GASTROINTESTINAL DISORDERS CHAPTER 7

100% VERIFIED LATEST VERSION GASTROINTESTINAL DISORDERS CHAPTER 7 QUESTIONS & ANSWERS WITH RATIONALS (GUARANTEED A+) chapter 7 gaStrointeStinal diSorderS 249 Gastrointestinal Disorders 7 Science is knowledge; wisdom is organized life. —Immanuel Kant The many organs making up the gastrointestinal system—the mouth, esophagus, stomach, upper and lower intestine, and related organs—are subject to many disorders/diseases. Some are relatively minor, such as temporary constipation or a short bout of diarrhea and gastroenteritis. Others, such as diverticulosis and inflammatory bowel disease, may be chronic, requiring the client to follow a specific diet and other lifestyle modifications. Some chronic diseases, including gastroesophageal reflux, may eventually lead to life-threatening problems such as esophageal cancer. Still other diseases affect the gastrointestinal tract. One—colon cancer—is one of the most common cancers in the United States. In addition, eating disorders rooted in psychological problems can be serious if not addressed promptly and effectively. Because gastrointestinal diseases/disorders are so common, the nurse must be aware of the signs/symptoms of each, what is considered normal or abnormal for the disease process, and how the specific problem is treated. 250 Med-Surg SucceSS KEYWORDS Ascites Asterixis Borborygmus Caput medusae Cathartic Cruciferous Dyspepsia Dysphagia Eructation Esophagogastroduodenoscopy Evisceration Exacerbation Feces Hematemesis Hypoalbuminemia Jaundice Lower esophageal sphincter Melena Nosocomial Odynophagia Oligomenorrhea Peritonitis Pruritus Pyrosis abbREviatiOnS Acquired immunodeficiency syndrome (AIDS) Blood pressure (BP) Body mass index (BMI) Esophagogastroduodenoscopy (EGD) Gastroesophageal reflux disease (GERD) Gastrointestinal (GI) Head of bed (HOB) Health-care provider (HCP) Inflammatory bowel disease (IBD) Intake and output (I&O) International normalized ratio (INR) Intravenous (IV) Nasogastric (N/G) tube Nonsteroidal anti-inflammatory drugs (NSAIDs) Nothing by mouth (NPO) Partial thromboplastin time (PTT) Patient-controlled analgesia (PCA) Percutaneous endoscopic gastrostomy (PEG) Prothrombin time (PT) Pulse (P) Red blood cells (RBCs) Three times a day (tid) Total parenteral nutrition (TPN) 249 Sedentary Steatorrhea Tenesmus Water brash Unlicensed assistive personnel (UAP) When required, as needed (prn) White blood cells (WBCs) Within normal limits (WNL) PRaCtiCE QUEStiOnS Gastroesophageal Reflux (GERD) 1. The male client tells the nurse he has been experiencing “heartburn” at night that awakens him. Which assessment question should the nurse ask? 1. “How much weight have you gained recently?” 2. “What have you done to alleviate the heartburn?” 3. “Do you consume many milk and dairy products?” 4. “Have you been around anyone with a stomach virus?” 2. The nurse caring for a client diagnosed with GERD writes the client problem of “behavior modification.” Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking. 3. The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions? 1. “I should not eat for at least one (1) day following this procedure.” 2. “I can lie down whenever I want after a meal. It won’t make a difference.” 3. “The stomach contents won’t bother my esophagus but will make me nauseous.” 4. “I should avoid orange juice and eating tomatoes until my esophagus heals.” 4. The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client’s favorite foods as long as the amount is limited. chapter 7 gaStrointeStinal diSorderS 251 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day. 5. The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral sidelying position and take antacids before meals. 4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client. 6. The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying. 7. The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent. 8. The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client’s Bernstein esophageal test was positive. 2. The client’s abdominal x-ray shows a hiatal hernia. 3. The client’s WBC count is 14,000/mm3 . 4. The client’s hemoglobin is 13.8 g/dL. 9. The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett’s esophagus who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today. 10. Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. “My chest hurts when I walk up the stairs in my home.” 2. “I take antacid tablets with me wherever I go.” 3. “My spouse tells me I snore very loudly at night.” 4. “I drink six (6) to seven (7) soft drinks every day.” 11. The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena. 12. Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer. inflammatory bowel Disease 13. Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis? 1. Twenty bloody stools a day. 2. Oral temperature of 102°F. 3. Hard, rigid abdomen. 4. Urinary stress incontinence. 14. The client with type 2 diabetes is prescribed prednisone, a steroid, for an acute exacerbation of inflammatory bowel disease (IBD). Which intervention should the nurse discuss with the client? 1. Take this medication on an empty stomach. 2. Notify the HCP if experiencing a moon face. 3. Take the steroid medication as prescribed. 4. Notify the HCP if the blood glucose is over 160. 252 Med-Surg SucceSS 15. The client diagnosed with inflammatory bowel disease has a serum potassium level of 3.4 mEq/L. Which action should the nurse implement first? 1. Notify the health-care provider (HCP). 2. Assess the client for muscle weakness. 3. Request telemetry for the client. 4. Prepare to administer potassium IV. 16. The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1. Provide a low-residue diet. 2. Rest the client’s bowel. 3. Assess vital signs daily. 4. Administer antacids orally. 17. The client diagnosed with IBD is prescribed total parenteral nutrition (TPN). Which intervention should the nurse implement? 1. Check the client’s glucose level. 2. Administer an oral hypoglycemic. 3. Assess the peripheral intravenous site. 4. Monitor the client’s oral food intake. 18. The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement? 1. Weigh the client daily and document in the client’s chart. 2. Teach coping strategies such as dietary modifications. 3. Record the frequency, amount, and color of stools. 4. Monitor the client’s oral fluid intake every shift. 19. The client diagnosed with Crohn’s disease is crying and tells the nurse, “I can’t take it anymore. I never know when I will get sick and end up here in the hospital.” Which statement is the nurse’s best response? 1. “I understand how frustrating this must be for you.” 2. “You must keep thinking about the good things in your life.” 3. “I can see you are very upset. I’ll sit down and we can talk.” 4. “Are you thinking about doing anything like committing suicide?” 20. The client diagnosed with ulcerative colitis has an ileostomy. Which statement indicates the client needs more teaching concerning the ileostomy? 1. “My stoma should be pink and moist.” 2. “I will irrigate my ileostomy every morning.” 3. “If I get a red, bumpy, itchy rash I will call my HCP.” 4. “I will change my pouch if it starts leaking.” 