A nurse is caring for a client with pneumonia who has a history of bleeding esophageal varices. Based on this information, the nurse plans care, knowing that it is important to prevent:
A nurse is reviewing the health care provider's prescriptions written for a client admitted with acute pancreatitis. Which health care provider prescription would the nurse verify if noted on the client's chart?
Position the client supine and flat.
After a liver biopsy, the nurse places the client in which of the following positions?
A left side-lying position with a small pillow or folded towel under the puncture site
A nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). The nurse would plan to do which of the following first once the client arrives?
Monitor for return of the gag reflex.
A nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. Which of the following is the appropriate nursing action?
Stop the irrigation temporarily.
A client is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP). The nurse includes which intervention in the plan of care for the client?
After the procedure, keep client nothing by mouth (NPO) until the gag reflex returns.
A client has undergone esophagogastroduodenoscopy (EGD). The nurse places highest priority on which of the following items as part of the client's care plan?
Checking for return of a gag reflex
A nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which of the following symptoms indicate this occurrence?
Sweating and pallor
A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse suggests foods that are on which of the following diets?
A low-fiber diet
A client arrives at the emergency department and complains of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the health care provider's prescriptions. Which of the following prescriptions would the nurse question if written on the health care provider's prescription form?
Administration of an analgesic
A client with ascites is scheduled for a paracentesis. The nurse is assisting the health care provider in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure?
A nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item is acceptable to include in the diet?
Turkey and lettuce sandwich
A nurse documents that a client with a hiatal hernia is implementing effective health maintenance measures after the client reports doing which of the following?
Eating low-fat or nonfat foods
A nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement would be included in the teaching?
"Be sure to sleep with your head elevated in bed."
A nurse is providing post-procedure teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately:
1 to 2 days
A client being seen in a health care provider's office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test?
"Remove jewelry before the test."
A client diagnosed with pernicious anemia asks the nurse what caused the deficiency. The nurse replies that it is likely a result of which of the following conditions that is part of the client's health history?
A client is admitted to the hospital with acute viral hepatitis. Which signs or symptoms would the nurse expect to note, based upon this diagnosis?
A post-gastrectomy client is at high risk for hyperglycemia related to uncontrolled gastric emptying of fluid and food into the small intestine (dumping syndrome). Because of this risk, the nurse plans to monitor the:
Postprandial blood glucose readings
A nurse is reinforcing dietary instructions to a client with peptic ulcer disease. The nurse encourages the client to:
Eat anything as long as it does not aggravate or cause pain.
A nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to see documented in the record?
A postgastrectomy client who is being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work and I'm really behind. If I don't get my act together, I may lose my job." Based on the client's statement, the nurse determines that at this time, it is appropriate to discuss:
Reducing stressors in life
A nurse is providing dietary instructions to a client with peptic ulcer disease. The nurse tells the client to:
Eat anything that does not aggravate or cause pain.
A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting, and a gastric ulcer is suspected. The nurse should gather which of the following additional supportive data for this diagnosis from the client?
History of alcohol use, smoking, and weight loss
A nurse is providing medication instructions to a client with peptic ulcer disease. Which of the following represents correct information given by the nurse?
Cimetidine (Tagamet) results in decreased secretion of stomach acid.
A nurse who is providing instructions to a client following gastric resection would include which of the following suggestions?
Take action to prevent dumping syndrome.
A nurse gathers data from a client admitted to the hospital with gastroesophageal reflux disease (GERD) who is scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse determines that the client may be at risk for which complication?
A nurse is working with a client diagnosed with anorexia nervosa. The nurse plans care, focusing on which of the following as the primary problem?
Impaired nutritional status
A client who has undergone a subtotal gastrectomy is being prepared for discharge. Which item concerning ongoing self-management should the nurse reinforce to the client?
Smaller and more frequent meals should be eaten.
A nurse is getting a client who underwent umbilical hernia repair ready for discharge. The nurse tells the client that it is important to continue to do which of the following after discharge?
A client with peptic ulcer disease is scheduled for a pyloroplasty and the client asks the nurse about the procedure. The nurse bases the response on which of the following?
A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
Treatment measures have been implemented for a client with bleeding esophageal varices and have been unsuccessful. The health care provider states that a Sengstaken-Blakemore tube will be used to control the resulting hemorrhage. The nurse prepares for insertion via which of the following routes?
