MS2 - GI - Questions Flashcards
1
Q
True/False
PEG tube and radiologically placed placed gastronomy procedures have more risks than surgical placement.
A
False.
PEG and radiologically placed gastronomy tubes have less risks than surgical placement.
2
Q
Enteral feedings can be started within ___ to ___ hours after a surgically placed gastronomy or jejunostomy tube without waiting for flatus or a bowel movement.
- 12 to 24
- 24 to 72
- 24 to 48
- 48 to 72
A
- 24 to 48 hours
3
Q
PEG tube feeding can be started within ____ hour(s) of insertion (though may vary by institution policy).
- 1
- 2
- 4
- 8
A
- 2 hours
4
Q
A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to
a. sympathetic inhibition.
b. mixing and propulsion.
c. sympathetic stimulation.
d. parasympathetic stimulation.
A
d. parasympathetic stimulation.
Peristalsis is increased by parasympathetic stimulation.
5
Q
A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that
a. the gallbladder is unable to contract to release stored bile.
b. bilirubin is not being conjugated and excreted into the bile by the liver.
c. the Kupffer cells in the liver are unable to remove bilirubin from the blood.
d. there is an obstruction in the bilirary tract preventing flow of bile into the small intestine.
A
b. bilirubin is not being conjugated and excreted into the bile by the liver.
Bilirubin is a pigment derived from the breakdown of hemoglobin and is insoluble in water. Bilirubin is bound to albumin for transport to the liver and is referred to as unconjugated. An indirect bilirubin determination is a measurement of unconjugated bilirubin, and the level may be elevated in hepatocellular and hemolytic conditions.
6
Q
As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the
a. inhibition of secretin release.
b. release of bicarbonate by the pancreas.
c. release of pancreatic digestive enzymes.
d. release of gastrin by the duodenal mucosa.
A
b. release of bicarbonate by the pancreas.
The hormone secretin stimulates the pancreas to secrete fluid with a high concentration of bicarbonate. This alkaline secretion enters the duodenum and neutralizes acid in the chyme.
7
Q
A patient is jaundiced and her stools are clay colored (gray). This is most likely related to
a. decreased bile flow into the intestine.
b. increased production of urobilinogen.
c. increased production of cholecystokinin.
d. increased bile and bilirubin in the blood.
A
a. decreased bile flow into the intestine.
Bile is produced by the hepatocytes and is stored and concentrated in the gallbladder. When bile is released from the common bile duct, it enters the duodenum. In the intestines, bilirubin is reduced to stercobilinogen and urobilinogen by bacterial action. Stercobilinogen accounts for the brown color of stool. Stools may be clay-colored if bile is not released from the common bile duct into the duodenum. Jaundice may result if the bilirubin level in the blood is elevated.
8
Q
An 80-year-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse’s response is based on the knowledge that the older adult
a. should not experience changes in taste.
b. has a loss of taste buds, especially for sweet and salt.
c. has some lost of taste but no difficulty chewing food.
d. loses the sense of taste because the ability to smell is decreased.
A
b. has a loss of taste buds, especially for sweet and salt.
Older adults have decreased numbers of taste buds and a decreased sense of smell. These age-related changes diminish the sense of taste (especially of salty and sweet substances).
9
Q
When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is
a. “What is your usual bowel elimination pattern?”
b. “What percentage of your income is spent on food?”
c. “Have you traveled to a foreign country in the last year?”
d. “Do you have any diarrhea when you are under a lot of stress?”
A
c. “Have you traveled to a foreign country in the last year?”
When assessing gastrointestinal function in relation to the health perception–health management pattern, the nurse should ask the patient about recent foreign travel with possible exposure to hepatitis, parasitic infestation, or bacterial infection.
10
Q
During an examination of the abdomen the nurse should
a. position the patient in the supine position with the bed flat and knees straight.
b. listen in the epigastrum and all four quadrants for 2 minutes for bowel sounds.
c. use the following order of techniques: inspection, palpation, percussion, auscultation.
d. describe bowel sounds as absent if no sound is heard in the lower right quadrant after 2 minutes.
A
b. listen in the epigastrum and all four quadrants for 2 minutes for bowel sounds.
The nurse should listen in the epigastrium and all four quadrants for bowel sounds for at least 2 minutes. The patient should be in the supine position and should slightly flex the knees; the head of the bed should be raised slightly. During examination of the abdomen, the nurse auscultates before performing percussion and palpation because the latter procedures may alter the bowel sounds. Bowel sounds cannot be described as absent until no sound is heard for 5 minutes in each quadrant.
11
Q
A normal physical assessment finding of the GI system is/are (select all that apply)
a. nonpalpable liver and spleen.
b. borborygmi in upper right quadrant.
c. tympany on percussion of the abdomen.
d. liver edge 2 to 4 cm below the costal margin.
e. finding of a firm, nodular edge on the rectal examination.
A
a. nonpalpable liver and spleen.
c. tympany on percussion of the abdomen.
Normal assessment findings for the gastrointestinal system include a nonpalpable liver and spleen and generalized tympany on percussion. Normally, bowel sounds are high pitched and gurgling; loud gurgles indicate hyperperistalsis and are called borborygmi (stomach growling). If the patient has chronic obstructive pulmonary disease, large lungs, or a low-set diaphragm, the liver may be palpated 0.4 to 0.8 inch (1 to 2 cm) below the right costal margin. On palpation, the rectal wall should be soft and smooth and should have no nodules.
12
Q
In preparing a patient for a colonoscopy, the nurse explains that
a. a signed permit is not necessary.
b. sedation may be used during the procedure.
c. only one cleansing enema is necessary for the preparation.
d. a light meal should be eaten the day before the procedure.
A
b. sedation may be used during the procedure.
Sedation is induced during a colonoscopy. A signed consent form is necessary for a colonoscopy. A cathartic or enema is administered the night before the procedure, and more than one enema may be necessary. Patients may need to be kept on clear liquids 1 to 2 days before the procedure.
