Exam 3 (Ch. 43, 47, & 48) Flashcards
1
Q
What are the 9 segments of the abdomen, and what orgins are in each?
Right to Left & Top to Bottom
See picture in Mod 9 PPT
A
- Righ Hypochondraic: Liver Gallbladder, Righ Kidney, & Small Intestine
- Epigastric Regin: Stomach, Liver, Pancrease, Doudenum, Spleen, & Adrenal Glands
- Left Hypochondraic: Spleen, Colon, Left Kidney, & Pancrease
- Righ Lumbar: Gallbladder, Liver, & Right Colon
- Umbilical Region: Umbilicus (navel), Parts of the Small Intestine, & Duodonum
- Left Lumbar: Descending Colon, & Left Kidney
- Right Iliac: Appendix & Cecum
- Hypogastric Region: Urinary Bladder, Sigmoid Colon, & Female Repoductive Organs
- Left Iliac: Descending Colon & Sigmoid Colon
2
Q
Ineffective Bowel Elimination-Diarrhea
Passage of blank or more loose stools/day indicates diarrhea.
How many days for acute, persistent, & chronic diarrhea?
A
3
Acute: 14 days or less
Persistent: more than 14 days
Chronic: more than 30 days
3
Q
Ineffective Bowel Elimination-Diarrhea
What are 2 ways diarrhea is transmitted?
A
- Contaminated food or water
- Fecal-oral route
4
Q
Ineffective Bowel Elimination-Diarrhea
What is the primary cause of diarrhea?
A
Infectious organisms
5
Q
Ineffective Bowel Elimination-Diarrhea
What are some factors that makes one susceptible to diarrhea?
A
Age—older adult
Gastric acidity—proton pump inhibitors decrease stomach acid; organisms survive
Intestinal microflora—microbial barrier altered by antibiotics
* C. difficile infection (CDI)—most serious antibiotic—associated diarrhea
Immune status—immunocompromised due to disease or jejunal enteral feedings
6
Q
Diarrhea - Manifestations
What are some common Upper GI tract, Lower GI tract, & Severe diarrhea manifestations?
A
Upper GI tract: Large-volume, watery stools; cramping, periumbilical pain; preceding nausea and vomiting; low grade or no fever
Lower GI tract: Small-volume bloody diarrhea; fever
Severe diarrhea: Dehydration (life-threatening), electrolyte imbalances (K+), and acid-base imbalances (metabolic acidosis)
Stool may contain leukocytes; blood, or mucus
C. Diff.—colitis and intestinal perforation
7
Q
Diarrhea - Diagnostic Studies
What are the 7 diagnostic studies for diarrhea?
A
- Stool cultures—blood, mucus, WBCs, infectious organisms
- Blood cultures—sepsis or immunocompromised
- WBCs
- Anemia from iron and folate deficiencies
- BUN, creatinine ,electrolytes, pH, osmolality
- Stool fat, protein
- GI hormones
8
Q
Diarrhea - Interprofessional Care
How is diarrhea treated?
A
Treatment: depends on cause
* Prevent transmission
* Replace fluid and electrolytes (Oral or IV)
* Protect the skin
* Antidiarrheals
9
Q
Diarrhea - Interprofessional Care
What are the goals of diarrhea care?
A
- Cessation of diarrhea and resumption of normal bowel patterns
- Normal fluid, electrolyte, and acid-base balance
- Normal nutritional status
- No perianal/perineal skin breakdown
10
Q
Diarrhea
What are some key nursing implementations for diarrhea?
A
- Consider all to be infectious until cause is known
- Meticulous hand hygien (soap & water)
- Flush vomitus & stool in toilet
- Teach pt. & caregiver
11
Q
Diarrhea
What should the nurse teach the pt./caregiver about diarrhea?
A
- Principles of hygiene, infection control precautions, potential dangers of infectious illness; proper food handling, cooking and storage
- CDI—Isolation; gown and gloves for everyone
- Disinfect with 10% bleach or C.difficile sporicidal
12
Q
Clostridium difficile Infection (CDI)
What is C.Diff and who is at risk?
A
Health care–associated infection (HAI)
Patients at risk: those receiving antimicrobial, chemotherapy, gastric acid-suppressing, or immunosuppressive agents
C. difficile spores—survive up to 70 days
13
Q
Clostridium difficile Infection (CDI)
What kind of precautions are used for C.diff and what prophylaxis/adjunct therapy is used?
