GI Nurses Labs - Nursing Questions PDF

GI-1-NL Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: A. 45 units/L B. 100 units/L C. 300 units/L D. 500 units/L A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been “bored” with the clear liquid diet. The nurse would offer which full liquid item to the client? A. Tea B. Gelatin C. Custard D. Popsicle Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: A. Pork B. Milk C. Chicken D. Broccoli Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is the appropriate action for the nurse to take? A. Hold the feeding B. Re-instill the amount and continue with administering the feeding C. Elevate the client’s head at least 45 degrees and administer the feeding D. Discard the residual amount and proceed with administering the feeding A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? A. Quickly insert the tube B. Notify the physician immediately C. Remove the tube and reinsert when the respiratory distress subsides D. Pull back on the tube and wait until the respiratory distress subsides Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks the contents for pH. The nurse verifies correct tube placement if which pH value is noted? A. 3.5 B. 7.0 C. 7.35 D. 7.5 A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? A. Exhale B. Inhale and exhale quickly C. Take and hold a deep breath D. Perform a Valsalva maneuver Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: A. Position the client supine to assist in medication absorption B. Aspirate the nasogastric tube after medication administration to maintain patency C. Clamp the nasogastric tube for 30 minutes following administration of the medication D. Change the suction setting to low intermittent suction for 30 minutes after medication administration A nurse is preparing to care for a female client with esophageal varices who just had a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? A. An obturator B. Kelly clamp C. An irrigation set D. A pair of scissors Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? A. Elevated hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreased erythrocyte sedimentation rate The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart? A. NPO status B. Nasogastric tube inserted C. Morphine sulfate for pain D. An anticholinergic medication A female client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? A. Fast for 8 hours before the test B. Eat a regular supper and breakfast C. Continue to take all oral medications as scheduled D. Monitor own bowel movement pattern for constipation The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? A. Palpates the abdomen for size B. Palpates the liver at the right rib margin C. Listens to bowel sounds in all four quadrants D. Percusses the right lower abdominal quadrant Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following the administration of the solution. What action by the nurse is appropriate? A. Start an IV infusion B. Administer an enema C. Cancel the diagnostic test D. Explain that diarrhea is expected The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin E The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question? A. Digoxin (Lanoxin) B. Furosemide (Lasix) C. Indomethacin (Indocin) D. Propranolol hydrochloride (Inderal) The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? A. Clamp the T-tube B. Irrigate the T-tube C. Notify the physician D. Document the findings The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? A. Halts stress reactions B. Heals the gastric mucosa C. Reduces the stimulus to acid secretions D. Decreases food absorption in the stomach The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? A. Leg exercises B. Early ambulation C. Irrigating the nasogastric tube D. Coughing and deep-breathing exercises The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? A. Ambulate following a meal B. Eat high carbohydrate foods C. Limit the fluid taken with meal D. Sit in a high-Fowler’s position during meals The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? A. Sweating and pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? A. Irrigating the drain B. Avoiding coughing C. Maintaining bed rest D. Restricting pain medication The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? A. Limit oral fluid B. Elevate the scrotum C. Apply heat to the abdomen D. Remain in a low-fiber diet The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. A hemoglobin level of 12 mg/dL The nurse is caring for a male client postoperatively following the creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? A. Sexual dysfunction B. Body image, disturbed C. Fear related to poor prognosis D. Nutrition: more than body requirements, imbalanced The nurse is reviewing the record of a female client with Crohn’s disease. Which stool characteristics should the nurse expect to note documented in the client’s record? A. Diarrhea B. Chronic constipation C. Constipation alternating with diarrhea D. Stools constantly oozing from the rectum The nurse is performing colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? A. Notify the physician B. Stop the irrigation temporarily C. Increase the height of the irrigation D. Medicate for pain and resume the irrigation The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? A. Increase fluid intake B. Place heat on the abdomen C. Perform the irrigation in the evening D. Reduce the amount of irrigation solution For a client in hepatic coma, which outcome would be the most appropriate? A. The client is oriented to time, place, and person. B. The client exhibits no ecchymotic areas. C. The client increases oral intake to 2,000 calories/day. D. The client exhibits increased serum albumin level. Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be included in the care plan for the client? A. Administering vitamin K subcutaneously B. Applying pressure when giving I.M. injections C. Decreasing the client's dietary protein intake D. Keeping the client's fingernails short and smooth Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse’s teaching has been successful? A. 4-6 small meals of low-carbohydrate foods daily B. High-fat, high-carbohydrate meals C. Low-fat, high-carbohydrate meals D. High-fat, low protein meals The hospital administrator had undergone percutaneous transhepatic cholangiography. Which assessment finding indicates complication after the operation? A. Fever and chills B. Hypertension C. Bradycardia D. Nausea and diarrhea When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client’s family? A. Keeping the client in complete isolation B. Using good sanitation with dishes and shared bathrooms C. Avoiding contact with blood-soiled clothing or dressing D. Forbidding the sharing of needles or syringes For Jayvin who is taking antacids, which instruction would be included in the teaching plan? A. "Take the antacids with 8 oz of water." B. "Avoid taking other medications within 2 hours of this one." C. "Continue taking antacids even when pain subsides." D. "Weigh yourself daily when taking this medication." Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to exhibit? A. Jaundice, dark urine, and steatorrhea B. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration C. Ecchymosis petechiae, and coffee-ground emesis D. Nausea, vomiting, and anorexia Pierre, who is diagnosed with acute pancreatitis, is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? A. Administration of vasopressin and insertion of a balloon tamponade B. Preparation for a paracentesis and administration of diuretics C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? A. Transports fatty acids into the brush border B. Breaks down fat into fatty acids and glycerol C. Triggers cholecystokinin to contract the gallbladder D. Breaks down protein into dipeptides and amino acids A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care? A. Measuring serum potassium for hyperkalemia B. Assessing the client for hypervolemia C. Measuring the client's weight weekly D. Documenting precise intake and output Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy? A. Passage of two or three soft stools daily B. Evidence of watery diarrhea C. Daily deterioration in the client's handwriting D. Appearance of frothy, foul-smelling stools Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client? A. "Jaundice is associated with pressure ulcer formation." B. "Jaundice impairs urea production, which produces pruritus." C. "Jaundice produces pruritus due to impaired bile acid excretion." D. "Jaundice leads to decreased tissue perfusion and subsequent breakdown." Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is hemorrhaging? A. Allowing the client to help insert the tube B. Beginning teaching for home care C. Maintaining the client's level of anxiety and alertness D. Obtaining cooperation and reducing fear For Rico who has chronic pancreatitis, which nursing intervention would be most helpful? A. Allowing liberalized fluid intake B. Counseling to stop alcohol consumption C. Encouraging daily exercise D. Modifying dietary protein Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? Select all that apply. A. Assessing the client's neurologic status every 2 hours B. Monitoring the client's hemoglobin and hematocrit levels C. Evaluating the client's serum ammonia level D. Monitoring the client's handwriting daily E. Preparing to insert an esophageal tamponade tube F. Making sure the client's fingernails are short For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important? A. Allowing complete independence of mobility B. Applying pressure to injection sites C. Administering antibiotics as prescribed D. Increasing nutritional intake A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for: A. Malaise B. Stomatitis C. Hand tremors D. Weight loss A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? Select all that apply. A. Range of motion every 4 hours B. Turn and reposition every 2 hours C. Abdominal and foot massages every 2 hours D. Alternating air pressure mattress E. Sit in chair for 30 minutes each shift Which of the following will the nurse include in the care plan for a client hospitalized with viral hepatitis? A. Increase fluid intake to 3000 ml per day B. Adequate bed rest C. Bland diet D. Administer antibiotics as ordered Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse should monitor the client for which of the following medication-related side effects? A. Jaundice B. Hyperkalemia C. Tachycardia D. Constipation GI-2-NL During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with the synthesis of which vitamin and may lead to hypoprothrombinemia? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. Increased intracranial pressure B. Decreased urine output C. Bradycardia D. Hypertension A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? A. Lying on the right side with legs straight B. Lying on the left side with knees bent C. Prone with the torso elevated D. Bent over with hands touching the floor A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking the client’s history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: A. “Tell me about your husband’s alcohol usage.” B. “Is your husband being treated for tuberculosis?” C. “Has your husband recently fallen or injured his chest?” D. “Describe spices and condiments your husband uses on food.” 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 male client is recovering from a small bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur? A. 5 to 10 minutes B. 15 to 30 minutes C. 30 to 60 minutes D. 2 to 4 hours The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Cholecystitis D. Gastric ulcer While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do? A. Irrigate the tube with warm water. B. Advance the tube into the intestine. C. Apply intermittent suction to the tube. D. Withdraw the obstruction with a 30-ml syringe. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: A. Meperidine provides a better, more prolonged analgesic effect. B. Morphine may cause spasms of Oddi’s sphincter. C. Meperidine is less addictive than morphine. D. Morphine may cause hepatic dysfunction. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? A. Hopelessness B. Powerlessness C. Chronic low self-esteem D. Deficient knowledge Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Endoscopy B. Upper GI series C. Hemoglobin (Hb) levels and hematocrit (HCT) D. Arteriography A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response? A. “You may have eaten contaminated restaurant food.” B. “You could have gotten it by using I.V. drugs.” C. “You must have received an infected blood transfusion.” D. “You probably got it by engaging in unprotected sex.” When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. C. The appendix may develop gangrene and rupture, especially in a middle-aged client. D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: A. Whole blood and albumin. B. Platelets and packed red blood cells. C. Fresh frozen plasma and whole blood. D. Cryoprecipitate and fresh frozen plasma. To prevent gastroesophageal reflux in a male client with a hiatal hernia, the nurse should provide which of the following discharge instructions? A. “Lie down after meals to promote digestion.” B. “Avoid coffee and alcoholic beverages.” C. “Take antacids with meals.” D. “Limit fluid intake with meals.” The nurse caring for a client with small bowel obstruction would plan to implement which nursing intervention first? A. Administering pain medication B. Obtaining a blood sample for laboratory studies C. Preparing to insert a nasogastric (NG) tube D. Administering I.V. fluids A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? A. The client doesn’t exhibit rectal tenesmus. B. The client is free from esophagitis and achalasia. C. The client reports diminished duodenal inflammation. D. The client has normal gastric structures. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond? A. Notify the physician. B. Reposition the tube. C. Irrigate the tube. D. Increase the suction level. What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated blood urea nitrogen (BUN) B. Elevated serum lipase C. Elevated aspartate aminotransferase (AST) D. Increased lactate dehydrogenase (LD) A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A. Yellow sclera B. Light amber urine C. Circumoral pallor D. Black, tarry stools 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. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures? A. Sigmoid colon B. Appendix C. Spleen D. Liver A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to: A. Call the physician. B. Place saline-soaked sterile dressings on the wound. C. Take blood pressure and pulse. D. Pull the dehiscence closed. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? A. Antiarrhythmic drugs B. Anticholinergic drugs C. Anticoagulant drugs D. Antihypertensive drugs A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: A. Increasing fluid intake to prevent dehydration. B. Wearing an appliance pouch only at bedtime. C. Consuming a low-protein, high-fiber diet. D. Taking only enteric-coated medications. 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 A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A. Severe abdominal pain radiating to the shoulder. B. Anorexia, nausea, and vomiting. C. Eructation and constipation. D. Abdominal ascites. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: A. Place the client in a private room. B. Wear a mask when handling the client’s bedpan. C. Wash the hands after touching the client. D. Wear a gown when providing personal care for the client. Which of the following factors can cause hepatitis A? A. Contact with infected blood. B. Blood transfusions with infected blood. C. Eating contaminated shellfish. D. Sexual contact with an infected person. The correct sequence for abdominal assessment is: A. Inspection, percussion, palpation, auscultation. B. Inspection, auscultation, palpation, percussion. C. Inspection, palpation, auscultation, percussion. D. Inspection, percussion, auscultation, palpation. Peritonitis can occur as a complication of: A. Septicemia B. Multiple organ failure C. Hypovolemic shock D. Peptic ulcer disease A patient has become very depressed postoperatively after receiving a colostomy for GI cancer. He does not participate in his colostomy care or looks at the stoma. An appropriate nursing diagnosis for this situation is: A. Ineffective Individual Coping B. Knowledge Deficit C. Impaired Adjustment D. Anxiety Patients with esophageal varices would reveal the following assessment: A. Increased blood pressure B. Increased heart rate C. Decreased respiratory rate D. Increased urinary output The nurse would anticipate using which medication if sclerotherapy has not been used? A. Neomycin B. Propranolol C. Vasopressin D. Cimetidine The nurse must be alert for complications with Sengstaken-Blakemore intubation including: A. Pulmonary obstruction B. Pericardiectomy syndrome C. Pulmonary embolization D. Cor pulmonale Peptic ulcer disease may be caused by which of the following? A. Helicobacter pylori B. Clostridium difficile C. Candida albicans D. Staphylococcus aureus Pain control with peptic ulcer disease includes all of the following except: A. Promoting physical and emotional rest. B. Identifying stressful situations. C. Eating meals when desired. D. Administering medications that decrease gastric acidity. Nitrosocarcinogen production can be inhibited with the intake of: A. Vitamin C B. Vitamin E C. Carbohydrates D. Fiber The nurse can expect a 60-year old patient with ischemic bowel to report a history of: A. Diabetes mellitus B. Asthma C. Addison's Disease D. Cancer of the bowel During the initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate: A. Ischemic bowel B. Peritonitis C. Hypovolemic shock D. Perforated bowel Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system? A. Ultrasonography B. MRI C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Computed tomography scan (CT scan) To inhibit pancreatic secretions, which pharmacologic agent would you anticipate administering to a patient with acute pancreatitis? A. Nitroglycerin B. Somatostatin C. Pancrelipase D. Pepcid Your patient’s ABG reveals an acidic pH, an acidic CO2, and a normal bicarbonate level. Which of the following indicates this acid-base disturbance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate relief of pain would place the patient in a: A. Knee-chest position B. Semi-Fowler's position C. Recumbent position D. Low-Fowler's position What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus? A. Grey-Turner's sign B. Homan's sign C. Rovsing's sign D. Cullen's sign