quizlet questions for EXAM 5 - GI #1 Flashcards
(103 cards)
1
Q
- A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient’s nausea?
a. Keep the patient NPO for 2 hours before and after dressing changes.
b. Avoid performing dressing changes close to the patient’s mealtimes.
c. Administer the prescribed morphine sulfate before dressing changes.
d. Give the ordered prochlorperazine (Compazine) before dressing changes.
A
c
2
Q
Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?
a. Glass of orange juice
b. Dish of lemon gelatin
c. Cup of coffee with cream
d. Bowl of hot chicken broth
A
B
3
Q
A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed?
a. “I take antacids between meals and at bedtime each night.”
b. “I sleep with the head of the bed elevated on 4-inch blocks.”
c. “I eat small meals during the day and have a bedtime snack.”
d. “I quit smoking several years ago, but I still chew a lot of gum.”
A
C
4
Q
A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient’s
a. apical pulse.
b. bowel sounds.
c. breath sounds.
d. abdominal girth.
A
C
5
Q
Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
a. “Peppermint tea may reduce your symptoms.”
b. “Keep the head of your bed elevated on blocks.”
c. “You should avoid eating between meals to reduce acid secretion.”
d. “Vigorous physical activities may increase the incidence of reflux.”
A
B
6
Q
A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
a. the amount of saturated fat in the diet.
b. any family history of gastric or colon cancer.
c. a history of a large recent weight gain or loss.
d. use of nonsteroidal antiinflammatory drugs (NSAIDs).
A
D
7
Q
The nurse will anticipate preparing a 71-year-old female patient who is vomiting “coffee-ground” emesis for
a. endoscopy.
b. angiography.
c. barium studies.
d. gastric analysis.
A
A
8
Q
A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?
a. The patient has been vomiting for 4 days.
b. The patient takes antacids 8 to 10 times a day.
c. The patient is lethargic and difficult to arouse.
d. The patient has undergone a small intestinal resection.
A
C
9
Q
A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which order from the health care provider will the nurse implement first?
a. Insert a nasogastric (NG) tube.
b. Infuse normal saline at 250 mL/hr.
c. Administer IV ondansetron (Zofran).
d. Provide oral care with moistened swabs.
A
B
10
Q
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
a. “You will need to remain on a bland diet.”
b. “Avoid foods that cause pain after you eat them.”
c. “High-protein foods are least likely to cause you pain.”
d. “You should avoid eating any raw fruits and vegetables.”
A
B
11
Q
The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider?
a. The bowel sounds are hyperactive in all four quadrants.
b. The patient’s lungs have crackles audible to the midchest.
c. The nasogastric (NG) suction is returning coffee-ground material.
d. The patient’s blood pressure (BP) has increased to 142/84 mm Hg.
A
B
12
Q
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?
1. An intestinal obstruction has developed.
2. Additional ulcers have developed.
3. The esophagus has become inflamed.
4. The ulcer has perforated.
A
4
13
Q
The nurse has instructed the client who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the client understands the dietary changes if the client selects which of the following menu choices?
a) Yogurt, crackers and sweet tea
b) Salad with chicken, whole wheat crackers
c) Bacon, tomato, lettuce with mayonnaise and a soft drink
d) Tuna on white bread and coconut cake
A
B
14
Q
The most frequently used diagnostic test for persons with GERD is:
a) Barium enema
b) upper endoscopy
c) barium swallow
d) acid perfusion test
A
C
15
Q
The nurse is planning to teach a client with GERD about substances that will increase the LES pressure.Which item shoud the nurse include on this list.
1. Coffee
2. Chocolate
3. Fatty Foods
4. Nonfat MIlk
A
4 - therefore DECREASING GERD
16
Q
The male client tells the nurse he has been experiencing “heartburn” at night that awakens him. Which assessment question should the nurse ask?
A. How much weight have you gained recently?
B. What have you done to alleviate the heartburn?
C. Do you consume many milk and dairy products?
D Have you been around anyone with a stomach virus
A
B
17
Q
The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement?
1. Provide a low-residue diet.
2.Monitor intravenous fluids.
3.Assess vital signs daily.