A nurse is caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse should plan to:
Provide frequent oral and nasal care on a regular basis.
A nurse documents that a client with a hiatal hernia is complying with the prescribed treatment if the client reports doing which of the following?
Consuming low-fat or nonfat foods
A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. The LPN would instruct the client to do which of the following?
Take and hold a deep breath.
A client with a possible hiatal hernia complains of frequent heartburn and regurgitation. Which sign or symptom would support this diagnosis?
Difficulty swallowing both liquids and solids
A nurse is caring for a client after a Billroth II procedure. On review of the postoperative prescriptions, which of the following, if prescribed, would the nurse question and verify?
Irrigating the nasogastric (NG) tube
A nurse is preparing to administer a soapsuds enema to a client. Into which position does the nurse place the client to administer the enema?
A nurse has been reinforcing dietary teaching for a client with peptic ulcer disease who has a routine follow-up visit. Which behavior is the best indicator of a successful outcome for this client?
A decrease in sour eructation
A nurse notes that the medical record of a client with cirrhosis states that the client has asterixis. To verify this information, the nurse would do which of the following?
Ask the client to extend the arms.
A client receiving a high cleansing enema complains of pain and cramping. The nurse would take which corrective action?
Clamp the tubing for 30 seconds and restart the flow at a slower rate.
A client who has undergone a barium enema is being readied for discharge from the ambulatory care unit. The nurse determines that the client has understood the discharge instructions if the client states:
"I should take a laxative and my stool should return to normal color."
A nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The nurse notes that the pH is 5 and determines that the:
Placement of the NG tube is accurate.
A nurse is collecting data on a client admitted to the hospital with hepatitis. Which data would indicate that the client may have liver damage?
A client will undergo a barium swallow to confirm a diagnosis of a hiatal hernia. In preparation for the test, the nurse instructs the client to:
Avoid eating or drinking after midnight before the test.
A client with peptic ulcer disease has been prescribed to take misoprostol (Cytotec) and sucralfate (Carafate). The nurse teaches the client that these two medications will work primarily to:
Protect the gastric mucosa.
A client in the emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse would question a prescription for which of the following?
Milk of magnesia
A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to absorb food. While carrying out this function, the nurse recalls that absorption is best defined as:
The transfer of digested food molecules from the GI tract into the bloodstream
A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. Which of the following data would further support this diagnosis?
History of alcohol use, smoking, and weight loss
An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. The nurse explains to the client that this test:
Requires the client to lie still for short intervals
A nurse is collecting admission data on the client with hepatitis. Which of the following findings would be a direct result of this client's condition?
A client who has a history of chronic ulcerative colitis is anemic. The nurse interprets that which factor is likely responsible for this laboratory finding?
A client who has undergone barium enema is being readied for discharge. The nurse determines that the client has understood discharge instructions when the client states:
"I should take a laxative, and my stool will then return to a normal color."
A nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer should focus interventions on which of the following?
Maintaining a patent nasogastric (NG) tube
A client is admitted to the hospital with a bowel obstruction secondary to a recurrent malignancy, and the health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, the nurse determines that the best action is to:
Remain with the client and be silent.
A client has undergone subtotal gastrectomy and the nurse is preparing the client for discharge. Which item should be included when teaching the client about ongoing self-management?
Smaller, more frequent meals should be eaten.
A nurse has taught a client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs additional information if the client makes which statement?
"I'm glad I don't have to lie still for this procedure."
Which statement by the spouse of a client with end-stage liver failure indicates the need for additional teaching by the multidisciplinary team regarding the management of pain?
"This opioid will cause very deep sleep, which is what my husband needs."
A nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. The nurse would plan to include which risk factor for colorectal cancer in the material?
Personal history of ulcerative colitis or gastrointestinal (GI) polyps
After the deflation of the balloon of a client's Sengstaken-Blakemore tube, the nurse monitors the client closely for which esophageal complication?
A client is admitted to an acute care facility with complications of celiac disease. Which question would be helpful initially in obtaining information for the nursing care plan?
"What is your understanding of celiac disease?"
A client presents to the urgent care center with complaints of abdominal pain. Suddenly the client vomits bright red blood. The nurse takes which immediate action?
