UPPER & LOWER GI REVIEW NURS 2204. REVIEW QUESTION 1 While assessing an older woman, the nurse...

UPPER & LOWER GI REVIEW NURS 2204

REVIEW QUESTION 1 While assessing an older woman, the nurse noticed her teeth have obvious caries and she has difficulty swallowing. She says, My mouth is so dry. What health problem might result from these findings? A. nutritional deficit B. acute pain C. altered elimination D. risk for infection

REVIEW QUESTION 1 - RESPONSE While assessing an older woman, the nurse noticed her teeth have obvious caries and she has difficulty swallowing. She says, My mouth is so dry. What health problem might result from these findings? A. nutritional deficit B. acute pain C. altered elimination D. risk for infection

REVIEW QUESTION 1 - RATIONALE The condition of the patients teeth, possible difficulty for her to chew comfortably, and her dry mouth because of decreased production of saliva in the older adult may cause a nutritional deficit because she will tend to eat food that is easier to chew and swallow.

REVIEW QUESTION 2 A patient asks you to tell her what internal hemorrhoids are. What would you say? A. They are part of the arteries of the body. B. They are just bits of tissue that occur for no reason. C. They are swollen veins in the anal canal. D. They are part of the lymphatic system.

REVIEW QUESTION 2 - RESPONSE A patient asks you to tell her what internal hemorrhoids are. What would you say? A. They are part of the arteries of the body. B. They are just bits of tissue that occur for no reason. C. They are swollen veins in the anal canal. D. They are part of the lymphatic system.

REVIEW QUESTION 2 - RATIONALE Internal hemorrhoids occur with impaired venous return during evacuation of stool or increased abdominal pressure in pregnancy causing distension of veins of the anus.

REVIEW QUESTION 3 Which of the following questions or statements would be appropriate for the patient with an ostomy? A. Have you had any bleeding from your hemorrhoids? B. Has your appetite changed lately? C. Tell me about your family. D. Describe the consistency of your stools.

REVIEW QUESTION 3 - RESPONSE Which of the following questions or statements would be appropriate for the patient with an ostomy? A. Have you had any bleeding from your hemorrhoids? B. Has your appetite changed lately? C. Tell me about your family. D. Describe the consistency of your stools.

REVIEW QUESTION 3 - RATIONALE A patient with an ostomy should have questions answered about the consistency of the stool. This information may indicate location of the opening within the intestinal tract and demonstrate how the bowel is functioning.

REVIEW QUESTION 4 Which diagnostic test would be most appropriate to detect intestinal parasites? A. colonoscopy B. CT of the abdomen C. barium enema D. stool specimen

REVIEW QUESTION 4 - RESPONSE Which diagnostic test would be most appropriate to detect intestinal parasites? A. colonoscopy B. CT of the abdomen C. barium enema D. stool specimen

REVIEW QUESTION 4 - RATIONALE A stool specimen will supply the opportunity to directly exam the feces and detect presence of intestinal parasites.

REVIEW QUESTION 5 Why is removal of polyps during a colonoscopy important? A. to identify genetic disorders B. to prevent the development of cancer C. to facilitate further examination of the bowel D. to decrease future problems with constipation

REVIEW QUESTION 5 - RESPONSE Why is removal of polyps during a colonoscopy important? A. to identify genetic disorders B. to prevent the development of cancer C. to facilitate further examination of the bowel D. to decrease future problems with constipation

REVIEW QUESTION 5 - RATIONALE Polyps have been documented as increased risk factors for developing cancer; therefore, removal is indicated to prevent neoplastic cell development.

REVIEW QUESTION 6 A nurse is conducting a health history and states, Tell me about any colon cancer in your family. Is this an appropriate question? A. No, colon cancer is rarely found in family members. B. No, this question should only be asked by physicians. C. Yes, but it should wait for further diagnostic testing. D. Yes, colon cancer is a common inherited disorder.

REVIEW QUESTION 6 - RESPONSE A nurse is conducting a health history and states, Tell me about any colon cancer in your family. Is this an appropriate question? A. No, colon cancer is rarely found in family members. B. No, this question should only be asked by physicians. C. Yes, but it should wait for further diagnostic testing. D. Yes, colon cancer is a common inherited disorder.

REVIEW QUESTION 6 - RATIONALE Colon cancer is often an inherited disorder; knowledge of family history is important.

REVIEW QUESTION 8 A patient on a reduced-calorie diet asks the nurse what she can do to lose weight faster, because most weeks she loses no more than 0.5 lb. At this rate, it will take me years to get to my goal! The most appropriate response by the nurse would be which of the following?

REVIEW QUESTION 8 - CHOICES A. Lets reevaluate your long-term goal. Perhaps it was set too low for you. B. A pound of body fat equals 3500 calories. Lets reevaluate your diet and exercise plan for calorie intake and expenditure. C. Perhaps we should look into a diet supplement since you are unable to stick with your prescribed diet plan. D. You sound frustrated. Would you like to take some time off from your diet and exercise plan?

