Practice Test Questions Flashcards

Question

Ensuring that a patient has given informed consent and understands his or her rights and all of the risks and benefits of a procedure or treatment supports which of the following ethical principles 1. Beneficence 2. Nonmaleficence 3. Justice 4. Autonomy

Answer 1

4 Autonomy is the ethical principle that the individual has the right to make decisions about his/her own care, based on informed consent and understanding of risks and benefits. Beneficence is an ethical principle that involves performing actions that are for the purpose of benefiting another person. Nonmaleficence is an ethical principle hat means healthcare workers should provide care in a manner that does not cause direct intentional harm to the patient. Justice is the ethical principle that relates to the distribution of the limited resources of healthcare benefits to the members of society

Answer 2

1 If a patient with inflammatory bowel disease (IBD) has bouts of severe diarrhea but is unsure of the cause, the nurse should advise the patient to maintain a food diary, writing down all food and fluid intake to see if a pattern emerges. While many patients with IBD are lactose intolerant, testing can show if this is the problem. Increasing fat or fiber in the diet may aggravate the diarrhea

Answer 3

4 Absorption of nutrients from the small bowel is often impaired in older adults because of broadening and shortening of villi, which decreases the surface area available. Additionally, levels of some enzymes decrease. For example, lactase levels may fall, and this can cause increased lactose intolerance. When fecal material moves slowly through the bowel, bacterial overgrowth may occur, and this can affect absorption of nutrients because the bacteria require nutrients and can also cause diarrhea, which interferes with absorption

Answer 4

2 If a 72-year-old patient has polyps removed, the type of polyp that is precancerous is the adenomatous polyp, which can include tubular adenomas, tubular villous adenoma, and villous adenoma. Polyps associated with hereditary polyposis syndromes (familial adenomatous polyposis) are also precancerous. Patients with precancerous polyps are generally advised to have routine follow-up colonoscopies every 3 years because of increased risk of colon cancer

Answer 5

3 The nurse is educating a patient who is to be discharged after surgery to remove a cancerous lesion of the colon and create a colostomy. The nurse advises the patient that some foods may cause - Odor: fish, eggs, onions, broccoli, asparagus and cabbage - Gas: beans, carbonated beverages, strong cheese, bear and sprouts - Diarrhea: beer, green beans, coffee, raw fruits, spicy foods, and spinach - Obstruction: popcorn, seeds, raw vegetables, nuts and corn

Answer 6

1 If, following a colonoscopy with removal of polyps, a patient developed abdominal pain with elevated temperature, WBC count, and C-reactive protein, the patient should have an abdominal CT to differentiate between thermal injury causing perforation and one causing post-polypectomy electrocoagulation syndrome (transmural burn without perforation). Symptoms for both are similar initially, but post-polypectomy electrocoagulation syndrome heals with conservative treatment while perforation requires surgical repair

Answer 7

4 If a patient develops an infection with a multi-drug resistant organism (MDRO), the nurse anticipates that the patient’s history will show previous antibiotic use as this is a factor in almost all cases. Other risk factors include prolonged hospitalization and intraabdominal surgery. MDRO infections are increasingly resistant to 2 or more antibiotics, including vancomycin. Restriction of vancomycin use alone has not proven successful in controlling development of MDRO because multiple other antibiotics are implicated

Answer 8

3 The standard triple therapy for H. Pylori- associated peptic ulcer disease include a proton pump inhibitor BID, Clarithromycin 500mg BID and amoxicillin 1g BID. Metronidazole 500mg BID may be substituted for amoxicillin for those with penicillin allergy. Treatment is usually continued for 10 to 14 days. Using two antibiotics is especially important because of increasing resistant strains. The standard triple therapy is most commonly utilized, but a standard quadruple therapy and sequential quadruple therapy may also be considered

Answer 9

1 When lifting an item, the muscles in the legs should be used. The nurse should stand close to the item or person being lifted and use the leg muscles to support weight rather than the arms or back and should stoop down rather than bending over. If items or people are heavy, then lift devices should be used rather than lifting manually. If items are up high, the nurse should avoid stretching but should use a step stool or gripping device to reach the item

Answer 10

2 When palpating a patient’s abdomen, a positive Murphy’s sign (sudden holding of breath with RUQ palpation) indicates cholecystitis. Murthy’s sign is usually negative with choledocholithiasis although Cholecystitis is most often caused by gallstones that obstruct the flow of bile, causing the gallbladder to swell and become inflamed. However, Cholecystitis may also result from tumors or impaired circulation (common with diabetics) . Typical symptoms include nausea and vomiting and severe middle or RUQ abdominal pain

Answer 11

3 If a patient is receiving methotrexate for maintenance treatment of Crohn’s disease, laboratory tests that should be routinely monitored include the CBC and renal (creatinine and BUN) and liver function tests. FDA guidelines advise testing at least every 1 to 2 months during therapy, but some authorities recommend testing every 2 to 4 weeks during the first few months of treatment. Adverse effects of methotrexate include renal failure, portal fibrosis, myelosuppression, headache and rash

Answer 12

2 If a patient presents with symptoms consistent with diverticulosis, the imaging technique that will likely be used to confirm the diagnosis is colonoscopy, which allows biopsy to rule out other disorders and allows visualization of involvement. Ultrasound shows non-specific abnormalities and cannot conclusively diagnose diverticulitis, colonic contrast studies, such as barium enema, have limited value because most diverticula are extraluminal, and it increases the risk of perforation if peritoneal irritation is present.

Answer 13

1 The primary tests that screen for hepatitis include alanine transaminase (ALT) (normal 5-35units) and aspartate transaminase (AST) (normal 10-40 units). These are liver enzymes that increase with inflammation and damage to hepatic cells. ALT is more specific than AST and usually shows a higher increase. ALT may increase to 10 times normal with acute infection and 2 to 3 times normal which chronic infection, so ALT is used most often to monitor treatment. However, many drugs can affect ALT results, so medication reconciliation is essential

Answer 14

4 Healthcare -associated infections kill almost 100,000 people each year in the United States, and environmental contamination is a factor in 20% to 40% of HAIs, with pathogens carried from environmental surfaces on the hands of healthcare workers. Pathogens that are of increasing concern are Norovirus, clostridium difficile, acinetobacter species, MRSA and vancomycin-resistant enterococcus. Patients admitted to rooms previously occupied by patient infected with these pathogens are at increased risk because the agents are capable of surviving for prolonged periods in the environment

Answer 15

3 The Spaulding system of sterilization and disinfection: 1. Critical: Contact sterile tissue or the vascular system, including surgical instruments, IV catheters and prosthetic implants. Contamination poses a high risk of infection, so these items must be sterile 2. Semi-critical: Contact mucous membranes or non-intact skin, including endoscopes, diaphragm fitting rings, and laryngoscope blades. These tissue tend to be more resistant to spores, so these items can be disinfected with high-level disinfectants 3. Non-critical: Contact intact skin only, including patient care items such as blood pressure cuffs and bedpans and environmental surfaces. Decontamination can be done at point of care

Answer 16

2 If, following removal of the Esophagogastroduodenoscopy tube, the patient begins to cough violently and appears cyanotic, the most appropriate initial intervention is to suction the airway and increase supplemental oxygen. These symptoms are consistent with aspiration of gastric fluids, which can lead to aspiration pneumonia. The patient needs an x-ray and antibiotic therapy. Patients with gastric bleeding, gastric obstruction, excessive sedation, and older adults are especially at risk of aspiration during endoscopic procedures

Answer 17

3 The CDC recommended method of routine hand hygiene is now using alcohol-based hand rubs. This can be done relatively quickly, and compliance tends to be better than washing hands with soap and water. However, if the hands are visibly soiled or have come into contact with bodily fluids, then they must be thoroughly washed with soap and water to remove all residue. Additionally, if the healthcare provider is exposed to spore-producing microbes, such as B. Anthracis or C. Difficile, or Norovirus, then washing with soap and water is required

Answer 18

4 In regard to reprocessing of single-use devices, the CMS recommends use of third-party reprocessors because of the stringency of the regulations by the FDA for reprocessing and the type of equipment needed. The trend is toward increased reprocessing of single-use devices because of the costs of medical care. The FDA categorizes medical devices as class I, II, or III with class I posting the lowest risk to the patient and class III the highest. Requirements for reprocessing of class III devices are more stringent than for class I or II

Answer 19

2 The incubation period for food borne illness caused by salmonella spp. is one to three days, and the infection persists for four to seven days. Symptoms include fever, abdominal cramping, and diarrhea. S. Typhi and S. Paratyphi result in more severe symptoms and typhoid fever. Infection often results from contaminated poultry, eggs, unpasteurized milk products or juices, and raw fruits and vegetables. Outbreaks may occur if the water supply becomes contaminated. Antibiotics are usually contraindicated except for S. Typhi and S paratyphi

Answer 20

3 Constipation is usually defined as fewer than three stools per week although there is considerable individual variation. Some people have two to three stools daily while others only defecate every two or three days, so it’s necessary to determine the normal pattern for a patient when assessing constipation. Constipation is also sometimes described in terms of stool consistency (hard, small) and difficulty defecating (need to strain, splinting). Constipation is most common in patients in their 60’s with rates about 5 times those of younger adults

Answer 21

4 Bowel retraining strategies include: 1. Keeping a bowel diary for a week 2. Modifying diet and fluid intake to assure normal stool consistency, including increased fiber and fluids, eating meals at scheduled times, and avoiding foods that increase bowel dysfunction 3. Establishing a schedule for defecation, preferably at the same time each day and about 20-30 minutes after a meal 4. Practicing Kegel exercises 5. Using a stimulus to promote defecation, such as enemas, suppositories, or laxatives in the beginning, with a goal to decrease such us. Digital stimulation or hot drinks may be used. 6. Keeping a record of stool consistency and evacuation

Answer 22

1 If a patient is receiving enteral feeding, administration of cold formula is most likely to contribute to diarrhea. Other causes of diarrhea include rapid infusion and bolus feedings, and hyperosmolar formula. If diarrhea occurs, the patient’s feedings should be re-evaluated (rate slowed, change in formula) and fluid balance and electrolyte status assessed. Medications should be assessed and pro-motility medications avoided as they may contribute to diarrhea

Answer 23

4 For the bowel transit time test, patients take capsules that contain radiopaque markers and then continue with their regular diet. They return 5 days later for radiographs. Typically, about 80% of the markers are excreted in 5 days, so if fewer than 20%, slower than normal. This test results are affected by the types of foods and amount of liquids consumed, so results must be evaluated in terms of diet and other factors

