elimation GI disorders- quizlet slides (quiz 2)

Question 1

1. A patient with deep partial-thickness burns experiences severe pain associated with nausea during dressing changes. Which action will be most useful in decreasing the patient’s nausea?
   a. The patient NPO for 2 hours before and after dressing changes.
   b. Avoid performing dressing changes close to the patient’s mealtimes.
   c. Administer the prescribed morphine sulfate before dressing changes.
   d. Give the ordered prochlorperazine (Compazine) before dressing changes.

Answer 1

ANS: C
Because the patient’s nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea/vomiting that occur at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient’s nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.

Question 2

2. A patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation is to start oral intake. Which of these should the nurse offer to the patient?
   a. A glass of orange juice
   b. A dish of lemon gelatin
   c. A cup of coffee with cream
   d. A bowl of hot chicken broth

Answer 2

ANS: B
Clear liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.

Question 3

The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed?
a. “I take antacids between meals and at bedtime each night.”
b. “I sleep with the head of the bed elevated on 4-inch blocks.”
c. “I quit smoking several years ago, but I still chew a lot of gum.”
d. “I eat small meals throughout the day and have a bedtime snack.”

Answer 3

ANS: D
GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

Question 4

When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient’s family that the patient has a history of gastroesophageal reflux disease (GERD). The nurse will plan to do frequent assessments of the patient’s
a. apical pulse.
b. bowel sounds.
c. breath sounds.
d. abdominal girth.

Answer 4

ANS: C
Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient’s stroke or GERD and do not require more frequent monitoring than the routine.

Question 5

A patient with recurring heartburn receives a new prescription for esomeprazole (Nexium). In teaching the patient about this medication, the nurse explains that this drug
a. neutralizes stomach acid and provides relief of symptoms in a few minutes.
b. reduces the reflux of gastric acid by increasing the rate of gastric emptying.
c. coats and protects the lining of the stomach and esophagus from gastric acid.
d. treats gastroesophageal reflux disease by decreasing stomach acid production.

Answer 5

ANS: D
The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

Question 6

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Peanut butter sandwich
d. Cherry gelatin and fruit

Answer 6

ANS: D
Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods like chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

Question 7

A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about
a. barium swallow.
b. radionuclide tests.
c. endoscopy procedures.
d. proton pump inhibitors.

Answer 7

ANS: D
Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

Question 8

A 62-year-old patient who has been diagnosed with esophageal cancer tells the nurse, “I know that my chances are not very good, but I do not feel ready to die yet.” Which response by the nurse is most appropriate?
a. “You may have quite a few years still left to live.”
b. “Thinking about dying will only make you feel worse.”
c. “Having this new diagnosis must be very hard for you.”
d. “It is important that you be realistic about your prognosis.”

Answer 8

ANS: C
This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have only a low survival rate, so the response “You may have quite a few years still left to live” is misleading. The response beginning, “Thinking about dying” indicates that the nurse is not open to discussing the patient’s fears of dying. And the response beginning, “It is important that you be realistic,” discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.

Question 9

12. Which information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
    a. “Peppermint tea may be helpful in reducing your symptoms.”
    b. “You should avoid eating between meals to reduce acid secretion.”
    c. “Vigorous physical activities may increase the incidence of reflux.”
    d. “It will be helpful to keep the head of your bed elevated on bl

Answer 9

ANS: D
Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will lower LES pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

Question 10

13. A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing action should be included in the postoperative plan of care?
    a. Elevate the head of the bed to at least 30 degrees.
    b. Reposition the nasogastric (NG) tube if drainage stops or decreases.
    c. Notify the doctor immediately about bloody NG drainage.
    d. Start oral fluids when the patient has active bowel sounds.

Answer 10

ANS: A
Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.

Question 11

The nurse will plan to teach the patient with newly diagnosed achalasia that
a. a liquid or blenderized diet will be necessary.
b. drinking fluids with meals should be avoided.
c. endoscopic procedures may be used for treatment.
d. lying down and resting after meals is recommended.

