Gastrointestinal Chapter 38 Assessment Guide PDF

**UNIT II Gastrointestinal chapters ** **Chapter 38: Assessment of Digestive and Gastrointestinal Func- tion** 1\. A nurse is caring for a client who is scheduled for a colonoscopy and **whose preparation will include polyethylene glycol electrolyte lavage prior to the procedure. The presence of w...

**UNIT II Gastrointestinal chapters ** **Chapter 38: Assessment of Digestive and Gastrointestinal Func- tion** 1\. A nurse is caring for a client who is scheduled for a colonoscopy and **whose preparation will include polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem would contraindicate the use of this form of bowel preparation?** **A. Inflammatory bowel disease** B. Intestinal polyps C. Diverticulitis D. Colon cancer ANS: A  2\. A nurse is promoting increased protein intake to enhance a client\'s wound healing. **What is the enzyme that will initiate the digestion of the protein that the client consumes?** A. **Pepsin**\ B. Intrinsic factor  C. Lipase  D. Amylase ANS: A 3\. A client has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The client is scheduled for an appendectomy but questions the nurse about how a person's health is affected by the absence of the appendix. How should the nurse **best** respond? ***A. \"Your appendix doesn\'t play a major role in health, so you won\'t notice any difference after your recovery from surgery.\"***\ B. \"The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate.\"\ C. \"Your body will absorb slightly fewer nutrients from the food you eat, but you won\'t be aware of this.\"\ D. \"Your small intestine will adapt over time to the absence of your appendix.\" 4\. An adult client is scheduled for an upper GI series that will use a **barium swallow**. What teaching should the nurse include when the client has completed the test? A. Stool will be yellow for the first 24 hours' post procedure.\ B. The barium may cause diarrhea for the next 24 hours.\ C. ***Fluids must be increased to facilitate the evacuation of the stool. *** D. Slight anal bleeding may be noted as the barium is passed.  5\. A nurse is caring for a client with recurrent ***hematemesis who is scheduled for upper gastrointestinal fibroscopy. How should the nurse in the radiology department prepare this client?*** A. Insert a nasogastric tube. B. Administer a micro Fleet enema at least 3 hours before the procedure.  C. Have the client lie in a supine position for the procedure. ***D. Apply local anesthetic to the back of the client\'s throat. *** 6\. The nurse is caring for a client scheduled for a colonoscopy. The nurse should assist the client into what position during this diagnostic test? A. In a knee-chest position (lithotomy position)\ B. Lying prone with legs drawn toward the chest\ ***C. Lying on the left side with legs drawn toward the chest***\ D. In a prone position with two pillows elevating the buttocks  7\. A client has sought ***care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should give what instructions to the client? *** ***A. "Take no NSAIDs within 72 hours of the test."\ ***B. "Take prescribed medications as usual."\ C. "Avoid over-the-counter (OTC) vitamin C supplements."  D. "Do not use fiber supplements before the test."  8\. The nurse is preparing to perform a client\'s abdominal assessment. What examination sequence should the nurse follow? ***A. Inspection, auscultation, percussion, and palpation***  B. Inspection, palpation, auscultation, and percussion  C. Inspection, percussion, palpation, and auscultation  D. Inspection, palpation, percussion, and auscultation 9\. A client who has been experiencing changes in his bowel function is scheduled for a ***barium enema. What instruction should the nurse provide for post procedure recovery?*** A. Remain NPO for 6 hours post procedure.\ B. Administer a Fleet enema to cleanse the bowel of the barium.  C. ***Increase fluid intake to evacuate the barium.\ ***D. Avoid dairy products for 24 hours' post procedure.  10\. A nurse is caring for a newly admitted client with a suspected GI bleed. The nurse assesses the client\'s stool after a bowel movement and notes it to be a ***tarry-black color.*** This finding is suggestive of bleeding from what location? A. Sigmoid colon  ***B. Upper GI tract *** C. Large intestine  D. Anus or rectum 11\. A nurse has auscultated a client\'s abdomen and noted one or two bowel sounds in a 2-minute period of time. How should the nurse document the client\'s bowel sounds? A. Normal\ B. Hypoactive C. Hyperactive  D. Paralytic ileus 12\. An advanced practice nurse is assessing the size and density of a client\'s abdominal organs. If the results of palpation are unclear to the nurse, what assessment technique should be implemented?  ***A. Percussion***\ B. Auscultation\ C. Inspection\ D. Rectal examination  **13. The nurse is caring for a client with gastrointestinal symptoms who reports being under a significant amount of stress at home and at work. Which gastrointestinal effect of stress should the nurse anticipate is affecting this client?** A. Increased gastric acid secretion\ ***B. Slowed peristalsis***\ C. Increased enteric blood flow\ D. Relaxed sphincter muscles\ **14. A client has returned to the medical unit after a barium enema. When assessing the client\'s subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider?** A. Large, wide stools\ B. Milky white stools\ C. Three stools during an 8-hour period of time\ ***D. Streaks of blood present in the stool*** ANS: D\ **15. A nurse is caring for clients in a stroke rehabilitation facility. Damage to what area of the brain will most affect a client\'s ability to swallow?** A. Temporal lobe\ ***B. Medulla oblongata***\ C. Cerebellum\ D. Pons ANS: B **16. A client is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production?** A. Muscle wasting\ B. Chronic jaundice in the absence of liver disease\ C. The presence of fat in the client\'s stool\ ***D. Persistently low hemoglobin and hematocrit*** ANS: D **17. A client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the client, what advantage should the nurse describe?** A. The entire peritoneal cavity can be visualized.\ B. The test allows for painless biopsy collection.\ C. The capsule is endoscopically placed in the intestine.\ ***D. The test is noninvasive.*** ANS: D 18\. A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. **What digestive enzymes does the pancreas secrete**? Select all that apply. A. Pepsin\ **B. Lipase\ C. Amylase\ D. Trypsin**\ E. Ptyalin ANS: B, C, D **19. A nurse is performing an abdominal assessment of an older adult client. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function?** A. Increased gastric motility\ B. Decreased gastric pH\ C. Increased gag reflex\ ***D. Decreased mucus secretion*** ANS: D **20. The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply.** **A. Splenic vein\ B. Inferior mesenteric vein\ C. Gastric vein\ **D. Inferior vena cava\ E. Saphenous vein ANS: A, B, C **21. The nurse is providing health education to a client with a gastrointestinal disorder.\ *What should the nurse describe as a major function of the GI tract?*** A. The breakdown of food particles into cell form for digestion\ B. The maintenance of fluid and acid-base balance\ ***C. The absorption into the bloodstream of nutrient molecules produced by Digestion***\ D. The control of absorption and elimination of electrolytes ANS: C **22. A nurse is providing pre-procedure education for a client who will undergo a lower GI tract study the following week. What should the nurse teach the client about bowel preparation?