REVIEW QUESTION 8 - RESPONSE A. Lets reevaluate your long-term goal. Perhaps it was set too low for you. B. A pound of body fat equals 3500 calories. Lets reevaluate your diet and exercise plan for calorie intake and expenditure. C. Perhaps we should look into a diet supplement since you are unable to stick with your prescribed diet plan. D. You sound frustrated. Would you like to take some time off from your diet and exercise plan?

REVIEW QUESTION 8 - RATIONALE This response informs the patient of the calorie pound relationship and involves the patient in the planning strategies to improve and maintain weight loss.

REVIEW QUESTION 9 An expected finding in a patient admitted with a diagnosis of protein-calorie malnutrition would be which of the following? A. recent 5-lb weight loss B. increased skinfold thickness measurements C. hyperactive bowel sounds D. anxiety and agitation

REVIEW QUESTION 9 - RESPONSE An expected finding in a patient admitted with a diagnosis of protein-calorie malnutrition would be which of the following? A. recent 5-lb weight loss B. increased skinfold thickness measurements C. hyperactive bowel sounds D. anxiety and agitation

REVIEW QUESTION 9 - RATIONALE Recent weight loss is the most prevalent finding in protein-calorie malnutrition. Skinfold thickness is decreased and the patient demonstrates lethargy and drowsiness.

REVIEW QUESTION 10 The nurse identifies which nursing diagnosis as high priority for a patient with a BMI of 30.4 kg/m 2 and a waisthip ratio of 1.1? A. Health-Seeking Behaviors: Weight Loss B. Risk for Impaired Tissue Perfusion: Cardiovascular C. Ineffective Coping D. Deficient Knowledge: Diet

REVIEW QUESTION 10 - RESPONSE The nurse identifies which nursing diagnosis as high priority for a patient with a BMI of 30.4 kg/m 2 and a waisthip ratio of 1.1? A. Health-Seeking Behaviors: Weight Loss B. Risk for Impaired Tissue Perfusion: Cardiovascular C. Ineffective Coping D. Deficient Knowledge: Diet

REVIEW QUESTION 10 - RATIONALE A BMI greater than 25 and central obesity as indicated by a waisthip ratio of 1 or greater are associated with a higher risk for hypertension, elevated lipid levels, heart disease, and stroke. These conditions have the greatest effect on health over time.

REVIEW QUESTION 11 Which of the following is a high-priority nursing intervention to prevent malnutrition in the surgical patient? A. aggressive pain management B. daily weights C. maintaining intravenous flow D. requesting early restoration of oral intake

REVIEW QUESTION 11 - RESPONSE Which of the following is a high-priority nursing intervention to prevent malnutrition in the surgical patient? A. aggressive pain management B. daily weights C. maintaining intravenous flow D. requesting early restoration of oral intake

REVIEW QUESTION 11 - RATIONALE Beginning oral intake of nutrients as soon as possible after surgery is the best way to prevent malnutrition.

REVIEW QUESTION 12 Three days after gastric bypass surgery, the patient complains of increasing abdominal pain. Bowel sounds are absent; the abdomen is firm and very tender. The nurse should do which of the following? A. Report findings to the surgeon. B. Ambulate the patient to promote peristalsis. C. Chart assessment data and continue to monitor. D. Evaluate the effectiveness of analgesia.

REVIEW QUESTION 12 - RESPONSE Three days after gastric bypass surgery, the patient complains of increasing abdominal pain. Bowel sounds are absent; the abdomen is firm and very tender. The nurse should do which of the following? A. Report findings to the surgeon. B. Ambulate the patient to promote peristalsis. C. Chart assessment data and continue to monitor. D. Evaluate the effectiveness of analgesia.

REVIEW QUESTION 12 - RATIONALE One of the postoperative complications with gastric bypass surgery is an anastomotic leak causing peritonitis. These manifestations could be related to this condition and the surgeon needs to be notified.

REVIEW QUESTION 13 The nurse assessing for oral cancer risk factors in a patient with a persistent sore on his tongue asks about which of the following? A. consumption of highly spiced foods B. thumb sucking or pacifier use as a child C. regular use of dental floss D. tobacco use in any form

REVIEW QUESTION 13 - RESPONSE The nurse assessing for oral cancer risk factors in a patient with a persistent sore on his tongue asks about which of the following? A. consumption of highly spiced foods B. thumb sucking or pacifier use as a child C. regular use of dental floss D. tobacco use in any form

REVIEW QUESTION 13 - RATIONALE The use of tobacco and drinking alcohol are the two primary risk factors for oral cancers.

REVIEW QUESTION 14 The nurse evaluates his teaching of a patient with acute stress gastritis as effective when the patient states that she will do which of the following? A. Avoid using aspirin or NSAIDs for routine pain relief. B. Consume only bland foods. C. Return for yearly upper endoscopy exams. D. Fully cook all meat, poultry, and egg products.

REVIEW QUESTION 14 - RESPONSE The nurse evaluates his teaching of a patient with acute stress gastritis as effective when the patient states that she will do which of the following? A. Avoid using aspirin or NSAIDs for routine pain relief. B. Consume only bland foods. C. Return for yearly upper endoscopy exams. D. Fully cook all meat, poultry, and egg products.