A
Contact precaution
* Strict infection control precautions
* Hand washing with soap and water
Prophylaxis or adjunct therapy—lactobacillus
* Given four times a day
14
Q
CDI
What is the treatment for C.diff
A
Oral vancomycin or fidaxomicin for 10 days
* Alternate: metronidazole
* Complicated: vancomycin and IV metronidazole
* Ileus: vancomycin via enema
Stop nonessential antibiotics, stool softeners, laxatives, and antidiarrheals
Recurrent: fecal microbiota transplantation (FMT)
* Donor feces administered via enema, nasoenteral tube or colonoscopy; Concern: transmission of infection
15
Q
Ineffective Bowel Elimination - Fecal Incontinence
What is the etiology & pathophysiology for fecal incontinence?
A
Involuntary passage of stool related to motor and/or sensory dysfunction.
16
Q
Ineffective Bowel Elimination - Fecal Incontinence
What diagnostic studies are performed for fecal incontinence?
A
History and Physical (H&P)
Rectal examination
Anorectal manometry, ultrasound, or electromyography
17
Q
Fecal Incontinence - Nursing Implementation
When is the best time to schedule elimanation for bowel training programs? What should be done if bowel training is ineffective?
A
30 minutes after breakfast
If ineffective:
* Administer bisacodyl, glycerin suppository, or small enema to stimulate anorectal reflex until pattern established
* Digital stimulation
* Tap water irrigation
18
Q
Constipation
What are some characteristics of constipation? When is it acute/chronic?
A
- Difficult or infrequent bowel movements
- May require excessive exertion to defecate
- Feeling of incomplete evacuation
- Symptom, not a disease
Acute—less than 1 week
Chronic—greater than 3 months
19
Q
Constipation
What are some risk factors of constipation?
A
Low-fiber diet
Decreased physical activity
Ignoring urge to defecate
Emotions, anxiety, depression
20
Q
Constipation
What are some disease and drugs that induced constipation?
A
- Colonic:Affecting the colon (large intestine).
- Neurologic: Affecting the nervous system
- Systemic: Affecting the entire body
- Collagen vascular: Affecting connective tissue & blood vessels
Drug-induced - Opioids
- Cathartic colon syndrome
- Chronic laxative use results in dilated, atonic colon
21
Q
Constipation - Interprofessional Care
What are some ways constaption is treated?
A
- Lifestyle Modifications (First-Line Approach: increase dietary fiber, fluid, & exercise
- Pharmacological Interventions: laxatives, enemas, & peripherally acting opioid receptor antagonists
- Other Interventions:
- Biofeedback: Helps patients learn to coordinate their pelvic floor muscles to improve bowel function.
- Colostomy, Ileostomy, Continent Fecal Diversion:
22
Q
Constipation - Interprofessional Care
What are some nutritional therapy interventions/care for constipation?
A
- Dietary Fiber: Emphasizes the importance of incorporating fiber-rich foods like vegetables, fruits, and grains into the diet.
- Adequate Fluid: Reinforces the need for sufficient fluid intake (2 liters per day).
- Probiotics: May help improve gut health and regularity, although more research is needed.
23
Q
Peritonitis
What is peritonitis?
A
Inflammation of the peritoneum (the abdominal wall)
life threatening
24
Q
Peritonitis
What are some clinical manifestations of peritonitis?
A
Intense Pain, Rebound Tenderness, Distended, Rigid, Fever
25
# Peritonitis
Hows is peritonitis diagnosed? How is it treated?
Dx: WBC abdominal xray, CT (abcess)
Tx: Fluids, antibiotic, analgesics
Surgery: removal of abcess
DEATH due to septicemia
26
What is the most common reason for emergency abdominal surgery?
Appendicitis
(Appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith or lymphoid hyperplasia)
| Peak incidence 10-12 years
27
How does appendicitis begin/progress (symptoms)?
As a dull, steady pain in periumbilical area.
Progressess over 4-6 hours & localizes to right lower quadrant
28
What are some symptoms of appendicitis and how is it diagnosed?
S/S: Low grade fever, Nausea, Anorexia, & Rebound Pain/Tenderness (RLQ) at McBurney's Point
- Sudden pain relief (may indicate rupture of appendix which leads to peritonitis)
Dx: Clinical S/S, Increase WBC, Abdominal Sonogram, & Exlopatory lap
29
What are the goals of appendicitis treatment/care?
* Relieving Pain
* Preventing fluid volume deficit
* Reducing anxiety
* Preventing or treating surgical site infection
* Preventing atelectasis
* Maintaining skin integrity
* Attaining optimal nutrition
30
What is diverticulosis?
Output of intestinal mucosa
31
What is diverticulitis?