** A. \"You\'ll need to fast for at least 18 hours prior to your test.\"\ B. \"Starting today, take over-the-counter (OTC) stool softeners twice daily.\"\ ***C. \"You\'ll need to have enemas the day before the test.\"\ ***D. \"For 24 hours before the test, insert a glycerin suppository every 4 hours.\" ANS: C **23. A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client?** ***A. \"Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food.\"\ ***B. \"As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to form acid.\"\ C. \"The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the stomach provides this environment.\"\ D. \"The acidic environment in the stomach exists to buffer the highly alkaline environment in the esophagus.\" ANS: A **24. Results of a client\'s preliminary assessment prompted an examination of the client\'s *carcinoembryonic antigen (CEA) levels, which have come back positive.* What is the nurse\'s most appropriate response to this finding?** A. Perform a focused abdominal assessment.\ ***B. Prepare to meet the client\'s psychosocial needs.***\ C. Liaise with the nurse practitioner to perform an anorectal examination.\ D. Encourage the client to adhere to recommended screening protocols. ANS: B **25. A nurse is assessing the abdomen of a client just admitted to the unit with suspected GI disease. *Inspection reveals several diverse lesions on the client\'s abdomen.* How should the nurse best interpret this assessment finding?** A. Abdominal lesions are usually due to age-related skin changes.\ B. Integumentary diseases often cause GI disorders.\ ***C. GI diseases often produce skin changes.***\ D. The client needs to be assessed for self-harm. ANS: C **26. A client\'s sigmoidoscopy has been successfully completed and the client is preparing to return home. What teaching point should the nurse include in the client\'s discharge education?** A. The client should drink at least 2 liters of fluid in the next 12 hours.\ B. The client can resume a normal routine immediately.\ C. The client should expect fecal urgency for several hours.\ D. The client can expect some scant rectal bleeding. ANS: B **27. A nurse is caring for an 83-year-old client who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the client\'s health issues?** ***A. Stomach emptying takes place more slowly.***\ B. The villi and epithelium of the small intestine become thinner.\ C. The esophageal sphincter becomes incompetent.\ D. Saliva production decreases. ANS: A **28. A client has been scheduled fo*r a urea breath test in one month\'s time.* What nursing diagnosis most likely prompted this diagnostic test?** A. Impaired dentition related to gingivitis\ ***B. Risk for impaired skin integrity related to peptic ulcers***\ C. Imbalanced nutrition: Less than body requirements related to enzyme deficiency\ D. Diarrhea related to Clostridium difficile infection ANS: B **29. A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse\'s assessment should focus on what potential cause?** A. Diet high in red meat\ B. Upper GI bleed\ C. **Hemorrhoids**\ D. Use of iron supplements ANS: C **30. A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure?** A. **Colonoscopy**\ B. Barium enema\ C. ERCP\ D. Upper gastrointestinal fibroscopy ANS: A **31. The nurse is caring for a client with a duodenal ulcer and is relating the client\'s symptoms to the *physiologic functions of the small intestine. What do these functions include? Select all that apply.*** A. Secretion of hydrochloric acid (HCl)\ B. Reabsorption of water\ C. ***Secretion of mucus\ D. Absorption of nutrients\ E. Movement of nutrients into the bloodstream*** ANS: C, D, E **32. A clinic client has described recent dark-colored stools, and the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the client\'s current health status would contraindicate FOBT?** A. Gastroesophageal reflux disease (GERD)\ B. Peptic ulcers\ C. **Hemorrhoids**\ D. Recurrent nausea and vomiting ANS: C **33. A client will be *undergoing a urea breath test for the detection of Helicobacter pylori.* Which instruction should the nurse give to the client to prepare for this test?** A. Ingest a capsule of carbon-labeled urea ingested three days before the test.\ B. Take prescribed antibiotics one month before the test.\ C. Fast for 12 hours before the test.\ ***D. Avoid taking cimetidine 24 hours before the test.*** ANS: D **34. *A medical client\'s CA 19-9 levels have become available and they are significantly elevated.* How should the nurse best interpret this diagnostic finding?** A. ***The client may have cancer, but other GI disease must be ruled out.***\ B. The client most likely has early-stage colorectal cancer.\ C. The client has a genetic predisposition to gastric cancer.\ D. The client has cancer, but the site is unknown. ANS: A **35. A client has come to the clinic reporting blood in the stool. A fecal occult blood test is performed but is negative. Based on the client\'s history, the health care provider suggests a colonoscopy, but the client refuses, citing a strong aversion to the invasive nature of the test. What other test might the provider order to check for blood in the stool?** A. A laparoscopic intestinal mucosa biopsy **B. Fecal immunochemical test (FIT) ** C. Computed tomography (CT)\ D. Magnetic resonance imagery (MRI) ANS: B **36. The nurse is providing a client with the supplies necessary to perform *two hemoccult tests on the client's stool. What instruction should the nurse give this client*?** A. \"If possible, fast for 12 hours before collecting a sample.\"\ B. \"Take all your medications except the antihypertensive ones.\"\ C. \"Don\'t eat highly acidic foods 72 hours before you start the test.\"\ ***D. \"Mail the paper slides to the clinic once you\'ve collected the samples.\"*** ANS: D **37. A client has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of the hormonal effects of stress, including *norepinephrine release. Release of this substance would have what effect on the client\'s gastrointestinal function? Select all that apply.*** A. Decreased motility\ B. Increased sphincter tone\ C. Increased enzyme release\ D. Inhibition of secretions\ E. Increased peristalsis ANS: A, B, D **38. The nurse is caring for a client who has a diagnosis of AIDS. Inspection of the client\'s mouth reveals the new presence of white lesions on the client\'s oral mucosa. What is the nurse\'s most appropriate response?** A. Encourage the client to gargle with salt water twice daily.\ B. Attempt to remove the lesions with a tongue depressor.\ C. Make a referral to the unit\'s dietitian.\ D. **Inform the primary provider of this finding.** ANS: D **39. A female client has presented to the emergency department with right upper quadrant pain; the health care provider has ordered abdominal ultrasound to rule out cholecystitis. The client expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best respond?** A. \"Abdominal ultrasound is very safe, but it can\'t be performed if you\'re Pregnant.\"\ B. \"Abdominal ultrasound poses no known safety risks of any kind.\"\ C. \"Current guidelines state that a person can have up to 3 ultrasounds per year.\"\ D. \"Current guidelines state that a person can have up to 6 ultrasounds per year.