REVIEW QUESTION 14 - RATIONALE The most common contributing factor to acute stress gastritis is the interruption of the integrity of the gastric lining by gastric irritants such as aspirin and/or NSAIDs. A period of gastric rest, followed by a slow progression to regular dietary intake is advised.

REVIEW QUESTION 15 The nurse identifies which of the following nursing diagnoses as highest priority for the patient admitted with peptic ulcer disease and possible perforation? A. Acute Pain B. Ineffective Health Maintenance C. Nausea D. Impaired Tissue Integrity: Gastrointestinal

REVIEW QUESTION 15 - RESPONSE The nurse identifies which of the following nursing diagnoses as highest priority for the patient admitted with peptic ulcer disease and possible perforation? A. Acute Pain B. Ineffective Health Maintenance C. Nausea D. Impaired Tissue Integrity: Gastrointestinal

REVIEW QUESTION 15 - RATIONALE A peptic ulcer is an interruption of the integrity of the gastric lining; perforation is the most lethal complication of this process. It produces inflammation, infection, and possibly shock.

REVIEW QUESTION 16 Following a partial gastrectomy for gastric cancer, a patient complains of nausea, abdominal pain and cramping, and diarrhea after eating. Recognizing manifestations of dumping syndrome, the nurse recommends which of the following?

REVIEW QUESTION 16 - CHOICES A. fasting for a period of 6 to 12 hours before meals B. decreasing the protein content of meals C. frequent small meals that contain solid foods or liquids, but not both D. a diet rich in carbohydrates to maintain blood glucose levels

REVIEW QUESTION 16 - RESPONSE A. fasting for a period of 6 to 12 hours before meals B. decreasing the protein content of meals C. frequent small meals that contain solid foods or liquids, but not both D. a diet rich in carbohydrates to maintain blood glucose levels

REVIEW QUESTION 16 - RATIONALE Frequent small meals with solid foods or liquids, not both, are effective in controlling the hyperosmolar problem of dumping syndrome.

REVIEW QUESTION 17 The nurse caring for a patient with esophageal cancer affecting the middle portion of the esophagus would immediately report which of the following? A. crackles in the base of the right lung B. bright bleeding from the mouth C. weight loss D. difficulty swallowing solid foods

REVIEW QUESTION 17 - RESPONSE The nurse caring for a patient with esophageal cancer affecting the middle portion of the esophagus would immediately report which of the following? A. crackles in the base of the right lung B. bright bleeding from the mouth C. weight loss D. difficulty swallowing solid foods

REVIEW QUESTION 17 - RATIONALE Bright bleeding from the mouth could indicate perforation of the esophageal wall or vessel rupture by invasion of a tumor.

REVIEW QUESTION 18 The physician has ordered omeprazole (Prilosec) 20 mg twice daily, clarithromycin 500 mg twice daily, and amoxicillin 1 g daily for a patient with peptic ulcer disease. It is most important for the nurse to instruct the patient to do which of the following?

REVIEW QUESTION 18 - CHOICES A. Stop the drugs immediately and notify the physician if a rash, hives, or itching develop. B. Consume 8 oz of yogurt or buttermilk daily while taking these drugs. C. Take the drugs on an empty stomach, 1 hour before breakfast and at least 2 hours after dinner. D. Take the drugs with a full glass of water.

REVIEW QUESTION 18 - RESPONSE A. Stop the drugs immediately and notify the physician if a rash, hives, or itching develop. B. Consume 8 oz of yogurt or buttermilk daily while taking these drugs. C. Take the drugs on an empty stomach, 1 hour before breakfast and at least 2 hours after dinner. D. Take the drugs with a full glass of water.

REVIEW QUESTION 18 - RATIONALE These manifestations indicate a possible hypersensitivity response to the antibiotics. Anaphylaxis could occur, so this is an emergency situation.

REVIEW QUESTION 19 When planning care for a patient with stomatitis, the nurse identifies which of the following as a priority intervention? A. Assist to cleanse mouth with alcohol based mouthwash following meals. B. Allow patient to select appealing foods from a menu. C. Provide viscous lidocaine to relieve mouth pain before meals. D. Refer the patient to a smoking cessation program.

REVIEW QUESTION 19 - RESPONSE When planning care for a patient with stomatitis, the nurse identifies which of the following as a priority intervention? A. Assist to cleanse mouth with alcohol based mouthwash following meals. B. Allow patient to select appealing foods from a menu. C. Provide viscous lidocaine to relieve mouth pain before meals. D. Refer the patient to a smoking cessation program.

REVIEW QUESTION 19 - RATIONALE The discomfort of stomatitis is aggravated by eating; viscous lidocaine to reduce mouth pain is important to promote nutrition.

REVIEW QUESTION 20 The evening following a gastric resection, the nurse notes that there has been no drainage from the nasogastric tube for the past 3 hours. The nurse should do which of the following? A. Chart the finding. B. Reposition the nasogastric tube. C. Gently irrigate the tube with normal saline. D. Notify the surgeon.