Answer 24

3 If a patient has developed acne, weight gain, mood swings, and hyperglycemia, the most likely cause is prednisone, a corticosteroid. Corticosteroids are prescribed to suppress the immune response and reduce inflammation, but have numerous adverse effect so they are usually used for short periods rather than extended use. Other possible adverse effects include insomnia, hypertension, osteoporosis, moon fancies, glaucoma, cataracts, and increased risk of infection

Answer 25

1 Omeprazole (Prilosec), a proton pump inhibitor, suppresses secretion of gastric acids and is used primarily to treat GERD and erosive esophagitis. Omeprazole should be taken on an empty stomach to be most effective. Adverse effects include stomach pain, nausea and vomiting, diarrhea, flatulence, and headache. In rare cases, patients may develop severe myopathy. Drug interactions may occur with methotrexate, clopidogrel, and St. John’s wort

Answer 26

2 While all of these are important factors in fecal incontinence, the most common cause is fecal impaction, which may result from chronic constipation. Chronic constipation increases pressure on the anal sphincters and can damage nerves and muscles. Additionally, transit time through the large intestine is often slowed with constipation, increasing fluid aspiration and contributing impaction. When stool becomes impacted, the body compensates by increasing fluid in the stool above the impaction, resulting in diarrhea stool leaking about the impaction and through the damaged sphincters

Answer 27

4. The Bristol stool Form has descriptions and pictures to help people identify the correct type of stool 1. Type 1: Separate small hard lumps of stool that are difficult to pass 2. Type 2: Sausage-shaped lumpy stool 3. Type 3: Sausage-shaped and lumpy but with cracks on the surface 4. Type 4: Long, smooth, soft, snake-like stool 5. Type 5: Soft blobs of stool that are easily passed and have clear-cut edges 6. Type 6: Mushy, fluffy pieces of stool with uneven ragged clear-cut edges 7. Type 7: Watery stool that is entirely liquid The bowel diary should include the time of each event (defecation, incontinence, and flatus), type of stool amount, activity at the time of incontinence, intake of food and drinks, and all medications

Answer 28

1 If a patient has been dieting but complains that she has developed chronic diarrhea, the item on the food log that is most likely the cause is dietetic hard candy. Dietetic candy, diet soda, sugarless gum, and other sugarless products contain sweeteners (such as sorbitol, sucralose, and xylitol) that often cause diarrhea, abdominal distention, and gas, especially if taken in large amounts. The patient should stop eating the dietetic candy until the diarrhea stops and then eat only small amounts to tolerance

Answer 29

3 If a patient has prescriptions from four different doctors and admits to take additional “pills” but can’t recall which ones and gives conflicting information regarding the dosage and frequency of the different medications, the nurse should recognize these findings as an indication of poly pharmacy. Poly pharmacy occurs when patients take too many drugs, some of which may be duplicates or may interact with other drugs, especially when prescriptions are from multiple physicians

Answer 30

2 The most common cause of Upper GI bleeding is peptic ulcer disease (about 50%) while the most common cause of lower GI bleeding is diverticulosis (about 50%). Symptoms of upper GI bleeding include epigastric pain and hematemesis. Melena may occur with both upper and lower GI bleeding but is most common with upper GI. Treatment varies depending on the cause, but those who are hemodynamically unstable require immediate resuscitation to maintain adequate blood pressure while the patient is being typed and cross-matched for transfusions

Answer 31

3 When teaching a patient to care for a PEG feeding tube the gerontological nurse should tell the patient that, in order to prevent dumping syndrome, the patient should stay in semi-Fowler’s position for one hour after feedings as this slows transit time by decreasing the force of gravity. Additionally, formula should be instilled slowly and at room temperature. Small volumes of water should be used to flush the tubing before and after feedings because diluted formula has a faster transit time. Continuous drip also results in less incidence of dumping syndrome than bolus administration

Answer 32

1 HIPAA regulations are designed to protect the rights of individuals regarding the privacy of their health information. The nurse must not release any information or documentation about a patient’s condition or treatment without consent. The individual has the right to determine who has access to personal information—which is considered protected health information (PHI)—including health history, condition, treatments in any form, and any documentation. Personal information can be shared with a spouse, legal guardians, and those with durable power of attorney

Answer 33

2 If a 69-year-old patient is learning to care for a colostomy but is quite tense and becomes confused about the sequence of actions required, the most appropriate teaching strategy is to breaks the tasks into small steps and teach sequentially. When the patient becomes adept at one step, the patient can begin to learn the next. When patients are ill and stressed, learning can be difficulty and procedures. Such as colostomy care, can seem overwhelming

Answer 34

4 These symptoms are consistent with a duodenal ulcer, and the positive urea breath test indicates a Helicobacter pylori infection, which is usually treated with a proton pump inhibitor plus Clarithromycin and amoxicillin/metronidazole. About 90% of duodenal ulcers are associated with H.pylori infection. H.pylori weakens the mucosa and results in hypersecretion of gastric acid. Eating may increase pain with gastric ulcers but usually relieves pain with duodenal ulcers. Smoking increases the risk of peptic ulcer disease, and use of NSAIDs increases risk of serious complications such as bleeding or perforation

Answer 35

3. Every 10 years. Screening should begin at age 50 or those with average risk at age 40 with increased risks. Screening tests include: 1. Colonoscopy - every 10 years. Or as follow-up for abnormalities in other screening: Allows for removal of polyps, small cancerous lesions, and biopsies and provides surveillance of inflammatory bowel disease 2. Fecal occult blood - yearly: checks for blood in stool 3. Flexible sigmoidoscopy - every 5 years: scope checks for polyps or signs of cancer in rectum and lower third of colon 4. Double contrast barium enema - every 5 years: X-ray with contrast to visualize intestinal abnormalities

Answer 36

2 Miller-Abbott is a long double-lumen tube inserted into the small intestine for drainage and decompression. The Salem-sump tube is also double lumen but is short and contains a small vein tube within the larger tube to help reduce pressure at the distal eyes to less than 24mmHg in order to prevent tissue damage. The Cantor tube is a single lumen tube that contains an inflatable balloon at the distal end to prevent the tube from migrating. The Levin tube is a single lumen tube with a solid end

Answer 37

2 The electrolyte imbalance that is likely to occur with persistent vomiting and diarrhea is hyponatremia. Gastric and intestinal fluids contains high levels of sodium can become depleted with nausea and diarrhea. Hyponatremia is a sodium level of less than 135mEq/L. This type of Hyponatremia resulting from hypovolemia is characterized by dry mucous membranes, orthostatic hypotension, tachycardia and poor skin turgor. The patient may appear weak, stuporous, confused and/or lethargic

Answer 38

3 Most absorption of nutrients occurs in the small intestine, in the jejunum and ileum. The digestive process starts in the mouth as saliva and chewing begin to break down the food that then enters the esophagus and travels to the stomach, where the food is further mixed and broken down by the addition of acids and enzymes. This process continues in the duodenum with most absorption of nutrients occurring in the small intestine. Fluid continues to be absorbed in the large intestine

Answer 39

4 Bulk-forming products, such as psyllium (Metamucil), methycellulose (Citrucel) and polycarbophil (Fibercon) are generally the drugs of choice for chronic constipation because they increase absorption of fluid in the stool, helping increase mass, soften stool, and stimulate peristalsis. Bulk-forming products have few adverse effects and are less irritating to the intestines than other preparations. However, if fluid intake is inadequate, bulk formers can cause obstruction, so they should be avoided with patients who are dehydrated or on fluid restriction

Answer 40

2 The tract of the PEG usually matures and heals within 2 to 4 weeks. Once the tract has healed, the original PEG tube can generally be replaced with a balloon gastrostomy tube. Gastrostomy tubes with an internal balloon or mushroom tip, measure markings, and an external disk are easier to stabilize, but internal devices should be checked daily by gently pulling until resistance is felt. External stabilizing devices can be applied to the skin to hold the tube in place. The tube may also be taped to the abdomen or secured with a binder

Answer 41

1 While the stoma may be edematous in the initial postoperative period, it should appear red to pink, shiny and moist, indicating adequate oxygenation and healthy tissue. If the stoma appears dull and cyanotic (blue to purple to brown/black if the tissue becomes necrotic), the physician should be notified immediately because reoperation to increase blood flow to the tissue may be indicated. The stoma should be assessed for circulatory impairment on a regular schedule after surgery

Answer 42

4 The Kock pouch may need to be irrigated postoperatively to promote drainage because of the accumulation of mucus. Also, once the patient begins to eat, drainage may slow, requiring irrigation. Up to 1000mL total of solution (usually tap water) may be needed to flush the pouch but only 30-40mL of fluid should be instilled at one time as the capacity of the pouch is small. The instilled fluid should be drained completely before doing another instillation and the patient observed carefully for abdominal discomfort

Answer 43

3 Unpreserved stool must be tested for ova and parasites within 2 hours of collection (The same is true for most tests with Unpreserved stool.) However, the stool may be placed in liquid transport media with preservative, such as orange Cary-Blair container, and tested within 14 days for ova and parasites or cultured. WBC count must be carried out on Unpreserved stool. Testing for rotavirus must also be carried out on Unpreserved stool immediately after collection

Answer 44

2 Increased frequency of stools, bloody diarrhea, fever and fecal incontinence are signs of pouchitis, non-specific inflammation of the pouch. Although the cause is not known, pouchitis may indicate undiagnosed regional enteritis (Crohn’s disease) in some patients although it is more common in patients with ulcerative colitis. Pouchitis is most common in the first two years after surgery. Pouchitis usually responds rapidly to metronidazole, and this helps to differentiate the condition from others that may cause similar symptoms

Answer 45

1 The pH of gastric fluids is usually 0 to 4, so this finding may indicate proximal migration of the J-tube. The pH in the small intestine is usually less than 6 while a higher pH such as >7.5 may indicate pulmonary migration. A marked increase in intestinal residual volume may indicate migration. If that occurs, then feedings should be held for at least an hour before pH testing is done. Gastric aspirant is usually curdled and clear to white while intestinal aspirant may be brownish/greenish because of bile staining

Answer 46

1 The initial goal of enterocutaneous fistula management is to control fluid and electrolyte imbalance. Dehydration is frequent with high-output fistulae, and patients may develop Hyponatremia and hypokalemia with metabolic acidosis. Parenteral nutrition, if necessary, should be initiated after the fluid/electrolyte balance is re-established. Up to 90% of patients with enterocutaneous fistulae develop malnutrition, and if patients are unable to obtain adequate nutrition orally, then enteral or Parenteral feedings may be indicated, depending on the site of the fistula

