Practice Questions r/t the Gastrointestinal System and Nutrition

Question 1

Your client is receiving continuous nasogastric feedings. You know to change the tube feeding container and line every ______________

Answer 1

24 h

the tube feeding container and line are normally changed every 24 hours to prevent transmission of bacteria. The feedings themselves should infuse for no longer than 8 hours.

Question 2

the most accurate assessment for correct placement of nasogastric tube is to:

1. determine the pH of aspirate
2. visualize the gastric area by X-ray
3. inject air into the tube and auscultate over the gastric area for the sound of air entering the stomach
4. palpate the gastric area following the injection of 100 cc of air into the tube

Answer 2

x-ray is the most accurate assessment of the correct placement of an NG tube as visual confirmation can be made about the position.

determining the pH of aspirate or auscultation over gastric area to hear sounds of injected air as it enters the stomach are ways to confirm placement - however, they are not the most accurate

palpation is not used to determine placement as injections of enough air to palpate would cause discomfort

Question 3

a client experiencing upper gastrointestinal bleeding was stabilized in the emergency department and was admitted to the hospital for further evaluation. To determine the cause and specific site of the bleeding, the nurse will anticipate a prescription for which diagnostic test first?

1. gastroscopy
2. gastrointestinal x-rays
3. fiberoptic colonoscopy
4. gastric analysis

Answer 3

A gastroscopy would be the most likely diagnostic procedure since upper gastrointestinal bleeding is suspected. A gastroscopy allows direct visualization of the mucosal lining of the esophagus, stomach, and duodenum

gastrointestinal x-ray would be requested only if the gastroscopy was inconclusive and it was thought that additional information would be useful

fiberoptic colonoscopy would not be requested since the bleeding is occurring in the upper gastrointestinal tract. A fiberoptic colonoscopy allows direct visualization of the colon up to the ileocecal valve. It is used to diagnose conditions such as inflammatory bowel disease, strictures, and bleeding sites. This procedure allows for removal of polyps.

a gastric analysis is usually requested to analyze the pH and volume of the gastric contents. This test could assist in determining the cause of bleeding, such as high acidity of stomach contents. However, gastric analysis cannot locate specific sites of bleeding, since direct visualization is not possible.

Question 4

a client who is to be weighed daily on bed scales is receiving continuous liquid feedings via a percutaneous endoscopic gastrostomy (PEG). An important nursing intervention would be to:

1. weight the day’s feeding formula and add it to the client’s weight
2. inform the physician that persons receiving continuous feedings cannot be weighted on bed scales
3. defer the daily weights and record this deferment on the chart
4. turn off the feed at least 30 minutes prior to weighing process

Answer 4

The percutaneous endoscopic gastrostomy (PEG) feeding should be turned off at least 30 minutes prior to the weighing process. This will decrease the risk of aspiration.

weighing the day’s feeding formula and adding it to the client’s weight is not an appropriate or common practice

clients receiving continuous PEG feedings can be weighed on bed scales

there is no clinical reason to defer daily weights

Question 5

your client had a resection of a diseased portion of the ileum. Which instructions will you give the client about performing deep breathing and coughing exercises?

1. sit in an upright position; take a deep breath, and then cough
2. hold your abdomen firmly, take several deep breaths, and then cough 2 or 3 times as you exhale
3. tighten your stomach muscles as you inhale and then cough forcefully
4. raise your shoulders to expand your chest and then give a deep cough

Answer 5

You will instruct the client to hold the abdomen firmly, take several deep breaths, and then cough two or three times as they exhale. Effective splinting of the surgical site will allow the client to breathe deeply and cough more effectively. The client will experience less pain since stress on the suture line is relieved. The goal of coughing and deep breathing is to fully expand and aerate the lungs, thus allowing secretions to be coughed out. Effective coughing is always preceded by deep breathing.

When possible, the nurse should teach the postoperative client to maintain a sitting position for coughing and deep-breathing exercises. This position lowers abdominal organs and allows the diaphragm to expand fully. However, a sitting position may not be therapeutic or appropriate for all surgical clients

the client should not tighten stomach muscles when doing C&DB exercises. Also, it is not necessary that coughing be forceful. It would be helpful to have the client slightly flex the knees to take tension off the abdomen

the client should be taught to breathe deeply from the diaphragm. Raising the shoulders tends to facilitate shallow breathing, not deep breathing.

Question 6

ingestion of which of the following foud has been found to exacerbate gastroesophageal reflux disease?