Answer 11

ANS: C
Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Patients are advised to drink fluid with meals. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying.

Question 12

A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
a. the amount of fat in the diet.
b. history of recent weight gain or loss.
c. any family history of gastric problems.
d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Answer 12

ANS: D
Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.

Question 13

Cobalamin injections have been prescribed for a patient with chronic atrophic gastritis. The nurse determines that teaching regarding the injections has been effective when the patient states,
a. “The cobalamin injections will prevent me from becoming anemic.”
b. “These injections will increase the hydrochloric acid in my stomach.”
c. “These injections will decrease my risk for developing stomach cancer.”
d. “The cobalamin injections need to be taken until my inflamed stomach heals.”

Answer 13

ANS: A
Cobalamin supplementation prevents the development of pernicious anemia. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin.

Question 14

A patient with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the patient about
a. sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol).
b. amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec).
c. famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix).
d. metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).

Answer 14

ANS: B
The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

Question 15

A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking?
a. Obtain a stool specimen for culture.
b. Administer antidiarrheal medications.
c. Teach about adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs).
d. Provide education about antibiotic therapy.

Answer 15

ANS: A
Patients with bloody diarrhea should have a stool culture for E. coli O157:H7. NSAIDs may cause occult blood in the stools, but not diarrhea. Antidiarrheal medications usually are avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications.

Question 16

A patient is hospitalized with vomiting of “coffee-ground” emesis. The nurse will anticipate preparing the patient for
a. endoscopy.
b. angiography.
c. gastric analysis testing.
d. barium contrast studies.

Answer 16

ANS: A
Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding.

Question 17

The health care provider orders intravenous (IV) ranitidine (Zantac) for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include?
a. “Ranitidine decreases secretion of gastric acid.”
b. “Ranitidine neutralizes the acid in the stomach.”
c. “Ranitidine constricts the blood vessels in the stomach and decreases bleeding.”
d. “Ranitidine covers the ulcer with a protective material that promotes healing.”

Answer 17

ANS: A
Ranitidine is a histamine-2 (H2) receptor blocker, which decreases the secretion of gastric acid. The response beginning, “Ranitidine constricts the blood vessels” describes the effect of vasopressin. The response beginning “Ranitidine neutralizes the acid” describes the effect of antacids. And the response beginning “Ranitidine covers the ulcer” describes the action of sucralfate (Carafate).

Question 18

The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will
a. prevent aspiration of gastric contents.
b. inhibit the development of stress ulcers.
c. lower the chance for H. pylori infection.
d. decrease the risk for nausea and vomiting.

Answer 18

ANS: B
Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.

Question 19

A patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
a. periodically aspirates and tests gastric pH.
b. monitors arterial blood gas values on a daily basis.
c. checks each stool for the presence of occult blood.
d. measures the amount of residual stomach contents hourly.

Answer 19

ANS: A
The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal (GI) bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.

Question 20

A patient with a peptic ulcer who has a nasogastric (NG) tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next?
a. Irrigate the NG tube.
b. Obtain the vital signs.
c. Listen for bowel sounds.
d. Give the ordered antacid.

Answer 20

ANS: B
The patient’s symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that should be taken.

Question 21

Twelve hours after undergoing a gastroduodenostomy (Billroth I), a patient complains of increasing abdominal pain. The patient has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The most appropriate action by the nurse at this time is to
a. notify the surgeon.
b. irrigate the NG tube.
c. administer the prescribed morphine.
d. continue to monitor the NG drainage.

Answer 21

ANS: A
Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion and/or return to surgery are needed. Because the NG is draining, there is no indication that irrigation is needed. The patient may need morphine, but this is not the highest priority action. Continuing to monitor the NG drainage is not an adequate response.

Question 22

the nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which patient statement indicates that the teaching has been effective?
a. “Persistent heartburn is expected after surgery.”
b. “I will try to drink liquids along with my meals.”
c. “Vitamin supplements may be needed to prevent problems with anemia.”
d. “I will need to choose foods that are low in fat and high in carbohydrate.”