\" ANS: B Chapter 39: Management of Patients with Oral and Esophageal Disorders **1. The nurse determines that a client who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the nurse\'s priority when suctioning this client?** A. Avoid applying suction on or near the suture line.\ B. Position client on the non-operative side with the head of the bed down.\ C. Assess the client\'s ability to perform self-suctioning.\ D. Evaluate the client\'s ability to swallow saliva and clear fluids. ANS: A **\ \ 2. A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client\'s subsequent care?** A. The client will be monitored closely to detect malignant changes.\ B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.\ C. Small amounts of blood are likely to be present in the stools and are not cause for concern.\ D. Antacids may be discontinued when symptoms of heartburn subside. ANS: A **3. A medical nurse who is caring for a client being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this client. What is a priority psychosocial outcome for this client?** A. Indicates acceptance of altered appearance and demonstrates positive Self-image\ B. Freely expresses needs and concerns related to postoperative pain management\ C. Compensates effectively for alteration in ability to communicate related to Dysarthria\ D. Demonstrates effective stress management techniques to promote muscle relaxation ANS: A **4. A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom?** A. Burning pain on swallowing\ B. Regurgitation of undigested food\ C. Symptoms mimicking a myocardial infarction\ D. Chronic parotid abscesses ANS: B **5. A nurse is caring for a client who is acutely ill and has included vigilant oral care in the client\'s plan of care. What factor increases this client\'s risk for dental caries?** A. Hormonal changes brought on by the stress response cause an acidic oral Environment\ B. Systemic infections frequently migrate to the teeth\ C. Hydration that is received intravenously lacks fluoride\ D. Inadequate nutrition and decreased saliva production can cause cavities ANS: D **6. A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What client most likely faces the highest immediate risk of oral cancer?** A. A 65-year-old man with alcoholism who smokes\ B. A 45-year-old woman who has type 1 diabetes and who wears dentures\ C. A 32-year-old man who is obese and uses smokeless tobacco\ D. A 57-year-old man with GERD and dental caries ANS: A **7. A nurse is caring for a client who has undergone neck resection with a radial forearm free flap. The nurse\'s most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurse\'s most appropriate action?** A. Document the findings as being consistent with a viable graft.\ B. Promptly report these indications of venous congestion.\ C. Closely monitor the client and reassess in 30 minutes.\ D. Reposition the client to promote peripheral circulation. ANS: B **8. A nurse is assessing a client who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?** A. Assess ability to clear oral secretions.\ B. Assess for signs of infection.\ C. Assess for a patent airway.\ D. Assess for ability to communicate. ANS: C **9. A client who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What should the goals of physical therapy for this client include?** A. Muscle training to relieve dysphagia\ B. Relieving nerve paralysis in the cervical plexus\ C. Promoting maximum shoulder function\ D. Alleviating achalasia by decreasing esophageal peristalsis ANS: C **10. A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action should the nurse recommend as having the greatest potential to prevent esophageal cancer?** A. Promotion of a nutrient-dense, low-fat diet\ B. Annual screening endoscopy for clients over 50 with a family history of esophageal cancer\ C. Early diagnosis and treatment of gastroesophageal reflux disease\ D. Adequate fluid intake and avoidance of spicy foods ANS: C **11. An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body?** A. Haloperidol  B. Prostigmine  C. Epinephrine  D. Glucagon ANS: D  12\. A nurse in an oral surgery practice is working with a client scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend what action? A. Rinse the mouth with alcohol before bedtime for the next 7 days.\ B. Use warm saline to rinse the mouth as needed.\ C. Brush around the area with a firm toothbrush to prevent infection.\ D. Use a toothpick to dislodge any debris that gets lodged in the socket.  **13. A client has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?** A. Radiation therapy often results in secondary brain tumors. B. Surgical complications are exceedingly common.\ C. Diagnosis rarely occurs until the cancer is end stage.\ D. Metastases are common and respond poorly to treatment. ANS: D **14. A client has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this client?** A. Placing the client in a left lateral position\ B. Administering opioids as prescribed C. Placing the client in Fowler position\ D. Teaching the client to use the client-controlled analgesia (PCA) system ANS: C **15. A client has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this client\'s discharge education?** A. Resumption of activities of daily living  B. Pain control\ C. Promotion of adequate nutrition\ D. Strategies for promoting communication **16. A The client is experiencing painful oral lesions following radiation for oropharyngeal cancer. Which instruction should the nurse give this client?** A. Spicy foods stimulate salivation and are soothing. B. Eat food while it is hot to enhance flavor.\ C. Avoid brushing teeth while lesions are present.  D. Eat soft or liquid foods. ANS: D  **17. A nurse is caring for a client who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the client and notes the presence of high-pitched adventitious sounds over the client\'s trachea on auscultation. The client\'s oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurse\'s most appropriate action?** A. Encourage the client to perform deep breathing and coughing exercises hourly.  B. Reposition the client into a prone or semi-Fowler position and apply supplementary oxygen by nasal cannula.\ C. Activate the emergency response system. D. Report this finding promptly to the health care provider and remain with the client. 18\. A nurse is providing care for a client whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis? A. Risk for disuse syndrome  B. Unilateral neglect\ C. Risk for trauma\ D. Ineffective tissue perfusion **19. A client\'s neck dissection surgery resulted in damage to the client\'s superior laryngeal nerve. What area of assessment should the nurse consequently prioritize?** A. The client\'s swallowing ability\ B. The client\'s ability to speak\ C. The client\'s management of secretions  D. The client\'s airway patency **20. A client who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. What should the nurse include in the client\'s immediate postoperative plan of care?** A. Teaching the client to self-suction\ B. Performing chest physiotherapy to promote oxygenation  C. Positioning the client to prevent gastric reflux\ D. Providing a regular diet as tolerated **21. A nurse is caring for a client who has had surgery for oral cancer. When addressing the client\'s long-term needs, the nurse should prioritize interventions and referrals with what goal? ** A. Enhancement of verbal communication  B. Enhancement of immune function\ C. Maintenance of adequate social support  D. Maintenance of fluid balance **22. A client returns to the unit after a neck dissection. The surgeon placed a Jackson-Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the health care provider immediately for what finding?