1. poultry
2. pasta
3. herbs and spices
4. caffeine and chocolate

Answer 6

Ingestion of caffeine and chocolate may exacerbate gastroesophageal reflux. The reflux of the stomach contents into the esophagus is due in part to a lowering of esophageal sphincter pressure. Certain foods have been found to lower the sphincter pressure. These foods include caffeine, chocolate, peppermint, and fatty foods

Question 7

A client is experiencing vomiting and gastrointestinal bleeding. You are to prepare an intravenous infusion that contains potassium chloride. The purpose of administering potassium chloride is t:

1. replace the potassium lost in the urine
2. restore lost potassium reserves
3. provide potassium to promote excretion of sodium
4. replace the potassium that is being lost through vomiting

Answer 7

Administering potassium chloride will replace the potassium that is being lost through vomiting. Potassium is one of the electrolytes contained in gastric secretions. When excessive vomiting or suctioning of gastric contents occurs, clients lose potassium. If potassium is not replaced, hypokalemia may occur.

potassium is usually lost in urine output during diuretic therapy

potassium cannot be stored in the body. A minimum of 40 mEq a day must be consumed. A normal potassium level is 3.5 to 5.5 mEq/l

potassium does not promote excretion of sodium. When potassium is lost from the cells, sodium shifts into the cells to replace lost K+

Question 8

your client had a subtotal gastrectomy and my experience the dumping syndrome as a direct result of:

1. the removal of a large portion of the stomach
2. hyperosmolar chyme
3. consuming large quantities of food
4. not resting after each meal

Answer 8

The dumping syndrome is a direct result of removing a large portion of the stomach. The dumping syndrome is a set of unpleasant vasomotor and gastrointestinal symptoms that occur in 10-50% of clients who have had gastric surgery. Food passes too rapidly from stomach remnant into the duodenum and jejunum. Symptoms include weakness, faintness, cramping, and diarrhea.

hyperosmolar chyme occurs as a result of food entering the duodenum and jejunum without proper mixing

consuming smaller meals, not drinking liquids with meals, and staying upright after meals can benefit those experiencing dumping syndrome - however th e opposites do not cause the condition

Question 9

how many ounces of commercially prepared formula will contain 500 kcal of energy?
________________________

Answer 9

commercial formula and breast milk contain ~20kcal/oz so 25oz will be needed

Question 10

a 10-lb baby requires how many kcal per day for energy?

1. 100 kcal
2. 500 kcal
3. 1000 kcal
4. 1500 kcal

Answer 10

babies require 105 to 110 kcal/kg/day

1 kg = 2.2 lbs

110x10/2.2=500kcal/day

Question 11

A client is admitted to the hospital with Crohn’s disease. What does the nurse anticipate the assessment will reveal? (select all that apply)

a. diarrhea
b. jaundice
c. steatorrhea
d. ascites
e. dependent edema
f. shortness of breath
g. tachycardia

Answer 11

a - manifestations of Crohn’s disease include diarrhea, fatigue, abdominal pain, and weight loss. Crohn’s diseaseis a chronic, nonspecific inflammatory disorder of unknown origin that can affect any part of the GI tract. It is characterized by inflammation of segments of the GI tract. It is also called regional ileitis and regional enteritis

jaundice and steatorrhea (fatty stool) are symptoms of gallbladder disease

shortness of breath and tachycardia would be symptoms manifested in a COPD client

dependent edema and ascites are seen in right-sided congestive heart failure

Question 12

Which of the following may result from prolonged gastroesophageal reflux disease and can quickly become life threatening?

1. pharyngitis
2. colitis
3. esophageal ulceration
4. angina

Answer 12

3 - prolonged gastroesophageal reflux disease can quickly become life-threatening, causing esophageal ulceration. A repeated assault on the esophageal mucosa by acid reflux can cause erosion of the esophagus and hemorrhage this is an uncommon occurrence but can be morbid if not treated promptly. Symptoms may become very severe and constant with little relief from previously effective treatments. This is a medical emergency

the chest pains associated with angina may easily be confused with the heartburn associated with GERD, and vice versa. Although one does not cause the other, pain that may be cardiac in origin must always be considered when a client complains of chest pain

Question 13

Which of the following diets would be most appropriate for a client who has hypercholesterolemia?

1. hamburger patty, macaroni and cheese, iced tea
2. baked chicken breast, apple, skim milk
3. fish sticks, French fries, cola
4. pizza, tossed salad, beer

Answer 13

2 - clients with hypercholesterolemia have elevated serum cholesterol levels, which have been found to contribute to the develompent of coronary artery disease. The consumption of low-fat food, such as white meats, fruits, vegetables, grins, and skimmed dairly products wil help lower serum lipid levels.

Question 14

During a physical assessment your client tells you: “I belch a lot and when I lie down, undigested food comes up into my mouth. I have noticed a gurgling sound after eating, and I have a sour taste in my mouth”. You suspect:

1. a diffuse esophageal spasm
2. gastroesophageal reflux
3. a hiatal hernia
4. a pharyngoesophageal diverticulum