13
Q
An 85-year-old woman seen in the primary care provider’s office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause?
a. Anosmia
b. Xerostomia
c. Hypochlorhydria
d. Salivary gland tumor
A
b. Xerostomia
Xerostomia (decreased saliva production), or dry mouth, affects many older adults and may be associated with difficulty swallowing (dysphagia). Anosmia is loss of sense of smell. Hypochlorhydria, a decrease in stomach acid, does not affect swallowing. Salivary gland tumors are not common.
14
Q
The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity?
a. Nitroglycerin
b. Digoxin (Lanoxin)
c. Ciprofloxacin (Cipro)
d. Acetaminophen (Tylenol)
A
d. Acetaminophen (Tylenol)
Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) may be hepatotoxic.
15
Q
The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient?
a. Tympany to abdominal percussion
b. Aortic pulsation visible in epigastric region
c. High-pitched sounds on abdominal auscultation
d. Liver border palpable 1 cm below the right costal margin
A
c. High-pitched sounds on abdominal auscultation
The bowel sounds are more high pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. Bowel sounds may also be diminished or absent with an intestinal obstruction. Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.
16
Q
A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient’s health history and is most concerned if the patient makes which statement?
a. “I am allergic to bee stings.”
b. “My tongue swells when I eat shrimp.”
c. “I have had epigastric pain for 2 months.”
d. “I have a pacemaker because my heart rate was slow.”
A
b. “My tongue swells when I eat shrimp.”
The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium. Having a pacemaker will not affect the patient during this procedure. It would be expected that the patient would have some epigastric pain given the patient’s condition.
17
Q
A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately?
a. Fever and abdominal pain
b. Flatulence and liquid stool
c. Loudly audible bowel sounds
d. Sleepiness and abdominal cramps
A
a. Fever and abdominal pain
The patient should be taught to observe for signs of rectal bleeding and peritonitis. Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.
18
Q
Which statement regarding the factors responsible for the development of esophageal reflux disease is true?
A. Esophageal reflux occurs with decreased lower esophageal sphincter tone.
B. Esophageal reflux occurs with increased lower esophageal sphincter tone.
C. Esophageal reflux occurs when the lower esophageal sphincter tenses.
D. Esophageal reflux occurs with decreased intraabdominal pressure.
A
A. Esophageal reflux occurs with decreased lower esophageal sphincter tone.
Esophageal reflux can occur when intraabdominal pressure is elevated or when the sphincter tone of the LES is decreased.
19
Q
Which of the following clients is most at risk for gastroesophageal influx?
A. A client who drinks decaffeinated beverages
B. A client who has a nasogastric tube placed
C. A client taking oral hypoglycemic agents
D. A client who eats small, frequent meals
A
B. A client who has a nasogastric tube placed
A nasogastric tube keeps the cardiac sphincter open allowing acidic contents from the stomach to enter the esophagus.
20
Q
Which assessment should you perform for a client experiencing regurgitation?
A. Auscultation for crackles
B. Inspection of the oral cavity
C. Palpation of the cervical lymph nodes
D. Culture of the throat for bacterial infection
A
A. Auscultation for crackles
The client with regurgitation is at risk of aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for crackles, an indication of aspiration.
21
Q
You are preparing a teaching plan for a client with gastroesophageal reflux. Which of the following instructions should you include in a dietary guide for this client?
A. “Eat four to six small meals each day.”
B. “Eat a small evening snack 1 to 2 hours before bed.”
C. “Drink carbonated beverages between meals only.”
D. “You may include orange or tomato juice with your breakfast.”
A
A. “Eat four to six small meals each day.”
The client is instructed to eat four to six small meals rather than three larger meals to avoid pressure in the stomach and delayed gastric emptying, which can increase reflux. Evening snacks, carbonated beverages, and acidic foods also should be avoided.
22
Q
You are taking the history of a client with a sliding hernia. Which of the following symptoms should you inquire about in this client? A. Reflux B. Bleeding C. Dysphagia D. Early satiety
A
A. Reflux
Clients with sliding hernias often experience symptoms of reflux; therefore, this client should be evaluated for GERD.
23
Q
Which of the following statements made by the client indicates an understanding of the management of hiatal hernia?
A. “I will lie flat for 30 minutes after each meal.”
B. “I will remain upright for several hours after each meal.”
C. “I will have my blood count done in 2 weeks to check for anemia.”
D. “I will sleep at night lying on my left side to prevent nighttime reflux.”
A
B. “I will remain upright for several hours after each meal.”
Clients with a sliding hernia experience GERD, and positioning, for these clients, is an important intervention. The client should be taught to sleep with the head of the bed elevated, to remain upright after meals, and to avoid straining or restrictive clothing.
24
Q
A client who has undergone a fundoplication wrap for hernia repair has returned from the postanesthesia care unit with a nasogastric tube draining dark brown fluid. What is your best action at this time?
A. Notify the physician.
B. Document the finding as the only action.
C. Clamp the nasogastric tube for 30 minutes.
D. Irrigate the nasogastric tube with normal saline.
A
B. Document the finding as the only action.
After fundoplication, drainage from the nasogastric tube is initially dark brown with old blood. This finding is expected and requires only documentation. The drainage should become yellow-green within 8 hours after surgery.
25
```
You are collecting the initial history from a client with suspected esophageal cancer. What factor in this client's history increases the risk of developing esophageal cancer?
A. A high stress occupation
B. A preference for high-fat foods
C. A 20 pack-year smoking history
D. A history of myocardial infarction
```
C. A 20 pack-year smoking history
In the United States, the two most important factors in the development of esophageal cancer are tobacco use and alcohol ingestion.
26
Which nursing diagnosis would be considered a priority in planning the care of a client with esophageal cancer?
A. Imbalanced Nutrition: Less than Body Requirements
B. Anticipatory Grieving
C. Risk of Aspiration
D. Acute Pain
A. Imbalanced Nutrition: Less than Body Requirements
The priority for care of a client with esophageal cancer is Imbalanced Nutrition: Less than Body Requirements related to impaired swallowing. Fear of choking and inability to take adequate nutrition because of tumor obstruction contributes to weight loss.