21. The client diagnosed with IBD is prescribed sulfasalazine (Asulfidine), a sulfonamide antibiotic. Which statement best describes the rationale for administering this medication? 1. It is administered rectally to help decrease colon inflammation. 2. This medication slows gastrointestinal (GI) motility and reduces diarrhea. 3. This medication kills the bacteria causing the exacerbation. 4. It acts topically on the colon mucosa to decrease inflammation. 22. The client is diagnosed with Crohn’s disease, also known as regional enteritis. Which statement by the client supports this diagnosis? 1. “My pain goes away when I have a bowel movement.” 2. “I have bright red blood in my stool all the time.” 3. “I have episodes of diarrhea and constipation.” 4. “My abdomen is hard and rigid and I have a fever.” 23. The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? 1. Grilled hamburger on a wheat bun and fried potatoes. 2. A chicken salad sandwich and lettuce and tomato salad. 3. Roast pork, white rice, and plain custard. 4. Fried fish, whole grain pasta, and fruit salad. 24. The client with ulcerative colitis is scheduled for an ileostomy. The nurse is aware the client’s stoma will be located in which area of the abdomen? 1. A 2. B 3. C 4. D Peptic Ulcer Disease 25. Which assessment data supports the client’s diagnosis of gastric ulcer to the nurse? 1. Presence of blood in the client’s stool for the past month. 2. Reports of a burning sensation moving like a wave. C B D A chapter 7 gaStrointeStinal diSorderS 253 3. Sharp pain in the upper abdomen after eating a heavy meal. 4. Complaints of epigastric pain 30 to 60 minutes after ingesting food. 26. The nurse is caring for a client diagnosed with ruleout peptic ulcer disease. Which test confirms this diagnosis? 1. Esophagogastroduodenoscopy. 2. Magnetic resonance imaging (MRI). 3. Occult blood test. 4. Gastric acid stimulation. 27. Which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease? 1. History of side effects experienced from all medications. 2. Use of nonsteroidal anti-inflammatory drugs ( NSAIDs ). 3. Any known allergies to drugs and environmental factors. 4. Medical histories of at least three (3) generations. 28. Which physical examination should the nurse implement first when assessing the client diagnosed with peptic ulcer disease? 1. Auscultate the client’s bowel sounds in all four quadrants. 2. Palpate the abdominal area for tenderness. 3. Percuss the abdominal borders to identify organs. 4. Assess the tender area progressing to nontender. 29. Which problems should the nurse include in the plan of care for the client diagnosed with peptic ulcer disease to observe for physiological complications? 1. Alteration in bowel elimination patterns. 2. Knowledge deficit in the causes of ulcers. 3. Inability to cope with changing family roles. 4. Potential for alteration in gastric emptying. 30. The nurse is caring for a client diagnosed with hemorrhaging duodenal ulcer. Which collaborative interventions should the nurse implement? Select all that apply. 1. Perform a complete pain assessment. 2. Assess the client’s vital signs frequently. 3. Administer a proton pump inhibitor intravenously. 4. Obtain permission and administer blood products. 5. Monitor the intake of a soft, bland diet. 31. Which expected outcome should the nurse include for a client diagnosed with peptic ulcer disease? 1. The client’s pain is controlled with the use of NSAIDs. 2. The client maintains lifestyle modifications. 3. The client has no signs and symptoms of hemoptysis. 4. The client takes antacids with each meal. 32. The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data require further intervention? 1. Bowel sounds auscultated 15 times in one (1) minute. 2. Belching after eating a heavy and fatty meal late at night. 3. A decrease in systolic blood pressure (BP) of 20 mm Hg from lying to sitting. 4. A decreased frequency of distress located in the epigastric region. 33. Which oral medication should the nurse question before administering to the client with peptic ulcer disease? 1. E-mycin, an antibiotic. 2. Prilosec, a proton pump inhibitor. 3. Flagyl, an antimicrobial agent. 4. Tylenol, a nonnarcotic analgesic. 34. The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective? 1. A decrease in alcohol intake. 2. Maintaining a bland diet. 3. A return to previous activities. 4. A decrease in gastric distress. 35. Which assessment data indicate to the nurse the client’s gastric ulcer has perforated? 1. Complaints of sudden, sharp, substernal pain. 2. Rigid, boardlike abdomen with rebound tenderness. 3. Frequent, clay-colored, liquid stool. 4. Complaints of vague abdominal pain in the right upper quadrant. 36. The client with a history of peptic ulcer disease is admitted into the intensive care department with frank gastric bleeding. Which priority intervention should the nurse implement? 1. Maintain a strict record of intake and output. 2. Insert a nasogastric (N/G) tube and begin saline lavage. 3. Assist the client with keeping a detailed calorie count. 4. Provide a quiet environment to promote rest. 254 Med-Surg SucceSS Colorectal Disease 37. The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included in the presentation? 1. Wear a high-filtration mask when around chemicals. 2. Eat several servings of cruciferous vegetables daily. 3. Take a multiple vitamin every day. 4. Do not engage in high-risk sexual behaviors. 38. The nurse is admitting a client to a medical floor with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis? 1. The client reports up to 20 bloody stools per day. 2. The client has a feeling of fullness after a heavy meal. 3. The client has diarrhea alternating with constipation. 4. The client complains of right lower quadrant pain. 39. The 85-year-old male client diagnosed with cancer of the colon asks the nurse, “Why did I get this cancer?” Which statement is the nurse’s best response? 1. “Research shows a lack of fiber in the diet can cause colon cancer.” 2. “It is not common to get colon cancer at your age; it is usually in young people.” 3. “No one knows why anyone gets cancer, it just happens to certain people.” 4. “Women usually get colon cancer more often than men but not always.” 40. The nurse is planning the care of a client who has had an abdominal–perineal resection for cancer of the colon. Which interventions should the nurse implement? Select all that apply. 1. Provide meticulous skin care to stoma. 2. Assess the flank incision. 3. Maintain the indwelling catheter. 4. Irrigate the (JP) drains every shift. 5. Position the client semirecumbent. 41. The client who has had an abdominal perineal resection is being discharged. Which discharge information should the nurse teach? 1. The stoma should be a white, blue, or purple color. 2. Limit ambulation to prevent the pouch from coming off. 3. Take pain medication when the pain level is at an “8.” 4. Empty the pouch when it is one-third to onehalf full. 42. The nurse caring for a client one (1) day postoperative sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention should the nurse implement first? 1. Mark the drainage on the dressing with the time and date. 2. Change the dressing immediately using sterile technique. 3. Notify the health-care provider immediately. 