meg surg 3 pt2
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
A nurse is aware that even though tube feedings are generally well-tolerated by most patients, there is a still a risk of dumping syndrome. Which of the following actions has the greatest potential to reduce a patient's risk of experiencing dumping syndrome?
Administering feedings at a low, continuous rate rather than by bolus
The client has the intake and output shown in the accompanying chart for an 8-hour shift. What is the positive fluid balance?
260
The nurse is caring for a group of clients. Which client(s) would be a candidate for total parenteral nutrition (TPN)? Select all that apply.
Child with short bowel syndrome Middle-aged man with acute pancreatitis Man with two-thirds of his colon removed
A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply.
Diarrhea Tachycardia Diaphoresis
The nurse is preparing to administer ondansetron to an older adult client. Which safety warning(s) should the nurse consider when administering the medication? Select all that apply.
Do not use if the client has a heart block or prolonged QT interval. It increases sedation if used with opiates. Emphasize prevention. The client must take consistently to prevent nausea and vomiting.
The health care provider orders the insertion of a single lumen nasogastric tube. When gathering the equipment for the insertion, what will the nurse select?
Levin tube
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?
Low residue
Immediate medical and nursing management is necessary for a patient who has ingested a corrosive substance and experienced a chemical burn. Select the first response.
Maintain a patent airway.
The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal?
Maintaining skin integrity
A 59-year-old woman with a recent history of heartburn, regurgitation, and occasional dysphagia has been diagnosed with a sliding hiatal hernia following an upper GI series. The nurse is providing patient education about the management of this health problem. What should the nurse suggest as a management strategy to this patient?
Remaining upright for at least 1 hour following each meal
A client with cancer has a neck dissection and laryngectomy. An intervention that the nurse will do is:
Make a notation on the call light system that the client cannot speak.
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?
"I will have to take vitamin B12 shots up to 1 year after surgery."
Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply.
Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas
Which term is used to describe stone formation in a salivary gland, usually the submandibular gland?
Sialolithiasis
A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?
Sigmoidoscopy
Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors?
"Have you ever been diagnosed with reflux?"
A 58-year-old man who leads a busy lifestyle managing his own business has been diagnosed with a gastric ulcer. The man has told the nurse, "My wife warned me that my job stress would eventually catch up with me!" How should the nurse best respond to the patient's statement?
"Actually, it's been found that stress doesn't really cause ulcers."
A 70-year-old woman with a complex medical history made an appointment with her primary care provider because she has recently been experiencing heartburn, abdominal pain, and nausea. The clinician has identified that the woman's symptoms are characteristic of acute gastritis. Which of the woman's following statements is suggestive of the etiology of her problem?
"I've changed from taking Tylenol for my arthritis pain to taking aspirin."
A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate?
"It is a vent that prevents backflow of the secretions."
A client with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective?
"It might cause a metallic taste in my mouth."
The nurse knows to assess the patient with a history of diarrhea for fluid volume deficit (FVD). Which of the following is a characteristic sign of FVD?
A weak, thready pulse
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems?
Acute gastritis
What is the most common cause of small-bowel obstruction?
Adhesions
The nurse is caring for a patient who has dumping syndrome from high-carbohydrate foods being administered over a period of fewer than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome?
Administer the feeding with the patient in semi-Fowler's position to decrease the effect of gravity on transit time.
A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. What would be the first activity performed by the nurse?
Assess lung sounds bilaterally.
The nurse is caring for a client with a new jejunostomy tube. Which interventions will the nurse add to the client's plan of care? Select all that apply.
Assess skin for signs of infection Provide aseptic daily wound care Begin feedings 4 hours after insertion Provide 30 mL of sterile water after tube insertion
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse?
Assess the client's abdomen and vital signs.
A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to
Auscultate lung sounds every 4 hours.
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer?
Awakening in pain
A nurse is preparing to assist a health care provider with a peripherally inserted central catheter. The nurse demonstrates understanding of this procedure by preparing which insertion site?
Basilic vein
Which term refers to intestinal rumbling?
Borborygmus
A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?
Chronic constipation with sporadic bouts of diarrhea
A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?
Colonoscopy
Which ulcer is associated with extensive burn injury?
Curling ulcer
A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply.
Daily weights Intake and output monitoring Calorie counts for oral nutrients
The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for?
Dehydration
A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document?
Hairy leukoplakia
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus and has been admitted to a medical unit. The nurse is writing a care plan for this patient. What information is essential to include?
He will need to undergo an upper endoscopy every 6 months to detect malignant changes.
A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed?
Hemorrhage
The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply.
Hemorrhage Perforation Penetration Pyloric obstruction
A client is being evaluated for esophageal cancer. What initial manifestation of esophageal cancer should the nurse assess?
Increasing difficulty in swallowing
A 26-year-old man experienced severe burns in an industrial accident and has been admitted to the burn unit of a tertiary care hospital. In the days since the accident, the care team has been pleased with the trajectory of the man's recovery, and they estimate that he will require parenteral nutrition for 2 to 3 months. Which of the following access devices is most likely appropriate for this patient's nutritional needs?