27
A client with a gastric ulcer develops a sudden, sharp pain in the mid-epigastric region. Upon assessment, you note the abdomen is tender and rigid. What is your best first action?
A. Increase the IV fluid rate.
B. Notify the health care provider.
C. Place the client in a knee-chest position.
D. Prepare to administer an H2 antagonist.
B. Notify the health care provider.
A client with a gastric or duodenal ulcer who is presenting with sudden onset of sharp mid-epigastric pain and a tender and board-like abdomen has most likely developed perforation, a surgical emergency. Notify the health care provider immediately.
28
A client being treated for peptic ulcer disease reports drinking four cups of decaffeinated coffee each day. What is your best response?
A. “You may drink decaffeinated coffee only with meals.”
B. “You should avoid both caffeinated and decaffeinated coffee.”
C. “Drinking decaffeinated coffee is correct, but limit your intake to two cups per day.”
D. “You should drink coffee only within 1 hour of taking your antiulcer medication.”
B. “You should avoid both caffeinated and decaffeinated coffee.”
The client is instructed to eliminate both caffeinated and decaffeinated coffee because they contain peptides that stimulate gastrin release.
29
A client underwent a Billroth II procedure 1 week ago for the treatment of a duodenal ulcer. Which of the following clinical manifestations should alert you to the late manifestations of dumping syndrome?
A. Severe abdominal pain and a strong desire to defecate
B. Epigastric distention and abdominal cramping
C. Mouth dryness and palpitations
D. Dizziness and palpitations
D. Dizziness and palpitations
The late manifestations of dumping syndrome include dizziness, lightheadedness, palpitations, diaphoresis, and confusion occurring 90 minutes to 3 hours after eating.
30
Which statement made by the client indicates an understanding of dietary management for dumping syndrome?
A. “I will eat a low-fat, low-carbohydrate, high-protein diet.”
B. “I will eat a high-fat, high-carbohydrate, low-protein diet.”
C. “I will eat a high-fat, low-carbohydrate, high-protein diet.”
D. “I will eat a high-fat, high-carbohydrate, high-protein diet.”
C. “I will eat a high-fat, low-carbohydrate, high-protein diet.”
A high-fat, low-carbohydrate, high-protein diet is recommended, because decreasing the carbohydrate content of meals minimizes the early symptoms associated with the syndrome.
31
You are preparing a dietary guide for a client with irritable bowel syndrome. Which of the following meals is appropriate for this client?
A. Tuna salad on white bread and a diet cola
B. Grilled steak, green beans, dinner roll, and coffee
C. Broiled chicken, brown rice, salad, and a glass of water
D. Fried shrimps, salad, baked potato, and a glass of wine
C. Broiled chicken, brown rice, salad, and a glass of water
Clients with irritable bowel syndrome are advised to eat a high-fiber diet, with 8 to 10 cups of liquid daily. They should avoid alcohol, caffeine, and other gastric irritants.
32
Which client would be at highest risk for the development of colorectal cancer?
A. 55-year-old woman whose father was treated for colon cancer
B. 45-year-old woman with irritable bowel syndrome
C. 33-year-old man who drinks four cups of coffee daily
D. 70-year-old man with peptic ulcer disease
A. 55-year-old woman whose father was treated for colon cancer
Individuals with a first-degree relative diagnosed with colorectal cancer have a three- to fourfold risk of developing the disease. In addition, 95% of colorectal cancers are diagnosed in people over the age of 50.
33
Twenty-four hours after a client has had a hemicolectomy and temporary colostomy placement, you note the client's stoma to appear dry and dark red in color. What would be your best action?
A. Notify the surgeon.
B. Document the finding as the only action.
C. Place a colostomy pouch system over the stoma.
D. Place petroleum gauze dressing over the stoma.
A. Notify the surgeon.
The stoma should appear reddish pink and moist. If the stoma takes on a dark red or purple hue and becomes dry, firm, or flaccid, the stoma has signs of ischemia. The surgeon should be notified immediately.
34
What postoperative nursing intervention would be a priority for the client who has undergone an abdominal-perineal resection for a rectal tumor?
A. Monitoring of perineal wound drainage
B. Assisting the client with a bowel training program
C. Administering corticosteroids to prevent rectal itching
D. Providing a high-fiber diet to ease the passage of stools
A. Monitoring of perineal wound drainage
Monitoring of drainage from the perineal wound and cavity is of primary importance in detecting infection or abscess formation.
35
```
A client is brought to the emergency unit with a strangulated obstruction. What complication of this type of obstruction should you be alert for in this client?
A. Pulmonary edema
B. Bacterial peritonitis
C. Deep vein thrombosis
D. Acute tubular necrosis
```
B. Bacterial peritonitis
A strangulated obstruction compromises blood flow to the area. Bacteria in intestinal contents stagnate and form an endotoxin, which is released into the peritoneum and circulatory system causing septic shock.
36
A client is being treated for an intestinal obstruction with decompression with a Cantor tube. What nursing intervention would be indicated in the care of this client?
A. Reposition the client every 2 hours to assist with advancement of the tube.
B. Tape the Cantor tube to the client's nose to prevent dislodgement.
C. Instill normal saline into the Cantor tube to keep it patent.
D. Withdraw 10 mL of air if drainage from the tube stops.
A. Reposition the client every 2 hours to assist with advancement of the tube.
The Cantor tube has a mercury-filled tip. To assist in progression of the tube, the nurse repositions the client every 2 hours.
37
A client who underwent removal of a benign colonic polyp asks you why a follow-up colonoscopy is necessary. What would be your best response?
