GI, Digestive, and Metabolic NCLEX

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A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
a) The client is free from esophagitis and achalasia.
b) The client reports diminished duodenal inflammation.
c) The client has normal gastric structures.
d) The client doesn't exhibit rectal tenesmus.

A) The client is free from esophagitis and achalasia.
Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first?
a) Notify the physician.
b) Remove the dressing, clean the site, and apply a new dressing.
c) Remove the catheter, check for catheter integrity, and send the tip for culture.
d) Draw a circle around the moist spot and note the date and time.

B) Remove dressing, clean the site, and apply a new dressing.
A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. She should notify the physician if she observes any catheter-related complications. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor?
a) Famotidine (Pepcid)
b) Metronidazole (Flagyl)
c) Omeprazole (Prilosec)
d) Sucralfate (Carafate)

C) Omeprazole
Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient?
a) The client should be monitored for any breathing related disorder or discomforts
b) The client should not be given any food and fluids until the gag reflex returns
c) The client should be monitored for cramping or abdominal distention
d) The client's fluid output should be measured for at least 24 hours after the procedure

B) The client should not be given any food and fluids until the gag reflex returns.
For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:
a) restrict fluid intake to 1 qt (1,000 ml)/day.
b) drink liquids only between meals.
c) don't drink liquids 2 hours before meals.
d) drink liquids only with meals.

B) Drink liquids only between meals.
A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient?
a) Instruct the patient to keep a record of food intake
b) Instruct the patient to avoid prune or apple juice
c) Suggest fluid intake of at least 2 L per day
d) Assist the patient regarding the correct diet or to minimize food intake

C) Suggest fluid intake of at least 2 L per day
For constipation the nurse should suggest a fluid intake of at least 2L per day. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the patient to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the patient to keep a record of food intake in case of diarrhea because this helps identify specific foods that irritate the GI tract.

A patient scheduled to undergo an abdominal ultrasonography is advised to do which of the following?
a) Do not undertake any strenuous exercise for 24 hours before the test
b) Restrict eating of solid food for 6 to 8 hours before the test.
c) Avoid exposure to sunlight for at least 6 to 8 hours before the test
d) Do not consume anything sweet for 24 hours before the test

B) Avoid eating of solid food for 6 to 8 hours before the test.
For a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict herself from solid food for 6 to 8 hours to avoid having images of her test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?
a) Left lower quadrant
b) Left upper quadrant
c) Right upper quadrant
d) Right lower quadrant

D) Right lower quadrant
The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
a) black, tarry stools.
b) circumoral pallor.
c) light amber urine.
d) yellow sclerae.

D) Yellow sclerae
Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
a) elevated liver enzymes and low serum protein level.
b) subnormal clotting factors and platelet count.
c) elevated blood urea nitrogen and creatinine levels and hyperglycemia.
d) subnormal serum glucose and elevated serum ammonia levels.

D) Subnormal serum glucose and elevated serum ammonia levels.
In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

Which outcome indicates effective client teaching to prevent constipation?
a) The client reports engaging in a regular exercise regimen.
b) The client limits water intake to three glasses per day.
c) The client verbalizes consumption of low-fiber foods.
d) The client maintains a sedentary lifestyle.

A) The client reports engaging in a regular exercise regimen.
The client having a regular exercise program indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet, a sedentary lifestyle, and limited water intake would predispose the client to constipation.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?
a) Slowed heart beat
b) Hyperglycemia
c) Diarrhea
d) Dry skin

C) Diarrhea
Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

A nurse is teaching an elderly client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?
a) "I need to drink 2 to 3 liters of fluids every day."
b) "I should exercise four times per week."
c) "I need to use laxatives regularly to prevent constipation."
d) "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

C) "I need to use laxatives regularly to prevent constipation."
The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?
a) The ostomy bag should be adjusted.
b) Blood supply to the stoma has been interrupted.
c) An intestinal obstruction has occurred.
d) This is a normal finding 1 day after surgery.

B) Blood supply to the stoma has been interrupted.
An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure?

a) Signs of perforation
b) Gag reflex
c) Client's tolerance for pain and discomfort
d) Client's ability to retain the barium

C) Client's tolerance for pain and discomfort
The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium.

What kind of feeding should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions?
a) Bolus feeding
b) Intermittent feeding
c) Cyclic feeding
d) Continuous feedings

D) Continuous feedings.
Continuous feedings should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions.

The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure?
a) At the lower border of the liver
b) In the right upper quadrant
c) At the umbilicus
d) Just below the last rib

C) At the umbilicus
Measurement of abdominal girth is done at the widest point, which is usually the umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib would be inappropriate sites for abdominal girth measurement.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
a) Hydrochloric acid
b) Histamine
c) Liver enzyme
d) Intrinsic factor

D) Intrinsic factor
Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?
a) Hypotension
b) Bradycardia
c) Warm moist skin
d) Polyuria

A) Hypotension
Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which of the following characteristics would the nurse be most likely to find?
a) Green color and texture
b) Black and tarry appearance
c) Clay-like quality
d) Bright red blood in stool

B) Black and tarry appearance
Black and tarry stools (melena) are a sign of bleeding in the upper gastrointestinal (GI) tract. As the blood moves through the GI system, digestive enzymes turn red blood to black. Bright red blood in the stool is a sign of lower GI bleeding. Green color and texture is a distractor for this question. Clay-like stools are a characteristic of biliary disorders

After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected?
a) Large intestine
b) Ileum
c) Stomach
d) Liver

C) Stomach
The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. The nurse suspects:
a) Peritonitis
b) A normal reaction to surgery
c) Dehiscence of the surgical wound
d) Vasomotor symptoms associated with dumping syndrome

D) Vasomotor symptoms associated with dumping syndrome
Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?
a) Skim milk
b) Nothing by mouth
c) Regular diet
d) Clear liquids

B) NPO
Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.