Answer 14

you will suspect a pharyngoesophageal diverticulum. A diverticulum is an outpouching of the mucosa that protrudes through a weak place in the esophageal musculature. Symptoms include dysphagia, belching, regurgitation of undigested food, gurgling sounds after eating (caused by fluid and food filling the diverticulum), coughing caused by trachea irritation, halitosis (bad breath), and a sour taste in the mouth caused by decomposing food lodged in the diverticulum

a diffuse esophageal spasm is caused by motor excitement of the esophagus that produces alternate periods of contractions and relaxation. Symptoms include dysphagia and chest pain

gastroesophageal reflux is characterized by backward flow of acidic contents of the stomach into the distal portion of the esophagus. Symptoms include pyrosis (heartburn), regurgitation, dysphagia, and a painful feeling of a lump in the throat

hiatal hernia type 1 is a sliding hernia where the upper stomach and the gastroesophageal junction are pushed upward in and out of the thorax. Type 2 is a herniation of a portion of the stomach through an opening (hiatus) into the esophagus. This condition is also known as esophageal or diaphragmatic hernia. Symptoms of types 1 and 2 include pyrosis and dysphagia

Question 15

your client has a history of scarring as a result of repeated ulcerations and healings of ulcers distal to the pyloric sphincter. Recent complaints include epigastric fullness, pain, distention, nausea, vomiting, and anorexia. The client sates that the pain is worse at night. You suspect:

1. peptic ulcer disease
2. acute gastritis
3. pyloric obstruction
4. paralytic ileus

Answer 15

3 - a pyloric obstruction is suspected. Scarring at the pylorus is likely to cause pyloric obstruction. As a result of the obstruction, the contents of the stomach are unable to empty properly, which causes gastric fullness, distention, pain, nausea, and vomiting. When clients lie down at night, pain intensifies since the stomach is even less likely to be emptied by peristalsis

symptoms of peptic ulcer perforation include sudden onset of severe upper abdominal pain that spreads rapidly throughout the abdomen as the spillage of gastrointestinal contents invade the peritoneal cavity. Clients experience rigid, board-like abdomen. Respirations become shallow and rapid. Bacterial septicemia develops, causing fever and hypovolemic shock.

some of the symptoms of acute gastritis are similar to those of pyloric obstruction. However, the client’s history of scarring at the distal end of the pyloric sphincter is highly suggestive of pyloric obstruction.

a paralytic ileus is a postoperative complication. Peristalsis stops in a portion of the bowel, which causes diminished or absent bowel sounds. Abdominal distention occurs and the client complains of pain and feelings of fullness. A nasogastric tube is usually required to relieve distention and vomiting until normal bowel peristalsis resumes

Question 16

Your client is experiencing the acute phase of ulcerative colitis. The client states, “ there is blood in my stools. I am afraid.” You will:

1. check the client’s stools for the presence of occult blood
2. recommend that the client keep a record of the number and description of stools
3. notify the client’s physician immediately
4. explain to the client that blood in the stools is expected in this condition

Answer 16

4 - the nurse should explain to the client that 90 to 100% of clients experiencing ulcerative colitis have blood, pus, and mucus in their stools. Understanding the nature and symptoms of the disease may help to alleviate the client’s anxiety.

it is not necessary to check for occult blood as blood in stool is a typical finding

clients should participate in maintaining a record of the number and description of stool, however, maintaining a record will not give the client information needed to allay anxiety about blood in the stool

nursing staff will record the number and description of stools - it is not necessary to notify a physician as this symptom is expected

Question 17

A client with cirrhosis of the liver has a serum bilirubin level of 50 mg/dl. In order to evaluate these laboratory results, you need to know that the normal serum bilirubin level is:

1. 0.2 to 1.0 mg/dl
2. 3 to 10 mg/dl
3. 10 to 20 mg/dl
4. 20 to 30 mg/dl

Answer 17

normal serum bilirubin is 02. to 1.0 mg/dl.

a serum bilirubin of 50 mg/dl is associated with late-stage liver disease

Question 18

Your client will have a permanent colostomy following a colon resection. You will teach the client that the colostomy should begin to function postoperatively within:

1. 12 to 24 hours
2. 2 to 4 days
3. 4 to 5 days
4. 5 to 6 days

Answer 18

The colostomy should begin to function within 2 to 4 days. It generally takes this long for peristalsis to be restored following abdominal surgery.

As peristalsis should return in 48-72 hours, any longer may suggest that complications such as a paralytic ileus should be suspected

Question 19

a child 4 years of age is acutely ill. Which of the following nursing measures will be most helpful in meeting the child’s nutritional needs during the acutely ill period?

1. serving foods that are lukewarm
2. giving liquids through a straw
3. offering small, frequent feedings of favourite foods
4. allowing the client to select foods from the regularly scheduled meal trays

Answer 19

3 - frequent, small potions of favourite foods will allow periods of rest that prevent exhaustion and help the acutely ill child to meet their nutritional needs.

temperature of the food is not the issue. Although a straw may conserve energy, if the child does not enjoy the liquid it won’t matter if there is a straw or not

Question 20

A client had an abdominoperineal resection with creation of an end colostomy. A sump drain was left in the client’s perineal wound. The purpose of this sump drain is to:

1. allow for easy assessment of the character and volume of drainage
2. allow for easy passage of flatus until peristalsis returns
3. prevent contamination of the operative site secondary to frequent dressing changes
4. allow wound healing from its lowest depth without forming an abscess