Inflammation of one or more diverticulosis due to trapped food or bacteria that can lead to perforation & peritonitis
32
# Diverticulosis and Diverticulitis
What are some symptoms, risk factors, & complications of diverticular disease
Symptoms: Abdominal pain (LLQ), Fever, Nausea, Vomiting, Change in Bowel Habits, & Painless Hematochezia
Risk Factors: Low Fiber Diet, Obesity, Alcohol use, Smoking, >Age 40, & Sedentary Lifestyle
Complications: Diverticular Bleeding, Abscess, Obstruction, Peritonitis, & Fistula
33
How is diverticulitis diagnosed?
Sigmoidoscopy or colonoscopy: scopes with cameras used to look inside the colon
CT scan of the abdomen and pelvis or a barium X-ray (barium enema). During an acute flare-up of diverticulitis, a CT scan may be used to diagnose the extent of the infection
34
What are some assessment abnormalities of diverticulitis? Managment?
Assessment: LLQ pain that worsens with palpation, Increased temperature, N/V, Abdominal distention, & Melena stool
Management: NPO-bowel rest, Bedrest, Introduce fiber slowly, Increase fluid intake, & Avoid gas forming foods
35
# Anorectal Conditions
What are some anorectal conditions?
- Anorectal abscess
- Anal fistula
- Anal fissure
- Hemorrhoids
- Pilonidal sinus or cyst
36
What the main goals of anorectal conditions nursing interventions?
Major goals may include:
* Adequate elimination patterns
* Reduction of anxiety
* Pain relief
* Promotion of urinary elimination
* Management of the therapeutic regimen
* Absence of complications
37
# Anorectal Conditions
What are some nursing managements/assessment for anorectal conditions?
* Health History
* Pruritus, pain, or burning
* Elimination patterns (frequency, consistency, difficulty)
* Diet (fiber and fluid intake)
* Exercise and activity level
* Occupation (sedentary vs. active)
* Inspection of the area (external and internal if appropriate)
* History of constipation
38
# Nursing Process: the care of the pt. w/an anorectal condition – Planning
What are some anorectal conditions nursing interventions?
* Encourage intake of at least 2 L of water a day
* Recommend high-fiber foods
* Bulk laxatives, stool softeners, and topical medications
* Promote urinary elimination
* Hygiene and sitz baths
* Monitor for complications
* Educate on self-care
*
39
What are the differences between the following intestinal obsturctions?
Partial
Complete
Simple
Strangulated
Partial—some contents get through
Complete—total occlusion; surgery
Simple—intact blood supply
Strangulated—no blood supply
40
# Intestinal Obstruction - Etiology and Pathophysiology
What are the etiology and pathophysiology of intestinal obstruction?
| Distal bowel & Proximal bowel
Distal bowel—empties and collapses
Proximal bowel—accumulation of fluid, gas, and intestinal contents results in distention which eventually results in decreased circulating blood volume which leads to hypotension and hypovolemic shock
41
# Intestinal Obstruction - Etiology and Pathophysiology
What is the etiology and pathophysiology of inadequate blood flow to bowel of intestinal obstruction?
Ischemia results in necrosis and perforation
Blood flow stops, resulting in edema and cyanosis which results in gangrene (intestinal strangulation or infarction)
Requires immediate treatment to avoid infection, septic shock and death
## Footnote
Strangulation or infarction can occur, leading to infection, septic shock, and death.
42
What are the 4 hallmarks of intestinal obstruction manifestations?
1. Abdominal pain
2. Nausea and vomiting
3. Distention—LBO
4. Constipation
Order and degree depend on cause, location, and type of obstruction
43
What kind of diagnostic studies are done for intestinal obstruction
History & Physical
Imaging: abd X-rays, CT scan, & Contrast Enema
Sigmoidoscopy/Colonoscopy
Blood test: CBC/blood chemistries
44
What are some interprofessional care methods for intestinal obstructions?
Treatment depends on cause.
Emergency surgery (strangulation or perforation)
Resection of obstructed segment w/anastomosis
Partial/total colectomy/ileostomy—obstruction of necrosis
Colonoscopy—remove polyps, dilate strictures, laser destruction and removal of tumors
Initial treatment: NPO, IV fluids, IV antiemetics, NG tube, Obtain cultures; IV antibiotics, & Parenteral nutrition
Malignant obstruction: Regain patency and resolve obstruction, Stent placement, IV fluids, & Corticosteroids with antiemetics
45
If evaluating obstruction to resolve on its own, what do you need to do?
Assess frequently and report: changes in VS, changes in bowel sounds, decreased urine output, increased distention and pain
Strict I & O; including NGT drainage and hourly urine output with urinary catheter
46
What are some indications for surgical resections?
| Surgical removal of a diseased or damaged portion of an organ or tissue.
Remove cancer
Repair perforation, fistula, or traumatic injury
Relieve obstruction or stricture
Treat an abscess, inflammatory disease or hemorrhage
## Footnote
A bowel perforation is a hole that develops in the wall of the intestine, causing the contents of the digestive tract to leak into the abdominal cavity
47
What are ostomies and how are they named?