A. “You are at risk for developing more polyps in the future.”
B. “You may have other cancerous lesions that could not be seen right now.”
C. “A regular colonoscopy will prevent the development of malignant polyps.”
D. “This test will ensure healing has occurred where the polyp has been removed.”
A. “You are at risk for developing more polyps in the future.”
Once a person has developed a polyp, there is a risk of multiple polyps occurring.
38
```
You note that a client with extensive peritonitis has developed evidence of decreased circulatory volume. What physiologic parameter should you monitor as a result of this alteration?
A. Heart rate
B. Urine output
C. Pedal pulses
D. Temperature
```
B. Urine output
Decreased circulatory volume is the result of the shunting of fluid from the vascular space into the peritoneal cavity, GI tract, and connective tissue resulting in insufficient kidney perfusion and a low urine output.
39
What statement regarding the symptoms of ulcerative colitis is true?
A. The client may have 5 to 6 soft stools per day.
B. The client may have 10 to 20 steatorrheal stools per day.
C. The client may have 10 to 20 liquid, bloody stools per day.
D. The client may have abdominal pain, but stool appearance is normal.
C. The client may have 10 to 20 liquid, bloody stools per day.
Ulcerative colitis is characterized by 10 to 20 liquid, bloody stools per day. The colon appears red and hemorrhagic.
40
A client with an exacerbation of ulcerative colitis has been placed on total parenteral nutrition (TPN). The client asks you why foods or fluids may not be given by mouth. What is your best response?
A. “TPN contains a high percentage of glucose that is more readily absorbed in the bloodstream than in the ulcerated colon.”
B. “TPN will be given in addition to your meals to help you gain any weight that you may have lost through diarrhea.”
C. “TPN is considered an elemental formula and, as such, is easier to digest.”
D. “TPN will be given during this period to allow your bowel to rest.”
D. “TPN will be given during this period to allow your bowel to rest.”
Bowel rest during severe exacerbations of ulcerative colitis is part of the nonsurgical management of the disease.
41
You are performing the initial postoperative assessment of a client with ulcerative colitis who has undergone a total proctocolectomy with placement of a permanent ileostomy. You note the drainage from the ileostomy appears loose, dark green in color, and contains some blood. What would be your best action?
A. Notify the physician.
B. Document the finding as the only action.
C. Irrigate the ileostomy.
D. Send a stool sample for culture and sensitivity.
B. Document the finding as the only action.
The initial drainage from the ileostomy appears loose, dark green, and may contain some blood. The nurse should document this normal finding. The stool consistency and color will change over time to a yellow-green or brown.
42
```
Which of the following is a complication of Crohn's disease?
A. Arthritis
B. Weight gain
C. Fistula formation
D. Gastrointestinal tuberculosis
```
C. Fistula formation
Complications of Crohn's disease are fistulas, hemorrhage, and obstruction.
43
An older adult client with diverticulitis is being prepared for discharge. Which of the following statements made by the client indicates a need for further teaching?
A. ” I will avoid straining when bending.”
B. “I will use a laxative to avoid constipation.”
C. “I will increase the amount of fiber in my diet.”
D. “I will notify the doctor if I notice blood in my stools.”
B. “I will use a laxative to avoid constipation.”
Laxatives and enemas increase intraluminal pressure and are therefore discouraged.
44
The nurse is planning to teach a client with gastroesophageal reflux disease about substances to avoid. Which items should the nurse include on the list? Select all that apply.
1. Coffee
2. Chocolate
3. Peppermint
4. Nonfat milk
5. Fried chicken
6. Scrambled eggs
1. Coffee
2. Chocolate
3. Peppermint
5. Fried chicken
Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of gastroesophageal reflux disease (GERD) and therefore should be avoided. Aggravating substances include chocolate, coffee, fried or fatty foods, peppermint, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect.
45
A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex
4. Assessing for the return of the gag reflex
The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also important; however, the client's airway is the priority.
46
The nurse is planning care for a client scheduled for esophagogastroduodenoscopy (EGD) and a barium swallow. What will the nursing care plan include?
1. Anticipating the client will receive a clear liquid diet in the evening and then nothing by mouth (NPO status) 6 to 12 hours before the test.
2. Discussing with the client the NG tube and the importance of gastric drainage for 24 hours after the test.
3. Explaining to the client that he will receive nothing by mouth (NPO status) for 24 hours after the test to make sure his stomach can tolerate food.
4. Discussing the general anesthesia and explaining to the client that he will wake up in the recovery room.
1. Anticipating the client will receive a clear liquid diet in the evening and then nothing by mouth (NPO status) 6 to 12 hours before the test.
NPO status before a barium swallow and a esophagogastrodudenoscopy (EGD) and a clear liquid diet the evening before the procedures are routine orders for these tests. There is no general anesthesia. The client can eat or drink as tolerated after procedure, and there is no routine placement of NG tubes.
47
You are preparing to administer TPN through a central line. Place the following steps for administration in the correct order.
Use aseptic technique when handling the injection cap.
Thread the IV tubing through an infusion pump.
Check the solution for cloudiness or turbidity.
Connect the tubing to the central line.
Select and flush the correct tubing and filter.
Set the infusion pump at the prescribed rate.
Confirm the order for TPN prior to administration.
1. Confirm the order for TPN prior to administration.
2. Check the solution for cloudiness or turbidity.
3. Select and flush the correct tubing and filter.
4. Thread the IV tubing through an infusion pump.
5. Use aseptic technique when handling the injection cap.
6. Connect the tubing to the central line.
7. Set the infusion pump at the prescribed rate.
Rationale:
Always check the order before administering TPN; generally, each bag is individually prepared by the pharmacist. The solution should not be cloudy or turbid. Prepare the equipment by priming the tubing and threading the pump. To prevent infection, scrub the hub and use aseptic technique when inserting the connector into the injection cap and connecting the tubing to the central line. Set the pump at the prescribed rate.
48
You are caring for a client with peptic ulcer disease. Which assessment finding is the most serious?