Which of the following is a protrusion of the intestine through a weakened area in the abdominal wall?
a) Tumor
b) Adhesion
c) Hernia
d) Volvulus

C) Hernia
A hernia is a protrusion of intestine through a weakened area in the abdominal muscle or wall. A tumor that extends into the intestinal lumen, or a tumor outside the intestine causes pressure on the wall of the intestine. Volvulus occurs when the bowel twists and turns on itself. An adhesion occurs when loops of intestine become adherent to areas that heal slowly or scar after abdominal surgery.

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which of the following strategies can the nurse employ to assist this client?
a) Regularly wipe the outside of the client's mouth to prevent germs from entering.
b) Provide the client with an irrigating solution of baking soda and warm water.
c) Recommend that the client drink a small glass of alcohol at the end of the day to kill germs.
d) Urge the client to regularly rinse the mouth with tap water.

B) Provide the client with an irrigating solution of baking soda and warm water
If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended.

Which of the following terms is used to refer to intestinal rumbling?
a) Diverticulitis
b) Tenesmus
c) Borborygmus
d) Azotorrhea

C) Borborygmus
Borborygmus is the intestinal rumbling that accompanies diarrhea. Tenesmus is the term used to refer to ineffectual straining at stool. Azotorrhea is the term used to refer to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
a) Hepatitis B is transmitted primarily by the oral-fecal route.
b) Hepatitis A is frequently spread by sexual contact.
c) Hepatitis C increases a person's risk for liver cancer.
d) Infection with hepatitis G is similar to hepatitis A.

C) Hep C increases a person's risk for liver cancer
Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?
a) "Lie down after meals to promote digestion."
b) "Avoid coffee and alcoholic beverages."
c) "Limit fluid intake with meals."
d) "Take antacids with meals."

B) Avoid coffee and alcoholic beverages
To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as:
a) Absent.
b) High-pitched.
c) Mild.
d) Hyperactive.

A) Absent
Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

A client has noticed increased incidence of constipation since he broke his ankle and cannot complete his daily three-mile walk. As his home care nurse, you complete your assessment and discuss the potential causes. During your client education session, what do you explain as the mechanical cause of his constipation?
a) No known cause
b) Ingesting excessive fiber
c) Stool remaining in the large intestine too long.
d) Drinking excessive water

C) Stool remaining in the large intestine too long
Whenever stool remains stationary in the large intestine, moisture continues to be absorbed from the residue. Consequently, retention of stool, for any number of reasons, causes stool to become dry and hard.

The most significant complication related to continuous tube feedings is
a) an interruption in fat metabolism and lipoprotein synthesis.
b) a disturbance in the sequence of intestinal and hepatic metabolism.
c) the interruption of GI integrity,
d) the potential for aspiration,

D) The potential for aspiration
Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings. Tube feedings preserve GI integrity by intraluminal delivery of nutrients. Tube feedings preserve the normal sequence of intestinal and hepatic metabolism. Tube feedings maintain fat metabolism and lipoprotein synthesis.

The nurse is caring for a 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

C) Purpura and petechiae
A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Which type of jaundice seen in adults is the result of increased destruction of red blood cells?
a) Obstructive
b) Nonobstructive
c) Hepatocellular
d) Hemolytic

D) Hemolytic
Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium?
a) Computer tomography
b) Small bowel series
c) Colonoscopy
d) Upper GI series

C) Colonoscopy
A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A nurse is caring for a client who had gastric bypass surgery 2 days ago. Which assessment finding requires immediate intervention?
a) The client states he has been passing gas.
b) The client states he is nauseated.
c) The client's right lower leg is red and swollen.
d) The client complains of pain at the surgical site.

C) Client's right lower leg is red and swollen
A red, swollen extremity is a possible sign of a thromboembolism, a common complication after gastric surgery because of the fact that the clients are obese and tend to ambulate less than other surgical clients. The nurse should inform the physician of the finding. Pain at the surgical site should be investigated, but the red, swollen leg is a higher priority. It isn't unusual for a client to be nauseated after gastric bypass surgery. The nurse should follow up with the finding, but only after she has notified the physician about the possible thromboembolism. Passing gas is normal and a sign that the client's intestinal system is beginning to mobilize.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are
a) absent.
b) hypoactive.
c) normal.
d) sluggish.

C) Normal
Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease?
a) To increase pepsin activity
b) To maintain a regular bowel pattern
c) To promote client compliance
d) To keep gastric pH at 3.0 to 3.5

D) To keep gastric pH at 3.0 to 3.5
To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
a) alcohol abuse and a history of acute renal failure.
b) a history of hemorrhoids and smoking.
c) a sedentary lifestyle and smoking.
d) alcohol abuse and smoking.

D) Alcochol abuse and smoking
The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes?
a) Gastric resection
b) Infectious disease
c) Inflammation of all layers of intestinal mucosa
d) Disaccharidase deficiency

C) Inflammation of all layers of intestinal mucosa
Crohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

What are medium-length nasoenteric tubes are used for?
a) Aspiration
b) Emptying
c) Decompression
d) Feeding

D) Feeding
Placement of the tube must be verified prior to any feeding. A gastric sump and nasoenteric tube are used for gastrointestinal decompression. Nasoenteric tubes are used for feeding. Gastric sump tubes are used to decompress the stomach and keep it empty.

Which diagnostic test is used first to evaluate a client with upper GI bleeding?
a) Hemoglobin levels and hematocrit (HCT)
b) Endoscopy
c) Arteriography
d) Upper GI series

A) Hemoglobin levels and hematocrit
Hemoglobin and HCT are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be:
a) black and tarry.
b) coffee-ground-like.
c) bright red.
d) clay-colored.

A) Black and tarry
Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

Blood shed in sufficient quantities into the upper GI tract, produces which color of stool?
a) Bright red
b) Milky white
c) Green
d) Tarry-black

D) Tarry-black
Blood shed in sufficient quantities into the upper GI tract produces a tarry-black stool. Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. A milky white stool is indicative "of" a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

Which of the following would be the least important assessment in a patient diagnosed with ascites?
a) Measurement of abdominal girth
b) Palpation of abdomen for a fluid shift
c) Foul-smelling breath
d) Weight

C) Foul smelling breath
Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.