Takes the client's vital signs
A client has had extensive surgery on the gastrointestinal tract and has been started on parenteral nutrition (PN). The client tells the nurse, "I think I'm going crazy...I feel like I'm starving and yet that bag is supposed to be feeding me." The best response of the nurse would be:
"That is because the empty stomach sends signals to the brain to stimulate hunger."
A nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse would place the client in which position during and after the feedings?
A nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse should question a prescription for which of the following?
Milk of magnesia
A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse plans care, knowing that which problem occurs with this disorder?
Alteration in comfort related to abdominal pain
A client with hepatic encephalopathy is receiving lactulose (Cephulac). The nurse determines that the medication is effective if which of the following is observed?
Client previously oriented to person only; can now state name, year, and present location
A nurse is assisting in caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse plans to:
Give frequent oral and nasal care.
A client is scheduled for an oral cholecystography. The nurse would plan to obtain what type of diet for the evening meal before the test?
A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client that which of the following will be prescribed to treat the problem?
Vitamin B12 injections
A nurse is collecting data from a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement, if made by the client, would support the diagnosis of gastric ulcer?
"My pain comes shortly after I eat, maybe a half hour or so later."
A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to digest food. The nurse recalls that digestion is best defined as:
A mechanical and chemical process involving the breakdown of foods
A nurse has a prescription to give 30 mL of an antacid to a client through a nasogastric (NG) tube that is connected to wall suction. The nurse would do which of the following to perform this procedure correctly?
Clamp the NG tube for 30 minutes following administration of the medication.
A licensed practical nurse (LPN) is assisting in insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by measuring:
From the tip of the client's nose to the earlobe and then down to the xiphoid process
A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN assists the client into which of the following positions?
Supine with the head raised slightly and the knees slightly flexed
A client is admitted to the hospital with viral hepatitis and is complaining of a loss of appetite. In order to provide adequate nutrition, the nurse encourages the client to:
Increase intake of fluids.
A nurse is performing an abdominal assessment on a client. The nurse interprets that which finding is abnormal and should be reported to the registered nurse (RN) or health care provider?
Pulsation between the umbilicus and pubis
A nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Choose the interventions that the nurse would expect to be prescribed for the client. Select all that apply.
Administer antacids, as prescribed.
Encourage coughing and deep breathing.
Administer anticholinergics, as prescribed.
A health care provider places a Miller-Abbott tube in a client who has a bowel obstruction. Six hours later, the nurse measures the length of the tube outside of the nares and notes that the tube has advanced 6 cm since it was first placed. Based on this finding, which action should the nurse take next?
Document the finding in the client's record.
A nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse assists the client to which of the following positions?
Left Sims' position
A client with a tentative diagnosis of gastroesophageal reflux is going to undergo ambulatory pH monitoring. The nurse brings which of the following items to the bedside?
Nasogastric (NG) tube
A health care provider asks a nurse to obtain a Salem Sump tube for gastric intubation. The nurse selects which of the following tubes from the unit storage area?
Tube with a lumen and an air vent
A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse tells the client to avoid which position that could aggravate the pain?
A nurse is assigned to care for a client with a Sengstaken-Blakemore tube. The nurse should suspect that the client has which diagnosis?
A nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse expects that the health care provider will prescribe the suction setting at:
Low and intermittent
A nurse is providing discharge instructions to a client who has had a total gastrectomy. The nurse tells the client about the importance of returning to the health care clinic as scheduled for which priority assessment?
Vitamin B12 and folic acid studies
A client with a Sengstaken-Blakemore tube in place to treat esophageal varices suddenly becomes restless. The client's heart rate and blood pressure increase and the client has difficulty breathing. The important initial nursing action is to:
Cut the tube and pull it out.
An adult client with hepatic encephalopathy has a serum ammonia level of 120 mcg/dL and receives treatment with lactulose (Chronulac) syrup. The nurse determines that the client has the best and most optimal response if the level changes to which of the following after medication administration?
A nurse assigned to care for a client with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care, knowing that which client position will best assist in facilitating breathing?
A nurse has assisted in the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse plans to set the suction to which of the following pressures?
Low and intermittent
A nurse is caring for a client with esophageal varices who is going to have a Sengstaken-Blakemore tube inserted. The nurse brings which priority item to the bedside so that it is available at all times?
A pair of scissors
A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken:
30 minutes before meals
A client has just undergone a gastroscopy. Which action should be taken by the nurse as the essential post-procedure nursing intervention?
