D. "Omeprazole (Prilosec) will coat the ulcer and help it heal.
A. "The cimetidine (Tagamet) will cause me to produce less stomach acid." Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.
A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A. "You may have eaten contaminated restaurant food." B. "You could have gotten it by using I.V. drugs." C. "You must have received an infected blood transfusion." D. "You probably got it by engaging in unprotected sex."
A. "You may have eaten contaminated restaurant food." Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? A. Change the tube feeding solutions and tubing at least every 24 hours. B. Maintain the head of the bed at a 15-degree elevation continuously. C Check the gastrostomy tube for position every 2 days. D. Maintain the client on bed rest during the feedings.
A. Change the tube feeding solutions and tubing at least every 24 hours. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.
Which of the following dietary measures would be useful in preventing esophageal reflux? A. Eating small, frequent meals B. Increasing fluid intake C. Avoiding air swallowing with meals D. Adding a bedtime snack to the dietary plan
A. Eating small, frequent meals Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Endoscopy B. Upper GI series C. Hemoglobin (Hb) levels and hematocrit (HCT) D. Arteriography
A. Endoscopy Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren't always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.
Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take? A. Hold the feeding B. Reinstill the amount and continue with administering the feeding C. Elevate the client's head at least 45 degrees and administer the feeding D. Discard the residual amount and proceed with administering the feeding
A. Hold the feeding Unless specifically indicated, residual amounts more than 100 mL require holding the feeding. Therefore options B, C, and D are incorrect. Additionally, the feeding is not discarded unless its contents are abnormal in color or characteristics
A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient's blood pressure because of which change that is associated with the liver failure? A. Hypoalbuminemia B. Increased capillary permeability C. Abnormal peripheral vasodilation D. Excess rennin release from the kidneys
A. Hypoalbuminemia Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidney's aren't direct ramifications of liver failure.
The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be: A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion B. After insertion into the nostril, instruct the client to extend his neck C. Introduce the tube with the client's head tilted back, then instruct him to keep his head upright for final insertion D. Instruct the client to hold his chin down, then back for insertion of the tube
A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. Extension of the neck (2) will impede NG tube insertion.
While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes cloggeD. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do? A. Irrigate the tube with cola B. Advance the tube into the intestine C. Apply intermittent suction to the tube D. Withdraw the obstruction with a 30-ml syringe
A. Irrigate the tube with cola The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it's inexpensive, and it's readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn't long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.
A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? A. Notify the physician B. Reposition the tube C. Irrigate the tube D. Increase the suction level
A. Notify the physician An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: A. Pork B. Milk C. Chicken D. Broccoli
A. Pork The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid
The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? A. Sweating and pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain
A. Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: A. increasing fluid intake to prevent dehydration B. wearing an appliance pouch only at bedtime C. consuming a low-protein, high-fiber diet D. taking only enteric-coated medications
A. increasing fluid intake to prevent dehydration Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy
To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? A. "Lie down after meals to promote digestion." B. "Avoid coffee and alcoholic beverages." C. "Take antacids with meals." D. "Limit fluid intake with meals."
B. "Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.
If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client? A. Blood replacement B. Antacid administration C. Nasogastric tube suction D. Fluid and electrolyte replacement
B. Antacid administration Antacids aren't helpful in perforation. The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.
Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis? A. Administration of antibiotics B. Assessment for complications C. Preparation for lithotripsy D. Preparation for surgery
B. Assessment for complications The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.
The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? A. Irrigating the drain B. Avoiding coughing C. Maintaining bed rest D. Restricting pain medication
B. Avoiding coughing Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure. Bed rest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure, although the client may be instructed in simple dressing changes.
A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? A. Ineffective coping related to fear of diagnosis of chronic illness B. Deficient knowledge related to unfamiliarity with significant signs and symptoms C. Constipation related to decreased gastric motility D. Imbalanced nutrition: Less than body requirements due to gastric bleeding
B. Deficient knowledge related to unfamiliarity with significant signs and symptoms Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their physician.
A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this information, which nursing diagnosis would be most appropriate? A. Imbalanced Nutrition: Less than Body Requirements related to anorexia B. Disturbed Sleep Pattern related to epigastric pain C. Ineffective Coping related to exacerbation of duodenal ulcer D Activity Intolerance related to abdominal pain
B. Disturbed Sleep Pattern related to epigastric pain Based on the data provided, the most appropriate nursing diagnosis would be Disturbed Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The client's feelings of anxiety do not necessarily indicate that she is coping ineffectively.