Answer 47

4 The complication that is most common outside of the gastrointestinal tract with patients with inflammatory bowel disease is anemia. Patient’s often have poor nutritional status with inadequate protein and iron in their diets and may have blood loss associated with lesions. Osteoporosis is also a common finding, and some patients have experienced other disorders such as interstitial cystitis, fibromyalgia, and migraines. Those with Crohn’s disease often have inflammation of joints and eyes

Answer 48

1 The external fixation device of a PEG should be place 1 to 2cm above the skin surface to prevent excessive tension that may result in buried bumper syndrome in which the internal fixation device become lodged in the mucosal lining of the gastric wall, resulting in ulceration. Rotating the PEG tube also helps to prevent BBS. Typical symptoms of BBS include increasing abdominal pain and difficulty infusing the feeding solution. If BBS occurs, the PEG must be replaced

Answer 49

2 Insertion of balloon replacement gastrostomy tube: 1. Gather supplies, position patient to 30 degrees 2. Inject 20ml sterile water into balloon port to check leaks, withdraw water and retain filled syringe 3. Move external disk to near distal end and catheter tip 4. Cleanse peristalsis area with NS in spiral movement. Dry skin 5. Insert tube gently to pre-measured distance and inflate balloon 6. Gently pull tube until resistance is met. Slide external bumper to 1.5cm from skin surface 7. Rotate tube in circular motion to ensure free rotation 8. Use 30-60ml syringe to aspirate gastric content. Flush tube with water 9. Apply barriers and mark exit measurement

Answer 50

3 A durable power of attorney is the legal document that designates someone to make decisions regarding medical and end-of-life care if a patient is mentally incompetent. This is a type of advanced directive, which can also include living wills or specific requests of the patient regarding treatment. A do-not-resuscitate order indicates the patient does not want resuscitative treatment for terminal illness or condition. A general power of attorney allows a designated person to make decisions for a person over broader areas, including financial

Answer 51

1 If a 30-year-old patient with Crohn’s disease is disabled and uninsured because of illness but unable to afford medications to control the disease, the most likely source of financial assistance is Medicaid. Medicaid is a joint program of federal and state governments, so eligibility criteria may vary from state to state, but Medicaid provides medical benefits, including the costs of drugs, to people with low income. People with disabilities, which can include Crohn’s disease, are in one of the categories eligible to apply for Medicaid

Answer 52

3 With cardiac arrest, immediate defibrillation is indicated for ventricular fibrillation and ventricular tachycardia (VF/VT) but is not indicated for pulseless electrical activity (PEA) or asystole because these conditions do not respond. Adrenaline (Epinephrine) (IV 1mg) and vasopressin (40 units) may be repeatedly administered with PEA, asystole, or VF and when two shocks have been unsuccessful. For VF/VT immediate defibrillation should be carried out, followed by CPR for 2 minutes and repeat defibrillation if necessary

Answer 53

2 If the patient is scheduled the next day for an abdominal ultrasound to evaluate the liver, pancreas, and bile ducts, the nurse anticipates that the patient will be advised to have a fat-free dinner the evening before and be NPO after midnight. Ultrasound is a non-invasive technique that utilizes high-frequency sound waves to create images (size, shape, contours, consistency) of internal structures. These images are viewed on a monitor during the procedure

Answer 54

4 A 70-year-old patient with advanced gastric carcinoma who has stopped curative treatments and has life expectancy of 6 months or less meets the criteria for Hospice care. Patients under hospice care are allowed palliative treatment to relieve pain, nausea, and other discomforts. Disease specific requirements include AIDS, cancer, liver disease, dementia, kidney disease, cardiac disease, stroke, and neurological disorders. Hospice benefits include medications (to control symptoms), medical equipment, nursing assessment, respite care (up to 5 days) and part-time aides

Answer 55

3 The most common site for obstruction of the small intestine is the ileum, usually associated with adhesions (70%) with the rest caused by hernias, IBS (which can result in strictures), or malignancies. Over 90% of patients who undergo abdominal surgery eventually develop adhesions. Obstructions of the colon are more likely to be associated with malignancies (60%). Diagnosis of small bowel obstruction is based on physical examination and symptoms and is typically confirmed with abdominal x-ray and/or CT scan

Answer 56

1 If a patient who has undergone cholecystectomy develops paralytic ileus, the most likely intervention is insertion of an NG tube and decompression. Antibiotics are generally not indicated. If the patient has been receiving enteral feedings, they should be discontinued. IV resuscitation is indicated while the NG tube is in place and -replacement of electrolytes as needed (especially potassium). Diagnosis is usually confirmed with x-ray and/or CT scan and to rule out mechanical obstruction, which requires surgical intervention

Answer 57

4 The acid-base disorder that is most common with acute mesenteric ischemia is metabolic acidosis. Other laboratory findings include increased WBC count, lactate, and amylase. Presenting symptoms usually include both abdominal pain and melena. Mesenteric ischemia, which can be caused by arterial hypoperfusion, impaired drainage of venous blood, or thrombosis, results in ischemia of the bowl and mild to severe damage of the tissue. In some cases, bowel ischemia can result from non-occlusive causes, such as impaired cardiac output (heart failure, cardiac arrest). In cases associated with occlusive causes, surgical repair is needed

Answer 58

2 If bacteria, such as Escherichia coli, produce extended spectrum beta lactamase (ESBL), the nurse should anticipate that the bacteria will be resistant to multiple antibiotics. The enzymes produced are able to destroy active ingredients found in antibiotics, such as cephalosporins and beta lactamases. ESBLs were first detected in the 1960s in Greece and in 1988 in the US. ESBLs have been associated with diarrhea, skin infections, pneumonia, UTIs, and sepsis. Most ESBL-bacteria respond to carbapenemase at present although CREs pose an increasing threat

Answer 59

1 The form of anesthesia that is most commonly used when a patient requires removal of a foreign object from the rectum is a benzodiazepine to relax the patient and an opioid for pain control. Objects can generally be removed in the ED if they are within 10cm of anus and palpable by digital exam. Patients are usually placed in lithotomy position. An anal or vaginal speculum may be needed to facilitate removal. If an object cannot be safely removed, surgical intervention may be needed.

Answer 60

3 The most common positioning for a patient who is to undergo a rigid sigmoidoscopy for a sigmoid volvulus or other purpose is the left lateral (Sims) position. The patient’s hips should slightly extend beyond the edge of the table, and the patient’s knees should be flexed. A small sandbag is often placed under the left hip. Rigid sigmoidoscopy is usually carried out with sedation, but must be preceded by a digital rectal exam. Rigid sigmoidoscopy is contraindicated with anal stenosis or bowel perforation

Answer 61

2 If a patient has received midazolam for an endoscopic procedure, the peak effect occurs within 3 to 5 minutes with duration of 1 to 3 hours. Romazicon (Flumazenil) may be administered as a reversal agent. The narcotic usually administered with midazolam is fentanyl with peak effect occurring within 5 to 8 minutes and the same 1 to 3 hour duration. Naloxone (Narcan) may be administered as a reversal agent

Answer 62

1 If a patient is to receive antibiotic prophylaxis for placement of PEG tube, the antibiotic should be administered 30 minutes before the procedure begins. All patients who are to have PEG placement should receive antibiotic prophylaxis. The most commonly administered prophylaxis is ampicillin (2g) and gentamicin (1.5mg/kg) unless the patient has an allergy to penicillin. In that case, vancomycin (1g) may be administered as an alternative

Answer 63

2 According to health.gov recommendations for fiber intake, 14 grams of fiber should be consumed for each 1000 calories. High fiber foods include beans, lentils, fruit, Brussels sprouts, spinach, corn, sweet potatoes, and whole grain breads and cereals. Some fiber (soluble) dissolves into a viscous gel and other fiber (insoluble) acts like a sponge and soaks up water. Fiber helps to slow gastric emptying, promote a sense of fullness, increase bulk in the stool, and prevent constipation

Answer 64

1 If, within 90 seconds of receiving midazolam for an endoscopic procedure, the patient exhibits signs of anaphylaxis with bronchospasm and severe hypotension, the correct initial emergent response is to administer epinephrine. The usual SQ/IM dosage is 0.1%(1:1000) and IV dosage is 0.01% (1:10000). If administered IM, the vastus lateralis muscle of the thigh is the preferred site. Additional medications include albuterol (inhaled), antihistamine (diphenhydramine) corticosteroid and H1 and H2 blockers (Famotidine)

Answer 65

4 A stool specimen to test for clostridium difficile may be held for 24 hours at room temperature or 5 days under refrigeration at 2 degrees to 8 degrees Celsius. The specimen must remain unpreserved and needs to be very soft, liquid or semi-liquid. Testing cannot be carried out if the stool is hard or formed because the amount of toxin present in the stool is minimal. Additionally, if the patient is infected with C.diff, the patient likely has 3 or more liquid stools daily

Answer 66

3 The esophageal pH probe is usually left in place for 24 hours. It is inserted nasally and attached to a monitor that continually assesses acidity. In some cases, a 48-hour probe is used. This 48 hour probe has a smaller monitor attached to a catheter and is placed at the distal portion of the esophagus. It sends acidity recordings wirelessly to a recorder worn on the body and automatically detaches and passes through the intestinal tract after 48 hours

Answer 67

4 Once a rubber band ligation is carried out for a second-degree hemorrhoid, the tissue usually sloughs off within about 7-14 days. The band is placed about the base of the hemorrhoid, effectively cutting off circulation to the hemorrhoid. Most people experience mild pain/discomfort and may have slight bleeding. However, a small risk of severe bleeding and sepsis exists. Patients should be advised to increase fiber to prevent constipation and to take a Sitz bath after defecation

Answer 68

1 If using the FAITH mnemonic as a guide to spiritual assessment, the H stands for Help: F: is there a faith, religion, or spiritual belief important to you? A: how does your belief system apply to your health? I: what involvement do you have in a church or faith community T: is your treatment affected by your spiritual beliefs? H: what help can i give you with spiritual concerns?

Answer 69

3 The most common reason for sexual dysfunction after an ileostomy/colostomy is psychological inhibitions. The patient may fear rejection, odor, or spillage and may be unsure of how to broach the subject of the ileostomy/colostomy with a partner. Some patients find coping with the change in body image difficult. Patients often benefit from participating in a support group and from guidance in sexual matters. For example, patients may feel more comfortable wearing undergarments (boxer shorts, crotchless panties) during sexual activity

Answer 70

2 Patient who have had bariatric surgery should generally limit total meal size to less than one cup and should eat 3 meals daily and 2 snacks of protein. The patient should avoid drinking liquids for 15 minutes before meals and 90 minutes after and should avoid liquids that contain calories (sodas, juices, wine/beer). Food choices should be high in nutrition. Patients should be advised to be aware of thirst and to observe urine for signs of dehydration

Answer 71

3 If administering a bolus feeding of 400mL per a gastrostomy tube, the feeding should generally be given over 10 to 15 minutes per gravity (raising and lowering the container to control flow). The patient’s response can help to guide administration. If the patient feels suddenly full, the rate should be slowed. Intermittent feedings are usually administered on a regular schedule for about 30 minutes at a time.