Monitoring for the gag reflex
A nurse reinforces instructions to a client following a gastrectomy about the signs and symptoms of pernicious anemia, knowing that:
Regular monthly injections of vitamin B12 will prevent this complication.
A client has just returned from the radiology department following an upper gastrointestinal (GI) series. The nurse reviews the health care provider's prescriptions, expecting to note which of the following needed for routine post-procedure care?
It has been determined that a client with hepatitis has contracted the infection from contaminated food. What type of hepatitis is this client most likely experiencing?
A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for teaching?
"I can never drink alcohol again."
A health care provider is about to perform a paracentesis on a client with abdominal ascites. The nurse would assist the client to assume which of the following positions?
A nurse has given postprocedure instructions to a client who has undergone a colonoscopy. The nurse determines that the client did not fully understand the directions if the client states that:
It is all right to drive an hour after the test is finished.
A client who has been prescribed indomethacin (Indocin) for gout is asked to provide a stool sample for guaiac testing. The nurse explains that the purpose of the test is to determine:
The end-products of carbohydrate and protein digestion are absorbed by the
blood vessels in the villi.
A 56-year-old patient with diverticulitis has been admitted to the medical unit. The nurse will most likely document which assessment in the charting?
Pain in the left lower quadrant
An ileostomy was performed on a patient for the treatment of debilitating ulcerative colitis disease. A problem the nurse should watch for in patients after this surgery is
A patient with cancer of the esophagus has been receiving radiation therapy. The nurse realizes that this patient should be assessed for
aspiration from fistula formation.
A patient has been admitted for diagnostic procedures including an esophagogastroduodenoscopy. The nurse explains to this patient that during this procedure, the physician will
view the esophagus, stomach, and upper small intestine.
The nurse determines that a patient has a knowledge deficit regarding her diagnosis of achalasia. The nurse begins patient teaching by explaining that achalasia is
caused by the inability of a muscle to relax.
Following a gastrectomy, the nurse would anticipate that the patient would need to be assessed for
vitamin B12 deficiency.
A 63-year-old patient is admitted with acute diverticulitis. The most appropriate nursing intervention to lessen this patient's signs and symptoms of increased flatus and chronic constipation alternating with diarrhea, anorexia, and nausea would be to
encourage a diet high in fiber content.
The patient, age 32, has ulcerative colitis, and his condition is deteriorating. An ileostomy is scheduled. After the procedure, this patient may be at risk for
Disturbed body image.
Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. A nursing measure that will prevent or minimize dumping syndrome is to administer the feeding
in six small daily meals high in protein and fat.
The emergency room staff is caring for a patient with an acute inflammatory intestinal disorder who is being observed to rule out appendicitis. Which intervention is contraindicated?
Apply heat to the abdomen
After barium swallow contrast studies are performed, the nurse should ensure that the patient
expels all barium rectally.
A patient, age 36, is admitted with diarrhea and dehydration. The physician has ordered several diagnostic studies of the patient's stools. When obtaining a stool specimen to be examined for ova and parasites, the nurse should
instruct the patient to obtain three different stool specimens on subsequent days.
The patient, age 32, is admitted with possible appendicitis after being evaluated by the physician. It is appropriate for the nurse to administer
fluid and electrolyte replacement
A patient, age 84, has a history of a large left inguinal hernia. He is complaining of nausea, vomiting, abdominal distention, and inguinal pain. A serious complication of a hernia in which the blood supply to the tissue becomes occluded is called a(n)
A patient had a ruptured diverticulum in his descending colon. He has undergone a transverse loop colostomy. He asks the nurse the purpose of this procedure, and the nurse tells him that it is
a temporary colostomy to allow healing of the bowel by diverting feces.
The patient complains that he will never adjust to his colostomy. In this situation, it would be best for the nurse to
encourage him to express his concern.
The most important nursing intervention to assure the patency of a nasogastric tube (NG) is to:
Monitor NG for patency and irrigate with sterile normal saline PRN as ordered.
A progressive wavelike movement that occurs involuntarily in hollow tubes of the body, especially in the alimentary canal, to propel fluids, gas, and digestive substances forward is called
A NANDA-accepted nursing diagnosis that could be written for a patient with an abdominoperineal resection and a permanent colostomy would include
Disturbed body image.
Bowel sound assessment is especially important for a postoperative patient who has had abdominal surgery as it can determine the:
return of peristalsis.