The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? A. Limit oral fluid B. Elevate the scrotum C. Apply heat to the abdomen D. Remain in a low-fiber diet
B. Elevate the scrotum Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed. Heat will increase swelling. Limiting oral fluids and a low-fiber diet can cause constipation.
A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? A. Elevated hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreased erythrocyte sedimentation rate
B. Elevated serum bilirubin level Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? A. Digoxin (Lanoxin) B. Indomethacin (Indocin) C Furosemide (Lasix) D. Propranolol hydrochloride (Inderal)
B. Indomethacin (Indocin) Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.
The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome? A. Eat high-carbohydrate foods B. Limit the fluids taken with meals C. Ambulate following a meal D. Sit in a high-Fowlers position during meals
B. Limit the fluids taken with meals The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmidocs as prescribed.
While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. A. Administering an antacid hourly until nausea subsides. B. Monitoring the client's vital signs C. Notifying the physician of the client's symptoms D. Initiating oxygen therapy E. Reassessing the client on an hour
B. Monitoring the client's vital signs C. Notifying the physician of the client's symptoms The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix C. The appendix may develop gangrene and rupture, especially in a middle-aged client D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage
B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. A. The client complains of a sore throat B. The client has a temperature of 100*F C. The client appears drowsy following the procedure D. The client complains of epigastric pain E The client experiences hematemesis
B. The client has a temperature of 100*F D. The client complains of epigastric pain E The client experiences hematemesis Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.
A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? A. The client doesn't exhibit rectal tenesmus B. The client is free from esophagitis and achalasia C. The client reports diminished duodenal inflammation D. The client has normal gastric structures
B. The client is free from esophagitis and achalasia Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.
A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate? A. The procedure will result in enlargement of the pyloric sphincter B. The procedure will result in anastomosis of the gastric stump to the jejunum C. The procedure will result in removal of the duodenum D. The procedure will result in repositioning of the vagus nerve
B. The procedure will result in anastomosis of the gastric stump to the jejunum A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client's daily care? A. Assess the oral cavity each time mouth care is given and record observations B. Use a soft toothbrush to brush the client's teeth after each meal C. Swab the client's tongue, gums, and lips with a soft foam applicator every 2 hours D. Rinse the client's mouth with mouthwash several times a day
B. Use a soft toothbrush to brush the client's teeth after each meal A soft toothbrush should be used to brush the client's teeth after each meal and more often as needed. Mechanical cleaning is necessary to maintain oral health, simulate gingiva, and remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse, not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.
The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin E
B. Vitamin B12 Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for vitamin A, C, or E deficiency.
A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A. severe abdominal pain radiating to the shoulder B. anorexia, nausea, and vomiting C. eructation and constipation D. abdominal ascites
B. anorexia, nausea, and vomiting Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.
When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. increased intracranial pressure B. decreased urine output C. bradycardia D. hypertension
B. decreased urine output Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.
A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: A. meperidine provides a better, more prolonged analgesic effect. B. morphine may cause spasms of Oddi's sphincter. C. meperidine is less addictive than morphine. D. morphine may cause hepatic dysfunction.
B. morphine may cause spasms of Oddi's sphincter. For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn't associated with hepatic dysfunction.
A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: A. call the physician B. place saline-soaked sterile dressings on the wound C. take a blood pressure and pulse D. pull the dehiscence closed
B. place saline-soaked sterile dressings on the wound The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.
Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? A. Hopelessness B. Powerlessness C. Chronic low self esteem D. Deficient knowledge
C. Chronic low self esteem Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn't result from a knowledge deficit, such as one regarding good nutrition.
Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: A. Position the client supine to assist in medication absorption B. Aspirate the nasogastric tube after medication administration to maintain patency C. Clamp the nasogastric tube for 30 minutes following administration of the medication D. Change the suction setting to low intermittent suction for 30 minutes after medication administration
C. Clamp the nasogastric tube for 30 minutes following administration of the medication If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the nasogastric tube will remove the medication just administered. Low intermittent suction also will remove the medication just administered. The client should not be placed in the supine position because of the risk for aspiration.