1. Projectile vomiting
2. Burning sensation 2 hours after eating
3. Coffee-ground emesis
4. Boardlike abdomen with shoulder pain
4. Boardlike abdomen with shoulder pain
Rationale:
A boardlike abdomen with shoulder pain is a symptom of a perforation, which is the most lethal complication of peptic ulcer disease. A burning sensation is a typical complaint and can be controlled with medications. Projectile vomiting can signal an obstruction. Coffee-ground emesis is typical of slower bleeding, and the client will require diagnostic testing.
49
You are providing immediate postoperative care for a client who had fundoplication to reinforce the lower esophageal sphincter for the purpose of a hiatal hernia repair. What is the priority action for the care of this client?
1. Elevate the head of the bed at least 30 degrees.
2. Assess the nasogastric tube for yellowish-green drainage.
3. Assist the client to start taking a clear liquid diet.
4. Assess the client for gas bloat syndrome.
1. Elevate the head of the bed at least 30 degrees.
Rationale:
The primary concern is the potential for airway complications. Elevating the head, at least 30 degrees, decreases the chance for aspiration and facilitates respiratory effort. The other options are also correct, but will occur later in the postoperative period.
50
A client hospitalized with ulcerative colitis reports 10 to 20 small diarrhea stools per day, with abdominal pain before defecation. The client appears depressed and underweight and is uninterested in self-care or suggested therapies. What is the priority nursing diagnosis?
1. Diarrhea related to irritated bowel
2. Imbalanced Nutrition: Less Than Body Requirements related to nutrient loss
3. Acute Pain related to increased GI motility
4. Ineffective Self-Health Management related to treatment plan
1. Diarrhea related to irritated bowel
Rationale:
The immediate problem is controlling the diarrhea. Addressing this problem is a step toward correcting the nutritional imbalance and decreasing the diarrheal cramping. Self-care and compliance with the treatment plan are important long-term goals that can be addressed when the client is feeling better physically.
51
The emergency department nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem?
1. Hepatic cirrhosis
2. Hypersplenomegaly
3. Gall bladder distention
4. Peritoneal inflammation
4. Peritoneal inflammation
When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness.
Text Reference - p. 875
52
A nurse assesses an elderly patient with colon cancer. The patient experiences much difficulty when moving and requires assistance with turning and ambulating. Which diagnostic test is appropriate to perform first?
1. Virtual colonoscopy
2. Conventional colonoscopy
3. Lower GI series examination
4. Endoscopic retrograde cholangiopancreatography
1. Virtual colonoscopy
Virtual colonoscopy should be the first diagnostic test for the patient as it is less invasive and provides a better view of the colon and rectum. It helps in detecting any polyps or tumors inside the colon. However, this technique is less sensitive and cannot detect flat or small (less than 10 mm) polyps. This procedure should be followed by conventional colonoscopy to obtain a biopsy and to remove the tumor. A lower GI series examination involves injection of air-contrast barium enema and is unsuitable for elderly patients, as they cannot retain the barium and may feel discomfort during the examination. However, if necessary, this test could be performed with extra care. Upper GI examination detects the structural abnormalities of the upper GI tract. Endoscopic retrograde cholangiopancreatography is used to examine the biliary and pancreatic ductal systems.
Text Reference - p. 882
53
M.J. calls to tell the nurse that her 85-year old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the health care provider, she instruct M.J. to
a. Administer antispasmodic drugs and observe skin turgor
b. Give her mother sips of water and elevate the head of her bed to prevent aspiration
c. Offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs
d. Offer her mother large quantities of Gatorade to drink because older adults are at risk needs for sodium depletion
b. Give her mother sips of water and elevate the head of her bed to prevent aspiration
Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. The elderly are particularly susceptible to the central nervous system (CNS) side effects of antiemetic drugs; these drugs may produce confusion. Dosages should be reduced and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances.
High-protein drinks or high-sodium liquids may be contraindicated.
54
The nurse explains to the patient with Vincent’s infection that treatment will include
a. Smallpox vaccinations
b. Viscous lidocaine rinses
c. Amphotericin B suspension
d. Topical application of antibiotics
d. Topical application of antibiotics
Vincent’s infection is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoidance of tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.
55
The nurse teaching young adults about behaviors that put the at risk for oral cancer includes
a. Discouraging use of chewing gum
b. Avoiding use of perfumed lip gloss
c. Avoiding use of smokeless tobacco
d. Discouraging drinking of carbonated beverages
c. Avoiding use of smokeless tobacco
Oral cancer has several predisposing risks factors:
• Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression
* Tongue: tobacco, alcohol, chronic irritation, and syphilis
* Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection)
56
The nurse explains to the patient with GERD that this disorder
a. Results in acid erosion of the esophagus from frequent vomiting
b. Will require surgical wrapping or repair of the pyloric sphincter to control the symptoms
c. Is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm
d. Often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus
d. Often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus
Gastroesophageal reflux disease (GERD) results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux.
57
A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of
a. An intolerance to the feedings
b. Extension of the tumor into the aorta
c. Leakage of fluid or foods into the mediastinum
d. Esophageal perforation with fistula formation into the lung
c. Leakage of fluid or foods into the mediastinum
After esophageal surgery, the nurse should observe the patient for signs of leakage from the feeding tube into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.
58
The pernicious anemia that may accompany gastritis is due to
a. Chronic autoimmune destruction of cobalamin stores in the body
b. Progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss
c. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa
d. Hyperchlorhydria resulting from an increase in acid-secreting parietal cells and mucosa degradation of RBCs
c. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa
Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lost; the loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body’s storage of cobalamin is depleted, and a deficiency state exists. Because cobalamin is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications.
59
The nurse is teaching the patient and family that peptic ulcers are
a. Caused by a stressful lifestyle and other acid-producing factors such as H. Pylori
b. Inherited within families and reinforced by bacterial spread of staphylococcus aureus in
c. Promoted by factors that tend to cause over secretion of acid such as excess dietary
d. Promoted by a combination of factors that may result in erosion of the gastric childhood fats, smoking, and H. pylori mucosa, including certain drugs and alcohol
d. Promoted by a combination of factors that may result in erosion of the gastric childhood fats, smoking, and H. pylori mucosa, including certain drugs and alcohol
Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin.