Answer 20

4 - the sump drain will allow wound healing to take place from its lowest depth without forming an abscess

the character and volume of drainage can be assessed by using a sump drain. However, this is not the primary purpose for the drain

flatus will be expelled from the colostomy, not the perineal wound

a sump drain can be contaminated as easily as a dressing

Question 21

Your client has a gastric ulcer and is to receive aluminum hydroxide. The client asks, “why am I receiving aluminum hydroxide?” You will explain that the expected action of this drug is to:
1. aid in inhibiting the secretion of hydrochloric acid

Answer 21

aluminum hydroxide (Amphojel) is an antacid that neutralizes gastric secretions by buffering hydrochloric acid

antiulcer (histamine H2 antagonists) such as Tagamet inhibit secretion of hydrochloride while antacids like Amphojel simply buffer

aluminum hydroxide does not impact the breakdown of protein, or absorb air that has been swallowed

Question 22

a 73-year-old client was admitted to the hospital with vomiting and gastrointestinal bleeding. The nurse prepares to administer an intravenous infusion that contains potassium chloride. The nurse will explain to the client that the purpose of the infusion is to:

1. replenish the potassium that is being lost in the urine
2. replace the potassium that is lost through vomiting
3. restore the potassium level that elderly clients cannot maintain through normal dietary intake.
4. Provide potassium in an amount sufficient to promote excretion of sodium chloride

Answer 22

2 - to replace potassium loss through vomiting. Potassium is one of the electrolytes contained in gastric secretions.

there is no indication potassium is being lost through urinary output. Clients who are treated with diuretics such as furosemide (Lasix) may lose potassium

as potassium is not stored in the body, people of all ages need potassium on a daily basis

Question 23

You are encouraging an elderly client to increase intake of protein. To provide the greatest amount of protein, you will plan to add which of the following to 100 cc of milk?

1. 50 cc of light cream and 2 tablespoons of corn syrup
2. 30 grams of powdered skim milk and 1 egg
3. 1 small scoop (90 grams) of vanilla ice cream and 1 tablespoon of chocolate syrup
4. 2 egg yolks and 1 tablespoon of sugar

Answer 23

the skim milk powder and whole egg will provide the highest amount of protein

Question 24

You are preparing a client for an upper gasterointestinal series. Which of the following explanations by the nurse would be both accurate and appropriate to share with the client

1. in the x-ray department you will be asked to drink a thick liquid, and then several x-rays of the upper part of your digestive system will be taken at intervals
2. you will be asked to swallow a tube so the physician can look at the lining of your stomach. X-rays will be taken at the same time
3. you will be asked to swallow a substance that is radioactive, and then a series of x-rays will be taken. this will help to determine what is wrong with your stomach
4. this test is carried out in the x-ray department. You will find it a little uncomfortable, but it’s not really painful

Answer 24

1 - in the x-ray department you will be asked to drink a thick liquid, and then several x-rays of the upper part of your digestive system will be taken at intervals. This is simple, factual and understandable to client

does not require client to swallow tube

the substance swallowed is radiopaque - not radioactive

a GI series is not uncomfortable

Question 25

An adult client is hospitalized with a hiatal hernia. Following a transthoracic hiatal herniorrhaphy, the client returns to the unit with a chest tube attached to a 3-chamber water-seal drain connected to suction. Which of the following actions should the nurse take initially if the client’s chest tube is not draining immediately following surgery?

1. clamp the chest tube near the point of exit from the chest
2. increase the suction applied to the drainage system
3. ask the client to deep-breathe and cough
4. turn the client toward the operative side

Answer 25

if a client’s chest tube is not draining immediately following transthoracic hiatal herniorrhaphy, the nurse should have the client deep breathe and cough. In the immediate postoperative period, bloody drainage is expected. Having the client deep breathe and cough will change the intrapleural pressures and, by observing for oscillation of the fluid in the water-seal chamber of the drainage apparatus, it will be possible to determine if the chest tube and connecting tubing are patent. If plugged, the increased intrapleural pressure manifested during coughing may be sufficient to dislodge any obstruction. A patent system is necessary to prevent a hemo- or pneumothorax

clamping the chest tube may be done when checking for an air leak. However, clamping of the chest tube is not done if it is not draining as anticipated

increasing the suction will only draw air through the vented tubing, it will not affect drainage

the client should be turned toward the operative site after coughing and deep breathing

Question 26

the nurse will instruct clients receiving thiazide drugs to include foods in their diets that are high in:
_______________________

Answer 26

Potassium

The nurse should instruct clients on thiazide drugs such as chlorothiazide (Diuril) to include foods in their diet that are high in potassium. Thiazide diuretics are potassium-depleting. Foods high in potassium include peaches, lima beans, winter squash, pears, baked potato with skin, bananas, and oranges

Question 27

a client complains of nausea. The nurse administers prochlorperazine maleate (comparazine) 25 mg IV as prescribed. Following the administration, the nurse will assess the client for:

1. hypotension
2. headaches
3. confusion
4. dry mouth

Answer 27

The nurse should assess the client for hypotension following prochlorperazine maleate (Compazine) administration. Hypotension is an adverse reaction to prochlorperazine maleate. Other side effects include drowsiness, dizziness, contact dermatitis, and photosensitivity

Question 28

The nurse is caring for a 3-year-old with chronic liver disease and marked ascites. To promote respiratory function and comfort, the child should be placed in which of the following positions?