The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? A. Digoxin (Lanoxin) B. Furosemide (Lasix) C. Indomethacin (Indocin) D. Propranolol hydrochloride (Inderal)
C. Indomethacin (Indocin) Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.
When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A. Assisting in inserting a Miller-Abbott tube B. Assisting in inserting an arterial pressure line C. Inserting a nasogastric tube D. Inserting an I.V.
C. Inserting a nasogastric tube An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line (2) is not appropriate at this time and an IV (4) is optional.
The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? A. Leg exercises B. Early ambulation C. Irrigating the nasogastric tube D. Coughing and deep-breathing exercises
C. Irrigating the nasogastric tube In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse should clarify the order. Options A, B, and D are appropriate postoperative interventions.
The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? A. Ambulate following a meal B. Eat high carbohydrate foods C. Limit the fluid taken with meal D. Sit in a high-Fowler's position during meals
C. Limit the fluid taken with meal Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.
The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? A. Palpates the abdomen for size B. Palpates the liver at the right rib margin C. Listens to bowel sounds in all four quadrants D. Percusses the right lower abdominal quadrant
C. Listens to bowel sounds in all four quadrants The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.
The client with a duodenal ulcer may exhibit which of the following findings on assessment? A. Hematemesis B. Malnourishment C. Melena D. Pain with eating
C. Melena The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as melena (black tarry poop). The other findings are consistent with a gastric ulcer.
After a subtotal gastrectomy, care of the client's nasogastric tube and drainage system should include which of the following nursing interventions? A. Irrigate the tube with 30 ml of sterile water every hour, if needed B. Reposition the tube if it is not draining well C. Monitor the client for N/V, and abdominal distention D. Turn the machine to high suction of the drainage is sluggish on low suction
C. Monitor the client for N/V, and abdominal distention Nausea, vomiting, or abdominal distention indicated that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician's order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.
The nurse is reviewing the physician's orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client's chart? A. NPO status B. Nasogastric tube inserted C. Morphine sulfate for pain D. An anticholinergic medication
C. Morphine sulfate for pain Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate interventions for the client with acute pancreatitis.
The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? A. Regular diet B. Skim milk C. Nothing by mouth D. Clear liquids
C. Nothing by mouth Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled.
Which of the following symptoms best describes Murphy's sign? A. Periumbilical ecchymosis exists B. On deep palpitation and release, pain in elicited C. On deep inspiration, pain is elicited and breathing stops D. Abdominal muscles are tightened in anticipation of palpation
C. On deep inspiration, pain is elicited and breathing stops Murphy's sign is elicited when the client reacts to pain and stops breathing. It's a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen's sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.
The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? A. Supine with the head of the bed flat B. On the stomach with the head flat C. On the left side with the head of the bed elevated 30 degrees D. On the right side with the head of the bed elevated 30 degrees
C. On the left side with the head of the bed elevated 30 degrees The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.
The most important pathophysiologic factor contributing to the formation of esophageal varices is: A. Decreased prothrombin formation B. Decreased albumin formation by the liver C. Portal hypertension D. Increased central venous pressure
C. Portal hypertension As the liver cells become fatty and degenerate, they are no longer able to accommodate the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.
The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy
C. Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. A hemoglobin level of 12 mg/dL
C. Rebound tenderness Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.
A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? A. Exhale B. Inhale and exhale quickly C. Take and hold a deep breath D. Perform a Valsalva maneuver
C. Take and hold a deep breath When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.
A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication? A. The client complains of a sore throat B. The client displays signs of sedation C. The client experiences a sudden increase in temperature D. The client demonstrates a lack of appetite
C. The client experiences a sudden increase in temperature The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors, including the disease process.
A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? A. The client has not been including enough fiber in his diet B. The client needs to increase his daily exercise C. The client is experiencing a side effect of the aluminum hydroxide. D. The client has developed a gastrointestinal obstruction
C. The client is experiencing a side effect of the aluminum hydroxide. It is most likely that the client is experiencing a side effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of bowel obstruction.
A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: A. place the client in a private room B. wear a mask when handling the client's bedpan C. wash the hands after touching the client D. wear a gown when providing personal care for the client
C. wash the hands after touching the client To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? A . "I should take my antacid before I take my other medications." B. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." C. "My antacid will be most effective if I take it whenever I experience stomach pains." D. "It is best for me to take my antacid 1 to 3 hours after meals."