A variety of agents (certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. The response to H. pylori is probably influenced by a variety of factors, including genetics, environment, and diet.
Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients taking corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors (e.g., fluoxetine [Prozac]) are also at increased risk for ulcers.
High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion. Psychologic distress, including stress and depression, can hamper the healing of ulcers after they have developed. Smoking also delays ulcer healing. In addition, infection with herpes and cytomegalovirus (CMV) in immunocompromised patients may lead to gastric ulcers.
60
An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about
a. Cancer support groups, alopecia, and stomatitis
b. Avitaminosis, ostomy care, and community resources
c. Prosthetic devices, skin conductance, and grief counseling
d. Wound and skin care, nutrition, drugs and community resources
d. Wound and skin care, nutrition, drugs and community resources
Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse’s role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient’s knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.
61
The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply)
a. Only taking aspirin with milk or bread products
b. Avoiding taking aspirin and drugs containing aspirin
c. Only taking drugs prescribed by the health care provider
d. Taking all drugs 1 hour before mealtime to prevent further bleeding
e. Reading all OTC drug labels to avoid those containing stearic acid and calcium
b. Avoiding taking aspirin and drugs containing aspirin
c. Only taking drugs prescribed by the health care provider
Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease, drug or alcohol abuse, and liver and respiratory diseases can cause upper GI bleeding. Help make the patient and caregiver aware of the consequences of noncompliance with drug therapy. Emphasize that no drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the health care provider should be taken. Smoking and alcohol should be eliminated because they are sources of irritation and interfere with tissue repair.
62
Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing
a. Beef
b. Meat and milk
c. Poultry and eggs
d. Home-preserved vegetables
b. Meat and milk
Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.
63
The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to
a. Increase fluid intake
b. Administer an antibiotic
c. Administer antimotility drugs
d. Quarantine the patient to prevent spread of the virus
a. Increase fluid intake
Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting. The major concerns are transmission prevention, fluid and electrolyte placement, and resolution of the diarrhea.
Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, hands should be washed before and after contact with the patient and when body fluids of any kind are handled. Vomitus and stool should be flushed down the toilet, and contaminated clothing should be washed immediately with soap and hot water.
64
When a 35-year old female patient is admitted to the emergency department with acute abdominal pain, which possible diagnosis should you consider that may be the cause of her pain (select all that apply)
a. Gastroenteritis
b. Ectopic pregnancy
c. Gastrointestinal bleeding
d. Irritable bowel syndrome
e. Inflammatory bowel disease
a. Gastroenteritis
b. Ectopic pregnancy
c. Gastrointestinal bleeding
d. Irritable bowel syndrome
e. Inflammatory bowel disease
All these conditions could cause acute abdominal pain.
65
Assessment findings suggestive of peritonitis include
a. Rebound abdominal pain
b. A soft, distended abdomen
c. Dull, continuous abdominal pain
d. Observing that the patient is restless
a. Rebound abdominal pain
With peritoneal irritation, the abdomen is hard, like a board, and the patient has severe abdominal pain that is worse with any sudden movement. The patient lies very still. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness
66
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 ulcerative colitis
c. Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy
d. Is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis
c. Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy
Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn’s disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.
67
The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply)
a. Persistent abdominal pain
b. Marked abdominal distention
c. Diarrhea that is loos or liquid
d. Colicky, severe, intermittent pain
e. Profuse vomiting that relieves abdominal pain
a. Persistent abdominal pain
b. Marked abdominal distention
With lower intestinal obstructions, abdominal distention is markedly increased and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation, not diarrhea.
68
A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that
a. Chemotherapy will begin after the patient recovers from the surgery
b. Both chemotherapy and radiation can be used as palliative treatments
c. Follow-up colonoscopies will be needed to ensure that the cancer does not recur
d. A wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy
c. Follow-up colonoscopies will be needed to ensure that the cancer does not recur
Stage 1 colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.
69
The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most formal functioning of the bowel is
a. A sigmoid colostomy
b. A transverse colostomy
c. A descending colostomy
d. An ascending colostomy
a. A sigmoid colostomy
The more distal the ostomy is, the more the intestinal contents resemble feces eliminated from an intact colon and rectum. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear a collection bag.
70
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
b. Often has no symptoms
Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.
71
A nursing intervention that is most appropriate to decrease post-operative edema and pain after an inguinal herniorrhaphy 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
d. Applying a scrotal support with ice bag
Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.
72
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 pancakes with syrup
c. Oatmeal, skim milk, and orange juice
d. Yogurt, strawberries, and rye toast with butter
a. Scrambled eggs and sausage
Celiac disease is treated with lifelong avoidance of dietary gluten. Wheat, barley, oats, and rye products must be avoided. Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is also found in some medications and in many food additives, preservatives, and stabilizers.
73
What should a patient be taught after a hemorrhoidectomy
a. Take mineral oil before 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
d. Use prescribed pain medication before a bowel movement
After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Pain medication may be given before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-retention enema is administered.
74
The nurse is performing a physical examination on a client. Which assessment finding leads the nurse to check the client's abdomen for the presence of an acquired umbilical hernia?
a. Body mass index (BMI) of 41.9
b. Cholecystectomy last year
c. History of irritable bowel syndrome
d. Daily dose of lansoprazole (Prevacid) 30 mg orally
a. Body mass index (BMI) of 41.9
This type of hernia is associated with obesity. The other assessment findings do not place the client at increased risk for an acquired umbilical hernia.
75
The nurse notes a bulge in a client's groin that is present when the client stands and disappears when the client lies down. Which conclusion does the nurse draw from these assessment findings?
a. Reducible inguinal hernia
b. Indirect umbilical hernia
c. Strangulated ventral hernia
d. Incarcerated femoral hernia
a. Reducible inguinal hernia
In a reducible hernia, the contents of the hernial sac can be replaced into the abdominal cavity by gentle pressure or by lying flat. The contents of irreducible, strangulated, or incarcerated hernias may not be replaced into the abdomen when the client lies down.