Answer 22

ANS: C
Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery and the patient should call the health care provider if this occurs.

Question 23

A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to
a. lie down for about 30 minutes after eating.
b. choose foods that are high in carbohydrates.
c. increase the amount of fluid intake with meals.
d. drink sugared fluids or eat candy after each meal.

Answer 23

ANS: A
The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

Question 24

A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
a. substitution of acetaminophen (Tylenol) for the NSAID.
b. use of enteric-coated NSAIDs to reduce gastric irritation.
c. reasons for using corticosteroids to treat the rheumatoid arthritis.
d. the benefits of misoprostol (Cytotec) in protecting the gastrointestinal (GI) mucosa.

Answer 24

ANS: D
Misoprostol, a prostaglandin analog, reduces acid secretion and incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient’s rheumatoid arthritis.

Question 25

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient’s peptic ulcer. The nurse will teach the patient to take
a. antacids 30 minutes before the sucralfate.
b. sucralfate at bedtime and antacids before meals.
c. antacids after eating and sucralfate 30 minutes before eating.
d. sucralfate and antacids together 30 minutes before each meal.

Answer 25

ANS: C
Sucralfate is most effective when the pH is low and should not be given with or soon after
antacid. Antacids are most effective when taken after eating. Administration of sucralfate 30
minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.

Question 26

Which information will be best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease?
a. “Avoid foods that cause pain after you eat them.”
b. “High-protein foods are least likely to cause pain.”
c. “You will need to remain on a bland diet indefinitely.”
d. “You should avoid eating many raw fruits and vegetables.”

Answer 26

ANS: A
The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa, but chewing well seems to decrease this and some patients may tolerate these well. High-protein foods help to neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.

Question 26

A patient with a recent 20-pound unintended weight loss is diagnosed with stomach cancer. Which nursing action will be included in the plan of care?
a. Refer the patient for hospice services.
b. Infuse IV fluids through a central line.
c. Teach the patient about antiemetic therapy.
d. Offer supplemental feedings between meals.

Answer 26

ANS: D
The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusi

Question 27

When counseling a patient with a family history of stomach cancer about ways to decrease risk for developing stomach cancer, the nurse will teach the patient to avoid
a. smoked foods such as bacon and ham.
b. foods that cause abdominal distention.
c. chronic use of H2 blocking medications.
d. emotionally or physically stressful situations.

Answer 27

ANS: A
Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Use of H2 blockers, stressful situations, and abdominal distention are not associated with an increased incidence of stomach cancer.

Question 28

Which assessment finding in a patient who had a total gastrectomy 12 hours previously is most important to report to the health care provider?
a. Absent bowel sounds
b. Scant nasogastric (NG) tube drainage
c. Complaints of incisional pain
d. Temperature 102.1° F (38.9° C)

Answer 28

ANS: D
An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery.

Question 29

Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?
a. The patient has taken only sips of water.
b. The patient is lethargic and difficult to arouse.
c. The patient’s chart indicates a recent resection of the small intestine.
d. The patient has been vomiting several times a day for the l

Answer 29

ANS: B
A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information also is important to collect, but it does not require as quick action as the risk for aspiration.

Question 30

the health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order will the nurse implement first?
a. Infuse normal saline at 250 mL/hr.
b. Administer IV ondansetron (Zofran).
c. Provide oral care with moistened swabs.
d. Insert a 16-gauge nasogastric (NG) tube.

Answer 30

ANS: A
Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.

Question 31

37. After receiving change-of-shift report, which patient should the nurse assess first?
    a. A patient who was admitted yesterday with gastrointestinal (GI) bleeding and has melena
    b. A patient who is crying after receiving a diagnosis of esophageal cancer
    c. A patient with esophageal varices who has a blood pressure of 96/54 mm Hg
    d. A patient with nausea who has a dose of metoclopramide (Reglan) scheduled

Answer 31

ANS: C
The patient’s history and blood pressure indicate possible hemodynamic instability caused by GI bleeding. The data about the other patients do not indicate acutely life-threatening complications.