4.Administer antacids orally
A
2
18
Q
The nurse is reviewing the record of a client
with Crohn’s disease. Which stool characteristic
should the nurse expect to note documented
in the client’s record?
a. Diarrhea
b. Chronic constipation
c. Constipation alternating with diarrhea
d. Stool constantly oozing from the rectum
A
Answer A: Crohns disease is characterized
by nonbloody diarrhea of usually not more than
4 or 5 stools daily. overtime the stools
increase frequency duration and severity
19
Q
While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient’s knowledge about
a. preventing noninfectious hepatitis.
b. treating inflammatory bowel disease.
c. risk for developing colorectal cancer.
d. using antacids and proton pump inhibitors.
A
C
20
Q
The nurse has been assigned to provide care for four clients at the beginning of the day shift. Which client should she assess first?
1. The client awaiting hiatal hernia repair at 11 am.
2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests.
3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain.
4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.
A
3
21
Q
A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?
1. Ineffective coping related to fear of diagnosis of chronic illness.
2. Deficient knowledge related to unfamiliarity with significant signs and symptoms.
3. Constipation related to decreased gastric motility.
4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.
A
2.
Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.
22
Q
The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following?
1. Bland foods.
2. High-protein foods.
3. Any foods that are tolerated.
4. Large amounts of milk.
A
3
23
Q
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?
1. Before meals.
2. With meals.
3. At bedtime.
4. When pain occurs.
A
bedtime
24
Q
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?
1. “I should take my antacid before I take my other medications.”
2. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
3. “My antacid will be most effective if I take it whenever I experience stomach pains.”
4. “It is best for me to take my antacid 1 to 3 hours after meals.”
A
4
25
Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will:
1. Demonstrate appropriate use of analgesics to control pain.
2. Explain the rationale for eliminating alcohol from the diet.
3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months.
4. Eliminate contact sports from his or her lifestyle.
2
26
Caffeinated beverages and smoking are risk factors to assess for in the development of what condition?
A. Duodenal ulcers
B. Peptic ulcers
C. Helicobacter pylori
D. Esophageal reflux
B
27
When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first?
1. Auscultate the client's bowel sounds in all four quadrants.
2.Palpate the abdominal area for tenderness.
3.Percuss the abdominal borders to identify organs. 4.Assess the tender area progressing to nontender
1
28
The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, board-like abdomen
4
29
The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the
nurse would be most accurate?
1. Aspirin
2. Acetaminophen
3. Naproxen
4. Ibuprofen
2. Acetaminophen is recommended for pain
relief because it does no promote irritation
of the mucosa. Aspirin, and nonsteroidal anti- inflammatory drugs suchs as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding
30
Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
A. a sedentary lifestyle and smoking.
B. a history of hemorrhoids and smoking
C. alcohol abuse and a history of acute renal failure
D. alcohol abuse and smoking
d
31
The nurse has been assigned to provide care for four clients at the beginning of the day shift. Which client should she assess first?
1. The client awaiting hiatal hernia repair at 11 am.
2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests.
3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain.
4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.
3
32
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?
1. An intestinal obstruction has developed.
2. Additional ulcers have developed.
3. The esophagus has become inflamed.
4. The ulcer has perforated.
4
33
The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?
a. regular diet
b. skim milk
c. nothing by mouth
d. clear liquids
c
34
A patient has a vagotomy with antrectomy to treat a duodenal ulcer. Postoperatively, the patient develops dumping syndrome. Which of the following statements, if made by the patient, should indicate to the nurse that further dietary teaching is needed?
1. I should eat bread with each meal
2. I should eat smaller meals more frequently.
3. I should lie down after eating.
4. I should avoid drinking fluids with my meals
1
35
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?
a. Change the tube feeding solutions and tubing at least every 24 hours
b. Maintain the head of the bed at a 15-degree elevation continuously.
c. Check the gastrostomy tube for position every 2 days.
d. Maintain the client on bed rest during the feedings
a
36
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis?
A. You'll need to drink at least two to three glasses of milk daily.
B."It would likely be beneficial for you to eliminate drinking alcohol."