** A. Presence of small blood clots in the drainage\ B. 60 mL of milky or cloudy drainage\ C. Spots of drainage on the dressings surrounding the drain  D. 120 mL of serosanguinous drainage ANS: B **23. A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug? ** A. Metoclopramide  B. Omeprazole\ C. Lansoprazole\ D. Calcium carbonate **24. A client seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?** A. \"Drinking beverages after your meal, rather than with your meal, may bring some relief.\"\ B. \"It\'s best to avoid dry foods, such as rice and chicken, because they\'re harder to swallow.\" C. \"Many clients obtain relief by taking over-the-counter antacids 30 minutes before eating.\"\ D. \"Instead of eating three meals a day, try eating smaller amounts more often.\" **25. A nurse is caring for a client who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this client, what would the nurse be sure to include?** 1. Increasing calcium intake to promote bone healing 1. Avoiding chewing food for the specified number of weeks after surgery 1. Techniques for managing parenteral nutrition in the home setting 1. Techniques for managing a gastrostomy **26. A nurse is caring for a client who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the client\'s appetite?** A. Encourage the family to bring in the client\'s favorite foods.  B. Limit visitors at mealtimes so that the client is not distracted.  C. Avoid offering food unless the client initiates. D. Provide thorough oral care immediately after the client eats.  27\. A nurse is caring for a client in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristic(s) of this stage of the disease? Select all that apply. A. Perforation into the mediastinum\ B. Development of an esophageal lesion  C. Erosion into the great vessels\ D. Painful swallowing\ E. Obstruction of the esophagus **28. The nurse is preparing to check for tube placement in the client\'s stomach as well as measure the residual volume. What are these nursing actions attempting to prevent?** A. Gastric ulcers\ B. Aspiration\ C. Abdominal distention  D. Diarrhea **29. The management of the client\'s gastrostomy is an assessment priority for the home care nurse. What statement would indicate that the client is managing the tube correctly?** A. \"I clean my stoma twice a day with alcohol.\"\ B. \"The only time I flush my tube is when I\'m putting in medications.\"\ C. \"I flush my tube with water before and after each of my medications.\"  D. \"I try to stay still most of the time to avoid dislodging my tube.\" **30. A client\'s NG tube has become clogged after the nurse instilled a medication that was insufficiently crushed. The nurse has attempted to aspirate with a large-bore syringe, with no success. What should the nurse do next?** A. Withdraw the NG tube 2 inches (5 cm) and reattempt aspiration.\ B. Attach a syringe filled with warm water and attempt an in-and-out motion of instilling and aspirating.\ C. Withdraw the NG tube slightly and attempt to dislodge by flicking the tube with the fingers.\ D. Remove the NG tube promptly and obtain an order for reinsertion from the primary care provider. **31. The nurse is administering medications to a client through a feeding tube. Which action should the nurse take?** A. Flush the tube with 5 mL of water before administering medication.\ B. Turn the tube feeding off for 1 hour before administering the medication.  C. Administer each medication separately.  D. flush with 50 ml of water between each medication 3**2. A client who suffered a stroke had an NG tube inserted to facilitate feeding shortly after admission. The client has since become comatose and the client\'s family asks the nurse why the health care provider is recommending the removal of the client\'s NG tube and the insertion of a gastrostomy tube. What is the nurse\'s best response?** A. "It eliminates the risk for infection."\ B. "Feeds can be infused at a faster rate."\ C. "Regurgitation and aspiration are less likely."\ D. "It allows caregivers to provide personal hygiene more easily." **33. A client has a gastrostomy tube that has been placed to drain stomach contents by low intermittent suction. What is the nurse\'s priority during this aspect of the client\'s care?** A. Measure and record drainage.\ B. Monitor drainage for change in color.\ C. Titrate the suction every hour.\ D. Feed the client via the G tube as prescribed.  **34. The nurse is caring for a client who had a low-profile gastrostomy device placed. Which instruction should the nurse give the client and family? ** A. Wear the tubing outside of clothing.\ B. Use tape to secure the device.\ C. Bring the connection tubing if going to the hospital. D. Change the wet-to-dry dressing daily.  **35. A nurse is preparing to place a client\'s prescribed nasogastric tube. What anticipatory guidance should the nurse provide to the client?** A. Insertion is likely to cause some gagging.\ B. Insertion will cause some short-term pain.\ C. A narrow-gauge tube will be inserted before being replaced with a larger-gauge tube.\ D. Topical anesthetics will be used to reduce discomfort during insertion. **36. A nurse is creating a care plan for a client receiving nasogastric tube feedings. Which intervention should the nurse include?** A. Check the gastric residual volume every 4 hours. B. Hold the tube feeding if the gastric residual volume is greater than 200 mL.  C. Position client flat in bed during feedings.\ D. Use client assessment findings to determine tolerance of feedings. **37. A nasogastric tube is being inserted in a client with the COVID virus. Which action should the nurse take? ** A. Place the client in a prone position.  B. Administer bolus feedings.\ C. Place a mask over the client's nose.  D. Wear personal protective equipment.  **UNIT II GI ** **Chapter 40: Management of Patients with Gastric and Duodenal Disorders** **1. A nurse is caring for a client who just has been diagnosed with a peptic ulcer. When teaching the client about his new diagnosis, how should the nurse best describe it?** A. Inflammation of the lining of the stomach B. Erosion of the lining of the stomach or intestine C. Bleeding from the mucosa in the stomach  D. Viral invasion of the stomach wall **2. A nurse is admitting a client diagnosed with late-stage gastric cancer. The client\'s family is distraught and angry that the client was not diagnosed earlier in the course of her disease. What factor most likely contributed to the client\'s late diagnosis?** A. Gastric cancer does not cause signs or symptoms until metastasis has occurred. B. Adherence to screening recommendations for gastric cancer is exceptionally low. C. Early symptoms of gastric cancer are usually attributed to constipation. D. The early symptoms of gastric cancer are usually not alarming or highly unusual.  **3. A nurse is preparing to discharge a client after recovery from gastric surgery. What is an appropriate discharge outcome for this client?** A. Bowel movements maintain a loose consistency.  B. Three large meals per day are tolerated. C. Weight is maintained or gained.