REVIEW QUESTION 20 - RESPONSE The evening following a gastric resection, the nurse notes that there has been no drainage from the nasogastric tube for the past 3 hours. The nurse should do which of the following? A. Chart the finding. B. Reposition the nasogastric tube. C. Gently irrigate the tube with normal saline. D. Notify the surgeon.

REVIEW QUESTION 20 - RATIONALE Maintaining patency of the nasogastric tube following gastric surgery is vital to prevent pressure gastric distension and pressure on the suture line. Irrigating gently with NS, if ordered, is the appropriate action. If unable to open tube, notify surgeon.

REVIEW QUESTION 21 A patient presents at the urgent care clinic with complaints of diarrhea for the past week. The nurse should first do which of the following?

REVIEW QUESTION 21 - CHOICES A. Advise the patient to abstain from all food intake until the diarrhea subsides. B. Ask the patient to describe the number and character of daily stools. C. Question the patient about possible exposure to an enterotoxin or protozoal infection. D. Recommend an over-the-counter antidiarrheal preparation such as Pepto-Bismol.

REVIEW QUESTION 21 - RESPONSE A. Advise the patient to abstain from all food intake until the diarrhea subsides. B. Ask the patient to describe the number and character of daily stools. C. Question the patient about possible exposure to an enterotoxin or protozoal infection. D. Recommend an over-the-counter antidiarrheal preparation such as Pepto-Bismol.

REVIEW QUESTION 21 - RATIONALE The nurse should first assess the number, frequency, and water content of stools to support the diagnosis of diarrhea and estimate fluid and electrolyte loss.

REVIEW QUESTION 22 Which of the following is of highest priority when caring for a patient admitted with possible appendicitis? A. Perform preoperative skin preparation. B. Teach postoperative coughing, deep breathing, and exercise. C. Withhold all food and fluids. D. Insert saline lock for intravenous antibiotic therapy.

REVIEW QUESTION 22 - RESPONSE Which of the following is of highest priority when caring for a patient admitted with possible appendicitis? A. Perform preoperative skin preparation. B. Teach postoperative coughing, deep breathing, and exercise. C. Withhold all food and fluids. D. Insert saline lock for intravenous antibiotic therapy.

REVIEW QUESTION 22 - RATIONALE Appendectomy, often performed on an emergency basis, is the usual treatment for appendicitis. Withholding food and fluids are the most appropriate measures in preparing the patient for surgery.

REVIEW QUESTION 23 When teaching a patient with inflammatory bowel disease about prescribed sulfasalazine (Azulfidine), the nurse instructs the patient to do which of the following? A. Use a sunscreen while taking the drug. B. Take the drug on an empty stomach. C. Limit fluid intake to 1500 mL per day or less. D. Take vitamin C while on the drug.

REVIEW QUESTION 23 - RESPONSE When teaching a patient with inflammatory bowel disease about prescribed sulfasalazine (Azulfidine), the nurse instructs the patient to do which of the following? A. Use a sunscreen while taking the drug. B. Take the drug on an empty stomach. C. Limit fluid intake to 1500 mL per day or less. D. Take vitamin C while on the drug.

REVIEW QUESTION 23 - RATIONALE Sulfasalazine makes the patient susceptible to sunburn so a sunscreen should be used while outside.

REVIEW QUESTION 24 A patient reports frequent large, fatty, foul-smelling stools. The nurse inquires further about which of the following? A. possible exposure to enterotoxins in food or water B. a history of alternating diarrhea and constipation C. known family history of colorectal cancer D. the relationship of episodes to particular foods

REVIEW QUESTION 24 - RESPONSE A patient reports frequent large, fatty, foul-smelling stools. The nurse inquires further about which of the following? A. possible exposure to enterotoxins in food or water B. a history of alternating diarrhea and constipation C. known family history of colorectal cancer D. the relationship of episodes to particular foods

REVIEW QUESTION 24 - RATIONALE Steatorrhea is a manifestation of malabsorption, and may relate to celiac disease. Exposure to foods containing gluten may trigger manifestations such as these.

REVIEW QUESTION 25 A patient tells the nurse that both his father and grandfather died of colon cancer, and he is worried that he is going to die from the same horrible disease. Which of the following does the nurse include in her recommendations?

REVIEW QUESTION 25 - CHOICES A. The genetic link is weak in colon cancer, so he should simply follow the usual recommendations for screening. B. He should plan for annual digital rectal exams and periodic colonoscopy for early identification of possible tumors. C. He should have annual CEA levels drawn to screen for early tumor development. D. Significantly increasing his intake of dietary fiber can reduce his risk of developing colon cancer within 5 years.

REVIEW QUESTION 25 - RESPONSE A. The genetic link is weak in colon cancer, so he should simply follow the usual recommendations for screening. B. He should plan for annual digital rectal exams and periodic colonoscopy for early identification of possible tumors. C. He should have annual CEA levels drawn to screen for early tumor development. D. Significantly increasing his intake of dietary fiber can reduce his risk of developing colon cancer within 5 years.

REVIEW QUESTION 25 - RATIONALE The recommendation for patient health with this familial history of cancer is to monitor for polyps and tumors early through annual digital examinations and periodic colonoscopy. Research has proven a direct genetic link of polyps and cancer development (20%).