C. Many people find that a minced or pureed diet eases their symptoms of PUD.
D. Your medications should allow you to maintain your present diet while minimizing symptoms
b
37
The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply)
a. only taking aspirin with milk or bread products
b. avoiding taking aspirin and drugs containing aspirin
c. taking only drugs prescribed by the health care provider
d. taking all drugs 1 hour before mealtime to prevent further bleeding e. reading all OTC drug labels to avoid those containing stearic acid and calcium
Answer A, C Aspirin contributes to thinning the blood and is linked to causing things like peritonitis further increasing the risk for bleeding. Taking only health care prescribed drugs can greatly reduce the risk from accidentally using OTC meds that might contribute to bleeding
38
18. Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?
stool culture
39
A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question?
a.
Infuse lactated Ringer's solution at 250 mL/hr.
b.
Monitor blood urea nitrogen and creatinine daily.
c.
Administer loperamide (Imodium) after each stool.
d.
Provide a clear liquid diet and progress diet as tolerated.
c
40
6. A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed?
a.
"I take antacids between meals and at bedtime each night."
b.
"I sleep with the head of the bed elevated on 4-inch blocks."
c.
"I eat small meals during the day and have a bedtime snack."
d.
"I quit smoking several years ago, but I still chew a lot of gum."
ANS: C
GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.
41
10. The nurse will anticipate teaching a patient experiencing frequent heartburn about
a.
a barium swallow.
b.
radionuclide tests.
c.
endoscopy procedures.
d.
proton pump inhibitors.
d
42
27. At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to
a.
increase the amount of fluid with meals.
b.
eat foods that are higher in carbohydrates.
c.
lie down for about 30 minutes after eating.
d.
drink sugared fluids or eat candy after meals.
ANS: C
The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.
43
24. A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?
a.
Irrigate the NG tube.
b.
Check the vital signs.
c.
Give the ordered antacid.
d.
Elevate the foot of the bed.
ANS: B
The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.
44
29. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take
a.
sucralfate at bedtime and antacids before each meal.
b.
sucralfate and antacids together 30 minutes before meals.
c.
antacids 30 minutes before each dose of sucralfate is taken.
d.
antacids after meals and sucralfate 30 minutes before meals.
d
45
30. Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
a.
"You will need to remain on a bland diet."
b.
"Avoid foods that cause pain after you eat them."
c.
"High-protein foods are least likely to cause you pain."
d.
"You should avoid eating any raw fruits and vegetables."
b
46
39. Which assessment should the nurse perform first for a patient who just vomited bright red blood?
a.
Measuring the quantity of emesis
b.
Palpating the abdomen for distention
c.
Auscultating the chest for breath sounds
d.
Taking the blood pressure (BP) and pulse
d
47
40. Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood?
a.
Give an IV H2 receptor antagonist.
b.
Draw blood for typing and crossmatching.
c.
Administer 1000 mL of lactated Ringer's solution.
d.
Insert a nasogastric (NG) tube and connect to suction.
c
48
The nurse is caring for a patient treated with intravenous fluid therapy for severe vomiting. As the pt recovers and begins to tolerate oral intake, the N understands that which of the following food choices would be most appropriate?
A) Ice tea
B) Dry toast
C) Warm broth
D) Plain hamburger
b
49
A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first?
A) Fecal impaction
B) Perineal hygiene
C) Dietary fiber intake
D) Antidiarrheal agent use
a
50
A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient?
A) Instruction on irrigating a colostomy
B) Administration of a cleansing enema
C) A high-fiber diet the day before surgery
D) Administration of IV antibiotics for bowel preparation
B) Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. Instructions to irrigate the colostomy will be done postoperatively. Oral antibiotics are given preoperatively, and an IV antibiotic may be used in the OR. A clear liquid diet will be used the day before surgery with the bowel cleansing.
51
Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)?
A) Restricted to rectum
B) Strictures are common.
C) Bloody, diarrhea stools
D) Cramping abdominal pain
E) Lesions penetrate intestine.
C, D) Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.
52
The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?
A) "The tube will help to drain the stomach contents and prevent further vomiting."
B) "The tube will push past the area that is blocked and thus help to stop the vomiting."
C) "The tube is just a standard procedure before many types of surgery to the abdomen."
D) "The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best."
a
53
A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?