Question 32

Which of these assessment findings in a patient with a hiatal hernia who returned from a laparoscopic Nissen fundoplication 4 hours ago is most important for the nurse to address immediately?
a. The patient is experiencing intermittent waves of nausea.
b. The patient has absent breath sounds throughout the left lung.
c. The patient has decreased bowel sounds in all four quadrants.
d. The patient complains of 6/10 (0 to 10 scale) abdominal pain.

Answer 32

ANS: B
Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The abdominal pain and nausea also should be addressed but they are not as high priority as the patient’s respiratory status. The patient’s decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

Question 33

A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse perform first?
a. Checking the level of consciousness
b. Measuring the quantity of any emesis
c. Auscultating the chest for breath sounds
d. Taking the blood pressure (BP) and pulse

Answer 33

ANS: D
The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal (GI) bleeding; BP and pulse are the best indicators of these complications. The other information also is important to obtain, but BP and pulse rate are the best indicators for hypoperfusion.

Question 34

All of the following orders are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first?
a. Insert a nasogastric (NG) tube and connect to suction.
b. Administer intravenous (IV) famotidine (Pepcid) 40 mg.
c. Draw blood for typing and crossmatching.
d. Infuse 1000 mL of lactated Ringer’s solution.

Answer 34

ANS: D
Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.

Question 35

A patient with acute gastrointestinal (GI) bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which assessment finding obtained by the nurse is most important to communicate immediately to the health care provider?
a. The patient’s blood pressure (BP) has increased to 142/94 mm Hg.
b. The nasogastric (NG) suction is returning coffee-ground material.
c. The patient’s lungs have crackles audible to the midline.
d. The bowel sounds are very hyperactive in all four quadrants.

Answer 35

A patient with acute gastrointestinal (GI) bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which assessment finding obtained by the nurse is most important to communicate immediately to the health care provider?
a. The patient’s blood pressure (BP) has increased to 142/94 mm Hg.
b. The nasogastric (NG) suction is returning coffee-ground material.
c. The patient’s lungs have crackles audible to the midline.
d. The bowel sounds are very hyperactive in all four quadrants.

Question 36

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation?

A. Maintain a high intake of fluid and fiber in the diet.
B. Reduce intake of medications causing constipation.
C. Eat several small meals per day to maintain bowel motility.
D. Sit upright during meals to increase bowel motility by gravity.

Answer 36

A
Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be reduced. Other medications may decrease constipation, but it is best to avoid laxatives. Eating several small meals per day and position do not facilitate bowel motility. Defecation is easiest when the person sits on the commode with the knees higher than the hips.

Question 37

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient’s medical record?

A. Abdominal pain and bloating
B. No bowel movement for 3 days
C. A decrease in appetite by 50% over 24 hours
D. Muscle tremors and other signs of hypomagnesemia

Answer 37

B
MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

Question 38

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way?

A. Increases bulk in the stool
B. Lubricates the intestinal tract to soften feces
C. Increases fluid retention in the intestinal tract
D. Increases peristalsis by stimulating nerves in the colon wall

Answer 38

D
Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

Question 39

The nurse is preparing to administer a scheduled dose of docusate sodium (Colace) when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse?

A. Write an incident report about this untoward event.
B. Attempt to have the family convince the patient to take the ordered dose.
C. Withhold the medication at this time and try to administer it later in the day.
D. Chart the dose as not given on the medical record and explain in the nursing progress notes.

Answer 39

D
Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today

Question 40

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium (Colace)?

A. Take a dose of mineral oil at the same time.
B. Add extra salt to food on at least one meal tray.
C. Ensure dietary intake of 10 g of fiber each day.
D. Take each dose with a full glass of water or other liquid.