Answer 72

1 If, following gastric surgery with removal of the pylorus, a patient develops bile reflux gastritis/esophagitis, the treatment that is most indicated is Cholestyramine (questran). Cholestyramine binds bile acids in the intestines and causes them to be excreted in the feces. Cholestyramine may decrease absorption of numerous drugs/substances (including beta blockers, corticosteroid, fat-soluble vitamins, thiazides, penicillin, and thyroid hormones), so these drugs must be administered 1 hour prior to Cholestyramine or 4 hours after.

Answer 73

4 Diarrhea: 1. Exudative —radiation and chemotherapy 2. Infectious —infectious agents, such as Clostridium difficile 3. Malabsorptive —decreased serum albumin 4. Osmotic —intestinal hemorrhage, pancreatic impairment, and lactose intolerance 5. Secretory —bacterial toxins and neoplasms

Answer 74

2 In order to prevent Escherichia coli infection from eating contaminated meat, all ground beef should be cooked to at least 160F, and the temperature should be verified by thermometer as appearance may vary. Raw meats should always be kept separate from other foods, and dairy products and juices should be pasteurized. Fruits and vegetables should be washed under clean running water. Alfalfa sprouts can harbor E.coli, so children under 5, older adults, and patients who are immunocompromised should avoid eating them

Answer 75

4 After the cuff of the Flexi-seal Fecal Management System is inserted into the rectum, the nurse should use a syringe to fill the cuff with 45mL of water. Procedure: 1. Don PPI, place patient in left lateral knee-chest position, and connect catheter to the bag 2. Withdraw air from cuff with syringe 3. Flatten cuff and fold in half, lubricate 4. Insert cuff into rectum and fill cuff with 45mL water with syringe to inflate the balloon end of the cuff 5. Gently tug the cuff into position to seal the rectum

Answer 76

1 The complication that is most likely to occur with ulcerative colitis is abscess. Abscesses form as tissue ulcerates and becomes inflamed; however, because the disorder involves the superficial mucosa and is not transmural, fistulas, fissures and obstructions (common with Crohn’s disease) usually do not occur. Inflammation generally begins in the rectum and spreads proximally throughout the colon. Patients tend to experience periods of remission and exacerbation, and symptoms may be mild, severe, or fulminant

Answer 77

3 Patients with celiac disease must be advised to avoid food that contain gluten, which is a protein that is found in various grains, such as rye, barley, and wheat. Patients should eat oat products only if they are labeled as gluten-free because they may be contaminated by wheat products during processing in some facilities. Many processed foods and liquids (such as soups, beer, candy, processed meats) contain hidden gluten. Additionally, some medications utilize gluten-containing binding agents

Answer 78

4 The ethnic groups with the highest prevalence of ulcerative colitis are caucasians and Ashkenazi (European) Jews. While the cause of ulcerative colitis is not clear, a genetic predisposition appears to play a role as family history is a risk factor. Studies have shown that patients with inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease, are also at increased risk of developing autoimmune disorders, such as multiple sclerosis and arthritis.

Answer 79

3 If a 40-year-old patient with a history of Chagas’ disease reports increasing dysphagia, cough, regurgitation, drooling, and heartburn, the most likely cause is megaesophagus, resulting from destruction of neurons. Patients usually exhibit symptoms between ages 20 and 40 and may also have hypertrophy of the salivary glands, resulting in drooling because of excess saliva. Patients may also develop mega colon, which can lead to fecal impaction and bowel obstruction because of lack of motility.

Answer 80

1 The drug of choice to treat Giardia infection is metronidazole (250mg TID for 5 to 7 days). Giardia often contaminates water sources and spreads easily from person to person through fecal contact. Symptoms include abdominal pain/cramping, diarrhea (greasy stools), nausea, and vomiting. Patients often experience weight loss and have persistent symptoms for up to 3 weeks, and some people develop a chronic form of infection that can last for months or years

Answer 81

2 The most common test for pinworms is the cellophane test in which tape is touched to the perianal area several times and then examined under a microscope for eggs. This test has sensitivity of about 90%. The test should be done for 3 days in a row and when the patient first awakens in the morning. Stool specimens are usually negative because only about 5% of those infected have eggs in the stool

Answer 82

4 For moderate sedation (AKA conscious sedation) ASA guidelines require monitoring of capnography and pulse oximetry. Level of consciousness should be assessed at least every 5 minutes and supplemental oxygen provided unless otherwise contraindicated. Resuscitative equipment and reversal agents (Flumazenil and naloxone) must be available and a person trained in assessment and use available. During the recovery period after the procedure oxygenation, ventilation and circulation should be monitored every 5 to 15 minutes

Answer 83

3 The primary reason for liver transplants is hepatitis C, which markedly increases risk of liver failure and hepatic cancer. Hepatitis C is spread through contact with blood or items contaminated with blood (shared needles, improperly sterilized equipment) and through sexual contact, tattooing, and piercing. No vaccine is available but antiviral treatments are available and up to 90% effective. Those with hepatitis C must avoid use of alcohol as it may cause progression of the disease.

Answer 84

1 The most common carbapenem-resistant Enterobacteriaceae (CRE) in the United States is Klebsiella pneumoniae carbapenemase (KPC). New Delhi Metallo-beta-lactamase (NDM-1) is found in Pakistan and India. Escherichia coli carbapenemase (ECC), an increasing concern, is found in the Middle East, South American, India, and Southeast Asia. Verona Integron-Mediated Metallo-beta-lactamase (VIM) is found in Southern Europe. Southeast Asia, and scattered cases (Indiana) in the US

Answer 85

4 When examining the abdomen for bowel sounds, the nurse should auscultate for five minutes before determining that bowel sounds are absent. Most commonly, bowel sounds are heard 5 to 30 times a minute, usually heard best in the RLQ. Abnormal bowel sounds are classified as hyperactive (loud, high-pitched, gurgling), hypoactive (diminished) or absent (silent). Hyperactive sounds are associated with mechanical bowel obstruction (early), diarrhea, gastroenteritis, and use of laxatives. Hypoactive sounds are associated with peritonitis, and paralytic ileus and late obstruction

Answer 86

2 If a patient who has recently had formation of an ileostomy suffers from disturbed body image, the best nursing intervention is to encourage the patient to verbalize feelings. The nurse must remain supportive and allow the patient to progress ant his/her own speed in viewing and learning to care for the ileostomy. Some patients may benefit from counseling if their body image issues do not resolve or if they worsen

Answer 87

1 H2 blockers, such as cimetidine (Tagamet), may decrease libido and increase erectile dysfunction, especially if taken in high doses or frequently during the day. These adverse effects tend to be worse with cimetidine than with other H2 blockers, so the patient may benefit from switching to a different drug or adjusting dosage. The nurse should question the patient about frequency of use and dosage of the drug and encourage the patient to discuss these issues with the physician.

Answer 88

3 Glutaraldehyde 2%, hydrogen peroxide 7.5%, ortho-phthaladehyde (OPA), as well as various hydrogen peroxide/ peracetic acid combinations can provide high-level disinfection with 12 to 30 minutes of exposure. Manufacturer’s recommendations for dilution and use must be followed carefully. Isopropyl and ethyl alcohol (70-99%), iodophor germicidal detergent, and sodium hypochlorite 5.25-6.15% can be used for intermediate and low-level disinfection at greater than 1 minute exposure

Answer 89

4 The primary treatment for norovirus infection is supportive care and fluids. Symptoms generally include diarrhea and vomiting with symptoms persisting for 1 to 3 days. Most people do not require treatment, but if diarrhea or vomiting is severe, an antiemetic or antidiarrheal may be prescribed if the patient is younger that 65. If severe dehydration occurs, the patient may require intravenous fluids until able to resume adequate oral intake

Answer 90

1. Almost all nutrients are absorbed by the small intestines, with the majority absorbed in the jejunum although some nutrients are absorbed at different parts of the small intestine: 1. Jejunum: Sodium, chloride, fats, proteins, and carbohydrates 2. Ileum: Bile salts and vitamin B-12 3. Duodenum: Iron 4. Throughout the small bowel: Magnesium, phosphate, water, lipids, and potassium Following a meal, residual wastes travel through the gastrointestinal tract and reach the terminal ileum within about 4 hours. Once in the large intestine, fluid and electrolytes continue to be absorbed and the stool thickens

Answer 91

3 While all foods can cause dyspepsia/indigestion, fatty foods usually cause the greatest discomfort because they are digested more slowly and stay in the stomach for a longer period of time. Patients with chronic dyspepsia may benefit from a low-fat diet. Some foods (spicy food, lettuce, gas producing vegetables) may also result in increased discomfort. About a fourth of adults experience some degree of dyspepsia, which may include heartburn, bloating, feeling of fullness and belching

Answer 92

4 If assisting with an endoscopic procedure, the nurse should expect to wear full surgical attire (gowns, gloves, face mask, eye guard or face shield, hair and foot coverings) as required by CMS. Since 2009, operating rooms and procedure rooms must function under the same guidelines for sterility although endoscopic procedures are generally not considered sterile procedures. However, because of a number of outbreaks associated with endoscopy (such as hepatitis C), more stringent standards are imposed.

Answer 93

2 A common age-related change in the stomach is decreased production of hydrochloric acid, which results in a slower digestive process. Motility slows and the stomach empties more slowly. The mucosal surface begins to atrophy and degenerate and other gastric acids and digestive enzymes decrease. As the person ages, these changes are likely to result in increased food intolerances and malabsorption (including decreased absorption of vitamin B-12

Answer 94

2 The flexible sigmoidoscope can examine a 45 to 50cm/16 to 20 inches distance from the anus, compared to a rigid sigmoidoscope, which can examine only about 25cm/20 inches. Additionally, the flexible sigmoidoscope allows video and still images to be obtained. The rigid sigmoidoscope is used much less frequently with the advent of flexible sigmoidoscope although a rigid sigmoidoscope may be used along with a digital rectal exam for anal/rectal conditions

Answer 95

1 If during a gastroscopy a patient becomes faint and light-headed and experiences hypotension, bradycardia, and diaphoresis, the most likely cause of these symptoms is a vasovagal response, which results from stimulation of baroreceptors during the procedure. The patient may briefly lose consciousness during the episode. The sudden drop in blood pressure decreases blood flow to the brain for a brief period. These episodes are usually transient but may be prolonged with depression of the central nervous system from sedation.