A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following nursing assessment data would support this? A. Oliguria and azotemia B. Metabolic alkalosis C. Decreased urinary concentration D. Weight gain of less than 1 lb per week Which phase of hepatitis would the nurse incur strict precautionary measures at? A. Icteric B. Non-icteric C. Post-icteric D. Pre-icteric You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate? A. The patient demonstrates an increase in the level of consciousness. B. The patient exhibits improved skin integrity. C. The patient experiences no evident signs of bleeding. D. The patient verbalizes decreased episodes of pain. What is the primary nursing diagnosis for a 4th to 10th-day postoperative liver transplant patient? A. Excess Fluid Volume B. Risk for Rejection C. Impaired Skin Integrity D. Decreased Cardiac Output GI-3 A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s blood pressure because of which change that is associated with liver failure? A. Hypoalbuminemia B. Increased capillary permeability C. Abnormal peripheral vasodilation D. Excess renin release from the kidneys You’re assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear: A. Pale, pink and moist B. Red and moist C. Dark or purple-colored D. Dry and black You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is: A. Formed B. Semisolid C. Semiliquid D. Watery You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend? A. Peas B. Cabbage C. Broccoli D. Yogurt You have to teach ostomy self-care to a patient with a colostomy. You tell the patient to measure and cut the wafer: A. To the exact size of the stoma. B. About 1/16” larger than the stoma. C. About 1/8” larger than the stoma. You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed? A. Observation, percussion, palpation, auscultation B. Observation, auscultation, percussion, palpation C. Percussion, palpation, auscultation, observation D. Palpation, percussion, observation, auscultation You’re doing preoperative teaching with Gertrude who has ulcerative colitis who needs surgery to create an ileoanal reservoir. Which information do you include? A. A reservoir is created that exits through the abdominal wall. B. A second surgery is required 12 months after the first surgery. C. A permanent ileostomy is created. D. The surgery occurs in two stages. You’re caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy? A. 100 ml B. 500 ml C. 1500 ml D. 5000 ml You’re preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery to close a temporary ileostomy. Which nutritional guidelines do you include in this plan? A. There is no need to change eating habits. B. Eat six small meals a day. C. Eat the largest meal in the evening. D. Restrict fluid intake.m Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is crying as he tells you, “I know that I have colon cancer, too.” Which response is most therapeutic? A. “I know just how you feel.” B. “You seem upset.” C. “Oh, don’t worry about it, everything will be just fine.” D. “Why do you think you have cancer?” You’re caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome, a complication associated with this procedure? A. Flushed, dry skin. B. Headache and bradycardia. C. Dizziness and sweating. D. Dyspnea and chest pain. You’re developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include? A. Omit fluids with meals. B. Increase carbohydrate intake. C. Decrease protein intake. D. Decrease fat intake. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicates that the paracentesis was effective? A. Pruritus B. Dyspnea C. Jaundice D. Peripheral Neuropathy You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct her to: A. Empty her bladder. B. Lie supine in bed. C. Remain NPO for 4 hours. D. Clean her bowels with an enema. After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate? A. Irrigate the wound & organs with Betadine. B. Cover the wound with a saline-soaked sterile dressing. C. Apply a dry sterile dressing & binder. D. Push the organs back & cover with moist sterile dressings. You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? A. Asterixis B. Chvostek’s sign C. Trousseau’s sign D. Hepatojugular reflux You are developing a care plan for Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? A. Administering a lactulose enema as ordered. B. Encouraging a protein-rich diet. C. Administering sedatives, as necessary. D. Encouraging ambulation at least four times a day. You have a patient with achalasia (incomplete muscle relaxation of the GI tract, especially sphincter muscles). Which medications do you anticipate to administer? A. isosorbide dinitrate (Isordil) B. digoxin (Lanoxin) C. captopril (Capoten) D. propranolol (Inderal) The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You include which of the following: A. Swallow foods while leaning forward. B. Omit fluids at mealtimes. C. Eat meals sitting upright. D. Avoid soft and semi soft foods. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? A. Serum creatinine and BUN B. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) C. Serum amylase and lipase D. Cardiac enzymes A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the following urine-specific gravity values do you expect to find in this patient? A. 1.005 B. 1.011 C. 1.020 D. 1.030 Your goal is to minimize David’s risk of complications after a herniorrhaphy. You instruct the patient to: A. Avoid the use of pain medication. B. Cough and deep breath Q2H. C. Splint the incision if he can’t avoid sneezing or coughing. D. Apply heat to scrotal swelling. Janice is waiting for discharge instructions after her herniorrhaphy. Which of the following instructions do you include? A. Eat a low-fiber diet. B. Resume heavy lifting in 2 weeks. C. Lose weight, if obese. D. Resume sexual activity once discomfort is gone. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include? A. “You’ll need to lie on your stomach during the test.” B. “You’ll need to lie on your right side after the test.” C. “During the biopsy, you’ll be asked to exhale deeply and hold it.” D. “The biopsy is performed under general anesthesia.” Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax? A. Dyspnea and reduced or absent breath sound over the right lung. B. Tachycardia, hypotension, and cool, clammy skin. C. Fever, rebound tenderness, and abdominal rigidity. D. Redness, warmth, and drainage at the biopsy site. Michael, 42 y.o. The man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22, and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to the patient. Which of the following is the most accurate explanation? A. “It empties the stomach of fluids and gas.” B. “It prevents spasms at the sphincter of Oddi.” C. “It prevents air from forming in the small intestine and large intestine.” D. “It removes bile from the gallbladder.” Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting an NG tube for liquid enteral feedings? A. Aspirate for gastric secretions with a syringe. B. Begin feeding slowly to prevent cramping. C. Get an X-ray of the tip of the tube within 24 hours. D. Clamp off the tube until the feedings begin. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide: A. Necessary fluids and electrolytes to the body. B. Complete nutrition by the I.V. route. C. Tube feedings for nutritional supplementation. D. Dietary supplementation with liquid protein given between meals. Type A chronic gastritis can be distinguished from type B by its ability to: A. Cause atrophy of the parietal cells. B. Affect only the antrum of the stomach. C. Thin the lining of the stomach walls. D. Decrease gastric secretions. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include which of the following instructions? A. Restrict intake of high-carbohydrate foods. B. Increase fluid intake with meals. C. Increase fat intake. D. Eat three regular meals a day. Jerod is experiencing an acute episode of ulcerative colitis. Which is the priority for this patient? A. Replace lost fluid and sodium. B. Monitor for increased serum glucose level from steroid therapy. C. Restrict the dietary intake of foods high in potassium. D. Note any change in the color and consistency of stools. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis? A. Barium Swallow B. Stool examination C. Gastric analysis D. Sigmoidoscopy Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care? A. Low-fiber diet and fluid restrictions. B. Total parenteral nutrition and bed rest. C. High-fiber diet and administration of psyllium. D. Administration of analgesics and antacids. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like: A. Watery and frothy B. Bloody and mucous C. Firm and well-formed D. Alternating constipation and diarrhea Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by: A. Periodic rectal hemorrhage. B. Hypertension and tachycardia. C. Vomiting and elevated temperature. D. Crampy and lower left quadrant pain and low-grade fever. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: A. Continuous peritoneal lavage. B. Regular diet with increased fat. C. Nutritional support with TPN. D. Insertion of a T tube to drain the pancreas. Glenda has cholelithiasis (gallstones). You expect her to complain of: A. Pain in the right upper quadrant, radiating to the shoulder. B. Pain in the right lower quadrant, with rebound tenderness. C. Pain in the left upper quadrant, with shortness of breath. D. Pain in the left lower quadrant, with mild cramping. After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson- Pratt drain in place. The purpose of the drain is to: A. Irrigate the incision with a saline solution. B. Prevent bacterial infection of the incision. C. Measure the amount of fluid lost after surgery. D. Prevent accumulation of drainage in the wound. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During the first 24 hours, which of the following observations about the stoma should you report to the doctor? A. Pink color B. Light edema C. Small amount of oozing D. Trickles of bright red blood You’re teaching Anthony how to use his new colostomy. How much skin should remain exposed between the stoma and the ring of the appliance? 1/16” 1/4” 1/2” Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is a priority for her? A. Obtain daily weights. B. Measure abdominal girth. C. Keep strict intake and output. D. Encourage her to increase fluids. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred method of feeding for your patient? A. TPN B. PPN C. NG feeding D. Oral liquid supplements Your patient is complaining of abdominal pain during assessment. What is your priority? A. Auscultate to determine changes in bowel sounds. B. Observe the contour of the abdomen. C. Palpate the abdomen for a mass. D. Percuss the abdomen to determine if fluid is present. Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next? A. Discontinue the procedure. B. Lower the height of the enema container. C. Complete the procedure as quickly as possible. D. Continue administration of the enema as ordered without making any adjustments. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? A. There is no skin breakdown. B. Her appetite improves. C. She lost more than 10 lbs. D. Stools are less fatty and decrease in frequency. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? A. Calcium B. Glucose C. Magnesium D. Potassium Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes: A. Giving pain medication Q6H. B. Flushing the NG tube with sterile water. C. Positioning her in high Fowler’s position. D. Keeping her NPO until the return of peristalsis. Sitty, a 66 y.o. patient underwent a colostomy for a ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor? A. Blanched stoma B. Edematous stoma C. Reddish-pink stoma D. Brownish-black stoma Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? A. Restrict fluids. B. Encourage ambulation. C. Increase sodium in the diet. D. Give antacids as prescribed. Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food should be included in the diet? A. Fruit B. Whole grains C. Milk and cheese products D. Dark green, leafy vegetables GI-4 Which of the following complications is thought to be the most common cause of appendicitis? A. A fecalith B. Bowel kinking C. Internal bowel occlusion D. Abdominal bowel swelling Which of the following terms best describes the pain associated with appendicitis? A. Aching B. Fleeting C. Intermittent D. Steady Which of the following nursing interventions should be implemented to manage a client with appendicitis? A. Assessing pain. B. Encouraging oral intake of clear fluids. C. Providing discharge teaching. D. Assessing for symptoms of peritonitis. Which of the following definitions best describes gastritis? A. Erosion of the gastric mucosa. B. Inflammation of a diverticulum. C. Inflammation of the gastric mucosa. D. Reflux of stomach acid into the esophagus. Which of the following substances is most likely to cause gastritis? A. Milk B. Bicarbonate of soda, or baking soda C. Enteric-coated aspirin D. Nonsteroidal anti-inflammatory drugs Which of the following definitions best describes diverticulosis? A. An inflamed outpouching of the intestine. B. A noninflamed outpouching of the intestine. C. The partial impairment of the forward flow of intestinal contents. D. An abnormal protrusion of an organ through the structure that usually holds it. Which of the following types of diets is implicated in the development of diverticulosis? A. Low-fiber diet B. High-fiber diet C. High-protein diet D. Low-carbohydrate diet Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis? A. Treating constipation with chronic laxative use, leading to dependence on laxatives. B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents. C. Herniation of the intestinal mucosa, rupturing the wall of the intestine. D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion. Which of the following symptoms indicated diverticulosis? A. No symptoms exist. B. Change in bowel habits. C. Anorexia with low-grade fever. D. Episodic, dull, or steady midabdominal pain. Which of the following tests should be administered to a client suspected of having diverticulosis? A. Abdominal ultrasound B. Barium enema C. Barium swallow D. Gastroscopy Medical management of the client with diverticulitis should include which of the following treatments? A. Reduced fluid intake. B. Increased fiber in the diet. C. Administration of antibiotics. D. Exercises to increase intra-abdominal pressure. Crohn’s disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? A. The entire length of the large colon. B. Only the sigmoid area. C. The entire large colon through the layers of mucosa and submucosa. D. The small intestine and colon; affecting the entire thickness of the bowel. Which area of the alimentary canal is the most common location for Crohn’s disease? A. Ascending colon B. Descending colon C. Sigmoid colon D. Terminal ileum Which of the following factors is believed to be linked to Crohn’s disease? A. Constipation B. Diet C. Hereditary D. Lack of exercise Which of the following factors is believed to cause ulcerative colitis? A. Acidic diet B. Altered immunity C. Chronic constipation D. Emotional stress Fistulas are most common with which of the following bowel disorders? A. Crohn’s disease B. Diverticulitis C. Diverticulosis D. Ulcerative colitis Which of the following areas is the most common site of fistulas in clients with Crohn’s disease? A. Anorectal B. Ileum C. Rectovaginal D. Transverse colon Which of the following associated disorders may a client with ulcerative colitis exhibit? A. Gallstones B. Hydronephrosis C. Nephrolithiasis D. Toxic megacolon Which of the following associated disorders may the client with Crohn’s disease exhibit? A. Ankylosing spondylitis B. Colon cancer C. Malabsorption D. Lactase deficiency Which of the following symptoms may be exhibited by a client with Crohn’s disease? A. Bloody diarrhea B. Narrow stools C. N/V D. Steatorrhea Which of the following symptoms is associated with ulcerative colitis? A. Dumping syndrome B. Rectal bleeding C. Soft stools D. Fistulas If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn’s disease or ulcerative colitis? A. Abdominal computed tomography (CT) scan B. Abdominal x-ray C. Barium swallow D. Colonoscopy with biopsy Which of the following interventions should be included in the medical management of Crohn’s disease? A. Increasing oral intake of fiber. B. Administering laxatives. C. Using long-term steroid therapy. D. Increasing physical activity. In a client with Crohn’s disease, which of the following symptoms should not be a direct result of antibiotic therapy? A. Decrease in bleeding. B. Decrease in temperature. C. Decrease in body weight. D. Decrease in the number of stools. Surgical management of ulcerative colitis may be performed to treat which of the following complications? A. Gastritis B. Bowel herniation C. Bowel outpouching D. Bowel perforation Which of the following medications is most effective for treating the pain associated with irritable bowel disease? A. Acetaminophen B. Opiates C. Steroids D. Stool softeners During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care? A. Body image B. Ostomy care C. Sexual concerns D. Skin care Colon cancer is most closely associated with which of the following conditions? A. Appendicitis B. Hemorrhoids C. Hiatal hernia D. Ulcerative colitis Which of the following diets is most commonly associated with colon cancer? A. Low-fiber, high fat B. Low-fat, high-fiber C. Low-protein, high-carbohydrate D. Low carbohydrate, high protein Which of the following diagnostic tests should be performed annually over age 50 to screen for colon cancer? A. Abdominal CT scan B. Abdominal x-ray C. Colonoscopy D. Fecal occult blood test Radiation therapy is used to treat colon cancer before surgery for which of the following reasons? A. Reducing the size of the tumor. B. Eliminating the malignant cells. C. Curing cancer. D. Helping the bowel heal after surgery. Which of the following symptoms is a client with colon cancer most likely to exhibit? A. A change in appetite. B. A change in bowel habits. C. An increase in body weight. D. An increase in body temperature. A client has just had surgery for colon cancer. Which of the following disorders might the client develop? A. Peritonitis B. Diverticulosis C. Partial bowel obstruction D. Complete bowel obstruction A client with gastric cancer may exhibit which of the following symptoms? A. Abdominal cramping B. Constant hunger C. Feeling of fullness D. Weight gain Which of the following diagnostic tests may be performed to determine if a client has gastric cancer? A. Barium enema B. Colonoscopy C. Gastroscopy D. Serum chemistry levels A client