Peripherally inserted central catheter (PICC)
Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:
Peritonitis
The nurse is caring for a client who has a gastrostomy tube feeding. Upon initiating care, the nurse aspirates the gastrotomy tube for gastric residual volume (GRV) and obtains 200 mL of gastric contents. What is the priority action by the nurse?
Place the client in a semi-Fowler's position with the head of the bed at 45 degrees.
A nurse is providing discharge teaching for a client following Roux-En-Y (RYGB) surgery. What should the nurse include in the teaching? Select all that apply.
Stop eating when you feel full. Avoid all sweets. Choose breads, cereals, and grains that provide less than 2 g of fiber per serving.
A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason?
The client's natural bowel function may become sluggish.
Which is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance.
A man with severe ulcerative colitis has been informed by his health care provider that he will require a colectomy and an ileostomy. The patient has been told by his health care provider that he is candidate for a continent ileal reservoir (Kock pouch). The patient's nurse recognizes which of the following advantages to the use of a Kock pouch as an alternative to the creation of an ileal stoma?
The patient will not have to wear an external collection bag.
A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative?
They can be habit forming and will require increasing doses to be effective.
A client is being seen in the clinic for reports of painful hemorrhoids. The nurse assesses the client and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?
Third degree
Which statement correctly identifies a difference between duodenal and gastric ulcers?
Vomiting is uncommon in clients with duodenal ulcers.
A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:
fissure.
The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is:
gram-negative bacteria.
The nurse is recording the medications a client uses on a daily basis for a client who is scheduled to undergo surgery in the morning. Which daily medication has the potential to result in constipation?
laxative
Which condition is caused by improper catheter placement and inadvertent puncture of the pleura?
pneumothorax
A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder?
A change in bowel habits
A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely?
Excess fluid volume
Semi-Fowler position is maintained for at least which timeframe following completion of an intermittent tube feeding?
1 hour
A patient has a gastric sump tube inserted and attached to low intermittent suction. The physician has ordered the tube to be irrigated with 30 mL of normal saline every 6 hours. When reviewing the patient's intake and output record for the past 24 hours, the nurse would expect to note that the patient received how much fluid with the irrigation?
120
The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis?
Antispasmodic
A nurse is completing an assessment on a client with a postoperative neck dissection. The nurse notices excessive bleeding from the dressing site and suspects possible carotid artery rupture. What action should the nurse take first?
Apply pressure to the bleeding site
A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions?
Knowledge deficit related to the implications of bariatric surgery
A patient is not having daily bowel movements and has begun taking a laxative for this problem. What should the nurse educate the patient about regarding laxative use?
Laxatives should not be routinely taken due to destruction of nerve endings in the colon.
The nurse is assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis?
Left lower quadrant
The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?
One part of the intestine telescopes into another portion of the intestine.
Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following?
Osteoporosis
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol?
Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)
The nurse is caring for a client with chronic gastritis. Which interventions will the nurse add to this client's plan of care? Select all that apply.
Remind to avoid alcohol intake. Review actions to reduce stress. Provide omeprazole as prescribed. Instruct to avoid foods that aggravate the condition.
A patient with a small bowel obstruction has had a Levin tube inserted and is admitted to a medical unit. The nurse who is caring for this patient is now checking that the wall suction settings are correct and should anticipate which of the following settings?
Intermittent low suction
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?
Right lower quadrant
A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________.
Rovsing sign; acute appendicitis
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order?
Nasogastric tube insertion
The nurse is caring for a client with a history of bulimia. The client complains of retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which condition?
Boerhaave syndrome
It is important for the nurse to monitor serum electrolytes in a patient with acute diarrhea. Select the electrolyte result that should be immediately reported.
Potassium of 2.8 mEq/L
A nurse on a medical unit is receiving morning report on a patient who has been admitted to the unit for the treatment of peritonitis. When providing this patient's care, the nurse should prioritize assessments relevant to what problem?
Sepsis
The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?
Bloating after meals
Celiac disease (celiac sprue) is an example of which category of malabsorption?
Mucosal disorders causing generalized malabsorption
A client with morbid obesity and a history of severe sleep apnea and severe diabetes is being considered for bariatric surgery. When reviewing the client's medical record, the nurse would identify that which body mass index (BMI) would meet the criteria for such surgery?
36 kg/m2
The nurse is assisting a client to drain his continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve?
2 in.
The nurse fills a tube feeding bag with two 8-oz cans of commercially prepared formula. The client is to receive the formula at 80 mL/hour via continuous gastrostomy feeding tube and pump. How many hours will this bag of formula run before becoming empty? Record your answer using a whole number.
6
Which client would be at greatest risk for the development of an anorectal fistula?
A 35-year-old female with Crohn's disease
An older woman has been receiving enteral feeds by nasogastric (NG) tube for the past several days due to a decrease in her level of consciousness. How can the nurse best assess the patient's tolerance of the current formula and rate of delivery?