Answer 96

3 If a patient has a hiatal hernia, important information to prevent symptoms (heartburn, reflux, dysphagia) includes eating small frequent meals and avoid reclining for at least an hour after meals or eating within two hours of bedtime. The head of the patient’s bed should be elevated on 4 to 8 inch blocks (pillows are not adequate). Medical treatments can include PPI and/or H2 blockers. Some patients may require surgical intervention if symptoms are severe

Answer 97

4 If a chemical spill occurs, the best initial resource to determine what actions to take is the Material Data Safety Sheet (MDSS), which must be on file for any chemical use. Spills are classified according to size: 1. Small: 300mL 3. Large: >5L

Answer 98

2 The primary purpose of a “time-out” period prior to beginning a procedure is to prevent surgical/procedural errors. Before a designated team member calls for the time out, all team members who will participate must be present and must communicate. The entire team must agree that they have the correct patient, correct site, and correct procedure. If a patient is to have more than one procedure or team members change, additional time-outs must be called before proceeding.

Answer 99

4 The correct method of administration of vedolizumab (Entyvio) is by infusion over 30 minutes. The drug comes packaged in a powered form and must be reconstituted with 4.8mL of sterile water injected into the vial, which is then swirled to mix for 15 seconds and allowed to sit for 20-30 minutes to dissolve. The vial is then inverted three times and 5mL of solution withdrawn by sterile needle and syringe and injected into 250mL of sterile 0.9% NaCl or Lactated Ringer’s solution

Answer 100

3 If the nurse is to mix two medications for administration and injects air into vial A and then vial B, the next step is to withdraw the medication from vial B while the needle remains in the vial. Once the first medication is obtained, then the needle is inserted into vial A and that medication withdrawn. It is important that the vials are not contaminated with medication from the opposite vial. Prior to mixing medications, a compatibility chart should be assessed to ensure that the two medications can be mixed

Answer 101

1 Gastric aspirate, obtained per an NG tube, must be neutralized with bicarbonate within 30 minutes of collection. For this reason, it is often collected in a special tube that contains bicarbonate. If not, the sample (generally 1mL but up to 5mL may be requested for suspected TB or fungal infections) must be transported to the laboratory immediately and the laboratory personnel alerted that the sample requires neutralization

Answer 102

3 Dumping syndrome usually responds to a change in dietary habits and is most often caused by carbohydrate intake, so increasing protein, reducing carbohydrates, and avoiding drinking fluids with meals may relieve symptoms. Acarbose is sometimes used with late-onset dumping syndrome (occurring 1 to 3 hours after eating) if other methods are ineffective. Octreotide requires injections and is use only for intractable symptoms because of adverse effects, such as diarrhea, distention, and Cholelithiasis.

Answer 103

2 A pH greater than 7 (alkaline) of aspirant from an NG tube most likely indicates that the tip is in the respiratory system. Gastric fluids tend to be acidic (although this can be altered by medications), so pH usually ranges from 1 to 4. The pH in intestinal fluids is less acidic and should be approximately 6 or higher. Some tubes have pH sensors in place and do not require aspiration to check. Checking pH is not effective with continuous feedings because tube feedings usually have a pH of 6.6 and a neutralizing effect on gastrointestinal pH

Answer 104

4 The best time for scheduled evacuation is 20 to 30 minutes after a meal because eating stimulates motility. The scheduled time (usually daily but may be 3-4 times weekly depending on individual habits) should be at the same time each day, so work hours or activities should be considered. Stimulation may include drinking hot liquid or rectal stimulation (inserting a gloved, lubricated finger into the anus and running it around the rim of the sphincters). The best position for defecation is upright and leaning forward with knees elevated slightly. The patient should massage the abdomen, strain, and attempt to tighten abdominal muscles and relax sphincters if possible

Answer 105

2 Post-infectious irritable bowel syndrome is a chronic bowel inflammation that develops in some people after acute enteritis, characterized by altered bowel habits, usually with chronic diarrhea and abdominal pain. About two-thirds have predominantly diarrhea, a fourth alternate between constipation and diarrhea, and the remaining have primarily constipation. Onset of symptoms is often abrupt. Symptoms often persist for years, with 40% still reporting symptoms after 6 years. Treatment usually entails antidiarrheal medication and a low fiber diet.

Answer 106

3 Case control studies compare those with a condition (cases) to a group without it (controls) to determine if the affected group has characteristics that are different. Prospective cohort studies choose a group of patients without disease, assess risk factors, and then follow the group over time to determine (prospect for) which ones develop disease. Retrospective cohort studies are initiated after a condition develops and data is collected retrospectively from medical records to evaluate whether members of the cohort selected had exposure and developed disease. Cross-sectional studies assess both disease and exposure at the same time in a target population, evaluating the presence of disease at a point in time.

Answer 107

1 Rectoceles can cause chronic constipation and difficulty in passing stool because of weakening of the muscles, contributing to fecal incontinence. Untreated, rectoceles can cause inflammation, ulcerations, and fistula formation. Pessaries may reduce the prolapse. Surgical repair may not correct all symptoms, especially underlying damage to muscles, and can result in surgical trauma to the rectum or sphincters, adding to the risk of incontinence. Rectoceles (rectal prolapses) occur when the muscles between the wall of the vagina and rectum weaken and the rectum prolapses or protrudes

Answer 108

4 A patient who has been stable on medications for gastric ulcer and begins to experience increasing back and epigastric pain that is unrelieved by medication may be experiencing erosion of the ulcer through the gastric serosa and into the surrounding organs and tissues, such as the pancreas or biliary tract. Penetration has a less acute presentation than perforation, which usually involves sudden acute abdominal pain (sometimes referred to the right shoulder), hypotension, bradycardia, omitting and abdominal distention and rigidity

Answer 109

1 Peristomal abscess is common with active Crohn’s disease distal to the stoma. Crohn’s disease is a form of inflammatory bowel disease in which ulcerations occur in the small and sometimes the large intestines. Peristomal abscess is characterized by open (from fistulae) and closed lesions that are painful, swollen and erythematous. Peristomal abscess may also occur after stoma revision because of contamination from skin bacteria. Colostomy irrigation may result in perforation that causes abscess formation. A Peristomal abscess rarely heals spontaneously but requires surgical incision.

Answer 110

3 Cimetidine (brand name Tagamet): First developed but used less frequently than others because of inhibition of enzymes that result in drug interactions, especially with contraceptive agents and estrogen. Ranitidine (brand name Zantac): Developed to decrease drug interactions and improve patient tolerance. It’s activity is about 10 times that of cimetidine. Ranitidine was recalled by the FDA due to presence of NDMA, a cancer-causing contaminant, when stored in high temperatures. Famotidine (brand name Pepcid): May be combined with an antacid to increase speed of effects, as it has a slow onset. It may be used pre-surgically to reduce postoperative nausea. Nizatidine (brand name Axid): Latest to be developed and about equal in potency and action to ranitidine.

Answer 111

4 Anal manometry measures the pressure of the sphincter muscles, the degree of sensation in the rectum and whether the neural reflexes that control normal bowel movements are intact. Anal wink (anocutaneous reflex, a reflexive contraction of the anus in response to gentle stroking or stimulation of the skin around the rectum) and Bulbocavernosus reflex (s reflexive contraction of the anus in response to natural or electrical stimulation of the Bulbocavernosus muscle of the penis), are used to determine interruption or defect in the reflux arc. Endoanal ultrasound is used to diagnose perianal fistulas and abscesses and to assess sphincter damage

Answer 112

1 Improving staff communication includes ensuring that the appropriate staff person receives laboratory test results on time and establishing a process for taking orders/report and read back for verbal/telephone orders. Other provisions include: 1. Identifying patient correctly: 2 identifiers for medicines, blood, or blood products 2. Using medications safely: complete medicine list, label medications, removing concentrated electrolytes from patient care units 3. Preventing infection: CDC hand washing procedures, infection control guidelines 4. Identifying safety risk: includes fall prevention 5. Preventing surgical mistakes: checklists, marking surgical site, presurgical pause

Answer 113

2 Anal sphincter electromyography (EMG) assess muscle contractions to determine if the sphincter muscles are contracting properly. Drugs such as muscle relaxants and cholinergic and Anticholinergic preparations can affect the outcome of the test. The procedure begins with the patient lying on the left side. A small lubricated sponge or plug electrode is inserted into the anal canal. Alternately, needle electrodes may be used. The patient must lie still during the procedure or results will be affected. Electrical activity of the anal sphincter muscles is recorded on a computer screen while the patient tightens the sphincter muscles, relaxes, and pushes

Answer 114

4 Monitoring intake and output is most important in preventing fluid and electrolyte imbalance along with ensuring adequate nutrition. During episodes of diarrhea, the patient should substitute water with a sports drink designed to replenish electrolytes and supply nutrition. With electrolyte imbalance, just increasing the oral intake of fluids is not sufficient because these fluids will be excreted through the kidneys and may not correct the electrolyte imbalance. If stools are too liquid, the patient can increase fiber: and if stools are too dry, sodium. Antidiarrheal agents should not be taken routinely but as necessary when dietary changes are insufficient

Answer 115

2 While some mucous discharge is normal, copious discharge is often associated with diversion colitis in which the distal segment becomes inflamed. Treatment includes rectal irrigation and topical steroids as well as oral antibiotics. The perianal area should be cleansed. Applying protective cream or ointment prevents irritation of the skin. The mucous fistula should be checked each time the appliance is changed and mucous gently wiped from the opening. The stoma should remain pink. Changes in color or swelling may indicated compromised circulation or infection

Answer 116

1 Under the ANA Nursing Code of Ethics, autonomy and self-determination are viewed within the broad context of diverse cultures. The idea of individualism is less important in some cultures, so the nurse must respect and appreciate the patient’s right to be guided by her family. Trying to convince the patient to assert herself may just lead to emotional conflict. This is not an appropriate concern for the ethics committee, because the woman is not being forced to comply with family decisions but choses to do so

Answer 117

3 Kinesthetic learners learn best by handling, doing and practicing and should be allowed to handle supplies/equipment with minimal directions. They benefit from demonstrating their understanding by doing the procedure. Visual learners learn best by seeing and reading and benefit from written directions, videos, diagrams, pictures and demonstrations. Auditory learners learn best by listening and talking, so procedures should be explained during demonstrations. Auditory learners learn best by listening and talking, so procedures should be explained during demonstrations. Auditory learners benefit from audiotapes and extra time for questions.