with gastric cancer can expect to have surgery for resection. Which of the following should be the nursing management priority for the preoperative client with gastric cancer? A. Discharge planning B. Correction of nutritional deficits C. Prevention of DVT D. Instruction regarding radiation treatment Care for the postoperative client after gastric resection should focus on which of the following problems? A. Body image B. Nutritional needs C. Skincare D. Spiritual needs Which of the following complications of gastric resection should the nurse teach the client to watch for? A. Constipation B. Dumping syndrome C. Gastric spasm D. Intestinal spasms A client with rectal cancer may exhibit which of the following symptoms? A. Abdominal fullness B. Gastric fullness C. Rectal bleeding D. Right upper quadrant pain A client with which of the following conditions may be likely to develop rectal cancer? A. Adenomatous polyps B. Diverticulitis C. Hemorrhoids D. Peptic ulcer disease Which of the following treatments is used for rectal cancer but not for colon cancer? A. Chemotherapy B. Colonoscopy C. Radiation D. Surgical resection Which of the following conditions is most likely to directly cause peritonitis? A. Cholelithiasis B. Gastritis C. Perforated ulcer D. Incarcerated hernia Which of the following symptoms would a client in the early stages of peritonitis exhibit? A. Abdominal distention B. Abdominal pain and rigidity C. Hyperactive bowel sounds D. Right upper quadrant pain Which of the following laboratory results would be expected in a client with peritonitis? A. Partial thromboplastin time above 100 seconds B. Hemoglobin level below 10 mg/dL C. Potassium level above 5.5 mEq/L D. White blood cell count above 15,000 Which of the following therapies is not included in the medical management of a client with peritonitis? A. Broad-spectrum antibiotics B. Electrolyte replacement C. I.V. fluids D. Regular diet Which of the following aspects is the priority focus of nursing management for a client with peritonitis? A. Fluid and electrolyte balance B. Gastric irrigation C. Pain management D. Psychosocial issues A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give the client? A. Low fiber, low-fat B. High fiber, low-fat C. Low fiber, high-fat D. High-fiber, high-fat A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? A. Metabolic acidosis with hyperkalemia B. Metabolic acidosis with hypokalemia C. Metabolic alkalosis with hyperkalemia D. Metabolic alkalosis with hypokalemia Five days after undergoing surgery, a client develops a small bowel obstruction. A Miller-Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority? A. Imbalanced nutrition: Less than body requirements B. Acute pain C. Deficient fluid volume D. Excess fluid volume When teaching an elderly client how to prevent constipation, which of the following instructions should the nurse include? A. “Drink 6 glasses of fluid each day.” B. “Avoid grain products and nuts.” C. “Add at least 4 grams of bran to your cereal each morning.” D. “Be sure to get regular exercise.” GI-5 In a client with diarrhea, which outcome indicates that fluid resuscitation is successful? A. The client passes formed stools at regular intervals. B. The client reports a decrease in stool frequency and liquidity. C. The client exhibits firm skin turgor. D. The client no longer experiences perianal burning. When teaching a community group about measures to prevent colon cancer, which instruction should the nurse include? A. “Limit fat intake to 20% to 25% of your total daily calories.” B. “Include 15 to 20 grams of fiber into your daily diet.” C. “Get an annual rectal examination after age 35.” D. “Undergo sigmoidoscopy annually after age 50.” A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain, and intermittent diarrhea after the birth of her 2nd child. Diagnostic tests reveal gluten- induced enteropathy. Which foods must she eliminate from her diet permanently? A. Milk and dairy products B. Protein-containing foods C. Cereal grains (except rice and corn) D. Carbohydrates After a right hemicolectomy for treatment of colon cancer, a 57-year old client is reluctant to turn while on bed rest. Which action by the nurse would be appropriate? A. Asking a coworker to help turn the client. B. Explaining to the client why turning is important. C. Allowing the client to turn when he’s ready to do so. D. Telling the client that the physician’s order states he must turn every 2 hours. A client has a percutaneous endoscopic gastrostomy tube inserted for tube feedings. Before starting a continuous feeding, the nurse should place the client in which position? A. Semi-Fowlers B. Supine C. Reverse Trendelenburg D. High Fowler’s An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take? A. Prepare 750 ml of irrigating solution warmed to 100° F. B. Question the physician about the order. C. Provide privacy and explain the procedure to the client. D. Assist the client to the left lateral Sims position. The client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test? A. Fast for 8 hours before the test. B. Eat a regular supper and breakfast. C. Continue to take all oral medications as scheduled. D. Monitor own bowel movement pattern for constipation. The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom indicates this occurrence? A. Abdominal cramping and pain B. Bradycardia and indigestion C. Sweating and pallor D. Double vision and chest pain The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan? A. Restricting pain medication. B. Maintaining bedrest. C. Avoiding coughing. D. Irrigating the drain. The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician?A. Bloody diarrhea A. Bloody diarrhea B. Hypotension C. A hemoglobin of 12 mg/dL D. Rebound tenderness The nurse is reviewing the record of a client with Crohn’s disease. Which of the following stool characteristics would the nurse expect to note documented on the client’s record? A. Chronic constipation B. Diarrhea C. Constipation alternating with diarrhea. D. Stool constantly oozes from the rectum. The nurse is performing colostomy irrigation on a client. During the irrigation, a client begins to complain of abdominal cramps. Which of the following is the most appropriate nursing action? A. Notify the physician. B. Increase the height of the irrigation. C. Stop the irrigation temporarily. D. Medicate with dilaudid and resume the irrigation. The nurse is teaching the client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? A. Increase fluid intake. B. Reduce the amount of irrigation solution. C. Perform the irrigation in the evening. D. Place heat on the abdomen. The nurse is reviewing the physician’s orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client’s chart? A. NPO status B. Insert a nasogastric tube C. An anticholinergic medication D. Morphine for pain The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which of the following most frequent symptom(s) of duodenal ulcer? A. Pain that is relieved by food intake. B. Pain that radiates down the right arm. C. N/V D. Weight loss The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma? A. Cleanse the peristomal skin meticulously. B. Take in high-fiber foods such as nuts. C. Massage the area below the stoma. D. Limit fluid intake to prevent diarrhea. The client who has undergone the creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client: A. Watch the nurse empty the colostomy bag. B. Look at the ostomy site. C. Read the ostomy product literature. D. Practice cutting the ostomy appliance. The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would observe which of the following if stoma prolapse occurred? A. Sunken and hidden stoma B. Dark- and bluish-colored stoma C. Narrowed and flattened stoma D. Protruding stoma The client with a new colostomy is concerned about the odor from the stool in the ostomy drainage bag. The nurse teaches the client to include which of the following foods in the diet to reduce odor? A. Yogurt B. Broccoli C. Cucumbers D. Eggs The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse determines that the client needs further instructions if the client starts to eat which of the following foods to make the stools less watery? A. Pasta B. Boiled rice C. Bran D. Low-fat cheese The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate post-op period for which of the following most frequent complications of this type of surgery? A. Intestinal obstruction B. Fluid and electrolyte imbalance C. Malabsorption of fat D. Folate deficiency The nurse is doing pre-op teaching with the client who is about to undergo the creation of a Kock pouch. The nurse interprets that the client has the best understanding of the nature of the surgery if the client makes which of the following statements? A. “I will need to drain the pouch regularly with a catheter.” B. “I will need to wear a drainage bag for the rest of my life.” C. “The drainage from this type of ostomy will be formed.” D. “I will be able to pass stool from my rectum eventually.” The client with a colostomy has an order for irrigation of the colostomy. The nurse used which solution for irrigation?A. Distilled water A. Distilled water B. Tap water C. Sterile water D. Lactated Ringer’s A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention? A. Administer dilaudid. B. Notify the physician. C. Call and ask