REVIEW QUESTION 26 A patient has developed a paralytic ileus following a recent abdominal surgery. What is the most important nursing consideration when caring for this patient? A. Ensure that the patient is able to eat a clear liquid diet. B. Maintain the patient on strict bedrest. C. Monitor bowel sounds every hour. D. Ensure nasogastric tube is functioning.

REVIEW QUESTION 26 - RESPONSE A patient has developed a paralytic ileus following a recent abdominal surgery. What is the most important nursing consideration when caring for this patient? A. Ensure that the patient is able to eat a clear liquid diet. B. Maintain the patient on strict bedrest. C. Monitor bowel sounds every hour. D. Ensure nasogastric tube is functioning.

REVIEW QUESTION 26 - RATIONALE It is most important to maintain the patency of the nasogastric tube to remove gastric secretions and air that may apply pressure to the anastomosis site and cause failure of the suture line.Keeping the stomach decompressed is important to prevent vomiting that could also cause damage to the anastomosis site.

REVIEW QUESTION 27 Mrs. Jones has a history of diverticulosis and has been having abdominal pain recently. When educating Mrs. Jones about her diet prior to discharge from the hospital, what type of foods should be excluded from Mrs. Joness diet? A. whole-wheat bread B. raspberries C. soup D. apples

REVIEW QUESTION 27 - RESPONSE Mrs. Jones has a history of diverticulosis and has been having abdominal pain recently. When educating Mrs. Jones about her diet prior to discharge from the hospital, what type of foods should be excluded from Mrs. Joness diet? A. whole-wheat bread B. raspberries C. soup D. apples

REVIEW QUESTION 27 - RATIONALE Raspberry seeds can cause obstruction to the diverticular opening and set up the environment to initiate diverticulitis.

REVIEW QUESTION 28 Which of the following nursing interventions are of highest priority when caring for a patient with a small bowel obstruction? A. placing the patient in semi-Fowlers position B. maintaining nasogastric suction C. keeping strict intake and output records D. administering prescribed analgesics

REVIEW QUESTION 28 - RESPONSE Which of the following nursing interventions are of highest priority when caring for a patient with a small bowel obstruction? A. placing the patient in semi-Fowlers position B. maintaining nasogastric suction C. keeping strict intake and output records D. administering prescribed analgesics

REVIEW QUESTION 28 - RATIONALE Gastrointestinal decompression removes gastric juices, reducing the amount of accumulated fluid and gas proximal to the obstruction and the risk for bowel ischemia and necrosis.

REVIEW QUESTION 29 A nurse is providing teaching about ileostomy care to a client. Which of the following statements by the client indicates a need for further teaching? A. I will empty my pouch when it becomes one third full. B. I will be certain to take enteric-coated medications. C. I will change my entire pouch system at least weekly. D. I will use caution when eating high fiber foods.

REVIEW QUESTION 29 - RESPONSE A nurse is providing teaching about ileostomy care to a client. Which of the following statements by the client indicates a need for further teaching? A. I will empty my pouch when it becomes one third full. B. I will be certain to take enteric-coated medications. C. I will change my entire pouch system at least weekly. D. I will use caution when eating high fiber foods.

REVIEW QUESTION 29 - RATIONALE This is not an appropriate statement and indicates a need for additional teaching. Enteric-coated medications should be avoided to reduce the risk of blockage caused by the coating The client should empty the pouch when it becomes 1/3 to 1/2 full. The client should change the entire pouch system every 3 to 7 days. The client should eat high fiber foods with caution, as these foods may lead to diarrhea, constipation, or obstruction.

REVIEW QUESTION 30 A nurse is caring for a client with nausea. The client is prescribed intravenous metoclopramide (Reglan), as needed. The nurse knows that Reglan is an effective antiemetic because it A. promotes gastric emptying. B. decreases gastric acid secretions. C. slows peristalsis. D. depresses the vagal nerve.

REVIEW QUESTION 30 - RESPONSE A nurse is caring for a client with nausea. The client is prescribed intravenous metoclopramide (Reglan), as needed. The nurse knows that Reglan is an effective antiemetic because it A. promotes gastric emptying. B. decreases gastric acid secretions. C. slows peristalsis. D. depresses the vagal nerve.

REVIEW QUESTION 30 - RATIONALE Reglan is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Reglan works by promoting gastric emptying. Reglan does not decrease gastric acid secretions. Reglan does not slow peristalsis. Reglan does not depress the vagus nerve.

REVIEW QUESTION 31 A nurse is preparing a client for a barium swallow to evaluate dysphagia. Which statement indicates to the nurse that the client understands the instructions? A. I should take all my oral medications before I come in the morning. B. I will drink plenty of fluids the morning of the test. C. I will remove my metal jewelry before coming in for the test. D. I will bring a snack because Ill be here all day.

REVIEW QUESTION 31 - RESPONSE A nurse is preparing a client for a barium swallow to evaluate dysphagia. Which statement indicates to the nurse that the client understands the instructions? A. I should take all my oral medications before I come in the morning. B. I will drink plenty of fluids the morning of the test. C. I will remove my metal jewelry before coming in for the test. D. I will bring a snack because Ill be here all day.