Surgically created opening (stoma) on the abdomen for fecal elimination
Named for location:
Ileum—ileostomy (involuntary drainage)
Colon—colostomy (possible regulation)
* Anatomic site: ascending, transverse, sigmoid
| May be temporary or permanent
48
What is a continent ileostomy?
Terminal ileum made into internal pouch with nipple valve and abdominal stoma
* Pouch is reservoir for stool
* Manually drained by insertion of catheter
* Low-residue diet for more fluid stool
49
What factors are considered for stoma site selection?
* Within rectus muscle (decreased risk of hernia)
* Flat surface (create seal less likely to leak)
* Patient able to see but discreetly hidden under clothing
50
What should the nurse include in their postop wound management?
How does managment of closed wound differ from open wound?
Closed wound—monitor incision/sutures
Open wound—dressing changes; monitor drainage
* Assess wound/drainage for inflammation/infection
* Monitor fever and WBCs
* Assess for complications: delayed wound healing, hemorrhage, fistulas, and infection
51
# Post-op care
What are normal ostomy characteristics?
Pink—red; mild swelling; small amount blood
52
# Postop Care
What should the nuse monitor/record in regards to colostomy function?
Record volume, color, consistency of drainage
- Excess gas common for 2 weeks—temporary
53
# Postop Care
What should the nuse monitor/record in regards to ileostomy function?
24 to 48 hours—minimal
* Peristalsis returns—1500 to 1800 mL/day
* Monitor fluid and electrolyte (Na+, K+) balance
* Bowels adapts and increases absorption—feces thickens and volume decreases to ~500mL/day
54
# Postop Care
What are the 4 factors of anal canal postoperative care?
1. Transient incontinence of mucus
2. Kegel exercise after 4 weeks
3. Perianal skin care
4. Phantom rectal pain
55
# Colostomy Care
What kind of things should the nurse include in pt/caregiver colostomy education?
1. What is it/functions
2. Describe underlying condition
3. Basic ostomy management skills (Empty, apply, clean, & remove pouch)
4. How to contact WOCN
5. Resources for problems (home care/supplies)
6. Diet
7. Community resources
8. Importance of follow-up care
| Empty before it is 1/3 full
56
# Colostomy Care
What kinds of foods should the nurse instruct the pt. to avoid?
Those that cause odor, gas, &/or diarrhea
E:alcohol, beans, spicy foods, etc.
| See table 47.33 for full list
57
# Colostomy Care
What are factors of the pouching system?
Adhesive skin barrier and pouch
Empty when 1/3 full to prevent pulling and leaks
Transparent pouch—visualize stoma
Pouch change—assess skin
Failed pouch—change immediately
Drainable or closed end pouch according to site
Charcoal filters—deodorize and release flatus
Irrigation for regulation (distal colon ostomy)
Bath, shower, swimming—no harm to stoma
58
# Ileostomy Care
What is the best type of pouch for ileostomy? What is the recommended fluid intake, and how do pt. advoid obstructions?
Best pouch—open-ended, drainable
- Secure pouching—stool caustic to skin
Fluid intake—at least 2 to 3 L/day
- Teach about fluid and electrolyte imbalance; esp. Na+
Increased risk of obstruction—narrowed lumen
Chew thoroughly; especially nuts, raisins, popcorn, coconut, mushrooms, olives, stringy vegetables, foods with skins, dried fruits, and meats with casings
59
What the definition & significance of cholelithiasis?
Definition: Presence of stones in the gallbladder.
Significance: It's the most common disorder of the biliary system.
60
What the definition, association, & significance of cholecystitis?
Definition: Inflammation of the gallbladder.
Association: Usually associated with gallstones (cholelithiasis).
Significance: Common health problem.
61
What are some risk factors for gallbladder disease?
Female: Women are more prone to gallbladder disease.
Multiparity: Multiple pregnancies increase the risk.
Age older than 40 years: Risk increases with age.
Estrogen therapy: Estrogen can increase cholesterol levels in bile.
Sedentary lifestyle: Lack of physical activity can contribute to gallstone formation.
Familial tendency: A family history of gallbladder disease increases risk.
Obesity: Increased cholesterol production is linked to obesity.
62
How do gallstones develop?
| Cause is unknown
Develop when balance that keeps cholesterol, bile salts, and calcium in solution is changed, leading to precipitation
Stones may stay in gallbladder or may migrate to cystic or common bile duct
Cause pain as they pass through ducts
* May lodge in ducts and cause an obstruction
63
What is cholecystitis most often associated with?
Most often associated with obstruction from stones or sludge
64
What are some risk factors of acalculous cholecystitis (without stones)?