The patient is on a continuous tube feeding. The tube placement should be checked every
a) 24 hours.
b) 12 hours.
c) hour.
d) shift.

D) Shift
Each nurse caring for the patient is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the patient is extremely restless or there is basis for rechecking the tube based on other patient activities. Checking for placement every 12 or 24 hours does not meet the standard of care due the patient receiving continuous tube feedings.

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?
a) "I'll wash my hands often."
b) "How did this happen? I've been faithful my entire marriage."
c) "I'll take all my medications as ordered."
d) "I'll be very careful when preparing food for my family."

B) How did this happen? I've been faithful my entire marriage
The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?
a) Imbalanced nutrition: Less than body requirements related to biliary inflammation
b) Anxiety related to unknown outcome of hospitalization
c) Deficient knowledge related to prevention of disease recurrence
d) Acute pain related to biliary spasms

D) Acute pain related to biliary spasms
The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
a) The client is free from esophagitis and achalasia.
b) The client doesn't exhibit rectal tenesmus.
c) The client has normal gastric structures.
d) The client reports diminished duodenal inflammation.

A) The client is free from esophagitis and achalasia
Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

Which client requires immediate nursing intervention? The client who:
a) complains of epigastric pain after eating.
b) complains of anorexia and periumbilical pain.
c) presents with ribbonlike stools.
d) presents with a rigid, boardlike abdomen.

D) Presents with a rigid, boardlike abdomen
A rigid, boardlike abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?
a) Maintaining wrinkles in the faceplate so it doesn't irritate the skin
b) Gently washing the area surrounding the stoma using a facecloth and mild soap
c) Scrubbing fecal material from the skin surrounding the stoma
d) Cutting the faceplate opening no more than 2? larger than the stoma

B) Gently washing the area surrounding the stoma using a facecloth and mild soap
For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes?
a) Infectious disease
b) Gastric resection
c) Disaccharidase deficiency
d) Inflammation of all layers of intestinal mucosa

D) Inflammation of all layers of intestinal mucosa
Crohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

A longitudinal tear or ulceration in the lining of the anal canal is termed a (an)
a) hemorrhoid.
b) anorectal abscess.
c) anal fissure.
d) anal fistula.

C) Anal fissure
Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

Which of the following medications used for the treatment of obesity prevents the reuptake of serotonin and norepinephrine?
a) Sibutramine hydrochloride (Meridia)
b) Orlistat (Xenical)
c) Bupropion hydrochloride (Wellbutrin)
d) Fluoxetine hydrochloride (Prozac)

A) Sibutramine hydrochloride (Meridia)
Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephrine. Meridia decreases appetite. Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. Bupropion hydrochloride (Wellbutrin) is an antidepressant medication. Fluoxetine hydrochloride (Prozac) has not been approved by the FDA for use in the treatment of obesity.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has:
a) diverticulitis.
b) peptic ulcer disease.
c) appendicitis.
d) ulcerative colitis.

D) Peptic Ulcer Disease
Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
a) subnormal serum glucose and elevated serum ammonia levels.
b) subnormal clotting factors and platelet count.
c) elevated liver enzymes and low serum protein level.
d) elevated blood urea nitrogen and creatinine levels and hyperglycemia.

A) Subnormal serum glucose and elevated serum ammonia levels
In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

Which of the following indicates an overdose of lactulose?
a) Hypoactive bowel sounds
b) Constipation
c) Watery diarrhea
d) Fecal impaction

C) Watery diarrhea
The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the:
a) rectum.
b) stomach.
c) small intestine.
d) large intestine.

C) Small intestine
The small intestine absorbs products of digestion, completes food digestion, and secretes hormones that help control the secretion of bile, pancreatic juice, and intestinal secretions. The stomach stores, mixes, and liquefies the food bolus into chyme and controls food passage into the duodenum; it doesn't absorb products of digestion. Although the large intestine completes the absorption of water, chloride, and sodium, it plays no part in absorbing food. The rectum is the portion of the large intestine that forms and expels feces from the body; its functions don't include absorption.

Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis?
a) Such clients can digest high-fat foods.
b) Such clients are at risk for hepatic encephalopathy.
c) Such clients are at risk for gallbladder contraction.
d) Such clients cannot tolerate high-glucose concentration.

D) Such clients cannot tolerate high glucose concentration
Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected?
a) Ileum
b) Liver
c) Large intestine
d) Stomach

D) Stomach
The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum?
a) Hypoharyngeal sphincter
b) Cardiac sphincter
c) Pyloric sphincter
d) Ileocecal valve

C) Pyloric Sphincter
The pyloric sphincter is the opening between the stomach and duodenum. The cardiac sphincter is the opening between the esophagus and the stomach. The hypopharyngeal sphincter or upper esophageal sphincter prevents food or fluids from re-entering the pharynx. The ileocecal valve is located at the distal end of the small intestine and regulates flow of intestinal contents into the large intestine.

Which of the following is the major carbohydrate that tissue cells use as fuel?
a) Proteins
b) Fats
c) Chyme
d) Glucose

D) Glucose
Glucose is the major carbohydrate that tissue cells use as fuel. Proteins are a source of energy after they are broken down into amino acids and peptides. Chyme stays in the small intestine for 3 to 6 hours, allowing for continued breakdown and absorption of nutrients. Ingested fats become monoglycerides and fatty acids by the process of emulsification.

The nurse asks a client to point to where she feels pain. The client asks why this is important. The nurse's best response would be which of the following?
a) "This determines the pain medication to be ordered."
b) "If the doctor massages over the exact painful area, the pain will disappear."
c) "Often the area of pain is referred from another area."
d) "The area may determine the severity of the pain."

C) Often the area of pain is referred from another area
Pain can be a major symptom of disease. The location and distribution of pain can be referred from a different area. If a client points to an area of pain and has other symptoms associated with a certain disease, this is valuable information for treatment.

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following?
a) "The examination will take only 15 minutes."
b) "You must be NPO for the day before the examination."
c) "Do you experience any claustrophobia?"
d) "You must remove all jewelry but can wear your wedding ring."