Answer 118

4 Patients who receive multiple transfusions with citrated blood products must be carefully monitored for hypocalcemia. Calcium is important for transmitting nerve impulses and regulating muscle contraction and relaxation, including the myocardium . Calcium activates enzymes that stimulate chemical reactions and has a role in coagulation of blood. Values include: 1. Normal values: 8.2-10.2mg/dL 2. Hypocalcemia: less than 8.2mg/dL 3. Critical value: less than 7mg/dL 4. Hypercalcemia: greater than 10.2mg/dL 5. Critical value: greater than 12mg/dL

Answer 119

2 The PEG tube does not have an inflatable balloon, but the tube should be stabilized by pulling gently to ensure the internal bumper is against the abdominal wall and then sliding the external stabilizer to 1.5cm above skin. Replacing the PEG tube is done only if the leakage cannot be otherwise controlled. Routine skin care, including application of barrier ointment or other skin sealant, is necessary to prevent skin breakdown. In some cases, alginates, foam dressing, gauze, or pouching may be necessary

Answer 120

1 A positive Murphy’s sign is indicative of Cholecystitis but is negative with choledocholithiasis and ascending cholangitis. This test is not accurate for geriatric patients, so a negative finding dose not rule out Cholecystitis for these patients. To test for Murphy’s sign, hook the fingers under the right coastal margin at the midpoint, palpating deeply, and ask the patient to inhale deeply. Positive result occur with pain causing the patient to stop inspiring. The Rovsing’s sign — pain in the RLQ when left-sided abdominal pressure is applied — suggests appendicitis along with RLQ pain (rebound tenderness) on quick removal of pressure

Answer 121

2 Esophageal diverticulum is a contraindication for upper GI endoscopy because the scope may enter the diverticulum sac, resulting in perforation. Endoscopy is indicated for complicated reflux disease, such as when a patient exhibits dysphagia or iron deficiency anemia and is routinely used to diagnose, biopsy tissue, assess, and treat Barrett’s esophagus. Endoscopy is usually done within 24 hours after caustic esophageal injuries, such as from accidental or deliberate ingestion of liquid or crystalline alkali, to assess the degree of mucosal tissue damage

Answer 122

4 While trends will show some normal variation, if the trend becomes erratic and measures are inconsistent, this suggests that the processes of care are not consistent or are inadequate. Tracking and trending is central to developing research-supported, evidence-based practice and is part of continuous quality improvement. Once processes and outcome measurements are selected, then at least one measure should be track for a number of periods of time, usually in increments of 4 weeks or quarterly. This tracking can be used to present graphical representation of results that will show trends

Answer 123

1 While all of these are important, studies have shown that completing a safety pre-procedure checklist is highly effective in reducing infections and other complications. Checklists should be standardized according to discipline/procedure and required for all procedures to ensure that infection control and safety practices are followed. Checklists usually include ensuring correct patient, following the correct procedure, and checking patient records to make sure orders hav been carried out. Checklists vary but may include hand washing, use of barrier precautions, and checking for known allergies.

Answer 124

3 A visit from a recovered ostomate who is functioning well can provide invaluable support. Refusing to look at the stoma or participate in care after surgery is very common as patients grapple with the alteration in body image and anxiety about their role in the family and society, their sexuality, and their ability to resume their normal activities. Family members should be encouraged to learn about ostomy care and to provide support as well, but they may also be very stressed and unsure. Referral to a psychologist may be indicated if the patient cannot overcome her anxiety and fears

Answer 125

2 Over-transfusing to treat esophageal variceal hemorrhage can result in increased central and portal venous pressures, increasing the risk of rebleeding, so the patient must be monitored very carefully. Coagulopathy is commonly found related to underlying cirrhosis. If actively bleeding, those with an INR above 1.8 to 2.0 or with platelet counts below 50,000 should be treated with fresh frozen plasma (20mL/kg loading, followed by 10mg/kg every 6 hours) or platelets. About half the hemorrhages will stop spontaneously, but over half of these patients experience rebleeding within 7 days.

Answer 126

3 A decrease in hematocrit greater than 10% within 48 hours of hospital admission is predictive of severe pancreatitis. Other warning signs include a BUN greater than 5 mg/dL, serum calcium less than 8mg/dL, a base deficit greater than 4 mEq/L PO2 less than 60 mmHg, and fluid retention/sequestration greater than 6 liters. On admission, indications include age over 55 years, white blood count greater than 16,000, serum glucose greater than 200mg/dL, serum LDH >350IU/L, and Aspartate aminotransferase (AST) greater than 250U/mL.

Answer 127

2 1. Standard I, Quality of Practice: Collecting data and participating in quality of care activities. 2. Professional Practice Evaluation: Participating in performance appraisal, feedback, peer review, and demonstrating cultural competency 3. Education: Having commitment to lifelong learning 4. Collegiality: Sharing with others, mentoring, participating in professional organizations 5. Ethics: Complying with ANA Code of Ethics, maintaining privacy and protecting patient autonomy 6. Collaboration: Collaborating with other health professionals, patient, and family members 7. Research: Participating in research, reading, and utilizing research. 8. Resource Utilization: Considering costs, effectiveness, and safety, and delegating care 9. Leader: Utilizing teamwork and mentoring and promoting the profession

Answer 128

1 The first method to use to clear a blockage in one of the endoscopic channels is to flush with water using a small syringe (1 to 5ml). A small syringe applies more water pressure than a larger syringe, although the larger syringe is better for suctioning. Water also applies more pressure than flushing with air and is better able to remove residue that may be blocking the channel. Only if flushing is ineffective should the tube be removed and wire used to cleanse residue. Scrupulous cleaning after use helps to avoid blockage.

Answer 129

2 Proton pump inhibitors and antibiotics may interfere with the results of both the urea breath test and the fecal antigen assay for H.pylori, so PPIs should be discontinued 1 to 2 weeks prior to testing and antibiotics at least 4 weeks prior. If patients cannot discontinue the medications, then serologic ELISA testing may be done, but it has only 80% accuracy compared to 95% accuracy for the breath and fecal tests. Endoscopic testing is usually not recommended for diagnosis, although, if done for other reasons, gastric biopsies may be taken to rule out or diagnose H.pylori

Answer 130

3 A low-fat diet is usually recommended for those with chronic pancreatitis. Because production of pancreatic enzymes may be impaired, patients may also need to take pancreatic enzymes with meals. If insulin production is affected, then some may require treatment for diabetes with insulin and diet modified to restrict carbohydrates. Since about 45% of those with chronic pancreatitis suffer from alcohol abuse, restricting alcohol intake is critical, so some patients may require referral to substance abuse programs

Answer 131

1 A patient who has had a Percutaneous transhepatic cholangiography is most at risk for bleeding, peritonitis, and septicemia. During the procedure, a flexible needle is inserted into the liver, increasing risk of bleeding, in order to aspirated bile. A water-soluble contrast agent is injected, the fluoroscopy table tilted, and multiple x-rays taken. Aspirating as much contrast agent and bile as possible prior to removing the needle helps reduce the risk of peritonitis. Antibiotics should be administered to reduce incidence of septicemia

Answer 132

4 The primary purpose of TIPS is to reduce portal hypertension by treating ascites. A cannula is threaded through the jugular vein to the portal vein and an expandable stent inserted to shunt fluid between the hepatic vein and portal circulation. TIPS is indicated for ascites that does not respond to more conservative treatments and helps to reduce sodium retention so that diuretics can act more effectively. Patients who will be referred for liver transplantation often have a TIPS while awaiting an organ.

Answer 133

2 Applying a heating pad to the right shoulder or scapula area after laparoscopic cholecystectomy for 15 to 20 minutes each hour may help to reduce pain caused by migration of carbon dioxide used for insufflation during the surgical procedure. Pain is usually not severe, so opioids are rarely indicated. Complications are rare, and this procedure is often done on an outpatient basis, but patients should be advised to report vomiting, loss of appetite, increasing pain, temperature, and abdominal distention.

Answer 134

3 After cholecystectomy, patients who had experienced preoperative fat intolerance should begin to add fat back into the diet in small increments to allow the body to adjust. In some cases, the liver may not produce enough bile to metabolize a high intake of fat and smoke fat restriction (40 to 50g daily) may be indicated. Generally, patients are able to resume eating a normal diet shortly after surgery and should not exhibit signs of dietary intolerance, such as pain, distention, nausea or vomiting

Answer 135

4 Fecal occult blood —yearly: checks for blood in stool. Screening at age 50 with average risk and age 40 with increased risk: 1. Flexible sigmoidoscopy—every 5 years: scope to check for polyps or signs of cancer in rectum and lower third of colon (often done with fecal occult blood test.) 2. Colonoscopy — every 10 years or as follow-up for abnormalities in other screening: longer flexible scope, usually with anesthesia, to check rectum and entire colon, remove polyps, do biopsies, and provide surveillance of inflammatory bowel disease 3. Double contrast barium enema — every 5 years: x-ray with contrast to visualize intestinal abnormalities

Answer 136

3 A nasoenteric tube for an adult should be marked prior to insertion with measurements including the distance from the nose to earlobe, plus earlobe to xiphoid process, plus 8 to 10 inches for enteric placement. Six inches are needed for gastric placement. The nasoenteric tube tip initially placed in the stomach (verified by chest x-ray) and then moves into the small intestine through peristalsis over about 24 hours. Proper placement should be reconfirmed before every feeding by checking tube length measurement, aspirating and observing aspirant, and checking pH.

Answer 137

2 Following bariatric surgery, such as the lap band procedure, general guidelines advise limiting total meal intake to less than one cup, with 3 meals daily (containing protein and fiber) and two protein snacks. Patients should be advised to chew slowly and thoroughly and to eat nutrient-rich foods, but should avoid combining food and liquids. Liquids should be taken 90 minutes after meals and up to 15 minutes prior to a meal, but caloric liquids (such as alcoholic beverages and juices) should be avoided.

Answer 138

1 Hemolytic uremic syndrome (HUS) is the most serious complication of enteritis caused by E.coli, such as type 0157:H7. Children under 5 and the elderly are especially at risk. HUS is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. HUS may affect the neurological system, resulting in seizures, stroke, and coma. About half of those who survive HUS will develop chronic renal problems. Various organs, such as the heart and brain, may be affected because HUS damages the blood vessels and causes clots to form in capillaries and arterioles.

Answer 139

4 These symptoms are indicative of intestinal obstruction, which may be partial or complete. Obstructions are common because strictures develop in the bowel from repeated ulcerations of mucoid tissue. Chronic diarrhea is common, and some diarrhea may persist even with obstruction, depending on the location and degree of obstruction. Other common complications include abscesses, fistulas (especially from the small bowel to the skin), fissures, and malnutrition. Lesions associated with Crohn’s disease are most common in the distal ileum and ascending colon.