Older adults and critically ill
Prolonged immobility, fasting, prolonged parenteral nutrition, diabetes
Biliary stasis
Adhesions, cancer, anesthesia, opioids
65
What are some gallbladder disease clinical manifestations?
Vary from severe to none at all
Pain more severe when stones moving or obstructing
* Steady, excruciating
* Tachycardia, diaphoresis, prostration
* Residual tenderness in RUQ
* Occur 3 to 6 hours after high-fat meal or when patient lies down
66
What are some symptoms of cholecytitis?
* Abdominal pain in RUQ or epigastric region
* Positve Murphy sign
* Fever
* Nausea
* Vomiting
* Intolerance for fatty foods
* Jaundice
67
What are some clinical manifestations of total gallbladder obstruction?
* Dark amber urine
* Clay-colored stools
* Pruritis
* Intolerance to fatty foods
* Bleeding tendencies
* Steatorrhea
68
What are some complications of cholecystitis?
* Gangrenous cholecystitis
* Subphrenic abscess
* Pancreatitis
* Cholangitis
* Biliary cirrhosis
* Fistulas
* Gallbladder rupture leads to peritonitis
* Choledocholithiasis
69
What diagnostic studies are used for gallbladder disease?
Ultrasound
ERCP
Percutaneous transhepatic cholangiography
Laboratory tests
* Increased WBC count
* Increased serum bilirubin level
* Increased urinary bilirubin level
* Increased liver enzyme levels
* Increased serum amylase level
70
What are some treatment for cholelithiasis?
| Treatment dependent on stage of disease
Oral dissolution therapy
ERCP w/sphincterotomy
Extracorporeal shock-wace lithotripsy (ESWL)
71
What are some treatments for cholecystitis?
Control possible infection (antibiotic treatment & NG tube for severe nausea/vomiting)
Cholecystotomy (opioids for pain control)
Anticholinergics (decrease GI secretions & counteract smooth muscle spasms)
72
What are 2 types of surgical therapy for gallbladder disease?
Laparoscopic cholecystectomy
* Treatment of choice
* Removal of gallbladder through 1 to 4 puncture holes
* Minimal postoperative pain
* Resume normal activities, including work, within 1 week
* Few complications
Incisional (open) cholecystectomy
* Removal of gallbladder through right subcostal incision
* T-tube inserted into common bile duct
- Ensures patency of duct
- Allows excess bile to drain
73
What is Hepatitis, what causes it?
Inflammation of the liver
Causes
* Viral (most common)
* Alcohol
* Medications
* Chemicals
* Autoimmune diseases
* Metabolic problems
74
What are some clinical manifestations of hepatitis?
Classified as acute and chronic
Many patients: asymptomatic
Symptoms intermittent or ongoing
* Anorexia
* Malaise, fatigue, lethargy
* Myalgias/arthralgias
* Right upper quadrant tenderness
75
What are some manifestations of acute liver failure?
| Liver transplant usually the cure
Manifestations: encephalopathy, GI bleeding, DIC, fever with leukocytosis, renal dysfunction
76
What is cirrhosis? What are some risk factors?
End-stage of liver disease
Extensive degeneration and destruction of liver cells
Results in replacement of liver tissue by fibrous and regenerative nodules
Usually happens after decades of chronic liver disease
Risk factors include male gender, alcohol use, fatty liver disease, excess iron deposits in liver
77
What is the etiology and pathophysiology of cirrhosis?
Most common causes in United States are chronic hepatitis C and alcohol-induced liver disease
Other causes
* Extreme dieting, malabsorption, obesity
* Environmental factors
* Genetic predisposition
78
What are some complications of cirrhosis?
Portal hypertension
* Increased venous pressure in portal circulation
* Splenomegaly
* Large collateral veins
* Ascites
* Gastric and esophageal varices
Esophageal and gastric varices:
Esophageal varices: Complex of tortuous, enlarged veins at lower end of esophagus
Gastric varices: Upper part of stomach
Peripheral edema
Abdominal ascities
Hepatorenal syndrome
Hepatic encephalopahty
## Footnote
Both esophageal. & gastric varices are very fragile, bleed easily
* Most life-threatening complication
79
What are the serum aminotransferase used to test liver function?
| 5
1. AST
2. ALT
3. GGT
4. GGTP
5. LDH
80
What are some of liver function tests/studies?
| 6 Not Serum aminotransferase
1. Serum protein studies
2. Direct and indirect serum bilirubin, urine bilirubin, and urine bilirubin and urobilinogen
3. Clotting factors
4. Serum alkaline phosphatase
5. Serum ammonia
6. Lipids
81
What are some liver diagnostic studies?
| 4
1. Liver biospy
2. Ultrasonography
3. CT
4. MRI
## Footnote
There may be other specialized/less common diagnostic studies that can be used depending on the specific clinical situation.