1. semi-upright
2. semi-prone
3. dorsal recumbent
4. prone

Answer 28

1 - the child should be placed in a semi-upright (45-degree) position. This affords the maximum lung expansion for the client with ascites

Question 29

The nurse is giving dietary instructions to mothers of infants and toddlers. The nurse will inform mothers that diets that include milk to the exclusion of other foods may be deficient in:

1. iron
2. carbohydrates
3. vitamin d
4. vitamin k

Answer 29

The nurse will inform the mother that diets that include milk to the exclusion of other foods may be deficient in iron. Infants and children between the age of 6 and 34 months may be vulnerable to iron-deficiency anemia since cow’s milk is low in iron. Brest-fed and iron-fortified formula receiving infants usually have adequate iron intake

Question 30

A client thought to have cholelithiasis has been hospitalized and scheduled for an ultrasonography. Prior to this diagnostic evaluation, the nurse will:

1. administer a sedative approximately 30 minutes before the procedure
2. question the client about allergies to iodine and seafood
3. provide a clear liquid diet the evening before the evaluation
4. explain the procedure and its purpose

Answer 30

a nurse should always do 4 - explain the procedure and it’s purpose

a sedative is not necessary for clients undergoing ultrasonography. There is no pain or discomfort

ultrasonography does not require the client to ingest a contrast media

special dietary prep is not required, however the client should not eat solid food for at least 12 hours before the procedure. Client may have water

Question 31

As a result of a positive guaiac test on the stools of your client, the physician has prescribed a bland diet. The nurse will provide dietary instructions for the client. Which of the following menus, if selected by the client, would indicate the client is able to identify appropriate meals?

1. hamburger with relish on a roll, ice cream, coffee
2. ham on rye bread, flavored gelatin, and milk
3. cream cheese on toasted white bread, canned peaches, and decaffeinated coffee
4. bacon, lettuce, and tomato sandwich on whole-wheat bread, applesauce, and tea

Answer 31

3 - cream cheese on toasted white bread, canned peachs, and decaffeinated coffee are foods allowed on a bland diet.

foods not permitted on a bland diet include fried foods, cured meats, high-fiber breads, highly season foods, and foods or drinks that contain caffeine

Question 32

to prepare your client for a barium enema, you will:
(select all that apply)
a. administer a bowel preparation
b. serve a liquid diet 24 hours before the test
c. instruct client to consume a minimum of 240 mL of clear liquids
d. instruct the client that a warm, flushed feeling may be experienced when the dye is infused
e. inform the client that the barium preparation has an unpleasant, thick, chalky taste

Answer 32

a, b, c

prior to a barium enema, prescribed bowel preparations should be completed. This includes the administration of laxatives and cleansing enemas.

a liquid diet should be consumed 24 hours before the test. Fecal matter and gas can interfere with test results.

To ensure adequate hydration clients should receive a minimum of 240 ml of clear liquids prior to the test

a warm, flushed sensation occurs when radiopaque dye is injected intravenousoy in procedures such as excretory urography

can’t taste an enema - if you can, you’ve done it super wrong! a barium swallow however, does have a thick, chalky taste

Question 33

a client was seen in the ED with severe abdominal pain, nausea, vomiting, and diarrhea. Vital signs were: BP 120/80, HR 100 bpm, RR 20 bpm, Temp of 103 F. The client has a history of angina. What was the clients chief complaint?

1. elevated temperature
2. angina pectoris
3. severe abdominal pain
4. nausea, vomiting, and diarrhea

Answer 33

severe abdominal pain

Question 34

A client receiving antineoplastic agents asks the nurse why the antigout medication allopurinol has been included in the chemotherapy regimen. The nurse’s explanation will include the information that allopurinol:

1. enhances the effects of antineoplstic agents
2. decreases side effects of nausea and vomiting
3. will prevent symptoms of gout that may occur during rapid cell destruction
4. will prevent normal cell destruction by promoting folic acid conversion

Answer 34

allopurinol (zyloprim) prevents symptoms of gout that occur due to rapid cell destruction by antineoplastic medications

Question 35

A client with pancreatitis has an increase in the serum amylase level. This is consistent with a nursing diagnosis of:

1. altered nutrition, more than body requirements r/t excessive intake
2. fluid volume excess r/t congestive heart failure
3. pain r/t inflamed pancreas
4. altered nutrition, less than body requirements r/t inadequate nutrition

Answer 35

a client with pancreatitis who has an increase in serum amylase levels will have a nursing diagnosis of pain related to inflamed pancreas. An elevation in serum amylase and lipase is consistent with pancreatitis. A common clinical manifestation of pancreatitis is pain

an increase in serum cholesterol may be seen with an increase in food intake

a decrease in serum sodium level may suggest increased fluid volume seen with congestive heart failure.