Answer 140

2 Total Parenteral nutrition (TPN) is high in glucose, so patients should have blood glucose levels monitored every 6 hours to evaluate hyperglycemia. Some patients may require insulin during administration of Parenteral nutrition. Symptoms of hyperglycemia may include increased thirst, increased urination, blurred vision and lethargy. Some patients may experience a rebound hypoglycemia when TPN is discontinued. The goal of TPN is usually for the patient to gain about 0.5kg daily. Once the patient’s symptoms decrease and weight stabilizes, the patient is placed on oral elemental feedings.

Answer 141

3 The most effective method for monitoring small changes in abdominal ascetic fluid is daily measuring of abdominal girth and weighing. This should be done routinely to assess the effectiveness of treatment. A large fluid accumulation may be indicated by bulging flanks with the patient in supine position. Abdominal percussion may also identify ascites, but assessing small increases or decreases is difficult. An abdominal fluid wave is usually not noted until there is a large accumulation of fluid.

Answer 142

3 A permanent colostomy in the descending colon is most likely to result in semi-soft, mushy stool. A colostomy in the ascending colon results in liquid stool, as little absorption has taken place as liquid stool enters the colon from the small intestine. A transverse colostomy results in semi-liquid, somewhat mushy stool. Because the sigmoid colostomy is directly above the rectum, most excess fluid has been absorbed by the proximal colon, so stool tends to be solid.

Answer 143

4 Upon completion of an endoscopic procedure, before the endoscope is removed from the procedure room and taken to the cleaning area, using standard precautions the exterior should be wiped down with a gauze pad to remove discharge and debris (feces, mucus, blood) and then the suction channel and water channel flushed with water until the water runs clear. Once in the cleaning area, procedures will vary depending on whether manual cleaning is completed or automated but usually begin with leak testing and cleaning and flushing with enzymatic detergent prior to placing in high-level disinfectant.

Answer 144

2 Diabetic patients who are well controlled on insulin are usually advised to take half of their usual dosage on the morning of a scheduled endoscopic procedure. Diabetics who take oral medications to control diabetes should omit the dosage for that morning. Glucose levels should be monitored when the patient arrives for the procedure and the physician is notified if the patient is hypoglycemic (<60mg/dL) or hyperglycemia (>200mg/dL). IV solutions administered may depend on blood glucose level. Those who are hypoglycemic may receive 50% glucose solution, and those who are hyperglycemic, NS.

Answer 145

1 Patients undergoing sigmoidoscopy (rigid or flexible) usually require no or minimal sedation, although patients with low pain threshold or severe anxiety may need moderate/conscious sedation. Moderate sedation (a narcotic such as fentanyl and a benzodiazepine such as midazolam) is usually indicated for endoscopic procedures, such as upper endoscopy and colonoscopy. Procedures that are complicated or prolonged, such as ERCP, may require deep sedation with the same drugs as well as droperidol or propofol. General anesthesia is generally indicated only for complex and surgical procedures because of increased risks associated with general anesthesia.

Answer 146

3 The best method to verify placement of a small-bore NG tube is with a chest x-ray. While aspirating fluid may indicate gastric placement, the tip may be in the esophagus. A gastric fluid pH less than 4 usually indicates that the tube is in the stomach, but some medications, such as proton pump inhibitors, may alter pH. Injecting air and auscultating may be inaccurate because the air sounds in the bronchial tree sound similar, and NG tubes can easily enter the trachea and a bronchus. Misplacement into the bronchus may not be evident on abdominal x-ray.

Answer 147

3 Flumazenil is a reversal agent for benzodiazepines, such as midazolam and diazepam. Flumazenil is usually given in a dose of 02.mg over 15 seconds and can be repeated every minute to a total of 1mg and then at 30 minute to 60 minute intervals because the action of Flumazenil is shorter than that of benzodiazepines. Therefore, patients must be monitored for at least 2 hours after administration to determine if further dosage is required. Naloxone should also be available as a reversal agent for opioids, such as fentanyl and meperidine

Answer 148

4 The best positioning for a paracentesis is for the patient to sit upright on a chair on the side of the bed because this causes the fluid to accumulate in the lower and anterior abdomen, making drainage more effective. Patients who are confined to bed may be placed in the Fowler’s position. Fluid should drain by gravity. The patient must be carefully monitored and VS taken frequently as vascular collapse/hypovolemia may occur as the body compensates for the fluid loss by shifting fluid from the vascular system to the peritoneal cavity

Answer 149

1 The method that is the most successful for postpyloric placement of enteral feeding tubes is to inject about 350mL of air and place the patient on the right side. An alternate method is to administer the prokinetic metoclopramide to stimulate peristalsis and then to position the patient on the right side. Combining both methods is not indicated. The air insufflation method usually results in faster placement, especially if the patient has received opioids, which tend to slow peristalsis

Answer 150

4 During an upper GI endoscopy procedure it’s important to aggressive suction all accumulated saliva and emesis to prevent aspiration. Pre-medicating with an antiemetic is usually not recommended, and positioning of the patient may have little effect. Recommendations for NPO status prior to endoscopic procedures vary slightly from 6 hours to 8 hours to ensure the stomach has emptied. While the endoscopic procedure may induce vomiting, 12 hours of NPO status is more than required

Answer 151

1 Patients have a right to refuse treatment for religious or other personal reasons, so the most appropriate action is to simply provide the patient with factual information about the disease, treatments, and prognosis in a neutral manner, without trying to coerce or frighten the patients. In some cases, patients may change their minds when presented with information, but the nurse should remain supportive regardless of the patient’s decision. Asking the family to intervene is not appropriate, and refusal of treatment alone does not suggest the need for referral to a psychologist

Answer 152

C. Gabriele Schindler

Answer 153

A. Egyptians

Answer 154

B. Hopkins

Answer 155

A. Simplicity, ease of use, and patient safety

Answer 156

B. Assessment, diagnosis, planning, implementation, evaluation

Answer 157

B. An individual trained to function in an assistive role in the GI setting have direct patient care responsibilities

Answer 158

C. Staff nurse (RN)

Answer 159

A. To work for one year on a medical-surgical unit to gain experience

Answer 160

A. Coordinating the five functions of management

Answer 161

A. Planning

Answer 162

A. Forecasting and managing the budget

Answer 163

B. Leading and guiding employees

Answer 164

C. Transformational

Answer 165

B. Volume of procedures and required staff

Answer 166

C. Evidence-based practice

Answer 167

B. Management

Answer 168

C. Direct expenses

Answer 169

D. Nursing informatics

Answer 170

D. Bacteria

Answer 171

C. Both cholangitis and endocarditis

Answer 172

B. Mycobacteria

Answer 173

D. Injection needles and biopsy forceps

Answer 174

B. Use of endoscopes in sterile operative field

Answer 175

A. Pre-clean, leak test, manual clean, inspect, high-level disinfect (or AER), rinse, and dry

Answer 176

B. High-level disinfection

Answer 177

C. Glutaraldehyde, hydrogen peroxide, peracetic acid, ortho-phthalaldehyde (OPA)

Answer 178

C. Both A&B

Answer 179

B. Critical medical devices originally manufactured and labeled for single-use should not be reused

Answer 180

A. Using a Halon extinguisher

Answer 181

B. Be placed in the safety holster

Answer 182

D. The wavelength of the laser being used

Answer 183

D. All of the above

Answer 184

D Both B and C

Answer 185

A. Wash the area thoroughly for the time recommended on the safety data sheet

Answer 186

D. All of the above

Answer 187

A. Schedule the procedure the first of the day

Answer 188

D. All of the above

Answer 189

D. All of the above

Answer 190

A. Standard

Answer 191

D. Both a & b

Answer 192

C. Communication

Answer 193

B. Are an accepted compilation of practical, well-founded recommendations

Answer 194

A. Standard 4 Planning

Answer 195

A. Demonstrates professional accountability and responsibility for nursing practice

Answer 196

B. A continuous conformance to meet the needs and expectations of the customers

Answer 197

D. All of the above

Answer 198

D. Measurable

Answer 199

D. Improving the process

Answer 200

D. All of the above

Answer 201

A. Provide education and training

Answer 202

B. Formulated before a process improvement plan can be developed

Answer 203

C. Plan-Do-Study-Act

Answer 204

A. Indicators

Answer 205

A. Ensure the electrocautery machine is present for the insertion of a PEG tube

Answer 206

B. A hypothesis that assumes no relationship between the variables under study

Answer 207

A. Treatment

Answer 208

A. The mean of the sample

Answer 209

A. Primary source information

Answer 210

C the random sample

Answer 211

B. Nominal, ordinal, interval, ratio

Answer 212

C. The empirical value that occurs most frequently in a set of values

Answer 213

D. Variability

Answer 214

C. The institutional board of review

Answer 215

C. Population, interventions, comparison, outcome, timeframe

Answer 216

A. Is a systematic approach to nursing care

Answer 217

D. Bowel sounds characterized by high-pitched tinkles and peristaltic rushes are abnorma

Answer 218

D. All of the above

Answer 219

B. Verification

Answer 220

D. “Patient is scanning her surroundings with wide open eyes”

Answer 221

C. Both a and b

Answer 222

A. The observation of a patient

Answer 223

C. Identify human responses to medical condition, treatments, and changes in activities of daily life

Answer 224

D. All of the above

Answer 225

C. A time-lapsed reassessment

Answer 226

C. The existence of a medical pathology

Answer 227

B. NANDA-I

Answer 228

C. Medical diagnosis

Answer 229

B. Clinical judgement describing a specific cluster of nursing diagnoses that occur together

Answer 230

A. Requires both nursing and medical intervention to diagnose, prevent, and treat

Answer 231

B. The health problem as related to the etiology and as manifested by the signs and symptoms

Answer 232

C. Present health problems

Answer 233

B. Swallowing, impaired

Answer 234

C. Ineffective therapeutic regimen

Answer 235

A. It is required by managed care companies

Answer 236

D. All of the above

Answer 237

D. Includes only actions that nurses can lawfully perform

Answer 238

A. Initial planning

Answer 239

D. All of the above

Answer 240

C. Is a multidisciplinary task

Answer 241

C. Patients and their families

Answer 242

C. Monitor vital signs every 2 hours until diarrhea stops. Observe for signs of hypotension with widening pulse pressure

Answer 243

A. A well-documented plan of care

Answer 244

B. Appearing to provide depersonalized care

Answer 245

A. Evaluation criteria are developed against which the effectiveness of nursing intervention can be measured

Answer 246

C. Counseling

Answer 247

Delegation

Answer 248

D. All of the above

Answer 249

C. A dependent nursing activity

Answer 250

B. Diagnosing a patient’s knowledge deficit

Answer 251

D. Implementing motivational counseling to stimulate drive and ambition

Answer 252

A. The research nurse

Answer 253

D. Document his or her action

Answer 254

B. Increased resources

Answer 255

A. Nurse recognize that a classification system for nursing diagnoses is important

Answer 256

D. Measurable

Answer 257

B. Determining whether a patient has achieved outcomes or is making progress toward goals developed in the outcome identification stage of care, whether nursing interventions chosen to treat identified health problems are effective in reducing or resolving identified health problems, and whether healthcare provided has been effective overall