76
The nurse is caring for a client with an umbilical hernia who reports increased abdominal pain, nausea, and vomiting. The nurse notes high-pitched bowel sounds. Which conclusion does the nurse draw from these assessment findings?
a. Bowel obstruction; client should be placed on NPO status.
b. Perforation of the bowel; client needs emergency surgery.
c. Adhesions in the hernia; client needs elective surgery.
d. Hernia is dangerously enlarged; client needs a nasogastric (NG) tube.
a. Bowel obstruction; client should be placed on NPO status.
The client with a hernia presenting with abdominal pain, fever, tachycardia, nausea and vomiting, and hypoactive bowel sounds should be suspected of having developed strangulation. Strangulation poses a risk of intestinal obstruction. The client should be placed on NPO status, and the health care provider should be notified. The symptoms are not suggestive of enlargement of the hernia, adhesion formation, or bowel perforation.
77
The nurse is teaching a client how to use a truss for a femoral hernia. Which statement by the client indicates the need for further teaching?
a. "I will put on the truss before I go to bed each night."
b. "I will put some powder under the truss to avoid skin irritation."
c. "The truss will help my hernia because I can't have surgery."
d. "If I have abdominal pain, I will let my health care provider know right away."
a. "I will put on the truss before I go to bed each night."
The client is instructed to apply the truss before arising, not before going to bed at night. The other statements show accurate knowledge in using a truss.
78
The nurse is providing preoperative teaching for a client who will undergo herniorrhaphy surgery. Which instruction does the nurse give to the client?
a. "Eat a low-residue diet for the first week after surgery."
b. "Change the dressing every day until the staples are removed."
c. "Take acetaminophen (Tylenol) 1000 mg every 4 hours for pain."
d. "Cough and deep breathe every 2 hours for the first week after surgery."
b. "Change the dressing every day until the staples are removed."
until the staples are removed, so the client can check the incision for signs of infection. Constipation is common following hernia surgery, so clients should include adequate amounts of fiber in the diet. The maximum daily dosage of Tylenol is 4000 mg. Taking 1000 mg of Tylenol every 4 hours means that intake is 6000 mg/day, which could cause toxicity and liver damage. The client should change positions and take deep breaths to facilitate lung expansion but should avoid coughing, which can place stress on the incision line.
79
The nurse is performing a physical assessment for a client who underwent a hemorrhoidectomy the previous day. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which is the nurse's priority action?
a. Assess the client's vital signs.
b. Determine the last time the client voided.
c. Insert a rectal tube to facilitate passage of flatus.
d. Document the findings in the client's chart.
b. Determine the last time the client voided.
Assessment findings indicate that the client may have an overfull bladder. In the immediate postoperative period, the client may experience difficulty voiding owing to urinary retention. A rectal tube should not be inserted for a client who had a hemorrhoidectomy the previous day. The client's vital signs may be checked after the nurse determines the client's last void. The nurse should document all findings and actions in the client's medical record.
80
The nurse is screening clients at a community health fair. Which client is at highest risk for development of colorectal cancer?
a. Young adult who drinks eight cups of coffee every day
b. Middle-aged client with a history of irritable bowel syndrome
c. Older client with a BMI of 19.2 who works 65 hours per week
d. Older client who travels extensively and eats fast food frequently
d. Older client who travels extensively and eats fast food frequently
Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Irritable bowel syndrome, a heavy workload, and coffee intake do not increase the risk for colon cancer. A BMI of 19.2 is within normal limits.
81
The nurse is performing a physical assessment of a client with a new diagnosis of colorectal cancer. The nurse notes the presence of visible peristaltic waves and, on auscultation, hears high-pitched bowel sounds. Which conclusion does the nurse draw from these findings?
a. The tumor has metastasized to the liver and biliary tract.
b. The tumor has caused an intussusception of the intestine.
c. The growing tumor has caused a partial bowel obstruction.
d. The client has developed toxic megacolon from the growing tumor.
c. The growing tumor has caused a partial bowel obstruction.
The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. Assessment findings do not indicate metastasis to the liver, intussusception of the intestine, or toxic megacolon.
82
The nurse is caring for a client who is scheduled to have fecal occult blood testing. Which instructions does the nurse give to the client?
a. "You must fast for 12 hours before the test."
b. "You will be given a cleansing enema the morning of the test."
c. "You must avoid eating meat for 48 hours before the test."
d. "You will be sedated and will require someone to accompany you home."
c. "You must avoid eating meat for 48 hours before the test."
The client is instructed to avoid meat, aspirin, vitamin C, and anti-inflammatory drugs for 48 hours before the test. The other directions are not accurate for this test.
83
A client who has had fecal occult blood testing tells the nurse that the test was negative for colon cancer and wishes to cancel a colonoscopy scheduled for the next day. Which is the nurse's best response?
a. "I will call and cancel the test for tomorrow."
b. "You need two negative fecal occult blood tests."
c. "This does not rule out the possibility of colon cancer."
d. "You should wait at least a week to have the colonoscopy."
c. "This does not rule out the possibility of colon cancer."
A negative result does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed, so the entire colon can be visualized and a tissue sample taken for biopsy. The client need not wait a week before the colonoscopy. Two negative fecal occult blood tests do not rule out the presence of colorectal cancer (CRC).
84
The nurse is caring for a client who has been newly diagnosed with colon cancer. The client has become withdrawn from family members. Which strategy does the nurse use to assist the client at this time?
a. Ask the health care provider for a psychiatric consult for the client.
b. Explain the improved prognosis for colon cancer with new treatment.
c. Encourage the client to verbalize feelings about the diagnosis.
d. Allow the client to remain withdrawn as long as he or she wishes.
c. Encourage the client to verbalize feelings about the diagnosis.