82
What are the preoperative nursing interventions for liver transplantation?
Support, education, and encouragement are provided to help prepare psychologically for the surgery
83
What are the postoperative nursing interventions for liver transplantation?
Monitor for infection, vascular complications, respiratory and liver dysfunction, constant close monitoring
84
What are some topics that the nurse should touch when educating the patient about liver transplant?
1. Long-term measures to promote health
2. Adhere closely to the therapeutic regimen, with special emphasis on administration, rationale, and side effects of immunosuppressive agents
3. The S/S that indicate problems necessitating consultation with the transplant team
4. The importance of follow-up laboratory tests and appointments with the transplant team
85
A 78-year-old patient is admitted with a diagnosis of Clostridium difficile infection (CDI). Which of the following factors may have contributed to the patient’s susceptibility to CDI? (Select all that apply)
A. Recent use of broad-spectrum antibiotics
B. History of hypertension
C. Use of proton pump inhibitors (PPIs) for GERD
D. Age-related changes in immune function
E. Regular consumption of a high-fiber diet
A, C, D
Rationale: Broad-spectrum antibiotics disrupt normal gut flora, PPIs reduce stomach acid, and age-related changes weaken the immune system, all increasing susceptibility to CDI.
86
A 65-year-old patient is prescribed a course of antibiotics for a respiratory infection. The nurse is providing patient education to prevent antibiotic-associated diarrhea. Which of the following instructions should the nurse include?
A. "Increase your intake of high-fiber foods."
B. "Take an over-the-counter antidiarrheal medication daily."
C. "Consume yogurt with live and active cultures."
D. "Discontinue the antibiotic if you develop loose stools."
C. "Consume yogurt with live and active cultures."
Rationale: Yogurt with live cultures can help replenish beneficial gut bacteria, reducing the risk of antibiotic-associated diarrhea.
87
A 70-year-old patient with a history of heart failure and type 2 diabetes is admitted with severe diarrhea for the past 5 days. The patient is taking multiple medications, including a proton pump inhibitor (PPI) for GERD. Which of the following is the MOST likely contributing factor to the patient's diarrhea?
A. Heart failure exacerbation
B. Type 2 diabetes complications
C. Use of proton pump inhibitors (PPIs)
D. Age-related changes in bowel motility
C. Use of proton pump inhibitors (PPIs)
Rationale: While heart failure and diabetes can affect bowel function, the PPI is the most directly linked factor, as it reduces stomach acid and increases the risk of infectious diarrhea.
88
A patient is diagnosed with Clostridium difficile infection (CDI). Which of the following nursing interventions are appropriate for this patient? (Select all that apply)
A. Administering antidiarrheal medications
B. Implementing contact precautions
C. Monitoring for signs of dehydration
D. Encouraging the use of alcohol-based hand sanitizer
E. Providing education on proper hand hygiene
B, C, E
Rationale: Antidiarrheals are generally avoided in CDI as they can prolong toxin exposure. Contact precautions are essential to prevent spread. Monitoring for dehydration is crucial due to fluid loss. Alcohol-based hand sanitizer is ineffective against C. difficile spores; soap and water are necessary.
89
A patient with Clostridium difficile infection (CDI) is experiencing severe diarrhea and abdominal pain. Which medication is the MOST appropriate first-line treatment for this patient?
A. Metronidazole
B. Oral vancomycin
C. Fecal microbiota transplantation (FMT)
D. Lactobacillus
B. Oral vancomycin
Rationale: Oral vancomycin or fidaxomicin are the first-line treatments for CDI. Metronidazole is an alternative. FMT is used for recurrent CDI. Lactobacillus may be used as prophylaxis or adjunct therapy.
90
A patient with chronic constipation has been following a bowel management program for several weeks. Which findings would indicate that the program is effective? Select all that apply.
A. The patient reports having bowel movements every other day.
B. The patient experiences frequent episodes of abdominal cramping.
C. The patient no longer requires laxatives.
D. The patient reports feeling complete evacuation after bowel movements.
E. The patient reports increased energy levels.
F. The patient continues to strain during bowel movements.
A, C, D, E
Rationale: * A indicates more regular bowel movements.
* C shows that the patient is managing constipation without reliance on laxatives.
* D demonstrates a feeling of complete evacuation.
* E reflects improved overall well-being.
* B is incorrect because abdominal cramping suggests the program may not be effective or may be causing discomfort.
* F is incorrect because continued straining indicates the program is not fully addressing the constipation.
91
What is the primary cause of death in patients with peritonitis?