REVIEW QUESTION 31 - RATIONALE A barium swallow is an esophageal study with fluoroscopy. The client must remove any objects that might show up on x-ray and block visualization of esophageal structures. The client should drink plenty of fluids after the barium swallow to prevent constipation from the barium. A barium swallow should not take any longer than 30 to 60 minutes.

REVIEW QUESTION 32 A nurse is caring for a client who is scheduled for a colonoscopy. The client asks the nurse if there will be a lot of pain during the procedure. Which of the following is an appropriate nursing response?

REVIEW QUESTION 32 - CHOICES A. "Most clients dislike the prep more than the procedure itself." B. "You'll be sedated, but you may remember feeling discomfort during the instrument insertion." C. "No, you shouldn't feel any pain because your rectum will be anesthetized." D. "Don't worry. You'll be sedated for the procedure and probably won't remember a thing."

REVIEW QUESTION 32 - RESPONSE A. "Most clients dislike the prep more than the procedure itself." B. "You'll be sedated, but you may remember feeling discomfort during the instrument insertion." C. "No, you shouldn't feel any pain because your rectum will be anesthetized." D. "Don't worry. You'll be sedated for the procedure and probably won't remember a thing."

REVIEW QUESTION 32 - RATIONALE This therapeutic response appropriately addresses the client's concerns. The client is seeking information, and this response provides the requested information: an accurate description of the sensations the client will experience during the procedure. The rectum will not be anesthetized, although the client may be sedated.

REVIEW QUESTION 33 A nurse is planning care for a client who has gastric ulcer disease. Which of the following conditions should concern the nurse most? A. Signs of dehydration B. Complains of dyspepsia C. Manifests melena D. Develops hematemesis

REVIEW QUESTION 33 - RESPONSE A nurse is planning care for a client who has gastric ulcer disease. Which of the following conditions should concern the nurse most? A. Signs of dehydration B. Complains of dyspepsia C. Manifests melena D. Develops hematemesis

REVIEW QUESTION 33 - RATIONALE The client with acute/urgent need for response to the development of hematemesis, massive bleed, takes priority. The client who shows signs of dehydration should have fluid intake monitored and is not the nursing priority at this time. The client who complains of dyspepsia, a burning gnawing pain, is a common symptom and is not the nursing priority at this time. The client who manifests melena, occult blood in stool, and is not the nursing priority at this time.

REVIEW QUESTION 34 A client with a long history of ulcerative colitis has anemia. The nurse should explain to the client that which of the following manifestations of colitis is likely to result in anemia? A. Decreased iron in the clients diet B. Intestinal malabsorption syndrome C. Chronic blood loss D. Intestinal parasites

REVIEW QUESTION 34 - RESPONSE A client with a long history of ulcerative colitis has anemia. The nurse should explain to the client that which of the following manifestations of colitis is likely to result in anemia? A. Decreased iron in the clients diet B. Intestinal malabsorption syndrome C. Chronic blood loss D. Intestinal parasites

REVIEW QUESTION 34 - RATIONALE A client with long-standing ulcerative colitis is most likely anemic due to chronic blood loss in small amounts that occurs over time. These clients often report bloody stools and are therefore at increased risk for developing anemia. Ulcerative colitis it is not a malabsorption syndrome Inflammatory bowel disease can cause dehydration and anorexia, however. Dietary approaches to ulcerative colitis do not restrict iron; in fact, they often include supplemental iron.

REVIEW QUESTION 35 A nurse is discharge teaching a client who has GERD. Which of the following client statements reveals an understanding of the teaching? A. I can eat whatever I want. B. I will sleep on my left side. C. I will lie down following meals. D. I will sleep with the head of my bed elevated.

REVIEW QUESTION 35 - RESPONSE A nurse is discharge teaching a client who has GERD. Which of the following client statements reveals an understanding of the teaching? A. I can eat whatever I want. B. I will sleep on my left side. C. I will lie down following meals. D. I will sleep with the head of my bed elevated.

REVIEW QUESTION 35 - RATIONALE The client should sleep with the head of the bed elevated 6 to 12 inches for sleep to prevent reflux at night. The client should avoid spicy and acidic foods, caffeine, and carbonated beverages The client should lie on the right side position to decrease symptoms of night time reflux The client should sit up in a chair following meals to decrease reflux; therefore, The client should stop eating 3 hours before bedtime

REVIEW QUESTION 36 A nurse is caring for a client who just had an upper gastrointestinal endoscopic procedure. Which of the following is the assessment priority for this client? A. Pain B. Nausea C. Gag reflex D. Level of consciousness

REVIEW QUESTION 36 - RESPONSE A nurse is caring for a client who just had an upper gastrointestinal endoscopic procedure. Which of the following is the assessment priority for this client? A. Pain B. Nausea C. Gag reflex D. Level of consciousness

REVIEW QUESTION 36 - RATIONALE The greatest risk to the clients safety following endoscopy is aspiration. Until the clients gag reflex returns, the nurse must keep to client NPO and prepare to intervene to keep the airway open and unobstructed. Following endoscopy, the nurse should monitor the clients level of consciousness, monitor the client for nausea and pain, and intervene accordingly HOWEVER return of gag reflex is HIGHEST PRIORITY

REVIEW QUESTION 37 A nurse is administering a tap water enema to a client who states he is having abdominal cramps as a result. Which of the following actions should the nurse take to relieve the client's discomfort? A. Lower the height of the solution container. B. Encourage the client to bear down. C. Allow the client to expel some fluid before continuing. D. Stop the enema and document that the client did not tolerate the procedure.