C) Do you experience any claustrophobia?
MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

A nurse is providing postprocedure instructions for a client who had an esophagogastroduodenoscopy. The nurse should perform which action?
a) Tell the client to call back in the morning so she can give him instructions over the phone.
b) Review the instructions with the person accompanying the client home.
c) Tell the client there aren't specific instructions for after the procedure.
d) Give instructions to the client immediately before discharge.

B) Review the instructions with the person accompanying the client home
A client who undergoes esophagogastroduodenoscopy receives sedation during the procedure, and his memory becomes impaired. Clients tend not to remember instructions provided after the procedure. The nurse's best course of action is to give the instructions to the person who is accompanying the client home. It isn't appropriate for the nurse to tell the client to call back in the morning for instructions. The client needs to be aware at discharge of potential complications and signs and symptoms to report to the physician.

A nurse is preparing a client for a protcosigmoidoscopy. Identify the quadrant on which this diagnostic test will focus.
A) RUQ
B) RLQ
C) LUQ
D) LLQ

D) LLQ
The sigmoid colon is in the left lower quadrant. Proctosigmoidoscopy is examination of the rectum and sigmoid colon using a rigid endoscope inserted anally about 10 inches.

The most common cause of esophageal varices includes which of the following?
a) Portal hypertension
b) Asterixis
c) Jaundice
d) Ascites

A) Portal hypertension
Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

Which of the follow statements provide accurate information regarding cancer of the colon and rectum?
a) There is no hereditary component to colon cancer.
b) Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
c) Rectal cancer affects more than twice as many people as colon cancer.
d) The incidence of colon and rectal cancer decreases with age.

B) Cancer of the colon and rectum is the second most common type of internal cancer in the US
Cancer of the colon and rectum is the second most common type of internal cancer in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

Blood shed in sufficient quantities into the upper GI tract, produces which color of stool?
a) Tarry-black
b) Milky white
c) Green
d) Bright red

A) Tarry-black
Blood shed in sufficient quantities into the upper GI tract produces a tarry-black stool. Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. A milky white stool is indicative "of" a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

A nurse is receiving report from the emergency room regarding a new client being admitted to the medical-surgical unit with a diagnosis of peptic ulcer disease. The nurse expects the age of the client will be between
a) 20 and 30 years
b) 15 and 25 years
c) 40 and 60 years
d) 60 and 80 years

C) 40 to 60 years
Peptic ulcer disease occurs with the greatest frequency in people 40 to 60 years old. It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
a) Polyps
b) Weight gain
c) Hemorrhoids
d) Duodenal ulcers

A) Polyps
Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care?
a) Provide frequent mouth care.
b) Keep the feeding formula refrigerated.
c) Ensure adequate hydration with additional water.
d) Flush the tube with water before adding the feedings.

A) Provide frequent mouth care
Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction?
a) "Eat three balanced meals every day."
b) "Avoid aspirin and products that contain aspirin."
c) "Stop taking the drugs when your symptoms subside."
d) "Increase your intake of fluids containing caffeine."

B) Avoid aspirin and products that contain aspirin
The nurse should instruct the client to avoid aspirin because it's a gastric irritant and should not be taken by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids and ranitidine prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach.

The nurse is checking the residual content for a client who is receiving intermittent feedings. Which residual content, if obtained, would lead the nurse to delay the feeding?
a) 120 mL
b) 60 mL
c) 30 mL
d) 90 mL

A) 120 mL
Feedings typically are delayed if the residual content measures more than 100 mL for intermittent feedings or 10% to 20% of the hourly amount of a continuous feeding. Thus a residual content of 120 mL would require the nurse to delay the feeding.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test?
a) Encourage plenty of fluids.
b) Order a high-fiber diet.
c) Serve dairy products.
d) Serve the client his usual diet.

A) Encourage plenty of fluids
The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

A 24-year-old athlete is admitted to the trauma unit following a motor-vehicle collision. The client is comatose and has developed ascites as a result of the accident. You are explaining the client's condition to his parents. In your education, what do you indicate is the primary function of the small intestine?
a) Digest proteins
b) Digest fats
c) Absorb nutrients
d) Absorb water

C) Absorb nutrients
The primary function of the small intestine is to absorb nutrients from the chyme.

A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy?
a) Low platelet count
b) Low hemoglobin
c) Decreased prothrombin time
d) Low sodium level

A) Low platelet count
Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to
a) Assess the client's abdomen and vital signs.
b) Irrigate the client's NG tube.
c) Place the client in the high-Fowler's position.
d) Notify the health care provider.

A) Assess the client's abdomen and vital signs
Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?
a) Hematocrit 42%
b) Serum potassium 4.2 mEq/L
c) Serum sodium 135 mEq/L
d) White blood cell (WBC) count 22.8/mm3

D) White blood cell (WBC) count 22.8/mm3
The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?
a) Decreased white blood cell count
b) Increased serum calcium levels
c) Elevated urine amylase levels
d) Decreased liver enzyme levels

c) Elevated urine amylase levels
Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience
a) weight loss.
b) vomiting.
c) pain 2 to 3 hours after a meal.
d) hemorrhage.

C) Pain 2 to 3 hours after a meal
The patient with a gastric ulcer often awakens between 1 to 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.

A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate?
a) Insulin has an adverse effect of constipation.
b) The nerve fibers of the intestinal lining are experiencing neuropathy.
c) Elevated glucose levels cause bacteria overgrowth in the large intestine.
d) The pancreas secretes digestive enzymes.

D) The pancreas secretes digestive enzymes
While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as foundi with diabetes, the digestive functioning may be impaired.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge?
a) Hold his breath
b) Bear down as if having a bowel movement
c) Pant like a dog
d) Take long, slow breaths

D) Take long, slow breaths
During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

A nursing instructor tells the class that review of oral hygiene is an important component during assessment of the gastrointestinal system. One of the students questions this statement. Which of the following explanations from the nurse educator is most appropriate?
a) "Injury to oral mucosa or tooth decay can lead to difficulty in chewing food."
b) "Mouth sores are caused by bacteria that can thin the villi of the small intestine."
c) "Decaying teeth secrete toxins that decrease the absorption of nutrients."
d) "Bad breath will encourage ingestion of fatty foods to mask odor."