. A NANDA-accepted nursing diagnosis that could be written for the patient who is hemorrhaging and in hypovolemic shock from a bleeding peptic ulcer would include
Ineffective tissue perfusion (gastrointestinal).
The goals of diet management in a patient with inflammatory bowel disease are: (Select all that apply.)
Prevent weight loss.
Correct and prevent malnutrition.
Provide adequate nutrition.
Replace fluid and electrolyte losses.
What nursing interventions would be appropriate for inflammatory bowel disease diagnoses of Imbalanced Nutrition: less than body requirements related to bowel hypermotility and decreased absorption?
Provide at least six small frequent meals per day.
Which nursing intervention would be the highest priority in evaluating a patient with peritonitis from a ruptured appendix?
Assessment of severity, location, and duration of pain
Sulfasalazine is the recommended medication for treatment of Crohn's disease. Patient teaching should include:
ensuring adequate hydration to prevent crystallization in kidneys.
Symptoms of GERD (gastroesophageal reflux disease) can be modified or eliminated by which nursing interventions?
Remain upright for 1 to 2 hours post meals
Peptic ulcers are often common in the aging population. Which medications should be taken with caution to help prevent this problem?
You administered the medication GoLYTELY to a 78-year-old woman in preparation for diagnostic tests. In planning for her care, which would be most appropriate?
Available bedside commode for possible weakness
A patient is admitted with a diagnosis of Crohn's disease. What nursing interventions would be appropriate when caring for this patient? (Select all that apply.)
Monitor I & O every shift
Accessibility to bedside commode
A patient was recently diagnosed with colorectal cancer. His wife asks the nurse, "What prevents colon cancer?" The nurse's answer should include which factors?
A diet high in fiber
Familial predisposition of a cancer-causing gene
Constipation is a problem for many older adults. The medical management to prevent constipation includes (Select all that apply):
Nutritional diet high in fiber
Increasing fluid intake
Increasing daily activity
Which abnormal lab value would be found in a patient with a pathological condition of the liver?
The patient has cirrhosis of the liver and an albumin/globulin ratio of 0.9 g/dL. The normal ratio is 1.2 to 2.2 g/dL. In collecting objective data for her, the nurse would probably note which outstanding clinical sign?
An essential nursing measure to prevent peritonitis after a paracentesis is
providing oral or intravenous fluids.
Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated?
A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purpose of the T-tube is to
keep the duct open and allow drainage of the bile until edema resolves.
If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to
position and secure the drainage bag at the abdominal level.
After the physician has performed a liver biopsy, the nursing interventions would usually include
keeping the patient on the right side for minimum of 2 hours.
The patient, age 56, has cirrhosis of the liver with severe ascites. The nurse is assisting the physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an
The nurse realizes that the patient requires additional teaching about an esophagoscopy after the patient states
"Right after the test, I want breakfast with black coffee."
Patients with hepatitis A, B, C, D, or E typically are instructed to
take vitamin B, C, and K supplements.
Which findings would the nurse expect in a patient with acute pancreatitis?
Abdominal pain that increases with lying down
The patient's cirrhosis of the liver has also caused a dilation of the veins of her lower esophagus secondary to vessel hypertension, resulting in her developing the complications of:
As a result of cirrhosis of the liver, the patient's condition deteriorates and he slips into a hepatic coma. The nurse would anticipate increasing levels of:
When a patient has hepatic encephalopathy, medications often administered to relieve toxic blood chemistry include:
The new operative procedure gaining in popularity for the removal of the gallbladder, if there is no cholecystitis or choledocholithiasis, is a(n)
In preparation for a cholecystography, the nurse asks if the patient has eaten since midnight. This is done to determine
the accuracy of the test.
The nurse assesses a patient with cholecystitis. Which pain description is typical of biliary colic?
Right upper abdomen, radiating to the back or right shoulder
The nurse can prevent the transmission of hepatitis A by avoiding
direct contact through fecal matter, contaminated food, or contaminated water.
Infection control is necessary in all areas of the health care setting. Which would be most appropriate in the prevention of hepatitis B in high-risk health workers?
Hepatitis B vaccine
A patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia and dark urine. What additional information would assist in diagnosing hepatitis A?
Recent ingestion of raw fish
What instructions should the patient receive before undergoing a paracentesis?