\ D. High calcium diet is consumed. ANS: C **4. A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the client\'s health problem?** A. Consumes one or more protein drinks daily.\ B. Take over-the-counter antacids frequently throughout the day. C. Smokes one pack of cigarettes daily.\ D. Reports a history of social drinking on a weekly basis. **5. A community health nurse is preparing for an initial home visit to a client discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?** A. Enteral feeding via gastrostomy tube (G tube)\ B. Gastrointestinal decompression by nasogastric tube  C. Periodic assessment for esophageal distension\ D. Administration of injections of vitamin B12 **6. A nurse is assessing a client who has peptic ulcer disease. The client requests more information about the typical causes of *Helicobacter pylori* infection. What would it be appropriate for the nurse to instruct the client?** A. Most affected clients acquired the infection during international travel. B. Infection typically occurs due to ingestion of contaminated food and water.  *C.* Many people possess genetic factors causing a predisposition to *H. pylori* infection D. The *H. pylori* microorganism is endemic in warm, moist climates. 7**. A client who experienced a large upper gastrointestinal (GI) bleed due to gastritis has had the bleeding controlled and is now stable. For the next several hours, the nurse caring for this client should assess for what signs and symptoms of recurrence? ** A. Tachycardia, hypotension, and tachypnea\ B. Tarry, foul-smelling stools\ C. Diaphoresis and sudden onset of abdominal pain\ D. Sudden thirst, unrelieved by oral fluid administration **8. A client presents to the clinic reporting vomiting and burning in the mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what?** *A.* Infection with *Helicobacter pylori * B. Excessive stomach acid secretion C. An incompetent pyloric sphincter  D. A metabolic acid--base imbalance 9\. A client with a peptic ulcer disease has had metronidazole added to their current medication regimen. What health education related to this medication should the nurse provide? 1. Take the medication on an empty stomach. 1. Take up to one extra dose per day if stomach pain persists. 1. Take at bedtime to mitigate the effects of drowsiness. 1. Avoid drinking alcohol while taking the drug.  **10. A client was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize?** A. Esophageal or pyloric obstruction related to scarring.  *B.* Uncontrolled proliferation of *H. pylori* C. Gastric hyperacidity related to excessive gastrin secretion  D. Chronic referred pain in the lower abdomen  **11. A client who underwent a gastric resection 3 weeks ago is having their diet progressed on a daily basis. Following the latest meal, the client reports dizziness and palpitations. Inspection reveals that the client is diaphoretic. What is the nurse\'s best action?** A. Insert a nasogastric tube promptly. B. Reposition the client supine. C. Monitor the client closely for further signs of dumping syndrome.  D. Assess the client for signs and symptoms of aspiration.  **12. A client is receiving education about an upcoming Billroth I procedure (gastroduodenostomy). This client should be informed that the client may experience which of the following adverse effects associated with this procedure?** A. Persistent feelings of hunger and thirst  B. Constipation or bowel incontinence C. Diarrhea and feelings of fullness D. Gastric reflux and belching  **13. A nurse is providing client education for a client with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The client has recently been prescribed misoprostol. What would the nurse be most accurate in informing the client about the drug?** A. It reduces the stomach\'s volume of hydrochloric acid  B. It increases the speed of gastric emptying C. It protects the stomach\'s lining D. It increases lower esophageal sphincter pressure  **14. A nurse is providing anticipatory guidance to a client who is preparing for a total gastrectomy. The nurse learns that the client is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the client\'s anxiety?** A. Emphasize the fact that gastric surgery has a low risk of complications.  B. Encourage the client to focus on the benefits of the surgery. C. Facilitate the client\'s contact with support services.  D. Obtain an order for a PRN benzodiazepine. ANS: C **15. A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. What would be the nursing care most needed by the client at this time?** A. Teaching the client about necessary nutritional modification  B. Helping the client weigh treatment options C. Teaching the client about the etiology of gastritis D. Providing the client with physical and emotional support  **16. A client is recovering in the hospital following gastrectomy. The nurse notes that the client has become increasingly difficult to engage and has had several angry outbursts at staff members in recent days. The nurse\'s attempts at therapeutic dialogue have been rebuffed. What is the nurse\'s most appropriate action?** A. Ask the client\'s primary provider to liaise between the nurse and the client.  B. Delegate care of the client to a colleague. C. Limit contact with the client in order to provide privacy. D. Make appropriate referrals to services that provide psychosocial support. **17. A client has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse\'s priority intervention?** A. Administration of antiemetics  B. Insertion of an NG tube for decompression  C. Infusion of hypotonic IV solution  D. Administration of proton pump inhibitors as prescribed **18. Diagnostic imaging and physical assessment have revealed that a client with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? ** A. peritonitis B. Gastritis C. Gastroesophageal reflux D. Acute pancreatitis **19. A client has been prescribed cimetidine for the treatment of peptic ulcer disease. When providing relevant health education for this client, the nurse should ensure the client is aware of what potential outcome?** A. Bowel incontinence B. Drug-drug interactions  C. Abdominal pain D. Heat intolerance  **20. A client has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of assessing the client\'s level of anxiety. Which of the following actions is most likely to accomplish this?** A. The nurse gauges the client\'s response to hypothetical outcomes. B. The client is encouraged to express fears openly. C. The nurse provides detailed and accurate information about the disease. D. The nurse closely observes the client\'s body language. ANS: B **21. A nurse is caring for a client who has a diagnosis of GI bleed. During shift assessment, the nurse finds the client to be tachycardic and hypotensive, and the client has an episode of hematemesis while the nurse is in the room. In addition to monitoring the client\'s vital signs and level of conscious, what would be a priority nursing action for this client? ** A. Place the client in a prone position. B. Provide the client with ice water to slow any GI bleeding.  C. Prepare for the insertion of an NG tube. D. Notify the health care provider.  **22. A nurse is caring for a client hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize?** A. Strategies for maintaining an alkaline gastric environment B. Safe technique for self-suctioning C. Techniques for positioning correctly to promote gastric healing  D. Strategies for avoiding irritating foods and beverages  **23. A client with gastritis required hospital treatment for an exacerbation of symptoms and received a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the client\'s continuing care in the home setting, what assessment question is most relevant?** A. \"Does anyone in your family have experience at giving injections?\" B. \"Are you going to be anywhere with strong sunlight in the next few months?\" C. \"Are you aware of your blood type?\" D. \"Do any of your family members have training in first aid?\" **24. A client comes to the clinic reporting pain in the epigastric region. What statement by the client is specific to the presence of a duodenal ulcer?** A. \"My pain resolves when I have something to eat.\" B. "The pain begins right after I eat." C. \"I know that my father and my grandfather both had ulcers.\" D. \"I seem to have bowel movements more often than I usually do.\"  **25. The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of:** A. total gastrectomy. B. bariatric surgery. C. diverticulitis. D. gastroesophageal reflux disease (GERD).  **26. A client has experienced symptoms of dumping syndrome following gastric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?** A. Irritation of the phrenic nerve due to diaphragmatic pressure  B. Chronic malabsorption of iron and vitamins A and C C. Reflux of bile into the distal esophagus D. Influx of extracellular fluid into the small intestine  **27. The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease?** A. Performing 15 minutes of physical activity at least three times per week\ B. Avoiding taking aspirin to treat pain or fever\ C. Taking multivitamins as prescribed and eating organic foods whenever possible D. Maintaining a healthy body weight **28. A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. Which of the following actions should the nurse prioritize?** A. Teaching the client about necessary nutritional modification  B. Helping the client weigh treatment options C. Teaching the client about the etiology of gastritis D. Providing the client with physical and emotional support  **29. A client is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the client to first seek care?** A. Hematemesis and persistent sensation of fullness  B. Abdominal bloating and recurrent constipation C. Intermittent pain and bloody stool D. Unexplained bowel incontinence and fatty stools  **30. A client with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the client has a perforated ulcer?** A. The client has abdominal bloating that developed rapidly.\ B. The client has a rigid, \"board-like\" abdomen that is tender.\ C. The client is experiencing intense lower right quadrant pain.\ D. The client is experiencing dizziness and confusion with no apparent hemodynamic changes. **31. Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse\'s anticipatory guidance should include what information?** A. The possibility of surgery, chemotherapy and radiotherapy B. The possibility of needing a short-term or long-term colostomy C. The benefits of weight loss and exercise as tolerated during recovery D. The good prognosis for clients who are treated for gastric cancer  32\. An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse\'s health education should include what guidelines? Select all that apply. A. Avoid drinking alcohol\ B. Adopt a low-residue diet\ C. Avoid nonsteroidal anti-inflammatories  D. Take calcium gluconate as prescribed E. Prepare for the possibility of surgery  **33. The nurse is providing care for a client whose peptic ulcer disease will be treated with a Billroth I procedure (gastroduodenostomy). Which statement(s) by the client indicates effective knowledge of the procedure? Select all that apply.** A. "I will be at risk of developing diarrhea, nausea, and feeling light-headed after eating." B. "It is likely that I will need to receive nutrition directly into my veins." C. "One of my nerves, the vagus nerve, may be cut during the surgery." D. "I can eat a normal diet again after 3 to 5 weeks." E. "This surgery will remove part of my stomach and colon." 34\. A client has come to the clinic reporting pain just above her umbilicus. When assessing the client, the nurse notes Sister Mary Joseph nodules. The nurse should refer the client to the primary provider to be assessed for what health problem? A. A GI malignancy B. Dumping syndrome C. Peptic ulcer disease D. Esophageal/gastric obstruction   **35. A client with gastric cancer has been scheduled for a total gastrectomy. During the preoperative assessment, the client confides in the nurse feeling the surgery will \"mutilate\" the client's body. The nurse should plan interventions that address what nursing diagnosis?** A. Disturbed body image B. Deficient knowledge related to the risks of surgery  C. Anxiety about the surgery D. Low self-esteem  **Chapter 41: Management of Patients with Intestinal and Rectal Disorders** **1. A nurse is working with a client who has chronic constipation. What should be included in client teaching to promote normal bowel function?** A. Use glycerin suppositories on a regular basis.\ B. Limit physical activity in order to promote bowel peristalsis.\ C. Consume high-residue, high-fiber foods.\ D. Resist the urge to defecate until the urge becomes intense. **\ 2. The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client\'s stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse\'s best action? ** A. Contact the care provider to have the client\'s hemoglobin and hematocrit measured.\ B. Document these expected assessment findings.\ C. Apply barrier ointment to the stoma as prescribed\ D. Cleanse the stoma with alcohol or chlorhexidine. **\ 3. A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse\'s rapid assessment reveals that the client\'s abdomen is uncharacteristically rigid on palpation. What is the nurse\'s best response?** A. Administer a Fleet enema as prescribed and remain with the client.\ B. Contact the primary care provider promptly and report these signs of perforation.\ C. Position the client supine and insert an NG tube.\ D. Page the primary provider and report that the client may be obstructed. ANS: B  **4. A 35-year-old client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize?** A. Insertion of a nasogastric tube\ B. Insertion of a central venous catheter\ C. Administration of a mineral oil enema\ D. Administration of a glycerin suppository and an oral laxative **5. A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this client\'s care, which of the following nursing diagnoses should the nurse prioritize?** A. Ineffective tissue perfusion related to bowel ischemia\ B. Imbalanced nutrition: Less than body requirements related to impaired absorption\ C. Anxiety related to bowel obstruction and subsequent hospitalization\ D. Impaired skin integrity related to bowel obstruction ANS: A **6. A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?** A. High levels of alcohol consumption\ B. History of bowel obstruction\ C. History of diverticulitis\ D. Longstanding psychosocial stress ANS: A  **7. A client\'s screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client\'s health problem?** A. Adherence to a high-fiber diet will help the polyps resolve.\ B. The client should be assured that this is a normal, age-related physiologic change\ C. The client\'s polyps constitute a risk factor for cancer.