A) Injury to the oral mucosa or tooth decay can lead to difficulty in chewing food
Poor oral hygiene can result in injury to the oral mucosa, lip, or palate; tooth decay; or loss of teeth. Such problems may lead to disruption in the digestive system. The ability to chew food or even swallow may be hindered.

Which of the following terms describes a gastric secretion that combines with vitamin B12 so that it can be absorbed?
a) Amylase
b) Trypsin
c) Pepsin
d) Intrinsic factor

D) Intrinsic factor
Intrinsic factor, secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed and pernicious anemia results. Amylase is an enzyme that aids in the digestion of starch. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein.

A client presents with complaints of blood in her stools. Upon inspection, the nurse notes streaks of bright red blood visible on the outer surface of formed stool. Which of the following will the nurse further investigate with this client?
a) Ingestion of cherry soda
b) Ingestion of cocoa
c) Presence or history of hemorrhoids
d) Recent barium studies

C) Presence or history of hemorrhoids
Stool is normally light to dark brown. Blood in the stool can present in various ways and must be investigated. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or blood is noted on toilet tissue.

A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor?
a) The client may eat a light meal before either test.
b) Both tests need to be done before breakfast.
c) The upper GI should be scheduled before the ultrasonography.
d) The ultrasonography should be scheduled before the GI procedure.

d) The ultrasonography should be scheduled before the GI procedure
Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure?
a) Spleen
b) Appendix
c) Liver
d) Sigmoid colon

C) Liver
The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

The nurse is preparing to examine the abdomen of a client complaining of a change in his bowel pattern. The nurse would place the client in which position?
a) Lithotomy
b) Supine with knees flexed
c) Knee-chest
d) Left Sim's lateral

B) Supine with knees flexed
When examining the abdomen, the client lies supine with his knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

What part of the GI tract begins the digestion of food?
a) Stomach
b) Mouth
c) Duodenum
d) Esophagus

B) Mouth
Food that contains starch undergoes partial digestion when it mixes with the enzyme salivary amylase, which the salivary glands secrete.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium?
a) Computer tomography
b) Colonoscopy
c) Small bowel series
d) Upper GI series

B) Colonoscopy
A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A physician plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which of the following medications while collecting stool for the test?
a) ibuprofen (Advil)
b) ciprofloxacin (Cipro XR)
c) docusate sodium (Colace)
d) acetaminophen (Tylenol)

A) Ibprofen (Advil)
Fecal occult blood testing (FOBT) is one of the most commonly performed stool tests. FOBT can be done at the bedside, in the physician's office, or at home. The client is taught to avoid aspirin, red meats, nonsteroidal antiinflammatory agents, and horseradish for 72 hours prior to the examination. Advil is an anti-inflammatory drug and should be avoided with FOBT.

A client comes into the emergency department with complaints of abdominal pain. Which of the following should the nurse ask first?
a) Family history of ruptured appendix
b) Characteristics and duration of pain
c) Concerns about impending hospital stay
d) Medications taken in the last 8 hours

B) Characteristics and duration of pain
A focused abdominal assessment begins with a complete history. The nurse must obtain information about abdominal pain. Pain can be a major symptom of gastrointestinal disease. The character, duration, pattern, frequency, location, distribution, and timing of the pain vary but require investigation immediately.

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The physician has ordered a visualization of the small intestine via a capsule endoscopy. Which of the following will the nurse include in the client education about this procedure?
a) "An x-ray machine will use a capsule ray to follow your intestinal tract."
b) "You will need to swallow a capsule."
c) "The physician will use a scope called a capsule to view your intestine."
d) "A capsule will be inserted into your rectum."

B) You will need to swallow a capsule
A capsule endoscopy allows for noninvasive visualization of the small intestinal mucosa. The technique consists of the client swallowing a capsule that is embedded with a wireless miniature camera, which is propelled through the intestine by peristalsis. The capsule passes from the rectum in 1 to 2 days.

A patient scheduled to undergo an abdominal ultrasonography is advised to do which of the following?
a) Restrict eating of solid food for 6 to 8 hours before the test.
b) Do not consume anything sweet for 24 hours before the test
c) Do not undertake any strenuous exercise for 24 hours before the test
d) Avoid exposure to sunlight for at least 6 to 8 hours before the test

A) Restrict eating of solid food for 6 to 8 hours before the test
For a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict herself from solid food for 6 to 8 hours to avoid having images of her test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color?
a) Black
b) Red
c) Dark brown
d) Green

A) Black
Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

A nurse is assisting with preoperative care for a client who requires an appendectomy. The nurse is aware that the surgery will involve which abdominal quadrant?
A) RLQ
B) RUQ
C) LLQ
D) LUQ

A) RLQ
The appendix is in the right lower quadrant.

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). The nurse performs the following actions while the client receives PN (select all that apply):
a) Document intake and output.
b) Use clean technique for all catheter dressing changes.
c) Weigh the client every day.
d) Cover insertion site with a transparent dressing that is changed daily.
e) Check blood glucose level every 6 hours.

A) Document intake and output; C) Weigh the client every day; E) Check blood glucose level every 6 hours
When a client is receiving PN through a central line, the nurse weighs the client daily, checks blood glucose level every 6 hours, and documents intake and output. These actions are to ensure the client is receiving optimal nutrition. The nurse also performs activities to prevent infection, such as covering the insertion site with a transparent dressing that is changed weekly and/or prn and using sterile technique during catheter site dressing changes.