the operating room team to perform the surgery as soon as possible. D. Reposition the client and apply a heating pad in a warm setting to the client’s abdomen. The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is: A. Severe and unrelenting, located in the epigastric area and radiating to the back. B. Severe and unrelenting, located in the left lower quadrant and radiating to the groin. C. Burning and aching, located in the epigastric area and radiating to the umbilicus. D. Burning and aching, located in the left lower quadrant and radiating to the hip. The client with Crohn’s disease has a nursing diagnosis of acute pain. The nurse would teach the client to avoid which of the following in managing this problem? A. Lying supine with the legs straight. B. Massaging the abdomen. C. Using antispasmodic medication. D. Using relaxation techniques. A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication: A. 30 minutes before meals B. On an empty stomach C. After meals D. On arising During the assessment of a client’s mouth, the nurse notes the absence of saliva. The client is also complaining of pain near the area of the ear. The client has been NPO for several days because of the insertion of a NG tube. Based on these findings, the nurse suspects that the client is developing which of the following mouth conditions? A. Stomatitis B. Oral candidiasis C. Parotitis D. Gingivitis The nurse evaluates the client’s stoma during the initial post-op period. Which of the following observations should be reported immediately to the physician? A. The stoma is slightly edematous. B. The stoma is dark red to purple. C. The stoma oozes a small amount of blood. D. The stoma does not expel stool. When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to an unlicensed assistant? Select all that apply. A. Assessing the client’s bowel sounds. B. Providing skincare following bowel movements. C. Evaluating the client’s response to antidiarrheal medications. D. Maintaining intake and output records. E. Obtaining the client’s weight. Which goal of the client’s care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? A. Promoting self-care and independence. B. Managing diarrhea. C. Maintaining adequate nutrition. D. Promoting rest and comfort. A client’s ulcerative colitis symptoms have been present for longer than 1 week. The nurse recognizes that the client should be assessed carefully for signs of which of the following complications? A. Heart failure B. DVT C. Hypokalemia D. Hypocalcemia A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs? A. Initiate continuous enteral feedings. B. Encourage a high protein, high-calorie diet. C. Implement total parenteral nutrition. D. Provide six small meals a day. Digoxin preparations and absorbents should not be given simultaneously. As a nurse, you are aware that if these agents are given simultaneously, which of the following will occur? A. Increased absorption of digoxin. B. Decreased absorption of digoxin. C. Increased absorption of the absorbent. D. Decreased absorption of the absorbent. When used with hyperacidic disorders of the stomach, antacids are given to elevate the gastric pH to: A. 2.0 B. 4.0 C. 6.0 D. >8.0 One of your patients is receiving digitalis orally and is also to receive an antacid at the same time. Your most appropriate action, based on the pharmacokinetics of antacids, is to: A. Delay the digitalis for 1 to 2 hours until the antacid is absorbed. B. Give the antacid at least 2 to 4 hours before administering the digitalis. C. Administer both medications as ordered and documented in the nurse’s notes. D. Contact the physician regarding the drug interaction and request a change in the time of dosing of the drugs. The nurse would teach patients that antacids are effective in the treatment of hyperacidity because they: A. Neutralize gastric acid. B. Decrease stomach motility. C. Decrease gastric pH. D. Decrease duodenal pH. The nurse would monitor for which of the following adverse reactions to aluminum-containing antacids such as aluminum hydroxide (Amphojel)? A. Diarrhea B. Constipation C. GI upset D. Fluid retention The nurse would question an order for which type of antacid in patients with chronic renal failure? A. Aluminum-containing antacids B. Calcium-containing antacids C. Magnesium-containing antacids D. All of the above. The nurse would monitor a patient using sodium bicarbonate to treat gastric hyperacidity for signs and symptoms of: A. Metabolic alkalosis B. Metabolic acidosis C. Hyperkalemia D. Hypercalcemia Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)? A. Increased risk for infection due to immunosuppression. B. Potential risk for bleeding related to thrombocytopenia. C. Alteration in urinary elimination related to retention. D. Alteration in tissue perfusion related to hypertension. Histamine2-receptor antagonists: A. Compete with histamine for binding sites on the parietal cells. B. Irreversibly bind to H+/K+ATPase. C. Cause a decrease in stomach pH. D. Decrease signs and symptoms of allergies related to histamine release. Proton pump inhibitors cause: A. Gastric ulcer formation B. GERD C. Achlorhydria D. Diverticulosis A patient unable to tolerate oral medications may be prescribed which of the following proton pump inhibitors to be administered intravenously? A. lansoprazole (Prevacid) B. omeprazole (Prilosec) C. pantoprazole (Protonix) D. esomeprazole (Nexium) When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important to: A. Crush the tablet into a fine powder before mixing with water. B. Administer with a bolus tube feeding. C. Allow the tablet to dissolve in water before administering. D. Administer with an antacid for maximum benefit. Sucralfate (Carafate) achieves a therapeutic effect by: A. Neutralizing gastric acid. B. Enhancing gastric absorption. C. Forming a protective barrier around gastric mucosa. D. Inhibiting gastric acid secretion. To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid? A. 4 B. 6 C. 8 D. 10 Bismuth subsalicylate (Pepto-Bismol), as an absorbent, has which of the following mechanisms of action? A. Decreased GI motility. B. Decreased gastric secretions. C. Increased fluid absorption. D. Binding to diarrhea-causing bacteria for excretion. Side effects of loperamide (Imodium) include all of the following except? A. Diarrhea B. Epigastric pain C. Dry mouth D. Anorexia The mechanism of action of diphenoxylate (Lotomil) is: A. An increase in intestinal excretion of water. B. An increase in intestinal motility. C. A decrease in peristalsis in the intestinal wall. D. A decrease in the reabsorption of water in the bowel. GI-6 Which of the following conditions can cause a hiatal hernia? A. Increased intrathoracic pressure. B. Weakness of the esophageal muscle. C. Increased esophageal muscle pressure. D. Weakness of the diaphragmatic muscle. Risk factors for the development of Hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure? A. Obesity B. Volvulus C. Constipation D. Intestinal obstruction Which of the following symptoms is common with a hiatal hernia? A. Left arm pain B. Lower back pain C. Esophageal reflux D. Abdominal cramping Which of the following tests can be performed to diagnose a hiatal hernia? A. Colonoscopy B. Lower GI series C. Barium swallow D. Abdominal x-rays Which of the following measures should the nurse focus on for the client with esophageal varices? A. Recognizing hemorrhage. B. Controlling blood pressure. C. Encouraging nutritional intake. D. Teaching the client about varices. Which of the following tests can be used to diagnose ulcers? A. Abdominal x-ray B. Barium swallow C. Computed tomography (CT) scan D. Esophagogastroduodenoscopy (EGD) Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease? A. Neutralize acid. B. Reduce acid secretions. C. Stimulate gastrin release. D. Protect the mucosal barrier. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? A. Supine with the head of the bed flat. B. On the stomach with the head flat. C. On the left side with the head of the bed elevated 30 degrees. D. On the right side with the head of the bed elevated 30 degrees. The nurse is caring for a client following a Billroth II procedure. On review of the post- operative orders, which of the following, if prescribed, would the nurse question and verify? A. Irrigating the nasogastric tube. B. Coughing and deep breathing exercises. C. Leg exercises D. Early ambulation The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome? A. Eat high-carbohydrate foods. B. Limit the fluids taken with meals. C. Ambulate following a meal. D. Sit in a high-Fowler's position during meals. The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client’s daily care? A. Assess the oral cavity each time mouth care is given and record observations. B. Use a soft toothbrush to brush the client’s teeth after each meal. C. Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours. D. Rinse the client’s mouth with mouthwash several times a day. A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication? A. The client complains of a sore throat. B. The client displays signs of sedation. C. The client experiences a sudden increase in temperature. D. The client demonstrates a lack of appetite. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During preoperative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate? A. The procedure will result in enlargement of the pyloric sphincter. B. The procedure will result in anastomosis of the gastric stump to the jejunum. C. The procedure will result in removal of the duodenum. D. The procedure will result in repositioning of the vagus nerve. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? A. Dark brown B. Bile green C. Bright red D. Cloudy white After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should include which of the following nursing interventions? A. Irrigate the tube with 30 ml of sterile water every hour if needed. B. Reposition the tube if it is not draining well. C. Monitor the client for N/V, and abdominal distention. D. Turn the machine to high suction if the drainage is sluggish on low suction. Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer? A. Regain weight loss within 1 month after surgery. B. Resume normal dietary intake of three meals per day. C. Control nausea and vomiting through regular use of antiemetics. D. Achieve optimal nutritional status through oral or parenteral feedings. The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? A. Development of laryngeal cancer. B. Irritation of the esophagus. C. Esophageal scar tissue formation. D. Aspiration of gastric contents. Which of the following dietary measures would be useful in preventing esophageal reflux? A. Eating small, frequent meals. B. Increasing fluid intake. C. Avoiding air swallowing with meals. D. Adding a bedtime snack to the dietary plan. 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 mid-epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following? A. An intestinal obstruction has developed. B. Additional ulcers have developed. C. The esophagus has become inflamed. D. The ulcer has perforated. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply. A. Epigastric pain at night B. Relief of epigastric pain after eating C. Vomiting D. Weight loss The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. A. The client complains of a sore throat. B. The client has a temperature of 100*F. C. The client appears drowsy following the procedure. D. The client complains of epigastric pain. E. The client experiences hematemesis. 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? A. Ineffective coping related to fear of diagnosis of chronic illness. B. Deficient knowledge related to unfamiliarity with significant signs and symptoms. C. Constipation related to decreased gastric motility. D. Imbalanced nutrition: Less than body requirements due to gastric bleeding. A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this information, which nursing diagnosis would be most appropriate? A. Imbalanced Nutrition: Less than Body Requirements related to anorexia. B. Disturbed Sleep Pattern related to epigastric pain. C. Ineffective Coping related to exacerbation of duodenal ulcer. D. Activity Intolerance related to abdominal pain. While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. A. Administering an antacid hourly until nausea subsides. B. Monitoring the client’s vital signs. C. Notifying the physician of the client’s symptoms. D. Initiating oxygen therapy. E. Reassessing the client in an hour. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? A. Before meals B. With meals C. At bedtime D. When pain occurs A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine which of the following is the most likely cause of the client’s constipation? A. The client has not been including enough fiber in his diet. B. The client needs to increase his daily exercise. C. The client is experiencing a side effect of the aluminum hydroxide. D. The client has developed a gastrointestinal obstruction. 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? A. “I should take my antacid before I take my other medications.” B. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.” C. “My antacid will be most effective if I take it whenever I experience stomach pains.” D. “It is best for me to take my antacid 1 to 3 hours after meals.” The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies? A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin E The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question? A. digoxin (Lanoxin) B. indomethacin (Indocin) C. furosemide (Lasix) D. propranolol hydrochloride (Inderal) The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most appropriate? A. Notify the physician. B. Document the findings. C. Irrigate the T-tube. D. Clamp the T-tube. The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.” B. “Sucralfate (Carafate) will change the fluid in my stomach.” C. “Antacids will coat my stomach.” D. “Omeprazole (Prilosec) will coat the ulcer and help it heal.” The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves: A. Cutting the vagus nerve. B. Removing the distal portion of the stomach. C. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid. D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum. A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure: A. Decreases food absorption in the stomach. B. Heals the gastric mucosa. C. Halts stress reactions. D. Reduces the stimulus to acid secretions. The nurse would assess the client experiencing an acute episode of cholecystitis for pain that is located in the right A. Upper quadrant and radiates to the left scapula and shoulder. B. Upper quadrant and radiates to the right scapula and shoulder. C. Lower quadrant and radiates to the umbilicus. D. Lower quadrant and radiates to the back. Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection? A. Monitoring gastric pH to detect complications. B. Assessing for bowel sounds. C. Providing nutritional support. D. Monitoring for symptoms of hemorrhage. If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client? A. Blood replacement B. Antacid administration C. Nasogastric tube suction D. Fluid and electrolyte replacement Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications? A. To inhibit mucus production. B. To neutralize acid production. C. To stimulate mucus production. D. To stimulate hydrogen ion diffusion back into the mucosa. When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important? A. Eat a low-protein diet. B. Eat a low-fat, low-cholesterol diet. C. Limit exercise to 10 minutes/day. D. Keep weight proportionate to height. Which of the following symptoms best describes Murphy’s sign? A. Periumbilical ecchymosis exists. B. On deep palpation and release, pain elicited. C. On deep inspiration, pain is elicited and breathing stops. D. Abdominal muscles are tightened in anticipation of palpation. Which of the following tests is most commonly used to diagnose cholecystitis? A. Abdominal CT scan B. Abdominal ultrasound C. Barium swallow D. Endoscopy Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis? A. Administration of antibiotics. B. Assessment for complications. C. Preparation for lithotripsy. D. Preparation for surgery. A client being treated for chronic cholecystitis should be given which of the following instructions? A. Increase rest. B. Avoid antacids. C. Increase protein in diet. D. Use anticholinergics as prescribed. The client with a duodenal ulcer may exhibit which of the following findings during an assessment? A. Hematemesis B. Malnourishment C. Melena D. Pain with eating The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics? A. Early satiety B. Pain on eating C. Dull upper epigastric pain D. Pain on an empty stomach The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be: A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion. B. After insertion into the nostril, instruct the client to extend his neck. C. Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion. D. Instruct the client to hold his chin down, then back for insertion of the tube. Incorrect The most important pathophysiological factor contributing to the formation of esophageal varices is: A. Decreased prothrombin formation. B. Decreased albumin formation by the liver. C. Portal hypertension. D. Increased central venous pressure. The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: A. Check that the hemostat is on the bedside. B. Monitor IV fluids for the shift. C. Regularly assess respiratory status. D. Check that the balloon is deflated on a regular basis. A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A. Cancer of the stomach B. Peptic ulcer disease C. Chronic gastritis D. Pylorospasm When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A. Assisting in inserting a Miller-Abbott tube. B. Assisting in inserting an arterial pressure line. C. Inserting a nasogastric tube. D. Inserting an I.V. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: A. Reduce gastric acid output. B. Protect the ulcer surface. C. Inhibit the production of hydrochloric acid (HCl). D. Inhibit vagus nerve stimulation. GI-7 Which of the following laboratory values would be the most important to monitor for a patient with pancreatic cancer? A. Serum glucose B. Radioimmunoassay (RIA) C. Creatine phosphokinase (CPK) D. Carcinoembryonic antigen (CEA) You observe changes in mentation, irritability, restlessness, and decreased concentration in a patient with cancer of the liver. Hepatic encephalopathy is suspected and the patient is ordered neomycin enemas. Which of the following information in the patient’s history would be a contraindication of this order? A. Left nephrectomy B. Glaucoma in both eyes C. Myocardial infarction D. Peripheral neuropathy A nursing intervention for a patient with hepatitis B would include which of the following types of isolation. A. Universal precautions B. Blood transfusions C. Enteric isolation D. Strict isolation A patient is admitted with lacerated liver as a result of blunt abdominal trauma. Which of the following nursing interventions would not be appropriate for this patient? A. Monitor for respiratory distress. B. Monitor for coagulation studies. C. Administer pain medications as ordered. D. Administer normal saline, crystalloids as ordered. A male client is recovering from a small bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur? A. 5 to 10 minutes B. 15 to 30 minutes C. 30 to 60 minutes D. 2 to 4 hours Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort? A. Give tepid baths. B. Avoid lotions and creams. C. Use hot water to increase vasodilation. D. Use cold water to decrease the itching. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s jaundiced and reports weakness. Which intervention will you include in his care? A. Regular exercise. B. A low-protein diet. C. Allow the patient to select his meals. D. Rest period after small, frequent meals. You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? A. “Now I can never get hepatitis again.” B. “I can safely give blood after 3 months.” C. “I’ll never have a problem with my liver again, even if I drink alcohol.” D. “My family knows that if I get tired and start vomiting, I may be getting sick again.” Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,” If I lie still and avoid turning after the operation, I’ll avoid pain. Do you think this is a good idea?” What is the best response? A. “You’ll need to turn from side to side every 2 hours.” B. “It’s always a good idea to rest quietly after surgery.” C. “The doctor will probably order you to lie flat for 24 hours.” D. “Why don’t you decide about activity after you return from the recovery room?” You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which response isn’t appropriate? A. Encourage her to not worry about the future. B. Encourage her to express her feelings about the illness. C. Discuss the effects of hepatitis B on future health problems. D. Provide avenues for financial counseling if she expresses the need. Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam? A. Give diazepam in the I.V. port closest to the vein. B. Mix diazepam with 50 ml of dextrose 5% in water and give it over 15 minutes. C. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture. D. Question the order because I.V. administration of diazepam is contraindicated. Annabelle is being discharged with a colostomy, and you’re teaching her about colostomy care. Which statement correctly describes a healthy stoma? A. “At first, the stoma may bleed slightly when touched.” B. “The stoma should appear dark and have a bluish hue.” C. “A burning sensation under the stoma faceplate is normal.” D. “The stoma should remain swollen away from the abdomen.” A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston syringe? A. Rapidly instill a stream of irrigating solution into the wound. B. Apply a wet-to-dry dressing to the wound after the irrigation. C. Moisten the area around the wound with normal saline solution after the irrigation. D. Irrigate continuously until the solution becomes clear or all of the solution is used. Hepatic encephalopathy develops when the blood level of which substance increases? A. Ammonia B. Amylase C. Calcium D. Potassium Your patient recently had abdominal surgery and tells you that he feels a popping sensation in his incision during a coughing spell, followed by severe pain. You anticipate an evisceration. Which supplies should you take to his room? A. A suture kit. B. Sterile water and a suture kit. C. Sterile water and sterile dressings. D. Sterile saline solution and sterile dressings. Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder? A. Ulcer B. Crohn’s disease C. Chronic gastritis D. Ulcerative colitis What information is correct about stomach cancer? A. Stomach pain is often a late symptom. B. Surgery is often a successful treatment. C. Chemotherapy and radiation are often successful treatments. D. The patient can survive for an extended time with TPN. Dark, tarry stools indicate bleeding in which location of the GI tract? a. Upper colon B. Lower colon C. Upper GI tract D. Small intestine A patient has an acute upper GI hemorrhage. Your interventions include: A. Treating hypovolemia. B. Treating hypervolemia. C. Controlling the bleeding source. D. Treating shock and diagnosing the bleeding source. You promote hemodynamic stability in a patient with upper GI bleeding by: A. Encouraging oral fluid intake. B. Monitoring central venous pressure. C. Monitoring laboratory test results and vital signs. D. Giving blood, electrolyte, and fluid replacement. You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient? A. Determine what the patient already knows about colostomies. B. Show the patient some pictures of colostomies. C. Arrange for someone who has a colostomy to visit the patient. D. Provide the patient with written material about colostomy care. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication? A. Fistula B. Bowel perforation C. Bowel obstruction D. Abscess A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include: A. Antacids B. Antibiotics C. Corticosteroids D. Histamine2-receptor blockers The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient’s diet? A. Meats and beans B. Butter and gravies C. Potatoes and pasta D. Cakes and pastries An intubated patient is receiving continuous enteral feedings through a Salem pump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding? A. Notify the doctor immediately. B. Stop the feeding, and clamp the NG tube. C. Discard the 220ml and clamp the NG tube. D. Give a prescribed GI stimulant such as metoclopramide (Reglan). Your patient with peritonitis is NPO and complaining of thirst. What is your priority? A. Increase the I.V. infusion rate. B. Use diversion activities. C. Provide frequent mouth care. D. Give ice chips every 15 minutes. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate? A. He has fresh, active upper GI bleeding. B. He needs immediate saline gastric lavage. C. His gastric bleeding occurred 2 hours earlier. D. He needs a transfusion of packed RBCs. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color? A. Brown B. Clear C. Red D. Yellow Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy? A. Peristalsis B. Gastric acidity C. Gastric motility D. Gastric pH Christina is receiving an enteral feeding that requires a concentration of 80 ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding? A. 60 ml B. 70 ml C. 80 ml D. 90 ml Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown? A. Ileostomy B. Ascending colostomy C. Transverse colostomy D. Descending colostomy George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage? A. “If there is any drainage, notify the surgeon immediately.” B. “The drainage will decrease daily until the bile duct heals.” C. “First, the drainage is dark green; then it becomes dark yellow.” D. “If the drainage stops, milk the tube toward the puncture wound.” Your patient Maria takes NSAIDS for her degenerative joint disease, and has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease? A. calcium carbonate (Tums) B. famotidine (Pepcid) C. misoprostol (Cytotec) D. sucralfate (Carafate) The student nurse is participating in a colorectal cancer screening program. Which patient has the fewest risk factors for colon cancer? A. Janice, a 45 y.o. with a 25-year history of ulcerative colitis. B. George, a 50 y.o. whose father died of colon cancer. C. Herman, a 60 y.o. who follows a low-fat, high-fiber diet. D. Sissy, a 72 y.o. with a history of breast cancer. Your patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority? A. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bed sheet. B. Obtain vital signs, call the doctor, and obtain emergency orders. C. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees. D. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution. DIABETES-1 Knowing that gluconeogenesis helps to maintain blood glucose levels, a nurse should: A. Document weight changes because of fatty acid mobilization. B. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation. C. Protect the patient from sources of infection because of decreased cellular protein deposits. D. Do all of the above. The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre- diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6% Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third day B. Every other day C. 1-2 weeks D. 2-4 weeks A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except: A. Integumentary inspection for the presence of brown spots on the lower extremities B. Observation for paleness of the lower extremities C. Observation for blanching of the feet after the legs are elevated for 60 seconds D. Palpation for increased pulse volume in the arteries of the lower extremities The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of insulin preoperatively? A. 10-20% B. 25-40% C. 50-60% D. 85-90% Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hour

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