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Module 8

chapter questions, iclickers, evolve questions
The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to:
a. increase fluid intake
b. administer an antibiotic
c. administer antimotility drugs
d. quarantine the patient to prevent spread of the virus
During the assessment of a patient with acute abdominal pain, the nurse should:
a. perform deep palpation before auscultation
b. obtain blood pressure and pulse rate to determine hypervolemic changes
c. auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus
d. measure body temperature because an elevated temperature may indicate an inflammatory or infectious process
The nurse would increase the comfort of the patient with appendicitis by:
a. having the patient lie prone
b. flexing the patients right knee
c. sitting the patient upright in a chair
d. turning the patient onto his or her left side
In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease is:
a. frequently results in toxic megacolon
b. causes fewer nutritional deficiencies than does ulcerative colitis
c. often occurs after surgery, whereas ulcerative colitis is curable with a colectomy
d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis
The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that a manifestation of an obstruction in the large intestine is (select all that apply)
a. a largely distended abdomen
b. diarrhea that is loose or liquid
c. persistent, colicky abdominal pain
d. profuse vomiting that relieves abdominal pain
A patient with metastatic colorectal cancer is scheduled for both chemotherapy and radiation therapy. Patient teaching regarding these therapies for this patient would include an explanation that:
a. chemotherapy can be used to cure colorectal cancer
b. radiation is routinely used as adjuvant therapy following surgery
c. both chemotherapy and radiation can be used as palliative therapy
d. the patient should expect few if any side effects from chemotherapeutic agencts
The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is:
a. sigmoid colostomy
b. a transverse colostomy
c. a descending colostomy
d. an ascending colostomy
In contrast to diverticulitis, the patient with diverticulosis:
a. has rectal bleeding
b. often has no symptoms
c. has localized cramping pain
d. frequently develops peritonitis
A nursing intervention that is most appropriate to decrease post-operative edema and pain following an inguinal herniorrhaphy is:
a. applying a truss to the hernia site
b. allowing the patient to stand to void
c. supporting the incision during coughing
d. applying a scrotal support with ice bag
The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu:
a. scrambled eggs and sausage
b. buckwheat pancakes with syrup
c. oatmeal, skim milk, and orange juice
d. yogurt, strawberries, and rye toast with butter
Which of the following should a patient be taught after a hemorrhoidectomy:
a. take mineral oil prior to bedtime
b. eat a low-fiber diet to rest the colon
c. administer oil-retention enema to empty the colon
d. use prescribed pain medication before a bowel movement
During assessment of a patient with obstructive jaundice, the nurse would expect to find:
a. clay-colored stools
b. dark urine and stools
c. pyrexia and severe pruritis
d. elevated urinary urobilinogen
A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that:
a. pruritis is a common problem with jaundice in this phase
b. the patient is most likely to transmit the disease during this phase
c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B
d.extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase
A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to:
a. avoid alcohol for the first three weeks
b. use a condom during sexual intercourse
c. have family members get an injection of immunoglobulin
d. follow a low-protein, moderate-carbohydrate, moderate-fat diet
A patient has been told that she has elevated liver enzymes cause by nonalcoholic fatty liver disease. The nursing teaching plan should include:
a. having genetic testing done
b. recommending a heart-healthy diet
c. the necessity to reduce weight rapidly
d.avoiding alcohol until liver enzymes return to normal
The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that:
a. a lack of clotting factors promotes the collection of blood in the abdominal cavity
b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space
c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel
d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid
In planning care for a patient with metastatic liver cancer, the nurse should include interventions that:
a. focus primarily on symptomatic and comfort measures
b. reassure the patient that chemotherapy offers a good prognosis
.c promote the patient's confidence that surgical excision of the tumor will be successful
d. provide information necessary for the patient to make decisions regarding liver transplantation
The nurse explains to the patient with acute pancreatitis that the most common pathogenic mechanism of the disorder is:
a. cellular disorganization
b. overproduction of enzymes
c. lack of secretion of enzymes
d. autodigestion of the pancreas
Nursing management of the patient with acute pancreatitis includes (select all that apply)
a. checking for signs of hypocalcemia
b. providing a diet low in carbohydrates
c. giving insulin based on a sliding scale
d. observing stools for signs of steatorrhea
e. monitoring for infection, particularly respiratory infection
A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves:
a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum

b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and stomach into the duodenum

c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, common bile duct, and stomach into the jejunum

d.radical removal of the pancreas, duodenum, and spleen, and attaching the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy
The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that:
a. shock-wave therapy should be tried initially
b. once gallstones are removed,they tend not to recur
c. the disorder can be successfully treated with oral bile salts that dissolve gallstones
d. laparoscopic cholecystectomy is the treatment of choice in most patient who are symptomatic
Teaching in relation to home management following a laparoscopic cholecystectomy should include:
a. keeping the bandages on the puncture sites for 48 hours
b. reporting any bile-colored drainage or pus from the incision
c. using over the counter antiemetics if nausea and vomiting occur
d. emptying and measuring the contents of the bile bage from the T tube every day
The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation?
A) a. Maintain a high intake of fluid and fiber in the diet.
B) b. Reduce intake of medications causing constipation.
C) c. Eat several small meals per day to maintain bowel motility.
D) d. Sit upright during meals to increase bowel motility by gravity.
The nurse should administer a prn dose of magnesium hydroxide (MOM) after noting which of the following while reviewing a patient's medical record?
A) a. Abdominal pain and bloating
B) b. No bowel movement for 3 days
C) c. A decrease in appetite by 50% over 24 hours
D) d. Muscle tremors and other signs of hypomagnesemia
The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would state that it acts in which of the following ways?
A) a. Increases bulk in the stool
B) b. Lubricates the intestinal tract to soften feces
C) c. Increases fluid retention in the intestinal tract
D) d. Increases peristalsis by stimulating nerves in the colon wall
The nurse is preparing to administer a scheduled dose of docusate sodium (Colace) when the patient complains of an episode of loose stool and does not want to take the medication. Which of the following is the appropriate action by the nurse?
A) a. Write an incident report about this untoward event.
B) b. Attempt to have the family convince the patient to take the ordered dose.
C) c. Withhold the medication at this time and try to administer it later in the day.
D) d. Chart the dose as not given on the medical record and explain in the nursing progress notes.
A patient is scheduled to receive "Colace 100 mg PO." The patient asks to take the medication in liquid form, and the nurse obtains an order for the interchange. Available is a syrup that contains 150 mg/15 ml. How many milliliters does the nurse administer?
A) a. 3
B) b. 5
C) c. 10
D) d. 12
The nurse would instruct the patient to do which of the following to best enhance the effectiveness of a daily dose of docusate sodium (Colace)?
A) a. Take a dose of mineral oil at the same time.
B) b. Add extra salt to food on at least one meal tray.
C) c. Ensure dietary intake of 10 g of fiber each day.
D) d. Take each dose with a full glass of water or other liquid.
The nurse would question the use of which of the following cathartic agents in a patient with renal insufficiency?
A) a. Bisacodyl
B) b. Lubiprostone
C) c. Cascara sagrada
D) d. Milk of magnesia
A patient who is administering a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which of the following time frames after administration?
A) a. 2-5 Minutes
B) b. 15-60 Minutes
C) c. 2-4 Hours
D) d. 6-8 Hours
The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis?
A) a. Rovsing sign
B) b. Referred pain
C) c. Chvostek's sign
D) d. Rebound tenderness