REVIEW QUESTION 37 - RESPONSE A nurse is administering a tap water enema to a client who states he is having abdominal cramps as a result. Which of the following actions should the nurse take to relieve the client's discomfort? A. Lower the height of the solution container. B. Encourage the client to bear down. C. Allow the client to expel some fluid before continuing. D. Stop the enema and document that the client did not tolerate the procedure.

REVIEW QUESTION 37 - RATIONALE If nausea or cramping occurs, the flow of water should momentarily be slowed, allowing the intestinal spasm to pass and leaving the catheter in place. The nurse should then raise the solution container when the cramping has passed. Bearing down will cause early release of the fluid, decreasing the effectiveness of the enema. Allowing the client to expel solution too early in the procedure will decrease the effectiveness of the enema.

REVIEW QUESTION 38 A nurse in the post anesthesia care unit is assessing a client who has a colostomy after a colectomy. Which of the following conditions should the nurse report to the provider? A. Stoma oozing red drainage B. Shiny moist stoma C. Purplish colored stoma D. Rosebud appearing stoma orifice

REVIEW QUESTION 38 - RESPONSE A nurse in the post anesthesia care unit is assessing a client who has a colostomy after a colectomy. Which of the following conditions should the nurse report to the provider? A. Stoma oozing red drainage B. Shiny moist stoma C. Purplish colored stoma D. Rosebud appearing stoma orifice

REVIEW QUESTION 38 - RATIONALE The client whose stoma is purplish in color indicates ischemia and the provider should be notified immediately. The client whose stoma oozes red drainage is normal immediately following surgery The client whose stoma appears shiny and moist is healthy appearing The client whose stoma has a rosebud appearing stoma orifice is normal

REVIEW QUESTION 39 A nurse is caring for a client who has peptic ulcer disease. The nurse knows to monitor the client for which of the following findings as an indication of the complication of gastrointestinal perforation? A. Hyperactive bowel sounds B. Sudden abdominal pain C. Increased blood pressure D. Bradycardia

REVIEW QUESTION 39 - RESPONSE A nurse is caring for a client who has peptic ulcer disease. The nurse knows to monitor the client for which of the following findings as an indication of the complication of gastrointestinal perforation? A. Hyperactive bowel sounds B. Sudden abdominal pain C. Increased blood pressure D. Bradycardia

REVIEW QUESTION 39 - RATIONALE Classic indications of gastrointestinal perforation include sudden sharp abdominal pain, with a rigid abdomen, declining peristalsis, and progression to septicemia and hypovolemic shock. With gastrointestinal perforation, bowel sounds decrease and paralytic ileus results Blood pressure generally decreases with gastrointestinal perforation due to hemorrhage and the progression to hypovolemic shock Tachycardia is more likely with gastrointestinal perforation due to the progression to hypovolemic shock.

REVIEW QUESTION 40 A nurse is planning care for a client who has a GI bleed. Which of the following actions should the nurse take first? A. Assess orthostatic blood pressure B. Explain the procedure for an upper GI series C. Administer pain medication D. Test the emesis for blood

REVIEW QUESTION 40 - RESPONSE A nurse is planning care for a client who has a GI bleed. Which of the following actions should the nurse take first? A. Assess orthostatic blood pressure B. Explain the procedure for an upper GI series C. Administer pain medication D. Test the emesis for blood

REVIEW QUESTION 40 - RATIONALE The first action the nurse should take using the nursing process is to assess the client; therefore, assessing the orthostatic blood pressure is the first priority to determine if the client is hypovolemic

REVIEW QUESTION 41 A nurse is caring for a client who has diverticular disease. When palpating the clients abdomen where should the nurse anticipate abdominal pain? A. Upper right quadrant B. Upper left quadrant C. Lower right quadrant D. Lower left quadrant

REVIEW QUESTION 41 - RESPONSE A nurse is caring for a client who has diverticular disease. When palpating the clients abdomen where should the nurse anticipate abdominal pain? A. Upper right quadrant B. Upper left quadrant C. Lower right quadrant D. Lower left quadrant

REVIEW QUESTION 41 - RATIONALE The nurse should expect the client to have abdominal pain in the lower left quadrant of the abdomen. The disease is usually found in the sigmoid colon where high pressure to move fecal contents from the rectum causes pouch formation.