A) 7:00 AM, 10:00 AM, and 1:00 PM
B) 8:00 AM, 12:00 PM, and 4:00 PM
C) 9:00 AM and 3:00 PM
D) 9:00 AM, 12:00 PM, and 3:00 PM
B) A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.
54
The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer?
A) Osteoarthritis
B) History of colorectal polyps
C) History of lactose intolerance
D) Use of herbs as dietary supplements
b
55
The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit?
A) Turn, deep breathe, cough, and use spirometer every 4 hours.
B) Maintain an upright position for at least 2 hours after eating.
C) NG will have bloody drainage, and it should not be repositioned.
D) Keep in a supine position to prevent movement of the anastomosis.
c
56
The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?
A) The patient must be able to see the site.
B) Outside the rectus muscle area is the best site.
C) It is easier to seal the drainage bag to a protruding area.
D) The ostomy will need irrigation, so area should not be tender.
a
57
When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?
A) "I will be able to regulate when I have stools."
B) "I will be able to wear the pouch until it leaks."
C) "Dried fruit and popcorn must be chewed very well."
D) "The drainage from my stoma can damage my skin."
A) The ileostomy is in the ileum and drains liquid stool frequently, unlike the colostomy which has more formed stool the further distal the ostomy is in the colon. The ileostomy pouch is usually worn 4-7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.
58
A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from
the nurse will be most useful in determining the cause of the patient's symptoms?
a. "What type of foods do you eat?"
b. "Is it possible that you are pregnant?"
c. "Can you tell me more about the pain?"
d. "What is your usual elimination pattern?"
c
59
A young adult patient is admitted to the hospital for evaluation of right lower quadrant
abdominal pain with nausea and vomiting. Which action should the nurse take?
a. Assist the patient to cough and deep breathe.
b. Palpate the abdomen for rebound tenderness.
c. Suggest the patient lie on the side, flexing the right leg.
d. Encourage the patient to sip clear, noncarbonated liquids.
c
The patient's clinical manifestations are consistent with appendicitis. Lying still with the right
leg flexed is often the most comfortable position. Checking for rebound tenderness frequently
is unnecessary and uncomfortable for the patient. The patient should be NPO in case
immediate surgery is needed. The patient will need to know how to cough and deep breathe
postoperatively, but coughing will increase pain at this time.
60
A 25-yr-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action
should the nurse take first?
a. Inform the patient that laboratory testing of blood and stools will be necessary.
b. Ask the patient to describe the character of the stools and any associated
symptoms.
c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade
or Pedialyte.
d. Advise the patient to use over-the-counter loperamide (Imodium) to slow
gastrointestinal (GI) motility.
ANS: B
The initial response by the nurse should be further assessment of the patient. The other
responses may be appropriate, depending on what is learned in the assessment.
61
After several days of antibiotic therapy, an older hospitalized patient develops watery
diarrhea. Which action should the nurse take first?
a. Notify the health care provider.
b. Obtain a stool specimen for analysis.
c. Teach the patient about hand-washing.
d. Place the patient on contact precautions.
The patient's history and new onset diarrhea suggest a C. difficile infection, which requires
implementation of contact precautions to prevent spread of the infection to other patients. The
other actions are also appropriate but can be accomplished after contact precautions are
implemented.
62
Which nursing action will be included in the plan of care for a 25-yr-old male patient with a
new diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the patient to express concerns and ask questions about IBS.
b. Suggest that the patient increase the intake of milk and other dairy products.
c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.
a
63
Which question from the nurse would help determine if a patient's abdominal pain might
indicate irritable bowel syndrome (IBS)?
a. "Have you been passing a lot of gas?"
b. "What foods affect your bowel patterns?"
c. "Do you have any abdominal distention?"
d. "How long have you had abdominal pain?"
ANS: D
One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal
discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food
intolerance are associated with IBS but are not diagnostic criteria.
64
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy
abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to
a. administer IV metoclopramide (Reglan).
b. discontinue the patient's oral food intake.
c. administer cobalamin (vitamin B12) injections.
d. teach the patient about total colectomy surgery.
ANS: B
An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the
bowel by making the patient NPO.