In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.
The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture?
A) a. Low pitched and rumbling above the area of obstruction
B) b. High pitched and hypoactive below the area of obstruction
C) c. Low pitched and hyperactive below the area of obstruction
D) d. High pitched and hyperactive above the area of obstruction
The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which of the following factors in the patient's history increases the patient's risk for colorectal cancer?
A) a. Osteoarthritis
B) b. History of rectal polyps
C) c. History of lactose intolerance
D) d. Use of herbs as dietary supplements
The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate?
A) a. "The tube will help to drain the stomach contents and prevent further vomiting."
B) b. "The tube will push past the area that is blocked, and thus help to stop the vomiting."
C) c. "The tube is just a standard procedure before many types of surgery to the abdomen."
D) d. "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."
A 61-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 4:00 am. The nurse shares in the morning report that the day shift staff should check the tube for patency at which of the following times?
A) a. 7:00 am, 10:00 am, and 1:00 pm
B) b. 8:00 am and 12:00 pm
C) c. 9:00 am and 3:00 pm
D) d. 9:00 am, 12:00 pm, and 3:00 pm
The nurse who inserted a nasogastric tube for a 68-year-old patient with suspected bowel obstruction should write which of the following priority nursing diagnoses on the patient's problem list?
A) a. Anxiety related to nasogastric tube placement
B) b. Abdominal pain related to nasogastric tube placement
C) c. Risk for deficient knowledge related to nasogastric tube placement
D) d. Altered oral mucous membrane related to nasogastric tube placement
A colectomy is scheduled for a 68-year-old woman with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient?
A) a. Instruction on irrigating a colostomy
B) b. Administration of a cleansing enema
C) c. A high-fiber diet the day before surgery
D) d. Administration of IV antibiotics for bowel preparation
Which of the following would be the highest priority information to include in preoperative teaching for a 68-year-old patient scheduled for a colectomy?
A) a. How to care for the wound
B) b. How to deep breathe and cough
C) c. The location and care of drains after surgery
D) d. What medications will be used during surgery
The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained well what is involved in the surgical procedure. Which of the following is the most appropriate action by the nurse?
A) a. Ask family members whether they have discussed the surgical procedure with the physician.
B) b. Have the patient sign the form and state the physician will visit to explain the procedure before surgery.
C) c. Explain the planned surgical procedure as well as possible, and have the patient sign the consent form.
D) d. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.
Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following?
A) a. Impaired peristalsis
B) b. Irritation of the bowel
C) c. Nasogastric suctioning
D) d. Anastomosis site inflammation
Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse?
A) a. Notify the physician.
B) b. Auscultate for bowel sounds.
C) c. Reposition the tube and check for placement.
D) d. Remove the tube and replace it with a new one.
The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). Which of the following would be the most appropriate response by the nurse?
A) a. "This will prevent air from accumulating in the stomach, causing gas pains."
B) b. "This will prevent the heartburn that occurs as a side effect of general anesthesia."
C) c. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."
D) d. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again."
A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To which of the following diagnoses does the nurse attribute these findings?
A) a. Malnutrition
B) b. Osteomyelitis
C) c. Alcohol abuse
D) d. Diabetes mellitus
The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing which of the following?
A) a. Relief of constipation
B) b. Relief of abdominal pain
C) c. Decreased liver enzymes
D) d. Decreased ammonia levels
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate?
A) a. "The hepatitis vaccine will provide immunity from this exposure and future exposures."
B) b. "I am afraid there is nothing you can do since the patient was infectious before admission."
C) c. "You will need to be tested first to make sure you don't have the virus before we can treat you."
D) d. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."
When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses?
A) a. Imbalanced nutrition: less than body requirements
B) b. Impaired skin integrity related to edema, ascites, and pruritus
C) c. Excess fluid volume related to portal hypertension and hyperaldosteronism
D) d. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume
When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which of the following nursing interventions would be appropriate to achieve this outcome (select all that apply)?
A) a. Use smallest gauge possible when giving injections or drawing blood.
B) b. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing.
C) c. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food.
D) d. Apply gentle pressure for the shortest possible time period after performing venipuncture.
E) e. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.
A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on knowledge that
A) a. Milk thistle may affect liver enzymes and thus alter drug metabolism.
B) b. Milk thistle is generally safe in recommended doses for up to 10 years.
C) c. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis.
D) d. Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.
When caring for a patient with a biliary obstruction, the nurse will anticipate administering which of the following vitamin supplements (select all that apply)?
A) a. Vitamin A
B) b. Vitamin D
C) c. Vitamin E
D) d. Vitamin K
E) e. Vitamin B