\ D. The presence of polyps is associated with an increased risk of bowel obstruction. ANS: C **8. A nurse is conducting health screening with a diverse group of clients. Which client likely has the most risk factors for developing hemorrhoids?** A. A 45-year-old teacher who stands for 6 hours per day\ B. A pregnant woman at 28 weeks\' gestation\ C. A 37-year-old construction worker who does heavy lifting\ D. A 60-year-old professional who is under stress ANS: B **9. An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform?** A. Encourage the client to take stool softener daily.\ B. Assess the client\'s food and fluid intake.\ C. Assess the client\'s surgical history.\ D. Encourage the client to take fiber supplements. ANS: B **10. A 16-year-old presents at the emergency department reporting right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this client\'s nursing care, the nurse should prioritize what nursing diagnosis?** A. Imbalanced nutrition: Less than body requirements related to decreased oral intake\ B. Risk for infection related to possible rupture of appendix\ C. Constipation related to decreased bowel motility and decreased fluid intake\ D. Chronic pain related to appendicitis **11. A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate?** A. Reassure the client that the procedure is relatively low risk and that clients are usually successful in adjusting to an ostomy.\ B. Provide the client with educational materials that match the client\'s learning style.\ C. Encourage the client to write down these concerns and questions to bring forward to the surgeon.\ D. Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse. ANS: D **12. The nurse is caring for a client who is undergoing diagnostic testing for suspected malabsorption. When taking this client\'s health history and performing the physical assessment, the nurse should recognize what finding as most consistent with this diagnosis?** A. Recurrent constipation coupled with weight loss\ B. Foul-smelling diarrhea that contains fat\ C. Fever accompanied by a rigid, tender abdomen\ D. Bloody bowel movements accompanied by fecal incontinence ANS: B **13. A nurse caring for a client with a newly created ileostomy assesses the client and notes that the client has not had ostomy output for the past 12 hours. The client also reports worsening nausea. What is the nurse\'s priority action?** A. Facilitate a referral to the wound-ostomy-continence (WOC) nurse.\ B. Report signs and symptoms of obstruction to the health care provider.\ C. Encourage the client to mobilize in order to enhance motility.\ D. Contact the health care provider and obtain a swab of the stoma for culture.  ANS. B **14. A nurse is providing care for a client who has a diagnosis of irritable bowel syndrome (IBS). When planning this client\'s care, the nurse should collaborate with the client and prioritize what goal?** A. Client will accurately identify foods that trigger symptoms.\ B. Client will demonstrate appropriate care of his ileostomy.\ C. Client will demonstrate appropriate use of standard infection control precautions.\ D. Client will adhere to recommended guidelines for mobility and activity.  ANS. A **15. A client has been experiencing disconcerting GI symptoms that have been worsening in severity. Following medical assessment, the client has been diagnosed with lactose intolerance. The nurse should recognize an increased need for what form of health promotion?** A. Annual screening colonoscopies\ B. Adherence to recommended immunization schedules\ C. Regular blood pressure monitoring\ D. Frequent screening for osteoporosis ANS: D  **16. An older adult has a diagnosis of Alzheimer disease and has recently been experiencing fecal incontinence. However, the nurse has observed no recent change in the character of the client\'s stools. What is the nurse\'s most appropriate intervention?** A. Keep a food diary to determine the foods that exacerbate the client\'s symptoms.\ B. Provide the client with a bland, low-residue diet.\ C. Toilet the client on a frequent, scheduled basis.\ D. Liaise with the primary provider to obtain an order for loperamide.  ANS. C **17. An adult client has been diagnosed with diverticular disease after ongoing challenges with constipation. The client will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply.** A. Anticholinergic medications\ B. Increased fiber intake\ C. Enemas on alternating days\ D. Reduced fat intake\ E. Fluid reduction  ANS: B, D **18. A client\'s health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn disease, rather than ulcerative colitis, as the cause of the client\'s signs and symptoms?** A. A pattern of distinct exacerbations and remissions\ B. Severe diarrhea\ C. An absence of blood in stool\ D. Involvement of the rectal mucosa ANS: C  **19. During a client\'s scheduled home visit, an older adult client has stated to the community health nurse that the client has been experiencing hemorrhoids of increasing severity in recent months. The nurse should recommend which of the following?** A. Regular application of an OTC antibiotic ointment\ B. Increased fluid and fiber intake\ C. Daily use of OTC glycerin suppositories\ D. Use of an NSAID to reduce inflammation **20. A nurse is providing care for a client whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis?** A. Encourage the client to conduct online research into colostomies.\ B. Engage the client in dialogue about the implications of having the colostomy.\ C. Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem.\ D. Emphasize the fact that the colostomy is a temporary measure and is not permanent. ANS: B  **21. The nurse is providing care for a client whose inflammatory bowel disease has necessitated hospital treatment. Which of the following would most likely be included in the client\'s medication regimen?** A. Antidiarrheal medications 30 minutes before a meal\ B. Antiemetics on a PRN basis\ C. Vitamin B12 injections to prevent pernicious anemia\ D. Beta adrenergic blockers to reduce bowel motility  ANS A **22. A client\'s colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse\'s most appropriate response to this observation?** A. Ensure that the client knows that he or she will be responsible for care after discharge.\ B. Reassure the client that many people are fearful after the creation of an ostomy.\ C. Acknowledge the client\'s reluctance and initiate discussion of the factors underlying it.\ D. Arrange for the client to be seen by a social worker or spiritual advisor.  ANS: C  **23. A nurse is caring for an older adult who has been experiencing severe *Clostridium difficile*-related diarrhea. When reviewing the client\'s most recent laboratory tests, the nurse should prioritize what finding?** A. White blood cell level\ B. Creatinine level\ C. Hemoglobin level\ D. Potassium level ANS: D  **24. A nurse is assessing a client\'s stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding?** A. Irrigate the ostomy to clear a possible obstruction.\ B. Contact the primary care provider to report this finding.\ C. Document that the stoma appears healthy and well perfused.\ D. Document a nursing diagnosis of Impaired Skin Integrity.  ANS. C **25. A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse\'s care should prioritize which of the following outcomes?