Empty bladder before procedure
Carefully monitoring the patient for signs that may indicate the development of pancreatitis (abdominal pain, nausea, and vomiting) is essential after a(n)
endoscopic retrograde cholangiopancreatography (ERCP).
A patient has been admitted with right upper quadrant pain. Which would most likely be a source of her pain?
A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet?
"The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system."
. Which would be a major nursing concern to monitor postoperatively in a patient who has had a liver transplant?
Which medication would the nurse expect the physician to order postoperatively for a patient who has had a liver transplant?
A nursing diagnosis of: Knowledge, deficient, related to relationship of infection to nutritional needs is critical because:
The body requires more protein intake to fight infection.
A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. The best response would be
"The pancreas is stimulated whenever you eat or drink and may aggravate your condition."
The nurse explains that morphine contraindicated in the patient with pancreatitis because:
Morphine may cause spasms of the sphincter of Oddi.
Which factors may increase a patient's risk of developing cancer of the pancreas?
Cigarette smokers and people with diabetes mellitus
Which assessment would indicate possible gallbladder disease in an older adult?
Changes in color of urine or stool
In preparing the patient for a paracentesis, the nurse must be sure
the fluid is removed over at least 30 minutes
A patient with a T-tube for an open cholecystectomy has resumed oral intake. The T-tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. The best intervention would be to
unclamp the tube immediately.
What are the indications for a liver transplant? (Select all that apply.)
Congenital biliary abnormalities
Esophageal varices can rupture as a result of increases in abdominal venous pressure. Which would increase the abdominal venous pressure? (Select all that apply.)
Performing the Valsalva maneuver
Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.)
Glazed chocolate doughnuts
Viral hepatitis may be treated at home. Teach the patient's family: (Select all that apply.)
Clothes should be laundered separately with hot water.
Personal items and drinking glasses should not be shared.
Hands need to be thoroughly washed after toileting.
Because the small intestine needs bile only a few times a day, bile is stored and concentrated in the:
Although food is digested throughout the almentary canal, up to 90% of digestion is accombpished in the:
Paralytic (adynamic) ileus is a functional intestinal obstruction that may result from:
Electrolyte imbalance, postabdominal surgery, or acute inflammatory reactions
To prepare the patient for endoscopic examination of the upper GI tract, the patient's pharynx is anesthetized with lidocaine (xylocaine), Nursing interventions for postendoscopic examination include:
keeping the patient NPO until gag reflex returns
a 35yo man has been admitted with a diagnosis of peptic ulcers. Which drugs are most commonly used in these patients to decrease acid secretions?
Tagamet and Zantac
A patient is scheduled in the morning for a hemicolectomy for removal of a cancreous tumor of the ascending colon. The physician has ordered intestinal antibiotics for her preoperative to:
reduce bacteria content of the colon
a 78yo woman was admitted during the evening shift with a tentative diagnosis of cancer of esophagus. The nurse in her intial assessment finds the patient's major complaint is:
Defecient knowledge is a commonly used nursing diagnosis when patients need information regarding their conditions and diagnistic tests. Before a gstroscopy, the nurse should inform the patient that:
fasting for 6-8 hours is necessary before the examination
In evaluating the care of a young executive admited with bleeding peptic ulcer, the nurse focuses on nursing interventions. A nursing intervention associated with this type of patient is:
Observing vomitus for color, consistency, and volyme
The staff nurse on the surgical floor is aware of pulmoray complications tha tfrequently follow upper abdominal incisions. These are most frequently related to:
Shallow Respirations to minimize pain
Which test can distinguish between peptic ulcer disease and gastric malignancy?
Endoscopy with biopsy
A recently approved medication for the treatment of Chron's disease, infliximab (remicade), is classified as which type of drug?
During assessment of the patient with esophageal achalasia, the nurse would expect the patient to report:
dysphagia, especially with liquids
A nursing intervention that is most appropriate to be decrease postoperative edema and pain in the male patient following an inguinal herniorrhaphy is:
elevating hte scrotum with support or small pillow
The use of nonabsorbably antibiotics as preparation for bowel surger is done primarily to:
Reduce bacterial flora in the colon
In planning care for the patient with ulcerative colitis, the nurse recognizees that a major difference between ulcerative colitis and Crohn's disease is that ulcerative colitis:
is curable with a colectomy, wheras Chrohn's disease often recurs after surgery
What should a patient be taught after a hemorrhoidectomy?