hypoalbuminenemia is seen with inadequate intake of nutrients

Question 36

A client with a hiatal hernia is receiving the dopamine antagonist metoclopramide hydrochloride. You will explain that the purpose of this medication is to:

1. lower esophageal sphincter pressure
2. increase gastric emptying
3. decrease gastric acid production
4. protect gastric mucosa

Answer 36

metoclopramide (Reglan) increases the resting tone of the lower esophageal sphincter and facilitates gastric emptying. Persons with hiatal hernia usually receive the dopamine antagonist metoclopramide. This medication stimulates motility of the upper gastrointestinal tract without stimulating gastric secretions.

metoclopramide doesn’t lower esophageal sphincter pressure. It is an antiemetic, gastrointestinal stimulant. It does not decrease gastric acid production

medications like sucralfate protect gastric mucosa, not metoclopromide

Question 37

Acid-ash foods for clients with hypercalcemia may be included as part of the treatment for angina. Which of the following will the nurse recognize as foods found on an acid-ash diet?

1. vegetables
2. milk
3. peaches and apples
4. meat

Answer 37

acid-ash foods include protein-rich choices such as meat, fish, poultry, eggs, cheese, grains (breads and cereals), and certain fruits (cranberries, prunes, and plums).

milk is high in calcium and would not be recommended for clients with hypercalcemia

Question 38

your client has a colostomy. After ambulation, you notice that the client’s stoma is a dusky colour. You will.

1. have the client lie down and then notify the physician
2. loosen the drainage pouch and inspect the stoma for ischemia
3. do nothing, since the stoma should appear dusky in colour
4. prepare the client for stomal irrigation

Answer 38

2 - the drainage pouch should be loosened and the stoma inspected for ischemia. A dusky colour indicates stomal ischemia. Blood supply may be promoted by loosening or adjusting the colostomy pouch. If this does not correct the deficiency of blood supply, the physician should be notified

a healthy stoma is pink

irrigating would not affect colour

Question 39

Which assessment finding is indicative of a vitamin K deficiency?

1. bruising
2. paresthesia
3. brittle nails
4. loss and thinning of hair

Answer 39

1 - when there is a deficiency in vitamin K, the client’s blood will not clot easily, therefore, bruising would be evident. Vitamin K plays an important role in blood coagulation

paresthesia is indicative of vitamin B12 deficiencies, not vitamin K

brittle nails, thinning hair, and hair loss are consistent with protein deficiency

Question 40

a 6-month-old infant with phenylketonuria is brought to the clinic. The client is on a phenylalanine-controlled diet. Which information will the nurse include in the teaching plan that emphasizes the cause of this condition

1. insufficient fat intake during early infancy
2. deficiency of an enzyme needed to utilize galactose during early infancy
3. inability of the infant to metabolize one of the essential amino acids
4. abnormal accumulation of lipids in the cells of infants

Answer 40

3 - inability of the infant to metabolize an essential amino acid. In PKU the hepatic enzyme needed to metabolize the amino acid phenylalanine (an essential amino acid formed from protein) is absent, resulting in the accumulation of phenylalanine in the bloodstream and excretion of phenyl acid in the urine

Galactose is a monosaccharide readily absorbed in the digestive tract and is converted into glycogen in the liver

Question 41

a client with cirrhosis of the liver is developing hepatic encephalopathy. You will anticipate laboratory studies that will monitor the clients level of:

1. blood ammonia
2. serum protein
3. alpha-fetoprotein
4. serum amylase

Answer 41

The blood ammonia level will be elevated in clients with hepatic encephalopathy (hepatic coma). The conversion of ammonia to urea normally occurs in the liver; therefore the ammonia level will be eleated when liver function is affected by cirrhosis.

alpha-fetoprotein refers to an antigen present in the human fetus. Elevated levels are also found in adults with hepatic carcinaomas or chemical injuries.

serum amylase is a class of enzymes that split up starches.

Question 42

A client with cirrhosis of the liver is concerned about spider angiomas on the nose and cheeks. You teach the client that the angiomas are caused by:

1. splenomegaly
2. decreased prothrombin levels
3. increased circulating estrogens
4. urea crystal deposits on the skin

Answer 42

3 - increased circulating estrogen as a result of the liver’s inability to inactivate it. Spider angiomas are small dilated blood vessels with bright red center and spidery-looking branches. They appear on the nose, cheeks, upper trunk, neck, and shoulders of clients with cirrhosis of the liver.

splenomegaly refers to enlargement of the spleen and does not cause spider angiomas. However, splenomegaly may be present in cirrhosis of the liver

prothrombin is a chemical substance in the circulating blood. Prothrombin is produced by thrombokinase interacting with calcium salts.

urea crystal deposits on the skin are associated with renal failure.