A. Hemorrhage
B. Cardiac arrest
C. Septicemia
D. Respiratory failure
C. Septicemia
Rationale: * The text explicitly states that death due to peritonitis is caused by septicemia (bloodstream infection).
92
The appendix can become occluded by a hardened mass of stool known as a __________.
Fecalith
Rationale: * The text identifies fecalith as one of the causes of appendix occlusion.
93
A patient is recovering from an appendectomy. Which findings would indicate potential complications and require further assessment? Select all that apply.
A. Decreased bowel sounds.
B. Serosanguineous drainage from the surgical site.
C. Sudden increase in abdominal pain.
D. Temperature of 99.1°F (37.3°C).
E. Redness and warmth at the incision site.
F. Pain controlled with prescribed analgesics.
A, C, E
Rationale: * A could indicate an ileus (lack of bowel movement), a potential complication.
* C suggests potential infection or other issues.
* E suggests potential infection at the surgical site.
* B is generally expected post-operatively.
* D is a normal temperature.
* F shows that pain is being managed effectively
94
A patient with diverticulitis develops sudden, severe abdominal pain, a rigid abdomen, and a high fever. Which of the following complications is MOST likely occurring?
A. Diverticular bleeding
B. Abscess formation
C. Peritonitis
D. Fistula formation
C. Peritonitis
Rationale: The sudden, severe abdominal pain, rigid abdomen, and high fever are classic signs of peritonitis, a serious complication of diverticulitis.
95
A patient with a history of chronic constipation presents with severe rectal pain and bleeding. Upon inspection, the nurse notes a tear in the anal mucosa. Which of the following conditions is MOST likely present?
A. Hemorrhoids
B. Anal fistula
C. Anal fissure
D. Rectal prolapse
C. Anal fissure
Rationale: The tear in the anal mucosa is characteristic of an anal fissure, often caused by chronic constipation and straining.
96
A patient with a sigmoid colostomy is being taught how to manage their ostomy at home. Which of the following statements by the patient indicates a need for further teaching?
A. "I will empty the pouch when it is about one-third to one-half full."
B. "I can regulate my bowel movements by irrigating my colostomy."
C. "I need to change the pouch every day."
D. "I should inspect the stoma regularly for any changes in color or size."
C. "I need to change the pouch every day."
Rationale: Pouch changes are not typically required daily unless there are specific issues. The other statements are accurate
97
A patient with a continent ileostomy (Kock pouch) needs education on how to manage their ostomy. What is the MOST appropriate method for emptying the pouch?
A. Apply gentle pressure to the abdomen.
B. Insert a catheter through the stoma.
C. Change the external pouch daily.
D. Irrigate the stoma with warm water.
B. Insert a catheter through the stoma.
Rationale: Continent ileostomies are designed to be drained via catheter insertion. Other options are incorrect.
98
A patient underwent an ileostomy 2 days ago. The nurse notes a stool output of 1600 mL. Which of the following nursing interventions is MOST important at this time?
A. Restricting oral fluids to reduce output.
B. Monitoring fluid and electrolyte balance.
C. Encouraging a high-fiber diet to thicken stool.
D. Teaching the patient to perform Kegel exercises.
B. Monitoring fluid and electrolyte balance.
Rationale: Early ileostomy output is high in fluid and electrolytes, requiring close monitoring. Other interventions are not appropriate at this stage.
99
A patient with a colostomy is concerned about odor. Which of the following interventions would be MOST helpful?
A. Using a closed-end pouch only.
B. Irrigating the colostomy daily.
C. Using a pouch with a charcoal filter.
D. Restricting fluid intake.
C. Using a pouch with a charcoal filter.
Rationale: Charcoal filters deodorize and release flatus. Other options are not primarily focused on odor control.
100
A patient with an ileostomy reports experiencing abdominal cramping and decreased stool output. Which of the following is the MOST likely cause?
A. Normal adaptation
B. Dehydration
C. Stomal stenosis (narrowing)
D. Dietary indiscretion leading to obstruction
D. Dietary indiscretion leading to obstruction
Rationale: Ileostomies are prone to obstruction from food not chewed properly. Other options are less likely given the symptoms.
101
A patient with cholecystitis develops dark amber urine and clay-colored stools. Which of the following complications is MOST likely occurring?
A. Pancreatitis
B. Kidney stones
C. Total biliary obstruction
D. Appendicitis
C. Total biliary obstruction
102
Which of the following are potential complications of cholecystitis? (Select all that apply)
A. Appendicitis
B. Pancreatitis
C. Cholangitis
D. Biliary cirrhosis
E. Gallbladder rupture leading to peritonitis
B, C, D, E
Rationale: Appendicitis is not related to cholecystitis.