65
A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is
receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the
nurse is most important to report to the health care provider?
a. Patient has not voided for the last 4 hours.
b. Skin is dry with poor turgor on all extremities.
c. Crackles are heard halfway up the posterior chest.
d. Patient has had 5 loose stools over the previous 6 hours.
c
66
The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia
about the need for
a. iron dextran infusions
b. oral ferrous sulfate tablets.
c. routine blood transfusions.
d. cobalamin (B12) supplements.
d
67
The nurse preparing for the annual physical exam of a 50-yr-old man will plan to teach the
patient about
a. endoscopy.
b. colonoscopy.
c. computerized tomography screening.
d. carcinoembryonic antigen (CEA) testing.
b
68
A patient in the emergency department has just been diagnosed with peritonitis caused by a
ruptured diverticulum. Which prescribed intervention will the nurse implement first?
a. Insert a urinary catheter to drainage.
b. Infuse metronidazole (Flagyl) 500 mg IV.
c. Send the patient for a computerized tomography scan.
d. Place a nasogastric (NG) tube to intermittent low suction.
ANS: B
Because peritonitis can be fatal if treatment is delayed, the initial action should be to start
antibiotic therapy (after any ordered cultures are obtained). The other actions can be done
after antibiotic therapy is initiated
69
A patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the
plan of care?
a. Position patient with the knees flexed.
b. Avoid use of opioids or sedative drugs.
c. Offer frequent small sips of clear liquids.
d. Assist patient to breathe deeply and cough.
ANS: A
There is less peritoneal irritation with the knees flexed, which will help decrease pain.
70
A 71-yr-old patient had an abdominal-perineal resection for colon cancer. Which nursing
action is most important to include in the plan of care for the day after surgery?
a. Teach about a low-residue diet.
b. Monitor output from the stoma.
c. Assess the perineal drainage and incision.
d. Encourage acceptance of the colostomy stoma.
c
Because the perineal wound is at high risk for infection, the initial care is focused on
assessment and care of this wound. T
71
A patient is transferred from the recovery room to a surgical unit after a transverse colostomy.
The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous
drainage. The nurse should
a. place ice packs around the stoma.
b. notify the surgeon about the stoma.
c. monitor the stoma every 30 minutes.
d. document stoma assessment findings.
d
72
The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to
a. administer IV fluids.
b. prepare for colonoscopy.
c. give stool softeners and enemas.
d. order a diet high in fiber and fluids.
ANS: A
A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber
and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool
softeners, are usually given, and these will be implemented later in the hospitalization. The
patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for
perforation and peritonitis.
73
Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?
a. Navy bean soup and vegetable salad
b. Whole grain pasta with tomato sauce
c. Baked potato with low-fat sour cream
d. Roast beef sandwich on whole wheat bread
ANS: A
A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis.
74
A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction,
IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel
perforation. Four hours after admission, the patient experiences nausea and vomiting. What is a priority nursing
intervention for the patient?
a. Assess the abdomen for distention and bowel sounds.
b. Inspect the surgical site and drainage in the Jackson-Pratt.
c. Check the amount and character of gastric drainage and the patency of the NG tube.
d. Administer prescribed prochlorperazine (Compazine) to control the nausea and vomiting.
c
75
A 22-year-old patient calls the outpatient clinic complaining of nausea and vomiting and right lower abdominal pain.
What should the nurse advise the patient to do?
a. Use a heating pad to relax the muscles at the site of the pain.
b. Drink at least 2 quarts of juice to replace the fluid lost in vomiting.
c. Take a laxative to empty the bowel before examination at the clinic.
d. Have the symptoms evaluated by a health care provider right away.
d. The patient is having symptoms of an acute abdomen
and should be evaluated by a health care provider
immediately. The patient's age, location of pain, and
other symptoms are characteristic of appendicitis. Heat
application and laxatives should not be used in patients
with undiagnosed abdominal pain because they may
cause perforation of the appendix or other inflammations.
Fluids should not be taken until vomiting is controlled,
nor should they be taken in the event that surgery may be
performed.