Question 43

your client has achalasia. To decrease esophageal pressure and improve swallowing, the nurse will anticipate a prescription for:

1. antilipemics
2. bronchodilators
3. calcium channel blockers
4. anti-infectives

Answer 43

calcium channel blockers. Achalasia is the absence of or ineffective peristalsis in the distal portion of the esophagus. it is associated with failure of the esophageal sphincter to relax and permit swallowing. Calcium channel blockers reduce esophageal pressure and thereby improve swallowing by reducing arterial resistance.

Question 44

The results of a diagnostic test reveal that a client has salmonellosis. Which of the following measures, if used by the nurse, would be most effective in preventing the transfer of this organism to others?

1. wearing a protective gown when in proximity of the client
2. discard any needle used in the treatment of the client
3. washing the hands upon leaving the clients room
4. using disposable dishes for the client’s foods

Answer 44

.The nursing measure that would be most effective in preventing the transfer of the organism salmonella is handwashing.

a gown and gloves should be worn by individuals in direct contact with the client

all needles should be discarded - however that isn’t how salmonellosis is transferred

disposable dishes may also be effective, but handwashing is the most important and effective measure

Question 45

After a colonoscopy, which of the following symptoms will suggest that a client has a bowel perforation secondary to the procedure?

1. nausea and vomiting
2. abdominal pain and fever
3. abdominal distension and hyperactive bowel sounds
4. hypotension and confusion

Answer 45

Abdominal pain and fever directly suggest bowel perforation and occurrence of peritonitis secondary to perforation

nausea, vomiting, abdominal distension, hyperactive bowel sounds, hypotension, and confusion may all indirectly suggest perforation

Question 46

A client is to have a stool culture for ova and parasites. The accuracy of the results of the client’s stool culture would be influenced mostly by which of the following measures taken by the nurse?

1. keeping the specimen warm
2. collecting a large sample
3. obtaining the specimen before the client has breakfast
4. omitting meat from the client’s diet for 3 days

Answer 46

1 - fresh and warm

only a small amount is required

before breakfast or omitting meats prior to collection does not impact specimen for ova and parasites. Omission of meat prior to specimen collection for occult blood is important as it can give false-positive results up to 4 days after meat is eaten

Question 47

A client has liver damage. The nurse will anticipate an abnormally low serum level for:

1. glutaminic-oxaloacetic transaminase
2. lactic dehydrogenase
3. albumin
4. alkaline phosphatase

Answer 47

3 - the nurse would expect abnormally low serum albumin. Liver damage is characterized by decreased ability of the liver to synthesize proteins. Consequently, albumin synthesis is reduced.

serum glutaminic-oxaloacetic transaminase (SGOT) is an enzyme present in serum and body tissue. An elevation of SGOT is associated with myocardial infarction or hepatic cell damage.

lactic dehydrogenase (LDH) is an enzyme found in various tissues and serum. LDH is important in catalyzing the oxidation of lactate. It has no direct impact on liver damage

alkaline phosphatase ALP is an enzyme originating mainly in the bone, liver, and placenta, with some activity in the kidney and intenstine

Question 48

An adult client is admitted to the hospital with a diagnosis of advanced cirrhosis and ascites. Because the client has advanced cirrhosis of the liver, the nurse would most likely obtain which of the following information during an assessment?

1. clubbing of the fingers
2. an acetone odor of the breath
3. epigastric pain and dysphasia
4. fatigue and muscle wasting

Answer 48

4 - fatigue and muscle wasting. Chronic cirrhosis and malnutrition affect carbohydrate nd protein metabolism, leading to generalized weakness, fatigue, and muscle wasting.

clubbing of the fingers is an indication of a heart condition due to ischemia

an acetone odor in the breath could indicate diabetic ketoacidosis

epigastric pain and dysphagia could indicate a gastrointestinal problem

Question 49

A client has been admitted to your unit with a jejunostomy tube. Which nursing action is contraindicated?

1. administer bolus tube feeding every 4 hours
2. flush tube with 30 cc of water every 4 hours
3. administer medication in liquid form
4. change feeding bag every 4 hours.

Answer 49

1 - administer bolus tube feeding q4h. A bolus feed is contraindicated when food is introduced directly into jejunum via jejunostomy tube. A bolus feeding would cause a hyperosmolar reaction much like dumping syndrome. Clients with a jejunostomy tube will need continuous enteral feeding

the other actions are all appropriate

Question 50

In planning dietary education for a client on a low-fat diet, the nurse should first:

1. determine a 24-hour recall and list of foods the client likes best
2. give the client a list of foods included in a low-fat diet
3. discuss with the client he important relationship between diet and exercise
4. tell the client that fruits and vegetables should form the bulk of a low-fat diet

Answer 50

1 -determining the client’s current eating habits and lifestyle should be considered as should what foods the client likes best. These will help the nurse plan an acceptable diet, thus increasing the chances of compliance!

the other three are helpful information, but not as important to effective education intervention planning

Question 51

A client is scheduled for a partial glossectomy. The nurse should recognize the primary purpose of oral hygiene preoperatively is to:

1. reduce bacterial count in mouth
2. alter pH of salivary secretions
3. improve functioning of the taste buds
4. promote softening of the lesion

Answer 51

1 - reducing bacterial count in the mouth. Measures to increase the cleanliness of oral cavity before surgery will reduce the incidence of postoperative infections such as surgical parotitis.

preoperative oral hygiene will not alter the pH of salivary secretions or improve the function of tastebuds and it is not given to soften lesions

Question 52

A client receives a diagnosis of acute pancreatitis. In assessing the client’s condition, the nurse should expect the laboratory test results to show an elevated serum level of which of the following substances?