Answer 40

D
Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended

Question 41

The nurse would question the use of which cathartic agent in a patient with renal insufficiency?

A. Bisacodyl (Dulcolax)
B. Lubiprostone (Amitiza)
C. Cascara sagrada (Senekot)
D. Magnesium hydroxide (Milk of Magnesia)

Answer 41

D
Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

Question 42

A patient who is given a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which time frame after administration?

A. 2-5 minutes
B. 15-60 minutes
C. 2-4 hours
D. 6-8 hours

Answer 42

B
Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

Question 43

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient’s clinical picture?

A. Low-pitched and rumbling above the area of obstruction
B. High-pitched and hypoactive below the area of obstruction
C. Low-pitched and hyperactive below the area of obstruction
D. High-pitched and hyperactive above the area of obstruction

Answer 43

D
Early in intestinal obstruction, the patient’s bowel sounds are hyperactive and high-pitched, sometimes referred to as “tinkling” above the level of the obstruction. This occurs because peristaltic action increases to “push past” the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

Question 44

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient’s history increases the patient’s risk for colorectal cancer?

A. Osteoarthritis
B. History of colorectal polyps
C. History of lactose intolerance
D. Use of herbs as dietary supplements

Answer 44

B
A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

Question 45

The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?

A. “The tube will help to drain the stomach contents and prevent further vomiting.”
B. “The tube will push past the area that is blocked and thus help to stop the vomiting.”
C. “The tube is just a standard procedure before many types of surgery to the abdomen.”
D. “The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best.”

Answer 45

A
The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents

Question 46

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?

A. 7:00 AM, 10:00 AM, and 1:00 PM
B. 8:00 AM, 12:00 PM, and 4:00 PM
C. 9:00 AM and 3:00 PM
D. 9:00 AM, 12:00 PM, and 3:00 PM

Answer 46

B
A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

Question 47

A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient?

A. Instruction on irrigating a colostomy
B. Administration of a cleansing enema
C. A high-fiber diet the day before surgery
D. Administration of IV antibiotics for bowel preparation

Answer 47

B
Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. Instructions to irrigate the colostomy will be done postoperatively. Oral antibiotics are given preoperatively, and an IV antibiotic may be used in the OR. A clear liquid diet will be used the day before surgery with the bowel cleansing.

Question 48

What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy?

A. How to care for the wound
B. How to deep breathe and cough
C. The location and care of drains after surgery
D. Which medications will be used during surgery

Answer 48

B
Because anesthesia, an abdominal incision, and pain can impair the patient’s respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

Question 49

The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician’s preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse?

A. Ask family members whether they have discussed the surgical procedure with the physician.
B. Have the patient sign the form and state the physician will visit to explain the procedure before surgery.
C. Explain the planned surgical procedure as well as possible and have the patient sign the consent form.
D. Delay the patient’s signature on the consent and notify the physician about the conversation with the patient

Answer 49

D
The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent.

Question 50

two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of

A. impaired peristalsis.
B. irritation of the bowel.
C. nasogastric suctioning.
D. inflammation of the incision site.

Answer 50

A
Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

Question 51

Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse?

A. Notify the physician.
B. Auscultate for bowel sounds.
C. Reposition the tube and check for placement.
D. Remove the tube and replace it with a new one.

Answer 51

C
The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

Question 52

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate?

A. “This will prevent air from accumulating in the stomach, causing gas pains.”
B. “This will prevent the heartburn that occurs as a side effect of general anesthesia.”
C. “The stress of surgery is likely to cause stomach bleeding if you do not receive it.”
D. “This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again

Answer 52

D
Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

Question 53

A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first?

A. Fecal impaction
B. Perineal hygiene
C. Dietary fiber intake
D. Antidiarrheal agent use

Answer 53

A
Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

Question 54

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn’s disease (select all that apply)?

A. Restricted to rectum
B. Strictures are common.
C. Bloody, diarrhea stools
D. Cramping abdominal pain
E. Lesions penetrate intestine.