D. "It is best for me to take my antacid 1 to 3 hours after meals." Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.
A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? A. An obturator B. Kelly clamp C. An irrigation set D. A pair of scissors
D. A pair of scissors When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside, but it is not the priority item.
The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen
D. A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.
Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer? A. Regain weight loss within 1 month after surgery B. Resume normal dietary intake of three meals per day C. Control nausea and vomiting through regular use of antiemetics D. Achieve optimal nutritional status through oral or parenteral feedings
D. Achieve optimal nutritional status through oral or parenteral feedings An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated.
The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? A. Administering pain medication B. Obtaining a blood sample for laboratory studies C. Preparing to insert a nasogastric (NG) tube D. Administering I.V. fluids
D. Administering I.V. fluids I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves: A. Cutting the vagus nerve B. Removing the distal portion of the stomach C. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum
D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.
The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? A. Development of laryngeal cancer B. Irritation of the esophagus C. Esophageal scar tissue formation D. Aspiration of gastric contents
D. Aspiration of gastric contents Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.
The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? A. Clamp the T tube B. Irrigate the T tube C. Notify the physician D. Document the findings
D. Document the findings Following cholecystectomy, drainage from the T tube is initially bloody and then turns to a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.
Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? A. Start an IV infusion B. Administer an enema C. Cancel the diagnostic test D. Explain that diarrhea is expected
D. Explain that diarrhea is expected The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours. Options A, B, and C are inappropriate actions
Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection? A. Monitoring gastric pH to detect complications B. Assessing for bowel sounds C. Providing nutritional support D. Monitoring for symptoms of hemorrhage
D. Monitoring for symptoms of hemorrhage The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.
A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? A. Quickly insert the tube B. Notify the physician immediately C. Remove the tube and reinsert when the respiratory distress subsides D. Pull back on the tube and wait until the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate action because, in this situation, it may be likely that the tube has entered the bronchus.
A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure: A. Decreases food absorption in the stomach B. Heals the gastric mucosa C. Halts stress reactions D. Reduces the stimulus to acid secretions
D. Reduces the stimulus to acid secretions A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.
A client being treated for chronic cholecystitis should be given which of the following instructions? A. Increase rest B. Avoid antacids C. Increase protein in diet D. Use anticholinergics as prescribed
D. Use anticholinergics as prescribed Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.
Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: A. a sedentary lifestyle and smoking. B. a history of hemorrhoids and smoking C. alcohol abuse and a history of acute renal failure D. alcohol abuse and smoking
D. alcohol abuse and smoking Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: A. whole blood and albumin B. platelets and packed red blood cells C. fresh frozen plasma and whole blood D. cryoprecipitate and fresh frozen plasma
D. cryoprecipitate and fresh frozen plasma The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated blood urea nitrogen (BUN) B, Elevated serum lipase C. Elevated aspartate aminotransferase (AST) D. Increased lactate dehydrogenase (LD)
B, Elevated serum lipase Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client's BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: A. "Tell me about your husband's alcohol usage." B. "Is your husband being treated for tuberculosis?" C. "Has your husband recently fallen or injured his chest?" D. "Describe spices and condiments your husband uses on food."
A. "Tell me about your husband's alcohol usage." A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn't occur from chest injuries or falls and isn't associated with eating spicy foods.
Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted? A. 3.5 B. 7.0 C. 7.35 D. 7.5
A. 3.5 If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.
The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify? A. Irrigating the nasogastric tube B. Coughing a deep breathing exercises C. Leg exercises D. Early ambulation
A. Irrigating the nasogastric tube In a Billroth II procedure the proximal remnant of the stomach is anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Cholecystitis D. Gastric ulcer
B. Pancreatitis Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications? A. To inhibit mucus production B. To neutralize acid production C. To stimulate mucus production D. To stimulate hydrogen ion diffusion back into the mucosa
C. To stimulate mucus production The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize acid production.
While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? A. Sigmoid colon B. Appendix C. Spleen D. Liver
D. Liver The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following? A. An intestinal obstruction has developed B. Additional ulcers have developed C. The esophagus has become inflamed D. The ulcer has perforated
D. The ulcer has perforated The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid, boardlike abdomen.
During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? A. vitamin A B. vitamin D C. vitamin E D. vitamin K
D. vitamin K Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamin, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.