4. Reinforce the dressing with a sterile gauze pad. 43. The client complains to the nurse of unhappiness with the health-care provider. Which intervention should the nurse implement next? 1. Call the HCP and suggest he or she talk with the client. 2. Determine what about the HCP is bothering the client. 3. Notify the nursing supervisor to arrange a new HCP to take over. 4. Explain the client cannot request another HCP until after discharge. 44. The client with a new colostomy is being discharged. Which statement made by the client indicates the need for further teaching? 1. “If I notice any skin breakdown, I will call the HCP.” 2. “I should drink only liquids until the colostomy starts to work.” 3. “I should not take a tub bath until the HCP okays it.” 4. “I should not drive or lift more than five (5) pounds.” 45. The nurse is preparing to hang a new bag of total parenteral nutrition for a client with an abdominal perineal resection. The bag has 1,500 mL of 50% dextrose, 10 mL of trace elements, 20 mL of multivitamins, 20 mL of potassium chloride, and 500 mL of lipids. The bag is to infuse over the next 24 hours. At what rate should the nurse set the pump? _________ 46. The nurse is caring for clients in an outpatient clinic. Which information should the nurse teach regarding the American Cancer Society’s recommendations for the early detection of colon cancer? 1. Beginning at age 60, a digital rectal examination should be done yearly. 2. After reaching middle age, a yearly fecal occult blood test should be done. chapter 7 gaStrointeStinal diSorderS 255 3. Have a colonoscopy at age 50 and then once every five (5) to 10 years. 4. A flexible sigmoidoscopy should be done yearly after age 40. 47. The nurse writes a psychosocial problem of “risk for altered sexual functioning related to new colostomy.” Which intervention should the nurse implement? 1. Tell the client there should be no intimacy for at least three (3) months. 2. Ensure the client and significant other are able to change the ostomy pouch. 3. Demonstrate with charts possible sexual positions for the client to assume. 4. Teach the client to protect the pouch from becoming dislodged during sex. 48. The client presents with a complete blockage of the large intestine from a tumor. Which healthcare provider’s order would the nurse question? 1. Obtain consent for a colonoscopy and biopsy. 2. Start an IV of 0.9% saline at 125 mL/hr. 3. Administer 3 liters of GoLYTELY. 4. Give tap water enemas until it is clear. Diverticulosis/Diverticulitis 49. The client diagnosed with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temperature of 100.6°F. Which intervention should the nurse implement first? 1. Notify the health-care provider. 2. Document the findings in the chart. 3. Administer an oral antipyretic. 4. Assess the client’s abdomen. 50. The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? 1. Discuss the importance of drinking 1,000 mL of water daily. 2. Instruct the client to exercise at least three (3) times a week. 3. Teach the client about eating a low-residue diet. 4. Explain the need to have daily bowel movements. 51. The client is admitted to the medical unit with a diagnosis of acute diverticulitis. Which healthcare provider’s order should the nurse question? 1. Insert a nasogastric tube. 2. Start an IV with D5W at 125 mL/hr. 3. Put the client on a clear liquid diet. 4. Place the client on bedrest with bathroom privileges. 52. The nurse is discussing the therapeutic diet for the client diagnosed with diverticulosis. Which meal indicates the client understands the discharge teaching? 1. Fried fish, mashed potatoes, and iced tea. 2. Ham sandwich, applesauce, and whole milk. 3. Chicken salad on whole-wheat bread and water. 4. Lettuce, tomato, and cucumber salad and coffee. 53. The client is two (2) hours post colonoscopy. Which assessment data warrant intermediate intervention by the nurse? 1. The client has a soft, nontender abdomen. 2. The client has a loose, watery stool. 3. The client has hyperactive bowel sounds. 4. The client’s pulse is 104 and BP is 98/60. 54. The nurse is preparing to administer the initial dose of an aminoglycoside antibiotic to the client diagnosed with acute diverticulitis. Which intervention should the nurse implement? 1. Obtain a serum trough level. 2. Ask about drug allergies. 3. Monitor the peak level. 4. Assess the vital signs. 55. The client diagnosed with acute diverticulitis is complaining of severe abdominal pain. On assessment, the nurse finds a hard, rigid abdomen and T 102°F. Which intervention should the nurse implement? 1. Notify the health-care provider. 2. Prepare to administer a Fleet’s enema. 3. Administer an antipyretic suppository. 4. Continue to monitor the client closely. 56. The nurse is preparing to administer 250 mL of intravenous antibiotic to the client. The medication must infuse in one (1) hour. An intravenous pump is not available and the nurse must administer the medication via gravity with IV tubing at 10 gtts/min. At what rate should the nurse infuse the medication? _________ 57. The client with acute diverticulitis has a nasogastric tube draining green liquid bile. Which intervention should the nurse implement? 1. Document the findings as normal. 2. Assess the client’s bowel sounds. 3. Determine the client’s last bowel movement. 4. Insert the N/G tube at least two (2) more inches. 58. The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when 256 Med-Surg SucceSS teaching ways to prevent an acute exacerbation of diverticulosis? Select all that apply. 1. Eat a high-fiber diet. 2. Increase fluid intake. 3. Elevate the HOB after eating. 4. Walk 30 minutes a day. 5. Take an antacid every two (2) hours. 59. The nurse is working in an outpatient clinic. Which client is most likely to have a diagnosis of diverticulosis? 1. A 60-year- old male with a sedentary lifestyle. 2. A 72-year- old female with multiple childbirths. 3. A 63-year- old female with hemorrhoids. 4. A 40-year-old male with a family history of diverticulosis. 60. The client is admitted to the medical floor with acute diverticulitis. Which collaborative intervention should the nurse anticipate the healthcare provider ordering? 1. Administer total parenteral nutrition. 2. Maintain NPO and nasogastric tube. 3. Maintain on a high-fiber diet and increase fluids. 4. Obtain consent for abdominal surgery. Gallbladder Disorders 61. The client is four (4) hours postoperative open cholecystectomy. Which data warrant immediate intervention by the nurse? 1. Absent bowel sounds in all four (4) quadrants. 2. The T-tube has 60 mL of green drainage. 3. Urine output of 100 mL in the past three (3) hours. 4. Refusal to turn, deep breathe, and cough. 62. The client two (2) hours postoperative laparoscopic cholecystectomy is complaining of severe pain in the right shoulder. Which nursing intervention should the nurse implement? 1. Apply a heating pad to the abdomen for 15 to 20 minutes. 2. Administer morphine sulfate intravenously after diluting with saline. 3. Contact the surgeon for an order to x-ray the right shoulder. 4. Apply a sling to the right arm, which was injured during surgery. 63. The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective? 1. “I will take my lipid-lowering medicine at the same time each night.” 2. “I may experience some discomfort when I eat a high-fat meal.” 3. “I need someone to stay with me for about a week after surgery.” 4. “I should not splint my incision when I deep breathe and cough.” 64. Which signs and symptoms should the nurse report to the health-care provider for the client recovering from an open cholecystectomy? Select all that apply. 1. Clay-colored stools. 2. Yellow-tinted sclera. 3. Amber-colored urine. 4. Wound approximated. 5. Abdominal pain. 65. The nurse is caring for the immediate postoper ative client who had a laparoscopic cholecystectomy. Which task could the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Check the abdominal dressings for bleeding. 2. Increase the IV fluid if the blood pressure is low. 3. Ambulate the client to the bathroom. 4. Auscultate the breath sounds in all lobes. 66. Which data should the nurse expect to assess in the client who had an upper gastrointestinal ( UGI) series? 1. Chalky white stools. 2. Increased heart rate. 3. A firm, hard abdomen. 4. Hyperactive bowel sounds. 67. The client is one (1) hour post–endoscopic retrograde cholangiopancreatogram (ERCP). Which intervention should the nurse include in the plan of care? 1. Instruct the client to cough forcefully. 2. Encourage early ambulation. 3. Assess for return of a gag reflex. 4. Administer held medications. 68. Which outcome should the nurse identify for the client scheduled to have a cholecystectomy? 1. Decreased pain management. 2. Ambulate first day postoperative. 3. No break in skin integrity. 4. Knowledge of postoperative care. 69. Which assessment data indicate to the nurse the client recovering from an open cholecystectomy may require pain medication? 1. The client’s pulse is 65 beats per minute. 2. The client has shallow respirations. 3. The client’s bowel sounds are 20 per minute. 4. The client uses a pillow to splint when coughing. 70. The charge nurse is monitoring client laboratory values. Which value is expected in the client with cholecystitis who has chronic inflammation? chapter 7 gaStrointeStinal diSorderS 257 1. An elevated white blood cell (WBC) count. 2. A decreased lactate dehydrogenase (LDH). 3. An elevated alkaline phosphatase. 4. A decreased direct bilirubin level. 71. Which problem is highest priority for the nurse to identify in the client who had an open cholecystectomy surgery? 1. Alteration in nutrition. 2. Alteration in skin integrity. 3. Alteration in urinary pattern. 4. Alteration in comfort. 72. The nurse assesses a large amount of red drainage on the dressing of a client who is six (6) hours postoperative open cholecystectomy. Which intervention should the nurse implement? 1. Measure the abdominal girth. 2. Palpate the lower abdomen for a mass. 3. Turn client onto side to assess for further drainage. 4. Remove the dressing to determine the source. Liver Failure 73. The client diagnosed with end-stage liver failure is admitted with esophageal bleeding. The HCP inserts and inflates a triple-lumen nasogastric tube (Sengstaken-Blakemore). Which nursing intervention should the nurse implement for this treatment? 1. Assess the gag reflex every shift. 2. Stay with the client at all times. 3. Administer the laxative lactulose (Chronulac). 4. Monitor the client’s ammonia level. 74. The client has had a liver biopsy. Which postprocedure intervention should the nurse implement? 1. Instruct the client to void immediately. 2. Keep the client NPO for eight (8) hours. 3. Place the client on the right side. 4. Monitor blood urea nitrogen (BUN) and creatinine level. 75. The client diagnosed with end-stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication? 1. Restrict sodium intake to 2 g/day. 2. Limit oral fluids to 1,500 mL/day. 3. Decrease the daily fat intake. 4. Reduce protein intake to 60 to 80 g/day. 76. The client diagnosed with end-stage renal failure and ascites is scheduled for a paracentesis. Which client teaching should the nurse discuss with the client? 1. Explain the procedure will be done in the operating room. 2. Instruct the client a Foley catheter will have to be inserted. 3. Tell the client vital signs will be taken frequently after the procedure. 4. Provide instructions on holding the breath when the HCP inserts the catheter. 77. The client diagnosed with liver failure is experiencing pruritus secondary to severe jaundice. Which action by the unlicensed assistive personnel (UAP) warrants intervention by the nurse? 1. The UAP is assisting the client to take a hot, soapy shower. 2. The UAP applies an emollient to the client’s legs and back. 3. The UAP puts mittens on both hands of the client. 4. The UAP pats the client’s skin dry with a clean towel. 78. The nurse identifies the client problem “excess fluid volume” for the client in liver failure. Which short-term goal would be most appropriate for this problem? 1. The client will not gain more than two (2) kg a day. 2. The client will have no increase in abdominal girth. 3. The client’s vital signs will remain within normal limits. 4. The client will receive a low-sodium diet. 79. The client in end-stage liver failure has vitamin K deficiency. Which interventions should the nurse implement? Select all that apply. 1. Avoid rectal temperatures. 2. Use only a soft toothbrush. 3. Monitor the platelet count. 4. Use small-gauge needles. 5. Assess for asterixis. 80. Which gastrointestinal assessment data should the nurse expect to find when assessing the client in end-stage liver failure? 1. Hypoalbuminemia and muscle wasting. 2. Oligomenorrhea and decreased body hair. 3. Clay-colored stools and hemorrhoids. 4. Dyspnea and caput medusae. 81. Which assessment question is priority for the nurse to ask the client diagnosed with end-stage liver failure secondary to alcoholic cirrhosis? 258 Med-Surg SucceSS 1. “How many years have you been drinking alcohol?” 2. “Have you completed an advance directive?” 3. “When did you have your last alcoholic drink?” 4. “What foods did you eat at your last meal?” 82. The client has end-stage liver failure secondary to alcoholic cirrhosis. Which complication indicates the client is at risk for developing hepatic encephalopathy? 1. Gastrointestinal bleeding. 2. Hypoalbuminemia. 3. Splenomegaly. 4. Hyperaldosteronism. 83. The client is diagnosed with end-stage liver failure. The client asks the nurse, “Why is my doctor decreasing the doses of my medications?” Which statement is the nurse’s best response? 1. “You are worried because your doctor has decreased the dosage.” 2. “You really should ask your doctor. I am sure there is a good reason.” 3. “You may have an overdose of the medications because your liver is damaged.” 4. “The half-life of the medications is altered because the liver is damaged.” 84. The client is admitted with end-stage liver failure and is prescribed the laxative lactulose (Chronulac). Which statement indicates the client needs more teaching concerning this medication? 1. “I should have two to three soft stools a day.” 2. “I must check my ammonia level daily.” 3. “If I have diarrhea, I will call my doctor.” 4. “I should check my stool for any blood.” Hepatitis 85. The client is in the preicteric phase of hepatitis. Which signs/symptoms should the nurse expect the client to exhibit during this phase? 1. Clay-colored stools and jaundice. 2. Normal appetite and pruritus. 3. Being afebrile and left upper quadrant pain. 4. Complaints of fatigue and diarrhea. 86. The public health nurse is teaching day-care workers. Which type of hepatitis is transmitted by the fecal–oral route via contaminated food, water, or direct contact with an infected person? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis D. 87. Which type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne Precautions. 2. Standard Precautions. 3. Droplet Precautions. 4. Exposure Precautions. 88. The school nurse is discussing methods to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important to teach the high school teachers? 1. Do not allow students to eat or drink after each other. 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Sing the happy birthday song while washing hands. 89. Which instruction should the nurse discuss with the client who is in the icteric phase of hepatitis C? 1. Decrease alcohol intake. 2. Encourage rest periods. 3. Eat a large evening meal. 4. Drink diet drinks and juices. 90. The public health nurse is discussing hepatitis B with a group in the community. Which health promotion activities should the nurse discuss with the group? Select all that apply. 1. Do not share needles or equipment. 2. Use barrier protection during sex. 3. Get the hepatitis B vaccine. 4. Obtain immune globulin injections. 5. Avoid any type of hepatotoxic medications. 91. The client with hepatitis asks the nurse, “I went to an herbalist, who recommended I take milk thistle. What do you think about the herb?” Which statement is the nurse’s best response? 1. “You are concerned about taking an herb.” 2. “The herb has been used to treat liver disease.” 3. “I would not take anything that is not prescribed.” 4. “Why would you want to take any herbs?” 92. The nurse writes the problem “imbalanced nutrition: less than body requirements” for the client diagnosed with hepatitis. Which intervention should the nurse include in the plan of care? 1. Provide a high-calorie intake diet. 2. Discuss total parenteral nutrition (TPN). 3. Instruct the client to decrease salt intake. 4. Encourage the client to increase water intake. 93. The female nurse sticks herself with a contaminated needle. Which action should the nurse implement first? 1. Notify the infection control nurse. 2. Cleanse the area with soap and water. 3. Request postexposure prophylaxis. 4. Check the hepatitis status of the client. chapter 7 gaStrointeStinal diSorderS 259 94. The client diagnosed with liver problems asks the nurse, “Why are my stools clay-colored?” On which scientific rationale should the nurse base the response? 1. There is an increase in serum ammonia level. 2. The liver is unable to excrete bilirubin. 3. The liver is unable to metabolize fatty foods. 4. A damaged liver cannot detoxify vitamins. 95. Which statement by the client diagnosed with hepatitis warrants immediate intervention by the clinic nurse? 1. “I will not drink any type of beer or mixed drink.” 2. “I will get adequate rest so I don’t get exhausted.” 3. “I had a big hearty breakfast this morning.” 4. “I took some cough syrup for this nasty head cold.” 96. Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Draw the serum liver function test. 2. Evaluate the client’s intake and output. 3. Perform the bedside glucometer check. 4. Help the ward clerk transcribe orders. Gastroenteritis 97. The female client came to the clinic complaining of abdominal cramping and at least 10 episodes of diarrhea every day for the last two (2) days. The client just returned from a trip to Mexico. Which intervention should the nurse implement? 1. Instruct the client to take a cathartic laxative daily. 2. Encourage the client to drink lots of Gatorade. 3. Discuss the need to increase protein in the diet. 4. Explain the client should weigh herself daily. 98. Which intervention should the nurse include when discussing ways to help prevent potential episodes of gastroenteritis from Clostridium botulism? 1. Make sure all hamburger meat is well cooked. 2. Ensure all dairy products are refrigerated. 3. Discuss why campers should drink only bottled water. 4. Discard damaged canned goods. 99. The client is diagnosed with salmonellosis secondary to eating some slightly cooked hamburger meat. Which clinical manifestations should the nurse expect the client to report? 1. Abdominal cramping, nausea, and vomiting. 2. Neuromuscular paralysis and dysphagia. 3. Gross amounts of explosive bloody diarrhea. 4. Frequent “rice water stool” with no fecal odor. 100. The client is diagnosed with gastroenteritis. Which laboratory data warrant immediate intervention by the nurse? 1. A serum sodium level of 137 mEq/L. 2. Arterial blood gases of pH 7.37, Pao2 95, Paco2 43, HCO3 24. 3. A serum potassium level of 3.3 mEq/L. 4. A stool sample positive for fecal leukocytes. 101. The client diagnosed with gastroenteritis is being discharged from the emergency department. Which intervention should the nurse include in the discharge teaching? 1. If diarrhea persists for more than 96 hours, contact the health-care provider. 2. Instruct the client to wash hands thoroughly before handling any type of food. 3. Explain the importance of decreasing steroids gradually as instructed. 4. Discuss how to collect all stool samples for the next 24 hours. 102. Which medication should the nurse expect the HCP to order to treat the client diagnosed with botulism secondary to eating contaminated canned goods? 1. An antidiarrheal medication. 2. An aminoglycoside antibiotic. 3. An antitoxin medication. 4. An ACE inhibitor medication. 103. Which nursing problem is priority for the 76- year-old client diagnosed with gastroenteritis from staphylococcal food poisoning? 1. Fluid volume deficit. 2. Nausea. 3. Risk for aspiration. 4. Impaired urinary elimination. 104. Which data should the nurse expect to assess in the client diagnosed with acute gastroenteritis? 1. Decreased gurgling sounds on auscultation of the abdominal wall. 2. A hard, firm, edematous abdomen on palpation. 3. Frequent, small melena-type liquid bowel movements. 4. Bowel assessment reveals loud, rushing bowel sounds. 105. The 79-year-old client diagnosed with acute gastroenteritis is admitted to the medical unit. Which task would be most appropriate for the 260 Med-Surg SucceSS nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Evaluate the client’s intake and output. 2. Take the client’s vital signs. 3. Change the client’s intravenous solution. 4. Assess the client’s perianal area. 106. Which statement indicates to the emergency department nurse the client diagnosed with acute gastroenteritis understands the discharge teaching? 1. “I will probably have some leg cramps while I have gastroenteritis.” 2. “I should decrease my fluid intake until the diarrhea subsides.” 3. “I should reintroduce solid foods very slowly back into my diet.” 4. “I should only drink bottled water until the abdominal cramping stops.” 107. Which nursing interventions should be included in the care plan for the 84-year-old client diagnosed with acute gastroenteritis? Select all that apply. 1. Assess the skin turgor on the back of the client’s hands. 2. Monitor the client for orthostatic hypotension. 3. Record the frequency and characteristics of sputum. 4. Use Standard Precautions when caring for the client. 5. Institute safety precautions when ambulating the client. 108. The nurse has received the a.m. shift report. Which client should the nurse assess first? 1. The 44-year-old client diagnosed with peptic ulcer disease who is complaining of acute epigastric pain. 2. The 74-year-old client diagnosed with acute gastroenteritis who has had four (4) diarrhea stools during the night. 3. The 65-year-old client diagnosed with IBD who has tented skin turgor and dry mucous membranes. 4. The 15-year-old client diagnosed with food poisoning who has vomited several times during the night shift. abdominal Surgery 109. The male client had abdominal surgery and the nurse suspects the client has peritonitis. Which assessment data support the diagnosis of peritonitis? 1. Absent bowel sounds and potassium level of 3.9 mEq/L. 2. Abdominal cramping and hemoglobin of 14 g/dL. 3. Profuse diarrhea and stool specimen shows Campylobacter. 4. Hard, rigid abdomen and white blood cell count 22,000/mm3 . 110. The client who had abdominal surgery tells the nurse, “I felt something give way in my stomach.” Which intervention should the nurse implement first? 1. Notify the surgeon immediately. 2. Instruct the client to splint the incision. 3. Assess the abdominal wound incision. 4. Administer pain medication intravenously. 111. The client is one (1) day postoperative major abdominal surgery. Which client problem is priority? 1. Impaired skin integrity. 2. Fluid and electrolyte imbalance. 3. Altered bowel elimination. 4. Altered body image. 112. The client has an eviscerated abdominal wound. Which intervention should the nurse implement? 1. Apply sterile normal saline dressing. 2. Use sterile gloves to replace protruding parts. 3. Place the client in reverse Trendelenburg position. 4. Administer intravenous antibiotic immediately (STAT). 113. The client is diagnosed with peritonitis. Which assessment data indicate to the nurse the client’s condition is improving? 1. The client is using more pain medication on a daily basis. 2. The client’s nasogastric tube is draining coffee-ground material. 3. The client has a decrease in temperature and a soft abdomen. 4. The client has had two (2) soft-formed bowel movements. 114. The client developed a paralytic ileus after abdominal surgery. Which intervention should the nurse include in the plan of care? 1. Administer a laxative of choice. 2. Encourage the client to increase oral fluids. 3. Encourage the client to take deep breaths. 4. Maintain a patent nasogastric tube. 115. The client who had an abdominal surgery has a Jackson Pratt (JP) drainage tube. Which assessment data warrant immediate intervention by the nurse? 1. The bulb is round and has 40 mL of fluid. 2. The drainage tube is taped to the dressing. chapter 7 gaStrointeStinal diSorderS 261 3. The JP insertion site is pink and has no drainage. 4. The JP bulb has suction and is sunken in. 116. The postanesthesia care nurse is caring for a client who had abdominal surgery and is complaining of nausea. Which intervention should the nurse implement first? 1. Medicate the client with a narcotic analgesic ( IVP ). 2. Assess the nasogastric tube for patency. 3. Check the temperature for elevation. 4. Hyperextend the neck to prevent stridor. 117. The nurse is assessing the client recovering from abdominal surgery who has a patientcontrolled analgesia (PCA) pump. The client has shallow respirations and refuses to deep breathe. Which intervention should the nurse implement? 1. Insist the client take deep breaths. 2. Notify the surgeon to request a chest x-ray. 3. Determine the last time the client used the PCA pump. 4. Administer oxygen at 2 L/min via nasal cannula. 118. The client has a nasogastric tube. The healthcare provider orders IV fluid replacement based on the previous hour’s output plus the baseline IV fluid ordered of 125 mL/hr. From 0800 to 0900 the client’s N/G tube drained 45 mL. At 0900, what rate should the nurse set for the IV pump? _______ 119. The nurse is caring for clients on a surgical unit. Which client should the nurse assess first? 1. The client who had an inguinal hernia repair and has not voided in four (4) hours. 2. The client who was admitted with abdominal pain who suddenly has no pain. 3. The client four (4) hours postoperative abdominal surgery with no bowel sounds. 4. The client who is one (1) day postappendectomy and is being discharged. 120. The 84-year-old client comes to the clinic complaining of right lower abdominal pain. Which question is most appropriate for the nurse to ask the client? 1. “When was your last bowel movement?” 2. “Did you have a high-fat meal last night?” 3. “Can you describe the type of pain?” 4. “Have you been experiencing any gas?” Eating Disorders 121. The female client presents to the clinic for an examination because she has not had a menstrual cycle for several months and wonders if she could be pregnant. The client is 5′10″ tall and weighs 45 kg. Which assessment data should the nurse obtain first? 1. Ask the client to recall what she ate for the last 24 hours. 2. Determine what type of birth control the client has been using. 3. Reweigh the client to confirm the data. 4. Take the client’s pulse and blood pressure. 122. The occupational health nurse observes the chief financial officer eat large lunch meals. The client disappears into the restroom after a meal for about 20 minutes. Which observation by the nurse would indicate the client has bulimia? 1. The client jogs two (2) miles a day. 2. The client has not gained weight. 3. The client’s teeth are a green color. 4. The client has smooth knuckles. 123. The nurse is caring for a client diagnosed with bulimia nervosa. Which nursing intervention should the nurse implement after the client’s evening meal? 1. Praise the client for eating all the food on the tray. 2. Stay with the client for 45 minutes to an hour. 3. Allow the client to work out on the treadmill. 4. Place the client on bedrest until morning. 124. The nurse writes a problem “low self-esteem” for a 16-year-old client diagnosed with anorexia. Which client goal should be included in the plan of care? 1. The client will spend one (1) hour a day with the parents. 2. The client eats 50% of the meals provided. 3. Dietary will provide high-protein milk shakes (tid). 4. The client will verbalize one positive attribute. 125. The female client diagnosed with anorexia nervosa is admitted to the hospital. The client is 67 inches tall and weighs 40 kg. Which client problem has the highest priority? 1. Altered nutrition. 2. Low self-esteem. 3. Disturbed body image. 4. Altered sexuality. 262 Med-Surg SucceSS 126. Which diagnostic test should the nurse monitor for the client diagnosed with severe anorexia nervosa? 1. Liver function tests. 2. Kidney function tests. 3. Cardiac function tests. 4. Bone density scan. 127. The female client is more than 10% over ideal body weight. Which nursing intervention should the nurse implement first? 1. Ask the client why she is eating too much. 2. Refer the client to a gymnasium for exercise. 3. Have the client set a realistic weight loss goal. 4. Determine the client’s eating patterns. 128. The client who is morbidly obese has undergone gastric bypass surgery. Which immediate postoperative intervention has the greatest priority? 1. Monitor respiratory status. 2. Weigh the client daily. 3. Teach a healthy diet. 4. Assist in behavior modification. 129. The client who is obese presents to the clinic before beginning a weight loss program. Which interventions should the nurse teach? Select all that apply. 1. Walk for 30 minutes three (3) times a day. 2. Determine situations that initiate eating behavior. 3. Weigh at the same time every day. 4. Limit sodium in the diet. 5. Refer to a weight support group. 130. The 22-year-old female who is obese is discussing weight loss programs with the nurse. Which information should the nurse teach? 1. Jog for two (2) to three (3) hours every day. 2. Lifestyle behaviors must be modified. 3. Eat one (1) large meal every day in the evening. 4. Eat 1,000 calories a day and don’t take vitamins. 131. The 36-year-old female client diagnosed with anorexia nervosa tells the nurse “I am so fat. I won’t be able to eat today.” Which response by the nurse is most appropriate? 1. “Can you tell me why you think you are fat?” 2. “You are skinny. Many women wish they had your problem.” 3. “If you don’t eat, we will have to restrain you and feed you.” 4. “Not eating might cause physical problems.” 132. The client is being admitted to the outpatient psychiatric clinic diagnosed with bulimia. Which question should the nurse ask to identify behaviors suggesting bulimia? 1. “When was the last time you exercised?” 2. “What over-the-counter medications do you take?” 3. “How long have you had a positive selfimage?” 4. “Do you eat a lot of high-fiber foods for bowel movements?” Constipation/Diarrhea Disorders 133. The client being admitted from the emergency department is diagnosed with a fecal impaction. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication every day and prn. 2. Perform bowel training every two (2) hours. 3. Administer an oil retention enema. 4. Prepare for an upper gastrointestinal (UGI) series x-ray. 134. The nurse is caring for a client who uses cathartics frequently. Which statement made by the client indicates an understanding of the discharge teaching? 1. “In the future I will eat a banana every time I take the medication.” 2. “I don’t have to have a bowel movement every day.” 3. “I should limit the fluids I drink with my meals.” 4. “If I feel sluggish, I will eat a lot of cheese and dairy products.” 135. The client has been experiencing difficulty and straining when expelling feces. Which intervention should the nurse discuss with the client? 1. Explain some blood in the stool will be normal for the client. 2. Instruct the client in manual removal of feces. 3. Encourage the client to use a cathartic laxative on a daily basis. 4. Place the client on a high-fiber diet. 136. The client has dark, watery, and shiny-appearing stool. Which intervention should the nurse implement first? 1. Check for a fecal impaction. 2. Encourage the client to drink fluids. 3. Check the chart for sodium and potassium levels. 4. Apply a protective barrier cream to the perianal area. chapter 7 gaStrointeStinal diSorderS 263 137. The charge nurse has just received the shift report. Which client should the nurse see first? 1. The client diagnosed with Crohn’s disease who had two (2) semiformed stools on the previous shift. 2. The elderly client admitted from another facility who is complaining of constipation. 3. The client diagnosed with AIDS who had a 200-mL diarrhea stool and has elastic skin tissue turgor. 4. The client diagnosed with hemorrhoids who had some spotting of bright red blood on the toilet tissue. 138. The dietitian and the nurse in a long-term care facility are planning the menu for the day. Which foods should be recommended for the immobile clients for whom swallowing is not an issue? 1. Cheeseburger and milk shake. 2. Canned peaches and a sandwich on wholewheat bread. 3. Mashed potatoes and mechanically ground red meat. 4. Biscuits and gravy with bacon. 139. The client diagnosed with AIDS is experiencing voluminous diarrhea. Which interventions should the nurse implement? Select all that apply. 1. Monitor diarrhea, charting amount, character, and consistency. 2. Assess the client’s tissue turgor every day. 3. Encourage the client to drink carbonated soft drinks. 4. Weigh the client daily in the same clothes and at the same time. 5. Assist the client with a warm sitz bath PRN. 140. The nurse, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task would be most appropriate to assign to the LPN? 1. Assist the UAP to learn to perform blood glucose checks. 2. Monitor the potassium levels of a client with diarrhea. 3. Administer a bulk laxative to a client diagnosed with constipation. 4. Assess the abdomen of a client who has had complaints of pain. 141. The client is placed on percutaneous endoscopic gastrostomy (PEG) tube feedings. Which occurrence warrants immediate intervention by the nurse? 1. The client tolerates the feedings being infused at 50 mL/hr. 2. The client pulls the nasogastric feeding tube out. 3. The client complains of being thirsty. 4. The client has green, watery stool. 142. The client presents to the emergency department experiencing frequent watery, bloody stools after eating some undercooked meat at a fast-food restaurant. Which intervention should be implemented first? 1. Obtain a stool sample from the client. 2. Initiate antibiotic therapy intravenously. 3. Have the laboratory draw a complete blood count. 4. Administer the antidiarrheal medication Lomotil. 143. The clinic nurse is talking on the phone to a client who has diarrhea. Which intervention should the nurse discuss with the client? 1. Tell the client to measure the amount of stool. 2. Recommend the client come to the clinic immediately. 3. Explain the client should follow the BRAT diet. 4. Discuss taking an over-the-counter histamine-2 blocker. 144. The nurse is caring for clients on a medical unit. Which client information should be brought to the attention of the HCP immediately? 1. A serum sodium of 128 mEq/L in a client diagnosed with obstipation. 2. The client diagnosed with fecal impaction who had two (2) hard formed stools. 3. A serum potassium level of 3.8 mEq/L in a client diagnosed with diarrhea. 4. The client with diarrhea who had two (2) semiliquid stools totaling 300 mL. COnCEPtS The concepts covered in this chapter focus on nutrition and acid–base problems. Exemplars that are covered are eating disorders/dietary recommendations and gastrointestinal disorders. Interrelated concepts of the nursing process and 264 Med-Surg SucceSS critical thinking are covered throughout the questions. The concept of critical thinking is presented in the prioritizing or “first” questions. 145. The nurse is caring for a postoperative client with a nasogastric tube to low intermittent suction. Which intervention should the nurse implement first based on the blood gas results? Arterial Blood Gas Results Client Value Normal Values pH 7.48 7.35–7.45 O2 Saturation 96 80–100 Paco2 46 35–45 HCO3 20 22–26 1. Assess the output in the suction canister. 2. Apply oxygen by nasal cannula. 3. Have the client take slow, deep breaths. 4. Place the client on stool specimen collection. 146. The 70-year-old client is admitted to the medical unit diagnosed with acute diverticulitis. Which interventions should the nurse implement? Select all that apply. 1. Tell the client not to eat or drink. 2. Start an intravenous line. 3. Assess the client for abdominal tenderness. 4. Have the dietitian consult for a low-residue diet. 5. Place the client on bedrest with bathroom privileges. 147. The nurse is admitting a client diagnosed with protein calorie malnutrition. Which interventions should the nurse implement? Select all that apply. 1. Place the client on a 72-hour calorie count. 2. Ask the client to describe the stools. 3. Have the UAP weigh the client. 4. Obtain a list of current medications. 5. Make a referral to the dietitian. 148. The client at the eating disorder clinic weighs 35 kg and is 5 ft 7 inches tall. Which would the nurse document as the Body Mass Index (BMI)? ________________ 149. The client presents to the outpatient clinic complaining of diarrhea for two (2) days. Which laboratory data should the nurse monitor? 1. The sodium level. 2. The albumin level. 3. The potassium level. 4. The glucose level. 150. The clinic nurse is returning client calls. Which client should the nurse call first? 1. The 39-year-old client complaining of headache pain with a 3 on the pain scale. 2. The 45-year-old client who needs a prescription refill for warfarin. 3. The 54-year-old client diagnosed with diabetes type 1 who has been vomiting. 4. The 60-year-old client who cannot afford to buy food and needs assistance. 151. The occupational health nurse has had five (5) clients come to the clinic complaining of abdominal cramping, nausea, and vomiting. Which information should the nurse teach the employees to decrease the spread of this condition? 1. Teach the employees to cough into the sleeve. 2. Teach the housekeepers to use an antibacterial soap. 3. Teach the coworkers to get a hepatitis vaccine. chapter 7 gaStrointeStinal diSorderS 265 4. Teach the employees to wash their hands frequently. 152. Which diagnostic data should be reported to the health-care provider (HCP) immediately? 1. The ABG result of pH 7.11, Paco2 45, HCO3 20, and Pao2 98 for a client diagnosed with type 1 diabetes. 2. Sodium 137 mEq/L, potassium 4 mEq/L, glucose 120 mg/dL for a client diagnosed with gastroenteritis. 3. Hemoglobin 9.4 g/dL and hematocrit 29% for a client who received a blood transfusion of the previous shift. 4. A pulse oximetry reading of 93% for a client diagnosed with chronic obstructive pulmonary disease (COPD). 153. The parents of a female toddler bring the child to the pediatrician’s office with nausea, vomiting, and diarrhea. Which intervention should the nurse implement first? 1. Ask the parent about the child’s diet. 2. Assess the child’s tissue turgor. 3. Give the child a sucker if she is “good.” 4. Notify the HCP the child is waiting to be seen. 154. The weight loss clinic nurse identifies the concept of nutrition for a client diagnosed with obesity. Which interventions should the nurse implement? Select all that apply. 1. Ask the client about previous diet attempts. 2. Refer the client to the dietitian. 3. Discuss maintaining a sedentary lifestyle. 4. Weigh the client. 5. Assist the client to set a realistic weight loss goal. 155. The client diagnosed with bulimia has a BMI of 20. The nurse understands which scientific rationale explains this finding? Body Mass Index Category BMI Lower Range BMI Upper Range Underweight Greater than 19 — Ideal weight 19 24.9 Overweight 25 30 Obese 30.1 — 1. The BMI is low because the client does not eat and exercises frequently. 2. The BMI is within normal range because the client’s therapy is effective. 3. The BMI is WNL because the client vomits or uses laxatives to prevent weight gain. 4. The BMI is high and the client needs to try new methods of weight control. 156. The nurse is teaching the American Diabetes Association diet to a client diagnosed with diabetes mellitus type 2. Which should the nurse teach the client? 1. Instruct the client to weigh all food before cooking it. 2. Teach the client to eat only carbohydrates if the blood glucose is low. 3. Demonstrate how to determine the amount of carbohydrates being eaten. 4. Explain that proteins should be 75% of the recommended diet. PRaCtiCE QUEStiOnS anSWERS anD RatiOnaLES Gastroesophageal Reflux (GERD) 1. 1. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss but not weight gain. 2. Most clients with GERD have been self-medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. 3. Milk and dairy products contain lactose, which are important if considering lactose intolerance but are not important for “heartburn.” 4. Heartburn is not a symptom of a viral illness. TEST-TAKING HINT: Clients will use common terms such as “heartburn” to describe symptoms. The nurse must be able to interpret or clarify the meaning of terms used with the client. Part of the assessment of a symptom requires determining what aggravates and alleviates the symptom. Content – Medical: Integrated Nursing Process – Assessment: Client Needs – Physiological Integrity, Reduction of Risk Potential: Cognitive Level – Analysis: Concept – Digestion. 2. 1. The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. Behavior modification is changing one’s behavior. 2. The client should be encouraged to quit smoking altogether. Referral to support groups for smoking cessation should be made. 3. The nurse should be careful when recommending OTC medications. This is not the most appropriate intervention for a client with GERD. 4. The client should be instructed to discontinue using alcohol, but the stem does not indicate the client is an alcoholic. TEST-TAKING HINT: Clients are encouraged to quit, not decrease, smoking. Current research indicates smoking is damaging to many body systems, including the gastrointestinal system. The test taker should not assume anything not in the stem of a question. Content – Medical: Integrated Nursing Process – Diagnosis: Client Needs – Physiological Integrity, Physiological Adaptation: Cognitive Level – Analysis: Concept – Digestion. 3. 1. The client is allowed to eat as soon as the gag reflex has returned. 2. An esophagogastroduodenoscopy is a diagnostic procedure, not a cure. Therefore, the client still has GERD and should be instructed to stay in an upright position for two (2) to three (3) hours after eating. 3. Stomach contents are acidic and will erode the esophageal lining. 4. Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal. TEST-TAKING HINT: This question assumes the test taker has knowledge of diagnostic procedures for specific disease processes. Content – Medical: Integrated Nursing Process – Evaluation: Client Needs – Physiological Integrity, Physiological Adaptation: Cognitive Level – Synthesis: Concept – Digestion. 4. 1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach. 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux. TEST-TAKING HINT: The word “any” in option “1” should