The nurse recognizes that the client may be expressing feelings of grief. The nurse should encourage the client to verbalize feelings and identify fears to move the client through the phases of the grief process. A psychiatric consult is not appropriate for the client. The nurse should not brush aside the client's feelings with a generalization about cancer prognosis and treatment. The nurse should not ignore the client's withdrawal behavior.
85
When assessing a patient's abdomen, what would be most appropriate for the nurse to do?
a. Palpate the abdomen before auscultation.
b. Percuss the abdomen before auscultation.
c. Auscultate the abdomen before palpation.
d. Perform deep palpation before light palpation.
c. Auscultate the abdomen before palpation.
During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.
86
When preparing a patient for a capsule endoscopy study, what should the nurse do?
a. Ensure the patient understands the required bowel preparation.
b. Have the patient return to the procedure room for removal of the capsule.
c. Teach the patient to maintain a clear liquid diet throughout the procedure.
d. Explain to the patient that conscious sedation will be used during placement of the capsule.
a. Ensure the patient understands the required bowel preparation.
A capsule endoscopy study involves the patient performing a bowel prep to cleanse the bowel before swallowing the capsule. The patient will be on a clear liquid diet for 1 to 2 days before the procedure and will remain NPO for 4 to 6 hours after swallowing the capsule. The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed.
87
The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis?
a. Gastric pH
b. Blood glucose
c. Serum amylase
d. Serum potassium
c. Serum amylase
Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction.
88
The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen?
a. Left lower quadrant
b. Left upper quadrant
c. Right lower quadrant
d. Right upper quadrant
d. Right upper quadrant
Although the left lobe of the liver is located in the left upper quadrant of the abdomen, the bulk of the liver is located in the right upper quadrant.
89
A patient had a stomach resection for stomach cancer. The nurse should teach the patient about the loss of the hormone that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Which hormone will be decreased with a gastric resection?
a. Gastrin
b. Secretin
c. Cholecystokinin
d. Gastric inhibitory peptide
a. Gastrin
Gastrin is the hormone activated in the stomach (and duodenal mucosa) by stomach distention that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Secretin inhibits gastric motility and acid secretion and stimulates pancreatic bicarbonate secretion. Cholecystokinin allows increased flow of bile into the duodenum and release of pancreatic digestive enzymes. Gastric inhibitory peptide inhibits gastric acid secretion and motility.
90
The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a
a. colectomy
b. cholecystectomy
c. choledocholithotomy
d. choledochojejunostomy
c. choledocholithotomy
A choledocholithotomy is an opening into the common bile duct for the removal of stones. A colectomy is the removal of the colon. The cholecystectomy is the removal of the gallbladder. The choledochojejunostomy is an opening between the common bile duct and the jejunum.
91
The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem?
a. Hepatic cirrhosis
b. Hypersplenomegaly
c. Gall bladder distention
d. Peritoneal inflammation
d. Peritoneal inflammation
When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness.
92
A patient who is scheduled for surgery with general anesthesia in 1 hour is observed with a moist, but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water?
a. Flat abdomen without movement upon inspection
b. Tenderness at left upper quadrant upon palpation
c. Easily heard, loud gurgling in the right upper quadrant
d. High-pitched, hollow sounds in the left upper quadrant
c. Easily heard, loud gurgling in the right upper quadrant
If the patient drank water on an empty stomach, gurgling can be assessed without a stethoscope or assessed with auscultation. High-pitched, hollow sounds are tympanic and indicate an empty cavity. A flat abdomen and tenderness do not indicate that the patient drank a glass of water.
93
When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status?
a. Ingestion
b. Digestion
c. Absorption
d. Elimination
c. Absorption
Substances that interface with the absorptive surfaces of the GI tract (primarily in the small intestine) diffuse across the intestinal membranes into intestinal capillaries and are then carried to other parts of the body for use in energy production. The cardiac output provides the blood flow for this absorption of nutrients to occur.
94
The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take?
a. Administer the medication subcutaneously for fast absorption.
b. Administer the medication into an arterial line to prevent extravasation.
c. Administer the medication deep into the muscle to prevent tissue damage.
d. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.
c. Administer the medication deep into the muscle to prevent tissue damage.
Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.
95
A 74-year-old female patient with gastroesophageal reflux disease (GERD) takes over-the-counter medications. For which medication, if taken long-term, should the nurse teach about an increased risk of fractures?
a. Sucralfate (Carafate)
b. Cimetidine (Tagamet)
c. Omeprazole (Prilosec)
d. Metoclopramide (Reglan)
c. Omeprazole (Prilosec)
There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. Lower doses or shorter duration of therapy should be considered.
96
The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved?
a. Diarrhea
b. Heartburn
c. Constipation
d. Lower abdominal pain
b. Heartburn
Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.
97
The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved?
a. Nausea
b. Belching
c. Epigastric pain
d. Difficulty swallowing
c. Epigastric pain
Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.
98
A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?
a. Providing IV fluids and inserting a nasogastric (NG) tube
b. Administering oral bicarbonate and testing the patient's gastric pH level
c. Performing a fecal occult blood test and administering IV calcium gluconate
d. Starting parenteral nutrition and placing the patient in a high-Fowler's position
a. Providing IV fluids and inserting a nasogastric (NG) tube
A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.
99
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis?
a. "You'll need to drink at least two to three glasses of milk daily."
b. "It would likely be beneficial for you to eliminate drinking alcohol."
c. "Many people find that a minced or pureed diet eases their symptoms of PUD."
d. "Your medications should allow you to maintain your present diet while minimizing symptoms."
b. "It would likely be beneficial for you to eliminate drinking alcohol."
Alcohol increases the amount of stomach acid produced so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.
100
A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing?
a. Keep the patient NPO.
b. Put the bed in the Trendelenberg position.
c. Have the patient eat 4 to 6 smaller meals each day.
d. Give various antacids to determine which one works for the patient.
c. Have the patient eat 4 to 6 smaller meals each day.
Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.