Which of the following is the primary symptom of achalasia?
a) Difficulty swallowing
b) Pulmonary symptoms
c) Chest pain
d) Heartburn

A) Difficulty swallowing
The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?
a) The client lying in a lateral position, with the head of bed flat
b) Foley catheter bag containing 500 ml of amber urine
c) Serosanguineous drainage on the dressing
d) A piggyback infusion of levofloxacin (Levaquin)

A) The client lying in a lateral position, with the head of bed flat
A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

To ensure patency of central venous line ports, diluted heparin flushes are used in which of the following situations?
a) Before drawing blood
b) With continuous infusions
c) When the line is discontinued
d) Daily when not in use

D) Daily when not in use
Daily instillation of dilute heparin flush when a port is not in use will maintain the port. Continuous infusion maintains the patency of each port. Heparin flushes are used after each intermittent infusion. Heparin flushes are used after blood drawing in order to prevent clotting of blood within the port. Heparin flush of ports is not necessary if a line is to be discontinued.

A client with GERD develops espophagitis. Which diagnostic test would the nurse expect the physician to order to confirm the diagnosis?
a) Upper endoscopy with biopsy
b) Stool testing for occult blood
c) 24-hour esophageal pH monitoring
d) Barium swallow

A) Upper endoscopy with biopsy
Upper endoscopy with biopsy confirms esophagitis. Barium-swallow would reveal inflammation or stricture formation from chronic esophagitis. Tests of stool may show positive findings of blood. Ambulatory 24-hour esophageal pH monitoring allows for observation of the frequency of reflux episodes and their associated symptoms.

Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube?
a) Buccal or sublingual tablets
b) Enteric-coated tablets
c) Soft gelatin capsules filled with liquid
d) Simple compressed tablets

B) Enteric-coated tablets
Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change in the form of medication is necessary for patients with tube feedings. Simple compressed tablets may be crushed and dissolved in water for patients receiving oral medications by feeding tube. Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended to the patient undergoing tube feedings. The nurse may make an opening in the capsule and squeeze out contents for administration by feeding tube.

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to
a) Notify the surgeon about the tube's removal.
b) Reinsert the nasogastric tube to the stomach.
c) Document the discontinuation of the nasogastric tube.
d) Place the nasogastric tube to the level of the esophagus.

A) Notify the surgeon about the tube's removal
If the nasogastric tube is removed accidently in a client who has undergone esophageal or gastric surgery, it is usually replaced by the physician. Care is taken to avoid trauma to the suture line. The nurse will not insert the tube to the esophagus or to the stomach in this situation. The nurse needs to do more than just document its removal. The nurse needs to notify the physician who will make a determination of leaving out or inserting a new nasogastric tube.

Paul Cavanagh, a 63-year-old retired teacher, had oral cancer and had extensive surgery to excise the malignancy. While is surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to Mr. Cavanagh and his family?
a) Knowing that everything will work out just fine
b) Time to mourn, accept, and adjust to the loss
c) Not giving in to anger
d) Having a courageous attitude

B) Time to mourn, accept, and adjust to the loss
The first time family members or clients see the effects of surgery, the experience usually is traumatic. The nurse needs to promote effective coping and therapeutic grieving at this time. Responses may range from crying or extreme sadness and avoiding contact with others to refusing to talk about the surgery or changes in appearance. Allowing the client time to mourn, accept, and adjust to losses is essential.

Initially, which diagnostic should be completed following placement of a NG tube?
a) X-ray
b) Measurement of tube length
c) pH measurement of aspirate
d) Visual assessment of aspirate

A) X-ray
Instead of auscultation, a combination of three methods is recommended: measurement of tube length, visual assessment of aspirate, and pH measurement of aspirate.

A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort?
a) Positioning the client flat on the abdomen or side.
b) Keeping the head of the bed elevated.
c) Turning the client's head to the side.
d) Providing a tracheostomy tray near the bed.

B) Keeping the head of the bed elevated
It is essential to position the client with the head of the bed elevated because it is easier for the client to breathe deeply and cough up secretions after recovering from the anesthetic. Positioning the client flat either on the abdomen or side with the head turned to the side will facilitate drainage from the mouth. A tracheostomy tray is kept by the bed for respiratory distress or airway obstruction. When mouth irrigation is carried out, the nurse should turn the client's head to the side to allow the solution to run in gently and flow out.

Which of the following is an accurate statement regarding cancer of the esophagus?
a) Chronic irritation of the esophagus is a known risk factor.
b) It is three times more common in women in the U.S. than men.
c) It is seen more frequently in Caucasian Americans than in African Americans.
d) It usually occurs in the fourth decade of life.

A) Chronic irritation of the esophagus is a known risk factor
In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life

Which of the following is the best method for determining nasogastric tube placement?
a) Placement of external end of tube under water
b) Testing of pH of gastric aspirate
c) X-ray
d) Observation of gastric aspirate

C) X-ray
Radiologic identification of tube placement in the stomach is the most reliable method. Gastric fluid may be grassy green, brown, clear, or odorless while an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining nasogastric tube placement in the stomach. Gastric pH values are typically lower or more acidic than that of the intestinal or respiratory tract, but not always. Placement of external end of tube under water and watching for air bubbles is not a reliable method for determining nasogastric tube placement in the stomach.

Regarding oral cancer, the nurse provides health teaching to inform the patient that
a) most oral cancers are painful at the outset.
b) blood testing is used to diagnose oral cancer.
c) a typical lesion is soft and craterlike.
d) many oral cancers produce no symptoms in the early stages.

D) Many oral cancers produce no symptoms in the early stages
The most frequent symptom of oral cancer is a painless sore that does not heal. The patient may complain of tenderness, and difficulty with chewing, swallowing, or speaking as the cancer progresses. Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless hardened ulcer with raised edges.