** A. Preventing infection\ B. Maintaining skin and tissue integrity\ C. Preventing nausea and vomiting\ D. Maintaining fluid and electrolyte balance ANS: D  **26. A client with a diagnosis of colon cancer is 2 days' postoperative following bowel resection and anastomosis. The nurse has planned the client\'s care in the knowledge of potential complications. What assessment should the nurse prioritize?** A. Close monitoring of temperature\ B. Frequent abdominal auscultation\ C. Assessment of hemoglobin, hematocrit, and red blood cell levels\ D. Palpation of peripheral pulses and leg girth ANS: B **27. A nurse at an outpatient surgery center is caring for a client who had a hemorrhoidectomy. What discharge education topics should the nurse address with this client?** A. The appropriate use of antibiotics to prevent postoperative infection\ B. The correct procedure for taking a sitz bath\ C. The need to eat a low-residue, low-fat diet for the next 2 weeks\ D. The correct technique for keeping the perianal region clean without the use of water ANS: B  **28. Which of the following is the most plausible nursing diagnosis for a client whose treatment for colon cancer has necessitated a colostomy?** A. Risk for unstable blood glucose due to changes in digestion and absorption\ B. Unilateral neglect related to decreased physical mobility\ C. Risk for excess fluid volume related to dietary changes and changes in absorption\ D. Ineffective sexuality patterns related to changes in self-concept  ANS: D  **29. A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client\'s coping after discharge? ** A. The family\'s ability to take care of the client\'s special diet needs\ B. The family\'s ability to monitor the client\'s changing health status\ C. The family\'s ability to provide emotional support\ D. The family\'s ability to manage the client\'s medication   ANS. C **30. A client is scheduled for the creation of a continent ileostomy. What dietary guidelines should the nurse encourage during the weeks following surgery?** A. A minimum of 30 g of soluble fiber daily\ B. Increased intake of free water and clear juices\ C. High intake of strained fruits and vegetables\ D. A high-calorie, high-residue diet ANS: C  **31. A client has been experiencing occasional episodes of constipation and has been unable to achieve consistent relief by increasing physical activity and improving the client's diet. When introducing the client to the use of laxatives, what teaching should the nurse emphasize?** A. The effect of laxatives on electrolyte levels\ B. The underlying causes of constipation\ C. The risk of fecal incontinence\ D. The risk of becoming laxative-dependent ANS: D  **32. The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurse\'s assessments most directly addresses a major complication of TPN?** A. Checking the client\'s capillary blood glucose levels regularly\ B. Having the client frequently rate his or her hunger on a 10-point scale\ C. Measuring the client\'s heart rhythm at least every 6 hours\ D. Monitoring the client\'s level of consciousness each shift ANS: A **33. A critical care nurse is caring for a client diagnosed with acute pancreatitis. The nurse knows this client should be started on parenteral nutrition (PN) after what indications?** A. 5% deficit in body weight compared to pre-illness weight and increased caloric need\ B. Calorie deficit and muscle wasting combined with low electrolyte levels\ C. Inability to take in adequate oral food or fluids within 7 days\ D. Significant risk of aspiration coupled with decreased level of consciousness ANS: C  **34. A nurse is preparing to administer a client\'s intravenous fat emulsion simultaneously with parenteral nutrition (PN). What principle should guide the nurse\'s action? ** A. Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered.\ B. The nurse should prepare for placement of another intravenous line, as intravenous fat emulsions may not be infused simultaneously through the line used for PN.\ C. Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site after running the emulsion through a filter.\ D. The intravenous fat emulsions can be piggy-backed into any existing IV solution that is infusing.  ANS: A  **35. A nurse is initiating parenteral nutrition (PN) to a postoperative client who has developed complications. The nurse should initiate therapy by performing which of the following actions?** A. Starting with a rapid infusion rate to meet the client\'s nutritional needs as quickly as possible\ B. Initiating the infusion slowly and monitoring the client\'s fluid and glucose tolerance\ C. Changing the rate of administration every 2 hours based on serum electrolyte values\ D. Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body  ANS. B **36. A nurse is caring for a client who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the client?** A. Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN.\ B. Administer a hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN.\ C. Administer 3 ampules of dextrose 50% immediately prior to discontinuing the PN.\ D. Administer 3 ampules of dextrose 50% 1 hour after discontinuing the PN. ANS: A  37\. A nurse is caring for a client with a subclavian central line who is receiving parenteral nutrition (PN). In preparing a care plan for this client, what nursing diagnosis should the nurse prioritize? A. Risk for activity intolerance related to the presence of a subclavian catheter\ B. Risk for infection related to the presence of a subclavian catheter\ C. Risk for functional urinary incontinence related to the presence of a subclavian catheter\ D. Risk for sleep deprivation related to the presence of a subclavian catheter ANS: B  38\. A nurse is creating a care plan for a client who is receiving parenteral nutrition. The client\'s care plan should include nursing action(s) relevant to what potential complications? Select all that apply. A. Dumping syndrome\ B. Clotted or displaced catheter  C. Pneumothorax\ D. Hyperglycemia  E. Line sepsis  ANS. B,C,D,E  39\. A nurse is caring for a client who is receiving parenteral nutrition. When writing this client\'s plan of care, which of the following nursing diagnoses should be included? A. Risk for peripheral neurovascular dysfunction related to catheter placement B. Ineffective role performance related to parenteral nutrition\ C. Bowel incontinence related to parenteral nutrition\ D. Chronic pain related to catheter placement ANS: B  40\. A nurse is aware of the high incidence of catheter-related bloodstream infections in clients receiving parenteral nutrition. What nursing action has the **greatest** potential to reduce catheter-related bloodstream infections? A. Use clean technique and wear a mask during dressing changes.\ B. Change the dressing no more than weekly.\ C. Apply antibiotic ointment around the site with each dressing change.\ D. Irrigate the insertion site with sterile water during each dressing change. ANS: B  41\. A nurse is preparing to discharge a client home on parenteral nutrition. What should an effective home care teaching program address? Select all that apply. A. Preparing the client to troubleshoot for problems\ B. Teaching the client and family strict aseptic technique\ C. Teaching the client and family how to set up the infusion\ D. Teaching the client to flush the line with sterile water\ E. Teaching the client when it is safe to leave the access site open to air ANS: A, B, C