Answer 54

C, D
Clinical manifestations of UC and Crohn’s disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn’s disease

Question 55

The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

A. The patient must be able to see the site.
B. Outside the rectus muscle area is the best site.
C. It is easier to seal the drainage bag to a protruding area.
D. The ostomy will need irrigation, so area should not be tender.

Answer 55

A
In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag.

Question 56

When evaluating the patient’s understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?

A. “I will be able to regulate when I have stools.”
B. “I will be able to wear the pouch until it leaks.”
C. “Dried fruit and popcorn must be chewed very well.”
D. “The drainage from my stoma can damage my skin.”

Answer 56

A
The ileostomy is in the ileum and drains liquid stool frequently, unlike the colostomy which has more formed stool the further distal the ostomy is in the colon. The ileostomy pouch is usually worn 4-7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

Question 57

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend?

A. White bread, cheese, and green beans
B. Fresh tomatoes, pears, and corn flakes
C. Oranges, baked potatoes, and raw carrots
D. Dried beans, All Bran (100%) cereal, and raspberries

Answer 57

D
A high fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

Question 58

The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to:
A. increased fluid intake
B. administer an antibiotic
C. administer antimotility drugs
D. quarantine the patient to prevent spread of the virus

Answer 58

a

Question 59

During the assessment of a patient with acute abdominal pain, the nurse should:
A. perform deep palpation before auscultation
B. obtain pulse rate and blood pressure to determine hypovolemic changes
C. auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus
D. measure body temperature because an elevated temp may indicate an inflammatory or infectious process

Answer 59

d

Question 60

The nurse would increase the comfort of a patient with appendicitis by:
A. having the patient lie prone
B. flexing the patient’s right knee
C. sitting the patient upright in a chair
D. turning the patient onto his left side

Answer 60

b

Question 61

In planning care for the patient with Crohn’s disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn’s disease is that Crohn’s disease:
A. frequently results in toxic megacolon
B. causes fewer nutritional deficiencies than does ulcerative colitis
C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy
D. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis

Answer 61

c

Question 62

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that a manifestation of an obstruction in the large intestine is (select all that apply):
A. a largely distended abdomen
B. diarrhea that is loose or liquid
C. persistent, colicky abdominal pain
D. profuse vomiting that relieves abdominal pain

Answer 62

a,c

Question 63

A patient with metastatic colorectal cancer is scheduled for both chemotherapy and radiation. Patient teaching regarding these therapies for this patient would include an explanation that:
A. chemotherapy can be used to cure colorectal cancer
B. radiation is commonly used as adjuvant therapy following surgery
C. both chemotherapy and radiation can be used as palliative treatments
D. the patient should expect few if any side effects from the chemotherapeutic agents

Answer 63

c

Question 64

The nurse explains to the patient undergoing ostomy surgery that the procedure that maintain the most normal functioning of the bowel is:
A. a sigmoid colostomy
B. a transverse colostomy
C. a descending colostomy
D. an ascending colostomy

Answer 64

a

Question 65

in contrast to diverticulitis, the patient with diverticulosis:
A. has rectal bleeding
B. often has no symptoms
C. has localized cramping pain
D. frequently develops peritonitis

Answer 65

b

Question 66

A nursing intervention that is most appropriate to decrease postoperative edema and pain following an inguinal herniorraphy is:
A. applying a truss to the hernia site
B. allowing the patient to stand to void
C. supporting the incision during coughing
D. applying a scrotal support with ice bag

Answer 66

d

Question 67

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu:
A. scrambled eggs and sausage
B. buckwheat pancake and syrup
C. oatmeal, skim milk, and OJ
D. yogurt, strawberries and rye toast with butter

Answer 67

a

Question 68

Which of the following should a patient be taught after a hemorrhoidectomy?
A. take mineral oil prior to bedtime
B eat a low fiber diet to rest the colon
C. administer oil retention enema to empty the colon
D. use prescribed pain medication before a bowel movement

Answer 68

d