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following?
a) Jejunostomy tube
b) Nasogastric tube
c) Orogastric tube
d) Gastrostomy tube

D) Gastrostomy tube
A gastrostomy tube enters the stomach through a surgically created opening into the abdominal wall. A jejunostomy tube enters jejunum or small intestine through a surgically created opening into the abdominal wall. A nasogastric tube passes through the nose into the stomach via the esophagus. An orogastric tube passes through the mouth into the stomach.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color?
a) Dark brown
b) Red
c) Black
d) Green

C) Black
Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

Which of the following would a nurse expect to assess in a client with peritonitis?
a) Decreased pulse rate
b) Deep slow respirations
c) Hyperactive bowel sounds
d) Board-like abdomen

D) Board-like abdomen
The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?
a) Maintaining wrinkles in the faceplate so it doesn't irritate the skin
b) Scrubbing fecal material from the skin surrounding the stoma
c) Cutting the faceplate opening no more than 2? larger than the stoma
d) Gently washing the area surrounding the stoma using a facecloth and mild soap

D) Gently washing the area surrounding the stoma using a facecloth and mild soap
For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following?
a) Intake and output
b) Passage of stool
c) Return of the gag reflex
d) Signs and symptoms of bleeding

D) Signs and symptoms of bleeding
A major complication after a liver biopsy is bleeding so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make?
a) Administer a tap-water enema weekly.
b) Take a mild laxative such as magnesium citrate when necessary.
c) Take a stool softener such as docusate sodium (Colace) daily.
d) Administer a phospho-soda (Fleet) enema when necessary.

C) Take a stool softener such as docusate sodium (Colace) daily
Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing a dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation.

Which patient teaching component is important for the nurse to communicate regarding pain management prior to or during diagnostic testing for a disorder of the GI system?
a) The patient should not expel gas and test fluids from the bowel when he or she experiences the urge during the procedure.
b) The patient should inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids.
c) The patient should take a sedative before the procedure to avoid the possibility of experiencing any discomfort.
d) The patient should lie down in a supine position for at least 3 hours before the test to reduce any discomfort during the test.

B) The patient should inform the test personnel if he or she experiences pressure or cramping during instillation of test fluids
To ensure that a patient who is to undergo a diagnostic test for a disorder of the gastrointestinal system experiences no or minimal discomfort during the test, the patient should be instructed to inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. The test personnel can slow the instillation or take other measures to relieve discomfort. The patient should also be advised to expel gas and test fluids from the bowel when he or she experiences the urge. Ignoring the urge to expel the bowel contents increases pain and discomfort. The patient should be advised not to take any sedative or analgesic before the test, unless prescribed. Lying down in a supine position is not known to have any consequence on the level of discomfort experienced by a patient during a diagnostic test for a GI disorder.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:
a) tenderness and pain in the right upper abdominal quadrant.
b) severe abdominal pain with direct palpation or rebound tenderness.
c) jaundice and vomiting.
d) rectal bleeding and a change in bowel habits.

B) Severe abdominal pain with direct palpation or rebound tenderness
Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see?
a) Constipation
b) Hypoglycemia
c) Lactic acidosis
d) Hyperkalemia

A) Constipation
Orthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition.

After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. Which of the following should the nurse do based on the assessment findings?
a) Listen longer for the sounds.
b) Call the physician to report absent bowel sounds.
c) Document that the client is constipated.
d) Return in 1 hour and listen again to confirm findings.

A) Listen longer for sounds
Auscultation is used to determine the character, location, and frequency of bowel sounds. The frequency and character of sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minutes. Normal sounds are heard about every 5 to 20 seconds, whereas hypoactive sounds can be one or two sounds in 2 minutes. Postoperatively, it is common for sounds to be reduced; therefore, the nurse needs to listen at least 3 to 5 minutes to verify absent or no bowel sounds.

A client is being treated for prolonged diarrhea. Which of the following foods should the nurse encourage the client to consume?
a) Protein-rich foods
b) High-fiber foods
c) Potassium-rich foods
d) High-fat foods

C) Potassium rich foods
The nurse should encourage the client with diarrhea to consume potassium-rich foods. Excessive diarrhea causes severe loss of potassium. The nurse should also instruct the client to avoid high-fiber or fatty foods because these foods stimulate gastrointestinal motility. The intake of protein foods may or may not be appropriate depending on the client's status.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?
a) Prepare the client for a gastrostomy tube placement.
b) Administer morphine (Duramorph PF) routinely, as ordered.
c) Test all stools for occult blood.
d) Administer topical ointment to the rectal area to decrease bleeding.

C) Test all stools for occult blood
Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?
a) Left upper quadrant
b) Right lower quadrant
c) Left lower quadrant
d) Right upper quadrant

B) Right lower quadrant
The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test?
a) Serve dairy products.
b) Encourage plenty of fluids.
c) Serve the client his usual diet.
d) Order a high-fiber diet.

B) Encourage plenty of fluids
The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for:
a) colonoscopy.
b) surgery.
c) nasogastric (NG) tube insertion.
d) barium enema.

B) Surgery
The client should be prepared for surgery because his signs and symptoms indicate bowel perforation. Appendicitis is the most common cause of bowel perforation in the United States. Because perforation can lead to peritonitis and sepsis, surgery wouldn't be delayed to perform other interventions, such as colonoscopy, NG tube insertion, or a barium enema. These procedures aren't necessary at this point.

The nurse is assessing a client for constipation. Which of the following is the first review that the nurse should conduct in order to identify the cause of constipation? Choose the correct option.
a) Review the client's current medications
b) Review the client's alcohol consumption
c) Review the client's usual pattern of elimination
d) Review the client's activity levels

C) Review the client's usual pattern of elimination
Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

A longitudinal tear or ulceration in the lining of the anal canal is termed a (an)
a) anorectal abscess.
b) anal fistula.
c) anal fissure.
d) hemorrhoid.

C) Anal fissure
Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

A 74-year-old client is on the hospital unit where you practice nursing. She will be undergoing rhinoplasty and you are completing her admission assessment and paperwork. She reports medications she uses on a daily basis, which you record for her chart. Which of her daily medications will result in constipation?
a) Acetaminophen
b) Laxative
c) NSAIDs
d) Multivitamin without iron

B) Laxative
Constipation may also result from chronic use of laxatives ("cathartic colon") because such use can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex.

Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency?
a) Beriberi
b) Scurvy
c) Night blindness
d) Hypoprothrombinemia

B) Scurvy
Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?
a) Maintaining adequate nutritional status
b) Preventing fluid volume overload
c) Relieving abdominal pain
d) Teaching about the disease and its treatment

C) Relieving abdominal pain
The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor?
a) Ingestion of a low-fat diet
b) One-time exposure to petrochemicals
c) Ingestion of caffeinated coffee
d) History of pancreatitis

D) History of pancreatitis
Pancreatitis is associated with the development of pancreatic cancer. Other factors that correlate with pancreatic cancer include diabetes mellitus, a high-fat diet, and chronic exposure to carcinogenic substances (i.e., petrochemicals). Although data are inconclusive, a relationship may exist between cigarette smoking and high coffee consumption (especially decaffeinated coffee) and the development of pancreatic carcinoma.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?
a) "I'll lie down immediately after a meal."
b) "I'll eat three large meals every day without any food restrictions."
c) "I'll eat frequent, small, bland meals that are high in fiber."
d) "I'll gradually increase the amount of heavy lifting I do."

C) I'll eat frequent, small, bland meals that are high in fiber
In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

The client is receiving a 25% dextrose solution of parenteral nutrition. The infusion machine is beeping, and the nurse determines the intravenous (IV) bag is empty. The nurse finds there is no available bag to administer. It is most important for the nurse to
a) Request a new bag from the pharmacy department.
b) Flush the line with 10 mL of sterile saline.
c) Infuse a solution containing 10% dextrose and water.
d) Catch up with the next bag when it arrives.

C) Infuse a solution containing 10% dextrose and water
If the parenteral nutrition solution runs out, a solution of 10% dextrose and water is infused to prevent hypoglycemia. The nurse would then order the next parenteral nutrition bag from the pharmacy. Flushing a peripherally inserted catheter is usually prescribed every 8 hours or per hospital established protocols. It is not the most important activity at this moment. The infusion rate should not be increased to compensate for fluids that were not infused, because hyperglycemia and hyperosmolar diuresis could occur.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?
a) Hypotension
b) Bradycardia
c) Polyuria
d) Warm moist skin

A) Hypotension
Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura?
a) Pneumothorax
b) Sepsis
c) Fluid overload
d) Air embolism

A) Pneumothorax
A pneumothorax is caused by improper catheter placement and inadvertent puncture of the pleura. Air embolism can occur from a missing cap on a port. Sepsis can be caused by the separation of dressings. Fluid overload is caused by fluids infusing too rapidly.

The nurse inserts a nasoduodenal tube for feeding of the client. To check best for placement, the nurse
a) Verifies location with an abdominal x-ray
b) Aspirates contents and checks the color of the aspirate
c) Auscultates when injecting air
d) Adds 8 to 10 inches of the tube after inserting to the xiphoid process

A) Verifies location with an abdominal x-ray
Initially, an x-ray should be used to confirm placement of the nasoduodenal tube. It is the most accurate method to verify tube placement. Adding 8 to 10 inches to the length of the tube after measuring from nose to earlobe to xiphoid process is not supported, because it does not indicate that the tube will be in the correct position. Intestinal aspirate is usually clear and yellow to bile-colored. Gastric aspirate is usually cloudy and green, tan, off-white, or brown. Food particles may be present. The traditional method of injecting air through the tube while auscultating the epigastric area with a stethoscope to detect air insufflation is also an unreliable indicator.

A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.

Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.5 mg/dL (43 fmol/L).

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
a) Vitamin K
b) Vitamin A
c) Riboflavin
d) Thiamine

B) Vitamin A
Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis?
a) Recent weight loss and temperature elevation
b) Presence of easy bruising and bradycardia
c) Adventitious breath sounds and hypertension
d) Presence of blood in the client's stool and recent hypertension

Recent weight loss and temperature elevation
Assessment findings associated with pancreatitis include recent weight loss and temperature elevation. Inflammation of the pancreas causes a response that elevates temperature and leads to abdominal pain that typically occurs with eating. Nausea and vomiting may occur as a result of pancreatic tissue damage that's caused by the activation of pancreatic enzymes. The client may experience weight loss because of the lost desire to eat. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with pancreatitis.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
a) elevated blood urea nitrogen and creatinine levels and hyperglycemia.
b) subnormal serum glucose and elevated serum ammonia levels.
c) subnormal clotting factors and platelet count.
d) elevated liver enzymes and low serum protein level.

B) Subnormal serum glucose and elevated serum ammonia levels
In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?
a) The client didn't take his morning dose of lactulose (Cephulac).
b) The client is relaxed and not in pain.
c) The client's hepatic function is decreasing.
d) The client is avoiding the nurse.

C) The client's hepatic function is decreasing
The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
a) cirrhosis.
b) cholelithiasis.
c) appendicitis.
d) peptic ulcer disease.

A) Cirrhosis
Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
a) Ascites and orthopnea
b) Gynecomastia and testicular atrophy
c) Purpura and petechiae
d) Dyspnea and fatigue

C) Purpura and petechiae
A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?
a) "Maintain a high-sodium, high-calorie diet."
b) "Maintain a high-carbohydrate, low-fat diet."
c) "Maintain a high-fat, high-carbohydrate diet."
d) "Maintain a high-fat diet and drink at least 3 L of fluid a day."

B) Maintain a high carbohydrate, low fat diet
A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?
a) Anxiety related to unknown outcome of hospitalization
b) Acute pain related to biliary spasms
c) Imbalanced nutrition: Less than body requirements related to biliary inflammation
d) Deficient knowledge related to prevention of disease recurrence

B) Acute pain related to biliary spams
The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency?
a) Hypoprothrombinemia
b) Scurvy
c) Beriberi
d) Night blindness

B) Scurvy
Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?
a) Bradycardia
b) Hypotension
c) Polyuria
d) Warm moist skin

B) Hypotension
Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?
a) Withhold oral feedings for the client.
b) Instruct the client to avoid coughing.
c) Monitor pulse oximetry every hour.
d) Reposition the client every 2 hours.

D) Reposition the client every 2 hours
Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered?
a) Chenodiol
b) Ursodiol
c) Tacrolimus
d) Interferon alfa-2b, recombinant

C) Tacrolimus
In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus or cyclosporine are two immunosuppresants that may be used. Chenodiol and ursodiol are agents used to dissolve gall stones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?
a) Albumin
b) Chloride
c) Urobilinogen
d) Creatinine

A) Albumin
Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

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