Use a prescribed analgesic before a bowel movement
It is believed that gastric mucosa of the body of the stomach undergoes a period of transient ischemia in association with hypotension, severe injury, extensive burns, or complicated suregery. This results in the development of what disorder?
In Chron's disease, major complications that develop due to the granulomatous collegstone lesions of the small intestine include:
malabsorption of nutrients
A severe intestingal infection caused by contaminated undercooked beef such as hamburger from a specific pathogenic bacteria present in some cattle is called:
Escherichia coli O157:H7 intestinal infection
After a transverse loop colostomy, the nurse inspects the patient's stoma. The stoma appears mostly pink with some dusky discoloration at the lower border. An appropriate action would be to:
clean the area around the stoma, apply a clean pouch, and notify the physician about the discoloration
The nurse is teaching a postgastrectomy patient about dumping syndrome. The patient wound indicate the need for further instruction if she made which statement?
I will avoid fats and increase carbohydrates
The primary medical management for a patient with duodenal ulcers is:
anacids, histamine (h2) receptor blockers, proton pump inhibitors, mucosal healing agents, antibiotic therapy
An 84yo patient has a history of a large ventral hernia. He is complaining of nausea, comiting, abdominal distention and abdombial pain. A serious coplication of a hernia in which the blood supply to the tisshe becomes occluded is called a:
Peptic ulcers result from: (select all that apply)
1. Excess of gastric acid or a decrease in the natural ability of the GI mucosa to protect itself from acid and pepsin.
2. invasion of the stomach and/or duodenum by H. Pylori
4. Taking certain drugs, including corticosteroids and antiinflammatory medications
Nurses, as well as other health care providers are at risk for Hep B. For prophylaxis to be most effective in these workers:
Prphylaxis must be instituted before exposure
LIver needle biopsy is a safe method of diagnosing pathologic liver conditions. However, the nurse must anticipate possible complications, including which nursing diagnosis?
Pain, related to leakage of blood and bile into the peritoneal cavity
A 78yo patient is admitted with common bile duct obstruction related to cancer of the pancreas. Which clinical manifestations would the nurse expect to find:
Dark, tea-colored urine
It is especially important fo rthe patient to cough and deep breathe postoperatively following an open cholecystectomy because:
The patient tends to take shallow breaths due to the placement of the incision
In hepatic encephalopathy, when the nurse requests that the patient stretch out the arm and hyperextended to see whether rapid, irregular flexion and extension (flapping) of the wrist occur, the nurse is assessing for the presence of:
The patient has advanced cirrhosis of the liver with an acute exacerbation of hepatic encephalopathy. What type of food might be limited in his diet?
Patients with liver abscess are seen with vague signs and symptoms, which are often:
fever accompanied by chills, abdominal pain, and tenderness in the right upper quadrant
A small number of patients who have had a laparoscopic cholecystectomy report mild shoulder pain resulting from:
diaphragmatic irratation secondary to residual carbon dioxide
The patient has been admitted with right upperquadrant pain and has been placed on a low-fat diet. Which of the following trays would be accetable for her?
Skim milk, lean fish, tapioca pudding, and fruit
Hepatitis types B, C, D, and G are spread mainly through the following:
Contaminated needles and instuments
Direct contact with body fluids from infected people
In patients with acute pancreatitis, the algesic meperidine is no longer the opiod of choice because of:
its toxic metabolite, normeperidine, which can cause seizures
A patient is scheduled for surgery for a common bile duct exploration. The nurse would expect the patient to return from surgery with:
a T-tube connected to gravity drainage
Nursing interventions for the patient with cholecystitis associated with cholelithiasis are based on the knowledge that:
A heavy meal with a high fat content may precipitate the signs and symptoms of the disease
Teaching in relation to home management following a lapraoscopic cholecstectomy should include:
reporting any bile-colored drainage or pus from any incision
A patient with advanced cirrhosis asks the nurse why his abdomen is so swollen. The nurse's response is based on the knowledge that:
portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space
When caring for a patient with acute exacerbation of hepatic encephalopathy, the nurse may give a lactulose enema, provide a low-protein diet, and limit physical activity. These measure are done to:
decrease ammonia production
In planning care for a patient with metastatic cancer of the liver, the nurse includes interventions that:
focus primarily on symptomatic and comfort measures
Patients who receive a liver transplant secondary to viral B or C hepatitis often experience ______ or ________ of the transplanted liver
reinfection or cirrhosis
If a patient is scheduled for an ultrasound of the pancreas, which two situations would cause the examination to be postponed?