Answer 258

D. All of the above

Answer 259

A. They define less measurable behavior differences

Answer 260

B. An ongoing process of review in which data collected over a period of time are used to com[are actual practice against standards of practice to determine if the care actually rendered meets a level of quality deemed acceptable within a practice setting

Answer 261

C. Performed jointly by the nurse, the patient, and the rest of the healthcare team involved with the patient’s care

Answer 262

A. Define increases in knowledge

Answer 263

C. Outcome achievement is determined

Answer 264

C. Muscularis

Answer 265

D. Secondary peristalsis

Answer 266

A. Lifestyle modification

Answer 267

C. Barrett’s esophagus

Answer 268

A. Esophageal varices

Answer 269

Epiphrenic diverticula

Answer 270

D. Piece of meat

Answer 271

D. Giardiasis

Answer 272

A. Lower esophageal sphincter

Answer 273

B. Hydrochloric acid and intrinsic factor

Answer 274

C. Absorption of vitamin B12

Answer 275

B. The composition of the chyme

Answer 276

A. Has been associated with gastric cancer

Answer 277

A. Adenocarcinomas

Answer 278

D. Stress ulcers

Answer 279

C. Dumping syndrome

Answer 280

C. Gastroscopy

Answer 281

C. Jejunum

Answer 282

B. Columnar epithelium

Answer 283

C. Secrete a viscous, alkaline fluid

Answer 284

D. Shortening and lengthening of the villi

Answer 285

B. Crohn’s disease

Answer 286

A. Diverticulectomy

Answer 287

B. Duodenum

Answer 288

D. Celiac disease

Answer 289

C. Adenocarcinomas

Answer 290

A. Haustra

Answer 291

D. Smooth-surfaced

Answer 292

B. Water, mucus, potassium, and bicarbonate

Answer 293

D. Gardner syndrome

Answer 294

B. Ulcerative colitis

Answer 295

C. Dietary management and hydrophilic colloids or bulk-forming laxatives

Answer 296

D. Anorectal fistula

Answer 297

B. Involuntary leakage of stool

Answer 298

B. Serosa, a fibromuscular layer, and mucosa

Answer 299

B. Hepatic artery

Answer 300

C. Cholelithiasis

Answer 301

B. Pigment gallstones

Answer 302

A. Potential recurrence of Cholelithiasis after cessation of treatment

Answer 303

B. Cholecystectomy

Answer 304

C. A gallstone impacted in the cystic duct

Answer 305

A. Supportive and symptomatic measures only

Answer 306

D. All of the above

Answer 307

A. Acinar cells

Answer 308

B. Islets of Langerhans

Answer 309

D. Insulin

Answer 310

B. The sight and smell of food

Answer 311

B. Necrotizing pancreatitis

Answer 312

D. Pseudocyst

Answer 313

A. Peptic ulcer disease

Answer 314

D. Surgical excision

Answer 315

A. Sweat electrolyte test

Answer 316

D. Cystic fibrosis

Answer 317

A. Stunted growth

Answer 318

C. Biliary disorders, medications, an idiopathic cause, systemic disease, and trauma

Answer 319

C. National Comprehensive Cancer Network (NCCN)

Answer 320

B. Hepatocytes

Answer 321

C. Portal vein

Answer 322

A. Glycogen

Answer 323

D. Phagocytosis of harmful substances

Answer 324

D. Biopsy of the liver

Answer 325

A. Iron and vitamin C supplements

Answer 326

C. Octreotide

Answer 327

C. Wilson’s disease

Answer 328

D. Porphyria cutanea tarda

Answer 329

B. Portal hypertension secondary to cirrhosis

Answer 330

C. Tylenol

Answer 331

C. Measure the hepatic vein pressure gradient (HVPG)

Answer 332

C. Obesity, type 2 diabetes, and hyperlipidemia

Answer 333

C. Before meals

Answer 334

A. 2.2 pounds

Answer 335

A. Weight in kilograms

Answer 336

C. One hour after meals

Answer 337

C. Reducing total acid load

Answer 338

C. Antacids or H2 blockers

Answer 339

A. Inflammatory bowel disease

Answer 340

A. Reduce GI motility

Answer 341

D. All of the above

Answer 342

A. Inhibits production of stomach acid

Answer 343

C. Electrolytes

Answer 344

B. Over the needle catheter

Answer 345

A. Cephalic vein

Answer 346

C. Chlorehexidine Gluconate

Answer 347

B. It complicates determination of the source of any adverse reaction

Answer 348

D. All of the above

Answer 349

B. O.45% NaCl

Answer 350

A. Packed RBCs

Answer 351

B. Stop the transfusion

Answer 352

B. Within the first 5-15 minutes of the transfusion

Answer 353

B. Glycogen

Answer 354

D. Losing more protein than he or she is taking in

Answer 355

A. Steatorrhea and diarrhea

Answer 356

A. Risk of aspiration

Answer 357

A. Patient who need nutritional supplementation for less than 1 week

Answer 358

D. Catheter-related sepsis

Answer 359

C. GI enzymes

Answer 360

D. Providing support for healing and regeneration of GI mucosa

Answer 361

C. Reinoculate

Answer 362

D. Replace

Answer 363

D. Bifidobacterium infantis

Answer 364

D. Bifidobacterium

Answer 365

B. Prebiotics

Answer 366

A. Prebiotics

Answer 367

C. Proximal duodenum

Answer 368

B. 6 hours

Answer 369

D. Pancreatitis and sepsis

Answer 370

C. Hemorrhoids and fissures

Answer 371

A. Severe cardiac arrhythmias

Answer 372

B. Two warm tap-water or sodium biphosphate enemas

Answer 373

D. Left lateral position

Answer 374

B. IV moderate sedation and analgesia

Answer 375

A. Excessive insufflation of air

Answer 376

C. Persistent blood loss with no identifiable source

Answer 377

B. Recent gastric or esophageal surgery

Answer 378

B. Requires a station pull-through of the LES

Answer 379

D. Evaluation of patients with symptoms of delayed gastric emptying

Answer 380

A. Performs a series of liquid swallows

Answer 381

A. Achalasia

Answer 382

B. Aperistalsis in the distal esophageal body and low to absent LES pressure

Answer 383

D. EGJ outlet obstruction always coexists with IEM

Answer 384

C. Indicated in the diagnosis of scleroderma

Answer 385

B. Severe coagulopathy

Answer 386

C. Immediate denial or confirmation of malignancy is required

Answer 387

A. Excessive bleeding

Answer 388

C. Endoscopic biopsy

Answer 389

D. The ligament of Treitz

Answer 390

A. A syringe

Answer 391

A.1-2 hours

Answer 392

A. Timed to the patient’s respiratory cycle

Answer 393

A. Sterile saline

Answer 394

A. Use of a specialized knife

Answer 395

D. All of the above

Answer 396

E. All of the above

Answer 397

A. Differences in tissue density

Answer 398

B. A major shortcoming is the lack of ability to perform therapeutic interventions

Answer 399

D. Intolerance to lactose, lactulose, fructose, or sucrose

Answer 400

A. Myeloproliferative neoplasm

Answer 401

A. Viral or drug-induced hepatitis

Answer 402

B. Vitamin B12 absorption

Answer 403

C. Diseases of the liver (specifically the biliary tract

Answer 404

B. Allow the patient to eat and drink normally

Answer 405

C. Diarrhea

Answer 406

A. Maloney dilator

Answer 407

B. Until the gag reflux returns

Answer 408

C. Bile duct strictures

Answer 409

C. Hydrostatic balloon

Answer 410

A. Full-strength contrast medium could crystallize

Answer 411

D. Diffuse esophageal spasm with a hypersensitive LES

Answer 412

A. For up to 1 minute

Answer 413

D. All of the above

Answer 414

D. All of the above

Answer 415

B. A grounding pad is needed

Answer 416

B. Nd: YAG

Answer 417

C. Hydrogen peroxide

Answer 418

A. Sengstaken-Blakemore tube

Answer 419

B. 25-45mmHg

Answer 420

C. Band ligation

Answer 421

D. Perforation

Answer 422

B. Multiple-band ligation is often complicated by Overtube trauma

Answer 423

B. The tube is in the patient’s esophagus

Answer 424

A. The condition commonly occurs in young children

Answer 425

A. Recurrent jaundice

Answer 426

For a maximum of 30 minutes

Answer 427

D. To avoid injury to the bladder when the needle is inserted

Answer 428

D. Confusion

Answer 429

C. Stent-induced pancreatic ductal change

Answer 430

D. Colonic pseudo-obstruction

Answer 431

A. A laryngoscope and curved forceps

Answer 432

D. All of the above

Answer 433

C. Protecting esophageal mucosa and airway

Answer 434

C. Polypectomy snare

Answer 435

C. Retrieval of the polyp

Answer 436

B. Intramural polypoid lesions, such as leiomyomas

Answer 437

A. Recent myocardial infarction

Answer 438

B. A mechanical lithotriptor with a pair of wire cutters

Answer 439

C. Have fewer than 3 stones

Answer 440

D. All of the above

Answer 441

B. Thoracic esophagus

Answer 442

D. All of the above

Answer 443

D. Lower GI bleeding

Answer 444

B. Remove the nasogastric tube

Answer 445

A. Increases

Answer 446

B. Impaired gag reflex

Answer 447

A. Call for help

Answer 448

B. Naloxone and/or Flumazenil

Answer 449

C. Position the patient with the head level with or below the rest of the body

Answer 450

C. Provides suction if necessary

Answer 451

C. Lower success rates than laparotomy fundoplication

Answer 452

A. H.pylori

Answer 453

B. Bilroth II

Answer 454

D. Hypertrophic pyloric stenosis

Answer 455

D. Fifty percent of the stomach and all of the duodenum

Answer 456

B. Irritable bowel syndrome

Answer 457

A. Is the congenital absence of intramural ganglia in the intestinal tract

Answer 458

D. May affect any part of the digestive tract

Answer 459

D. Rectal resection and descending colon anastomosis of the rectal remnant

Answer 460

D. All of the above