Aspirate and measure the stomach contents on a regular basis.
A nurse caring for a client who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What is an expected, normal amount of drainage?
Approximately 80 to 120 mL
A client presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate which area?
Between the umbilicus and the anterior superior iliac spine
A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description?
Black and tarry
A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?
Bowel perforation
The primary source of microorganisms for catheter-related infections are the skin and which of the following?
Catheter hub
A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member?
Enterostomal nurse
Which medication is classified as a histamine-2 receptor antagonist?
Famotidine
The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for?
Flexible sigmoidoscopy
The nurse is caring for a client during the postoperative period following radical neck dissection. Which finding should be reported to the physician?
High epigastric pain and/or discomfort
A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition?
Impaired ability to absorb food
The nurse caring for a patient who is being discharged home after a radical neck dissection has worked with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?
Indicates acceptance of altered appearance and demonstrates positive self-image
Computed tomography of a patient with a sudden onset of severe nausea and vomiting has revealed the presence of a pyloric obstruction. Which of the following interventions is the nurse's priority in the immediate care of this patient?
Insertion of a nasogastric (NG) tube to suction to decompress the stomach
An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of:
Iron and vitamin B12
The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease?
Its course is prolonged and variable
The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly?
Keep the vent lumen above the patient's waist to prevent gastric content reflux.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?
Mental confusion
Vomiting results in which of the following acid-base imbalances?
Metabolic alkalosis
Which of the following is considered a bulk-forming laxative?
Metamucil
The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice?
Nausea and esophageal distention can result from eating too fast.
A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction?
Nausea and vomiting
During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take?
Notify the primary health care provider.
A 22-year-old college student has been diagnosed with Crohn's disease after a diagnostic workup that was prompted by his complaints of recurring abdominal pain and diarrhea. The nurse who is contributing to this patient's care should recognize the possibility of which complications of his disease? Select all that apply.
Nutritional deficits Fluid and electrolyte imbalances Intestinal obstruction Fistula
A client has been taking a 10-day course of antibiotics for pneumonia. The client has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the client about?
Nystatin
When preparing a client 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?
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer.
Omeprazole
Which medication classification represents a proton (gastric acid) pump inhibitor?
Omeprazole
The client has returned to the floor following a radical neck dissection. Anesthesia has worn off. What is the nurse's priority action?
Place the client in the Fowler's position.
A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
Polyps
A client with oral cancer reports dryness of the mouth. What is the nurse's best response?
Provide a humidifier for the client to use while sleeping.
A 16-year-old girl presents at the emergency department complaining of right lower quadrant pain and is diagnosed with appendicitis. When assessing this patient, what signs or symptoms should the nurse expect to find?
Rebound tenderness, McBurney's sign, low-grade fever
A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation?
Red, sensitive skin around the stoma site
A nurse is inserting a nasogastric tube for feeding a client. Place in order the steps from 1 to 6 for correctly inserting the tube.
Sit the client in an upright position Apply gloves to the nurse's hands Measure the length of the tube that will be inserted Apply water-soluble lubricant to the tip of the tube Tilt the client's nose upward Instruct the client to lower the head and swallow
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?
Slows gastric emptying
A nurse at a long-term care facility is conducting an intake assessment and health history with a new female resident and the resident's daughter. The daughter states that her mother had a Billroth II gastrectomy performed several years ago, a fact that must be accommodated into her care. The nurse would be justified in questioning the resident about her history of:
Stomach cancer
A client has received a diagnosis of oral cancer. During client education, the client expresses dismay at not having recognized any early signs or symptoms of the disease. The nurse tells the client that in early stages of this disease, it is usual to have:
no symptoms.
A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:
paralytic ileus.
A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find?
severe abdominal pain with direct palpation or rebound tenderness
The nurse is caring for client scheduled to undergo radical neck dissection. During preoperative teaching, the nurse states that an associated complication is
shoulder drop.
The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a(n)
chancre.
The client is receiving 50% dextrose parenteral nutrition with fat emulsion therapy through a peripherally inserted central catheter (PICC). The nurse has developed a care plan for the nursing diagnosis "Risk for infection related to contamination of the central catheter site or infusion line." The nurse includes the intervention
Wear a face mask during dressing changes.
The nurse collaborates with the physician and dietician to determine the best type of tube feeding for a client at risk for diarrhea due to hypertonic feeding solutions. Which type of feedings should the nurse suggest?
continuous feedings
A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, what must the nurse remain alert for?
diaphoresis, vomiting, and diarrhea.
The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be
solid.
A patient has a gastric sump tube attached to low intermittent suction. The nurse empties the suction collection chamber and records an output of 320 mL for this 8-hour shift. The record shows that the tube had been irrigated with 20 mL of normal saline twice this shift. What would be the actual output of the gastric sump tube?
280
The nurse cares for a client who receives continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct?
Monitoring the feeding closely.