REVIEW QUESTION 42 A client is admitted to acute care after discharge three days ago and now has clostridium difficile. Which of the following is an appropriate nursing action? A. Implement neutropenia isolation B. Disinfect equipment with bleach solution C. Use alcohol hand sanitizer D. Obtain a urine culture

REVIEW QUESTION 42 - RESPONSE A client is admitted to acute care after discharge three days ago and now has clostridium difficile. Which of the following is an appropriate nursing action? A. Implement neutropenia isolation B. Disinfect equipment with bleach solution C. Use alcohol hand sanitizer D. Obtain a urine culture

REVIEW QUESTION 42 - RATIONALE The nurse should disinfect equipment with bleach solution to effectively eliminate the spores spread to other clients and personnel. The nurse should implement contact isolation, to prevent the spread of the spores to other clients and personnel. The nurse should use soap and water, not alcohol hand sanitizer, because the spores are resistant to alcohol based sanitizers. The nurse should obtain stool cultures as the spores are found in the intestines.

REVIEW QUESTION 43 A nurse is inserting a nasogastric tube for a client who had a colectomy. The client ask the nurse why he needs the tube. Which of the following statements by the nurse is appropriate? A. The tube will be removed shortly, then you can eat. B. The tube will relieve your stomach pain. C. The tube will decompress your stomach of the gas and fluid. D. Your doctor wants you to have it.

REVIEW QUESTION 43 - RESPONSE A nurse is inserting a nasogastric tube for a client who had a colectomy. The client ask the nurse why he needs the tube. Which of the following statements by the nurse is appropriate? A. The tube will be removed shortly, then you can eat. B. The tube will relieve your stomach pain. C. The tube will decompress your stomach of the gas and fluid. D. Your doctor wants you to have it.

REVIEW QUESTION 43 - RATIONALE The nurse stating the tube will decompress the stomach of gas and fluid is an appropriate statement. The tube will not be removed until bowel sounds are present.

REVIEW QUESTION 44 A nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse? A. "I signed up for a swimming class." B. "I've been buying Tagamet to help with the indigestion I've had." C. "I've lost 2 pounds since my appointment 2 weeks ago." D. "The Naprosyn goes down easier when I crush it and put it in applesauce."

REVIEW QUESTION 44 - RESPONSE A nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse? A. "I signed up for a swimming class." B. "I've been buying Tagamet to help with the indigestion I've had." C. "I've lost 2 pounds since my appointment 2 weeks ago." D. "The Naprosyn goes down easier when I crush it and put it in applesauce."

REVIEW QUESTION 44 - RATIONALE NSAIDs, like Naprosyn, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client may be taking cimetidine (Tagamet) because he is experiencing one or more of these manifestations. Naproxen can be crushed or swallowed whole.

REVIEW QUESTION-46 A patient with Crohns disease has had a bowel resection. The nurse understands that the patient will: A. be disease free once their recovery is complete B. possibly have a reoccurrence in another section of bowel C. have a higher potential to have ulcerative colitis D. experience intestinal strictures

REVIEW QUESTION 46-RESPONSE A patient with Crohns disease has had a bowel resection. The nurse understands that the patient will: A. be disease free once their recovery is complete B. possibly have a reoccurrence in another section of bowel C. have a higher potential to have ulcerative colitis D. experience intestinal strictures

REVIEW QUESTION 46-RATIONALE The disease is chronic and relapsing, so removal of part of the bowel is not curative. It is likely that it will occur elsewhere. Although adhesions might occur this is not likely and colitis is not related.

REVIEW QUESTION 47 A patient with irritable bowel syndrome has been prescribed fluoxetine (Prozac). The patient asks the nurse, Why am I getting this, Im not depressed. The nurse's best response is A. you may not realize that you are depressed B. bowel disorders are caused by depression C. your physician will explain it to you D. it will help relieve your abdominal pain

REVIEW QUESTION 47-RESPONSE A patient with irritable bowel syndrome has been prescribed fluoxetine (Prozac). The patient asks the nurse, Why am I getting this, Im not depressed. The nurse's best response is A. you may not realize that you are depressed B. bowel disorders are caused by depression C. your physician will explain it to you D. it will help relieve your abdominal pain

REVIEW QUESTION 47-RATIONALE SSRIs help relieve the abdominal pain. IBS may be linked to depression, but it is not a cause or effect.

REVIEW QUESTION 48 A client with Crohns disease has now developed short bowel syndrome. The patient is upset and tired of being sick. The nurse tells the patient which of the following? A. this will be a life long challenge for the patient B. more surgery is likely in the near future C. dietary modifications will help greatly D. TPN will be required in order to maintain adequate nutrition

REVIEW QUESTION 48-RESPONSE A client with Crohns disease has now developed short bowel syndrome. The patient is upset and tired of being sick. The nurse tells the patient which of the following? A. this will be a life long challenge for the patient B. more surgery is likely in the near future C. dietary modifications will help greatly D. TPN will be required in order to maintain adequate nutrition

REVIEW QUESTION 48-RATIONALE Small high calorie and high protein meals can maintain nutrition. The bowel can often compensate after a while, so it may not be lifelong. Surgery is not used for short bowel disorder and TPN is not always required.

UPPER & LOWER GI REVIEW NURS 2204. REVIEW QUESTION 1 While assessing an older woman, the nurse...

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