Abdomen distended with gas, recent barium enema examination
The surgical procedure for cancer of the pancreas involves resection of the antrum of the stomach, the gallbladder, the duodenum, and varying amounts of the pancreas. Anastomoses are constructed between the stomach, the common bile and pancreatic ducts, and jejunum. This procedure is called:
A major factor in high death rate from pancreatic cancer is: (select all that apply)
Difficulty in diagnosing it at at an early curable stage
The majority of cancers have metastasized at the time of diagnosis
The patient with cirrhosis has bleeding tendencies because the cirrhotic liver cannot:
Produce prothromin; finrinogen' and clotting factors VII, IX, and X or absorb Vit K
Monitoring the color of stools of a patient with Hep A is important. The nurse caring for such a patient would expect the stools to be:
clay colored (acholic)
Lab values that are often abnormal in a patient with liver disease include: (select all that apply)
a 56 yo patient has cirrhosis of the liver. He has an accumulation of serous fluid in the abdominal cavity called ascites. THe nurse is assisting hte physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an:
The patient has acute pancreatitis. The discnostic examination that would probably be ordered would include: (select all that apply)
serum amylase and lipase, ultra sound of pancrease
The patient was scheduled for a laparoscopic cholecystectomy. Complications developed during surgery, and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purposes of the T-tube are to:
keep the common bile duct open until edema resolves, and allow drainage of bile into drainage bag
The patient has a history of cholelithiasis. He has excruciating pain in the right upper quadrant radiating to the scapula, and severe nausea and vomiting; within a few hours he develops early signs of jaundice. The physician syspects
The largest glandular organ in the body, which functions as an accessory organ of digestion, is the:
The diagnostic test that involves visualization of the esophagus, stomach, and duodenum via a flexible endoscope is called a(n):
Your patient is undergoing diagnostic tests to rule out carcinoma of the oral cavity. Which of the following symptoms have been associated with the disease? Select all that apply.
Difficulty in chewing, swallowing, or speaking
Numbness or loss of sensation in part of the mouth
Your patient with carcinoma of the esophagus is about to undergo surgery, an esophagogastrectomy, and is very anxious about what to expect immediately after surgery. Which of the following statements would be appropriate to help calm his anxiety?
When you wake up, we will be monitoring you very closely. We will give you pain medication and do everything we can to keep you as comfortable as possible."
Your female patient has been diagnosed with gastroesophageal reflux disease (GERD). You are beginning your patient teaching about lifestyle changes she can implement to minimize the symptoms of this disease. You will be certain to mention:
Reducing caffeine and alcohol consumption may alleviate symptoms of the disease.
Which of the following medications would be the most effective in treating a duodenal ulceration caused by Helicobacter pylori?
Dumping syndrome is a disorder associated with what condition?
Following gastric resection or peptic ulcer surgery
Malabsorption can be a major problem with Crohn's disease when what portion of the intestine is involved?
The small intestine
Your patient has been diagnosed with diverticulosis as a result of muscle thickening and increased intracolonic pressure. Which of the following recommendations would you give her regarding food choices?
Bran, fruits, and vegetables
Jaundice, a yellow discoloration of body tissues, results when there is an excess amount of __________________ in the bloodstream.
The preferred diagnostic test for visualizing the biliary tree in a patient with jaundice is called a(n):
A patient is scheduled to undergo T-tube cholangiography. Prior to administration of contrast dye, it is essential that the nurse determine if the patient has any allergy to:
An imaging technique whereby deep structures of the body are visualized by recording reflections or echoes of ultrasonic waves directed into the tissues is called:
Your patient has undergone a needle liver biopsy 15 minutes ago. You enter her room to discover her sitting up in bed reading the newspaper. The first action you should take is to place her:
On her right side
The type of liver cirrhosis that is caused by viral hepatitis, exposure to hepatotoxins (e.g., industrial chemicals), or infection is called:
Your patient has alcoholic cirrhosis of the liver. Which of the following items written on the nursing Kardex would you question with the R.N. prior to implementing?
Acetaminophen prn pain
The most common form of hepatitis today, having an incubation period of 10 to 40 days, is hepatitis: