1. The nurse is collecting data on a pt w/ruptured appendix that is painful. Where would the nurse expect the pt's pain to be located?
    • Right Lower Quadrant - RLQ
  2. Which of the following is a function of the liver?

    a.  Synthesis of plasma proteins
    b.  Elimination of carbohydrates
    c.  Concentration of bile
    d.  Secretion of cholecystokinin
    • a.  Synthesis of plasma proteins
  3. The nurse is contributing to POC for a 78 y/o pt's elimination needs. Which of the following should the nurse recommend to reduce complications from aging changes of slowed motility?

    a.  Decrease ambulation
    b.  Decrease fluid intake
    c.  Increase dairy products
    d.  Increase dietary fiber
    • d.  Increase dietary fiber
  4. The nurse is listening to a pt's bowel sounds. The nurse understands that bowel sounds heard at irregular rate every 5 to 15 seconds should be documented as which of the following?

    a.  Normal
    b.  Hyperactive
    c.  Hypoactive
    d.  Abnormal
    • a.  Normal
  5. What best describes the technique of palpation?
    • Lightly depress abdomen 0.5 to 1 inch
  6. The nurse is contributing to POC for a pt having a lower GI series. Which measure should the nurse recommend be included in the POC?

    a.  Cough/deep breath hourly while awake
    b.  Encourage fluids
    c.  Check for return of gag reflex
    d.  Keep pt in semi-fowlers position
    • b.  Encourage fluids
  7. The patient is admitted w/an order for a sump tube (Salem sump).  The nurse knows this tube is used for which of the following purposes?

    a.  Supplemental feeding
    b.  Decomprssion
    c.  Irrigation
    d.  Lavage
    e.  Gavage
    f.  Parenteral nutrition
    • b.  Decompression
    • c.  Irrigation
    • d.  Lavage
  8. The nurse inserts flexible feed tube into patient.  Which action should the nurse take to confirm tube placement?

    a.  Aspirate gastric contents for green-colored fluid
    b.  Measure pH of secretions from tube
    c.  Obtain x-ray to check for placement
    d.  Look in the back of the mouth for a coiled tube
    • c.  Obtain an x-ray to check for placement

    Rationale:  A chest x-ray is the only accurate way to verify correct placement of the feeding tube
  9. The nurse is caring for a patient who is receiving a TPN infusion.  Blood glucose monitoring every 6hrs is ordered to detect which of the following?

    a.  Hyponatremia
    b.  Hyperkalemia
    c.  Hypocalcemia
    d.  Hyperglycemia
    • d.  Hyperglycemia

    Rationale:  Hperglycemia may occur due to the high dextrose concentration in TPN
  10. The nurse would expect to assess steatorrhea in which disease process?

    1.  Malabsorption syndrome
    2.  Gastritis
    3.  Irritable bowel syndrome (IBS)
    4.  Duodenal Ulcer
    • 1.  Malabsorption syndrome

    *Steatorrhea refers to the formation and passage of bulky, fatty stools, indicating decreased fat absorption
  11. Which nursing intervention would be included in POC for a patient w/acute diverticulitis?

    1.  Administering bulk laxatives and increasing fluid intake
    2.  Encouraging high-fiber diet and inserting rectal tube
    3.  Administering NPO and initiating nasogastric suctioning
    4.  Administering antidiarrheal medications and encouraging low-fiber diet
    • 3.  Administering NPO and initiating nasogastric suctioning

    *During acute diverticulitis, the bowel must be put totally at rest. Patient must receive NPO and gastric suctioning helps decompress the bowel. After the episode resolves and the pain subsides, patient should resume eating a low-residue diet. Bulk laxatives and increased fluid intake help prevent and exacerbation of diverticulitis. A high-fiber diet would further irritate the bowel. A rectal tube is not required. Diarrhea usually does not accompany diverticulitis.
  12. What S/S would the nurse expect when assessing a pt w/esophagitis?

    1.  Mid-epigastric pain/tenderness
    2.  ABD distention/fever
    3.  ABD cramping/vomiting
    4.  Heartburn/dysphagia
    • 4.  Heartburn/dysphagia

    *Common clinical manifestation of esophagitis includes heartburn, acid regurgitation, belching, dysphagia, and esophageal pain radiating to arms, neck, and jaw.
  13. When assessing a client admitted with a bleeding gastric ulcer, the nurse would expect to assess which type of stool?

    1.  Coffee-ground color
    2.  Clay colored
    3.  Black, tarry
    4.  Bright red
    • 3.  Black, tarry

    • *With a bleeding ulcer, bleeding is occurring high in the GI tract.  Melena or black tarry stools is a sign of bleeding high in the GI tract. The action of the digestive enzymes turns bright red blood to black and tarry before defication occurs.
    • -Coffee ground color is used to describe emesis, indicative of digested blood from a slow bleeding gastric or duodenal lesion.
    • -Clay colored stools indicative of biliary obstruction
    • -Bright red, bloody indicative of bleeding low in GI tract.
  14. For a patient w/GERD, the nurse should include which of the following discharge instructions?

    1.  Elevate food of bed by 6 to 8 inches
    2.  Lie down immediately after meals
    3.  Take antidiarrheal after each loose stool
    4.  Avoid caffeine, tobacco, and peppermint
    4.  Avoid caffeine, tobacco, and peppermint

    *For pts w/GERD, avoid anything that can increase gastric acid production including caffeine, tobacco, peppermint, chocolate, onions, and fatty/fried foods. HOB should be elevated, not FOB. Patient should sit up after eating for at least 1 hour.  Diarrhea is not associated w/GERD.
  15. A 17 y/o patient w/temperature of 100.4*F comes into ER complaining of severe ABD pain in RLQ and has nausea/vomiting in last 6hrs.  Which condition would the nurse suspect?

    1.  Diverticulitis
    2.  Appendicitis
    3.  Gastroenteritis
    4.  Irritable bowel syndrome (IBS)
    2.  Appendicitis

    *Severe RLQ pain (McBurney's point), nausea, vomiting & low-grade fever are common S/S of appendicitis.

    • -Diverticulitis; pain in LLQ or epigastrium
    • -Gastroenteritis; ABD cramping, nausea, vomiting & diarrhea
    • -IBS; altered bowel habits & pain localized in LLQ - relieved by passing flatus or stool
  16. A client who has developed a malabsorption problem after receiving radiation therapy to head, neck & ABD 6mo earlier is at greatest risk for nutritional problems r/t which body area?

    1.  Teeth & tongue
    2.  Sigmoid and rectum
    3.  Small intestine
    4.  Large intestine
    3.  Small intestine

    *It is the small intestine that supports nutrient absorption. The small bowel (duodenum, jejunum, ileum) is responsible for the absorption of most of the major nutrients and a malabsorption problem would place the patient at greatest risk for nutritional problems.
  17. Which would be an appropriate outcome for the patient experiencing constipation?

    1.  Eat high-fiber diet
    2.  Avoid physical exercise
    3.  Drink 1 to 2 glasses of water daily
    4.  Maintain a sedentary lifestyle
    1.  Eat a high-fiber diet

    *A high-fiber diet induces rapid movement through the colon and a large, soft stool.  Lack of physical exercise, inadequate fluid intake, and sedentary lifestyle are predisposing factors for constipation.  Regular physical exercise, high fiber diet and plenty of water contribute to regular elimination.
  18. When assisting a client diagnosed with malabsorption syndrome to develop criteria for reporting stool characteristics, which stool characteristics would be most valuable in identifying diarrhea?

    1.  Quantity
    2.  Constituents
    3.  Color
    4.  Consistency
    4.  Consistency

    *Consistency of stool reflects water content - an increase in fecal fluid content is most descriptive of diarrhea
  19. Which statement by a patient with stomatitis receiving nystatin suspension indicates that the nurse's teaching has been effective?

    1.  Chew tablet thoroughly before swallowing
    2.  Hold medication in mouth for 2 min, swish, then swallow
    3.  Take medication with food to decrease gastric irritation
    4.  I will not drink milk/dairy products at least 1 hr before taking medication
    2.  I will hold the medication in my mouth for 2 min, swish, then swallow

    *Nystatin suspension is prescribed for an oral fungal infection
  20. Which nursing intervention would be included for a patient diagnosed with IBS?

    1.  eat low-fiber diet
    2.  administer a histamine-receptor antagonist
    3.  avoid fluids with meals
    4.  elevate HOB on 6 to 8 inch blocks
    3.  Avoid fluids with meals

    *IBS is a functional disorder of motility. Fluids w/meals should be avoided because this increases ABD distention.
  21. Priority intervention for gastroenteritis?

    1.  Optimal nutritional intake
    2.  Alleviate ABD pain/cramping
    3.  Oral antiemetic every 2 hrs
    4.  Monitor I&O and electrolyte levels
    4.  Monitor I&O and electrolyte levels

    *With gastroenteritis, the client typically experiences vomiting and diarrhea, which put the client at risk for fluid volume deficit and electrolyte imbalance. Close monitoring of I&O along w/serum electrolyte levels is important to prevent imbalances and ensure prompt tx.  Usually, GI tract is allowed to rest by omitting all oral intake.
  22. Two days after emergencyu appendectomy for a ruptured appendix, a 58 y/o patient has a hard, rigid ABD and is complaining of ABD pain that he describes as 7 on scale of 10. Which intervention should the nurse implement?

    1.  Encourage pt to use patient-controlled anesthesia more frequently
    2.  Notify patient's physician immediately
    3.  Assess to determine if patient has bowel sounds
    4.  Encourage patient to turn, cough, and deep breathe
    5.  Administer opioid analgesic IV
    6.  Determine patient's last WBC count
    • 2.  Notify patient's physician immediately
    • 3.  Assess to determine if patient has bowel sounds
    • 6.  Determine patient's last WBC count

    *High pain rating, and a hard, rigid ABD indicate peritonitis and possibly a ruptured appendix. This is a medical emergency; the pt's physician should be notified. Further assessment, which would include assessing bowel sounds and determining if the pt's WBC count is elevated, is needed. The nurse should always rule out complications prior to administering pain medication, and encouraging the client to turn, cough, and deep-breathe will not help peritonitis.
  23. Which nursing action best demonstrates the nurse's understanding of one of the primary complications of peritonitis?

    1.  Providing small, frequent meals
    2.  Performing frequent respiratory assessments
    3.  Assessing skin integrity regularly
    4.  Evaluating stool for color and consistency
    2.  Performing frequent respiratory assessments

    *Because of the proximity of the diaphram to the ABD cavity, the patient is at high risk for respiratory complications.  The severe pain associated w/peritonitis interferes w/max lung expansion. Frequent assessments of respiratory status are essential.  Because pralytic ileus commonly occurs, feeding a client w/peritonitis and assuming diarrhea will occur are inappropriate.
  24. Which medications are used in eradicating Helicobacter pylori in pts diagnosed with peptic ulcer disease?

    1.  Bismuth subsalicylate, metronidazole, and tetracycline
    2.  Antacids, proton pump inhibitors, and antiemetics
    3.  Antibiotics, analgesics, and corticosteroids
    4.  Mucosal protective agents, histamine-receptor antogonists, and antidiarrheals
    1.  Bismuth subsalicylate, metroindazole, and tetracycline

    *These medications exert a bacteriostatic effect to eradicate H. pylori bacteria in the gastric mucosa.
  25. Which teaching instruction should be included for a patient receiving corticosteroids?

    1.  Avoid going out in the sun without using sunblock
    2.  Stop taking the medication if moon face or buffalo hump occur
    3.  Take the medication on an empty stomach
    4.  Discontinue the medication gradually by tapering the dose
  26. 4.  Discontinue the medication gradually by tapering the dose
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