103
A patient with suspected cholecystitis has an elevated serum amylase level. Which of the following complications is MOST likely occurring?
A. Cholangitis
B. Pancreatitis
C. Biliary cirrhosis
D. Gangrenous cholecystitis
B. Pancreatitis
Rationale: Elevated amylase indicates pancreatic involvement.
104
A patient with chronic cholecystitis develops jaundice and pruritus. Which of the following complications is MOST likely occurring?
A. Gangrenous cholecystitis
B. Biliary cirrhosis
C. Subphrenic abscess
D. Gallbladder rupture leading to peritonitis
B. Biliary cirrhosis
Rationale: Jaundice and pruritus suggest chronic bile flow obstruction and liver involvement.
105
Which of the following interventions are used in the treatment of cholelithiasis? (Select all that apply)
A. Oral dissolution therapy with Ursodiol
B. ERCP with sphincterotomy
C. Extracorporeal shock-wave lithotripsy (ESWL)
D. Antibiotic treatment
E. Anticholinergic medications
A, B, C
Rationale: Antibiotics and anticholinergics are used for cholecystitis, not cholelithiasis.
106
Which procedure uses high-energy shock waves to disintegrate gallstones?
A. ERCP
B. Cholecystotomy
C. ESWL
D. Cholecystectomy
C. ESWL
Rationale: ESWL is specifically designed to break up gallstones using shock waves.
107
A patient with cholecystitis is experiencing severe nausea and vomiting. Which of the following nursing interventions is MOST appropriate?
A. Administer oral dissolution therapy.
B. Insert an NG tube.
C. Prepare the patient for ESWL.
D. Encourage a high-fat diet.
B. Insert an NG tube.
Rationale: An NG tube helps decompress the stomach and alleviate nausea and vomiting.
108
A patient with cholelithiasis is scheduled for an ERCP with sphincterotomy. Which of the following statements by the patient indicates a need for further teaching?
A. "This procedure will help visualize my bile ducts."
B. "The doctor will be able to remove the stones during the procedure."
C. "I will need to take medication to dissolve the stones after the procedure."
D. "An endoscope will be passed through my mouth into my duodenum."
C. "I will need to take medication to dissolve the stones after the procedure."
Rationale: ERCP removes stones directly; medication is not needed post-procedure for stone dissolution.
109
Which of the following are potential causes of hepatitis? (Select all that apply)
A. Bacterial infection
B. Viral infection
C. Alcohol consumption
D. Autoimmune diseases
E. Physical trauma
B, C, D
Rationale: Bacterial infections and physical trauma are not listed as direct causes of hepatitis in the provided information.
| Viral infections are explicitly stated as the most common cause.
110
Which of the following are common causes of cirrhosis in the United States? (Select all that apply)
A. Acute hepatitis A
B. Chronic hepatitis C
C. Alcohol-induced liver disease
D. Bacterial infection
E. Genetic predisposition
B, C, E
111
A patient with a history of chronic hepatitis C is diagnosed with cirrhosis. Which of the following pathophysiological processes is occurring in the patient's liver?
A. Acute inflammation and cellular swelling
B. Replacement of liver tissue with fibrous nodules
C. Rapid regeneration of healthy liver cells
D. Temporary accumulation of fat in liver cells
B. Replacement of liver tissue with fibrous nodules
Rationale: This is the hallmark of cirrhosis.
112
Which of the following is the MOST life-threatening complication of cirrhosis?
A. Ascites
B. Peripheral edema
C. Esophageal varices
D. Hepatorenal syndrome
C. Esophageal varices
Rationale: Esophageal varices can rupture and cause massive bleeding.
113
A liver transplant patient is being discharged and needs education on immunosuppressive medications. Which of the following statements by the patient indicates a need for further teaching?
A. "I should take my medications at the same time every day."
B. "I should stop taking my medications if I feel better."
C. "I need to understand the side effects of my medications."
D. "I will need regular blood tests to monitor my medication levels."
B. "I should stop taking my medications if I feel better."
Rationale: Immunosuppressive medications must be taken consistently to prevent rejection, even if the patient feels well.
114
A liver transplant patient reports experiencing fever, abdominal pain, and jaundice. Which of the following actions should the nurse instruct the patient to take?
A. Increase the dose of immunosuppressive medications.
B. Contact the transplant team immediately.
C. Apply warm compresses to the abdomen.
D. Rest and monitor symptoms for 24 hours.
B. Contact the transplant team immediately.
Rationale: These are signs of potential transplant rejection or infection, requiring prompt medical attention.
115
Which of the following are complications of portal hypertension? (Select all that apply)
A. Peripheral edema
B. Splenomegaly
C. Esophageal varices
D. Hepatic encephalopathy
E. Ascites
B, C, E