1. amylase
2. bilirubin
3. cholesterol
4. gastrin

Answer 52

a client with acute pancreatitis will show an elevated serum amylase due to activation of this enzyme while it is still in the pancreas. This causes actual tissue damage and autodigestion of the pancreas.

bilirubin is produced from the hemoglobin of red blood cells. it is changed chemically in the liver and excreted in the bile. the accumulation of bilirubin leads to jaundice, but does not directly affect the pancreas or cause pancreatitis

cholesterol is a component in cell membrane and plasma lipoproteins. It is absorbed from the diet and synthesized in the liver and other body tissues. Elevated cholesterol may indicate a risk for pancreatitis

gastrin refers to a group of hormones secreted by the mucosa of the pyloric area of he stomach. Gastrin affects the secretionary activity of the gallbladder, pancreas, and small intestine. However, it does not directly cause an increase in amylase

Question 53

a 6-month-old has been vomiting, crying, screaming, and drawing her knees up to her abdomen for 3 hours. The diagnosis is possible intussusception. Which of the following additional signs would the nurse observe and record?

1. jaundice
2. hematuria
3. petechial
4. currant jelly-like stools

Answer 53

4 - currant-jelly-likestools. They are caused by blood and mucus in the intestinal tract. Other symptoms are the absence of stools, increasing abdominal distention, and tenderness, sausage-like mass in the upperright abdomen, dehydration, fever, and a shock-like state

Question 54

You are to give potassium chloride liquid to a client with a percutaneous endoscopic gastrostomy who is on continual feedings. Prior to administering medications, you aspirate 30 cc of residual feed. You should:

1. discard residual and withhold med
2. reinstill residual and give med
3. question administration of potassium chloride via a PEG
4. increase tube feeding rate and give the medication

Answer 54

2 - reinstall the residual feed and give medication. Reinstallation helps avoid fluid and electrolyte imbalance.

residua volumes are usually re-installed. There is no reason to withhold medication. Potassium chloride can be given via PEG -there is no reason to question this. There is no indication the rate should be increased

Question 55

which of the following do you recognize as risk factors associated with cancer?
(select all that apply)
a. excessive alcohol intake
b. low-fat diet
c. high fiber intake
d. low vitamin and mineral intake
e. smoking tobacco

Answer 55

a, d, e

Excessive alcohol intake, low vitamin and mineral intake, and smoking tobacco as well as a high-fat diet, contaminated food intake and low calcium intake are all risk factors for cancer

Question 56

A client comes into the clinic and tells the nurse, “ about an hour or two after I drink milk or eat ice cream, I become bloated and have gas, crampy abdominal pain, and diarrhea”. You suspect this client has a deficiency in the enzyme
____________________________

Answer 56

lactase

Question 57

Client’s experiencing complications from Crohn’s disease may have a deficiency in which of the following vitamins? (select all that apply)

a. A
b. B
c. C
d. D
e. E
f. K

Answer 57

a, d, e, and f
complications from Crohn’s disease include impaired absorption of fat, which leads to deficiency in fat-soluable vitamins: A, D, E, and K

Question 58

Your client has an ileostomy. Which of the following foods is associated with potential obstruction in clients with an ileostomy? (select all that apply)

a. celery
b. nuts
c. onions
d. popcorn
e. beans

Answer 58

a, b, d

onions produce odor and gas, not obstruction

beans produce gas

Question 59

The nurse is providing education to a group of concerned citizens about how to reduce their exposure to pesticides through food. Which comments show the group understands how to minimize their risks?: (select all that apply)

a. discard the fat from meats and skin from poultry and fish
b. peel fruits like oranges and grapefruit with a knife.
c. discard outter leaves of vegetables like cabbage and lettuce
d. there is no need to wash produce with a scrub brush
e. fruits and vegetables should be washed and rinsed in running water to take off pesticide residues

Answer 59

a, b, c, e

it is good to use a scrub brush when washing fresh produce. it is effective in cleaning out crevices and sunken areas around stems

Question 60

Which groups of food are highest in iron?

1. milk, pork, squash
2. steak, spinach, whole-grain bread
3. oranges, chicken, green beans
4. tomatoes, strawberries, and liver

Answer 60

steak, spinach, and whole-grain breads are high in iron. Other foods high in iron include muscle meats, eggs, dried fruits, legumes, dark green leafy vegetables, potatoes, enriched bread, and cereals