76
When caring for a patient with irritable bowel syndrome (IBS), what is most important for the
nurse to do?
a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed.
b. Develop a trusting relationship with the patient to provide support and symptomatic care.
c. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation.
d. Inform the patient that new medications for IBS are available and effective for treatment of IBS manifested by
either diarrhea or constipation.
b
77
For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the
bowel (select all that apply)?
a. NPO d. Sedatives
b. IV fluids e. Nasogastric suction
c. Bed rest f. Parenteral nutrition
a, b, e, f. With an acute exacerbation of inflammatory
bowel disease (IBD), to rest the bowel the patient will be
NPO, receive IV fluids and parenteral nutrition, and have
nasogastric suction. Sedatives would be used to alleviate
stress. Enteral nutrition will be used as soon as possible
78
A 20-year old patient with a history of Crohn's disease comes to the clinic with persistent diarrhea. What are
characteristics of Crohn's disease (select all that apply)?
a. Weight loss d. Toxic megacolon
b. Rectal bleeding e. Has segmented distribution
c. Abdominal pain f. Involves the entire thickness of the bowel wall
a, c, e, f. Crohn's disease may have severe weight loss,
segmented distribution through the entire wall of the bowel, and crampy abdominal pain. Rectal bleeding and
toxic megacolon are more often seen with ulcerative
colitis.
79
An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to
a. offer ice chips to suck PRN.
b. provide mouth care every 1 to 2 hours.
c. irrigate the tube with normal saline every 8 hours.
d. keep the patient supine with the head of the bed elevated 30 degrees.
B
80
When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the
patient about
a. dietary intake.
b. sports involvement.
c. environmental exposure to carcinogens.
d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).
a. A diet high in red meat and low fruit and vegetable intake
is associated with development of colorectal cancer (CRC),
as are alcohol intake and smoking. Family and personal
history of CRC also increases the risk. Other environmental
agents are not known to be related to colorectal cancer.
Long-term use of nonsteroidal antiinflammatory drugs
(NSAIDs) is associated with reduced CRC risk.
81
The patient has peritonitis, which is a major complication of appendicitis. What treatment will the nurse plan to
include?
a. Peritoneal lavage c. IV fluid replacement
b. Peritoneal dialysis d. Increased oral fluid intake
c. IV fluid replacement along with antibiotics, NG suction,
analgesics, and surgery would be expected. Peritoneal lavage
may be used to determine abdominal trauma. Peritoneal
dialysis would not be performed. Oral fluids would be
avoided with peritonitis.
82
82-year-old man is admitted with an acute attack of diverticulitis. What should the nurse include in his care?
monitor for peritonitis
83
What should the nurse teach the patient with diverticulosis to do?
a. Use anticholinergic drugs routinely to prevent bowel spasm.
b. Have an annual colonoscopy to detect malignant changes in the lesions.
c. Maintain a high-fiber diet and use bulk laxatives to increase fecal volume.
d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel.
c
84
Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)?
a. Restricted to rectum
b. Strictures are common.
c. Bloody, diarrhea stools
d. Cramping abdominal pain
e. Lesions penetrate intestine.
c.d
85
A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that:
a. chemotherapy will begin after the patient recovers from the surgery
b. both chemotherapy and radiation can be used as palliative treatments
c. follow-up colonoscopies will be needed to ensure that the cancer does not occur
d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy
c
86
Assessment findings suggestive of peritonitis include
a. rebound abdominal pain
b. a soft, distended abdomen
c. dull, continuous abdominal pain
d. observing that the patient is restless
a
87
When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?
a. "I will be able to regulate when I have stools."
b. "I will be able to wear the pouch until it leaks."
c. "Dried fruit and popcorn must be chewed very well."
d. "The drainage from my stoma can damage my skin."
a
88
In contrast to diverticulitis, the patient with diverticulosis:
a. has rectal bleeding
b. often has no symptoms
c. has localized cramping pain
d. frequently develops peritonitis
b. often has no symptoms
Rationale: Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.
89
Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse?
a. Notify the physician.
b. Auscultate for bowel sounds.
c. Reposition the tube and check for placement.
d. Remove the tube and replace it with a new one.
c
90
10. Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?
a.
Restrict oral fluid intake.
b.
Monitor stools for blood.
c.
Ambulate four times daily.
d.
Increase dietary fiber intake.
b
91
26. The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to
a.
administer IV fluids.
b.
give stool softeners and enemas.
c.
order a diet high in fiber and fluids.
d.
prepare the patient for colonoscopy.
a
92
A patient with anorexia nervosa shows signs of malnutrition. During initial referring, the nurse carefully assesses the patient for
a. hyperkalemia.
b. hypoglycemia.
c. hypercalcemia.
d. hypophosphatemia.
Correct answer: d
Rationale: Refeeding syndrome is characterized by fluid retention, electrolyte imbalances (e.g., hypophosphatemia, hypokalemia, hypomagnesemia), and hyperglycemia. Conditions that predispose patients to refeeding syndrome include long-standing malnutrition
93
A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse administers
a. 20% intralipids.
b. 5% dextrose solution.
c. 0.45% normal saline solution.
d. 5% lactated Ringer's solution
Correct answer: b
Rationale: If a peripheral parenteral nutrition (PPN) formula bag empties before the next solution is available, a 5% dextrose solution (based on the amount of dextrose in the peripheral PN solution) may be administered to prevent hypoglycemia.
94
An older patient was admitted with a fractured hip after being found on the floor of her home. She was extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding would be of most concern to the nurse?
a. Blood glucose level of 125 mg/dL
b. Serum phosphate level of 1.9 mg/dL
c. White blood cell count of 10,500/µL
d. Serum potassium level of 4.6 mEq/L
b - refeeding
95
A patient who has dysphagia as a consequence of a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into this patient's care?
a. Flush the tube with 30 mL of normal saline every 4 hours.
b. Flush the tube before and after feedings if the patient's feedings are intermittent.
c. Flush the PEG with 100 mL of sterile water before and after medication administration.
d. To prevent fluid overload, avoid flushing when the patient is receiving continuous feeding.
b
96
Which assessment should the nurse prioritize in the care of a patient who has recently begun receiving parenteral nutrition (PN)?
a. Skin integrity and bowel sounds
b. Electrolyte levels and daily weights
c. Auscultation of the chest and tests of blood coagulability
d. Peripheral vascular assessment and level of consciousness (LOC)
b
97
Before administering a bolus of intermittent tube feeding to a patient with a percutaneous endoscopic gastrostomy (PEG), the nurse aspirates 220 mL of gastric contents. How should the nurse respond?
a. Return the aspirate to the stomach and recheck the volume of aspirate in an hour.
b. Return the aspirate to the stomach and continue with tube feeding as planned.
c. Discard the aspirate to prevent over distending the stomach when the new feeding is given.
d. Notify the health care provider that the feedings have been scheduled too frequently to allow for stomach emptying.
b
98
A 48-year-old man who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take?
A. Slow the infusion rate of the tube feeding.
B. Check gastric residual volumes more frequently.
C. Change the enteral feeding system and formula every 8 hours.
D. Discontinue administration of water through the feeding tube.
a
99
A 20-year-old man with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?
a. Keep the patient positioned on the left side.
B. Check the gastric residual volume every 4 to 6 hours.
C. Avoid giving bolus tube feedings through the PEG tube.
D. Obtain a daily abdominal x-ray to verify tube placement.
b
100
7. A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action is best for the nurse to take?
A. Ask the health care provider to clarify the written PN order.
B. Add a new container of PN using the current tubing and filter.
C. Hang a new container of PN and change the IV tubing and filter.
D. Infuse the remaining 50 mL and then hang a new container of PN
b
101
A patients capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. The most appropriate action by the nurse is to
A. obtain a venous blood glucose specimen.
B. slow the infusion rate of the PN infusion.
C. recheck the capillary blood glucose in 4 to 6 hours.
D. notify the health care provider of the glucose level.
c
102
After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition?
A. Serum albumin level is 3.5 mg/dL.
B. Fluid intake and output are balanced.
C. Surgical incision is healing normally.
D. Blood glucose is less than 110 mg/dL
c
103
After change-of-shift report, which patient will the nurse assess first?
A. A 40-year-old woman whose parenteral nutrition infusion bag has 30
minutes of solution left
B. A 40-year-old man with continuous enteral feedings who has developed pulmonary crackles
C. A 30-year-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition
D. A 30-year-old woman whose gastrostomy tube is plugged after crushed medications were administered
b
