A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognized that increased peristalsis resulting in diarrhea can be related to:
a. sympathetic inhibition
b. mixing and propulsion
c. sympathetic stimulation
d.
D
A patient has an elevated blood level of indirect (unconjugated) bilirubin. Onecause of this finding is that:
a. the gallbladder is unable to contract to release stored bile
b. bilirubin is not being conjugated and excreted into the bile by the liver
c. t
B
As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the:
a. inhibition of secretin release
b. release of bicarbonate by the pancreas
c. release of pancreatic digestive enzymes
d. relea
B
A patient is jaundiced and her stools are clay colored (gray). This is most likely related to:
a. decreased bile flow into the intestine
b. increased production of urobilinogen
c. increased production of cholecystokinin
d. increased bile and bilirubin in
A
An 80-year-old man states that although he adds a lot of salt to his food it still does not have much taste. The nurse's response is based on the knowledge that the older adult:
a. should not experience changes in taste
b. has a loss of taste buds, especi
B
When assessing the health perception-health maintenance pattern as related to GI function, an appropriate question by the nurse is:
a. what is your usual bowel elimination pattern?
b. what percentage of your income is spent on food?
c. have you traveled t
C
During an examination of the abdomen the nurse should:
a. position the patient in the supine position with the bed flat and the knees straight
b. listen in the epigastrium and all found quadrants for 2 to 5 minutes for bowel sounds
c. use the following or
B
A normal physical assessment finding of the GI system is/are: (select all the apply)
a. nonpalpable liver and spleen
b. borborygmi in upper right quadrant
c. tympany on percussion of the abdomen
d. liver edge 2 to 4 cm below the costal margin
e. finding a
A,C
In preparing a patient for a colonoscopy, the nurse explains that:
a. a signed permit is not necessary
b. sedation may be used during the procedure
c. only one cleansing enema is necessary for preparation
d. a light meal should be eaten the day before the
B
The percentage of daily calories for a healthy individual consists of:
a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids
b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids
c. 50% car
A
During starvation, the order in which the body obtains substrate for energy is:
a. visceral protein, skeletal protein, fat, glycogen
b. glycogen, skeletal protein, fat stores, visceral protein
c. visceral protein, fat stores, glycogen, skeletal protein
d.
B
The optimal way to administer medications via a feeding tube is to:
a. use only sustained-release medications
b. pour medications into the enteral formula
c. grind all the pills together and dilute with water
d. remover powder from a gelatin capsule and d
D
The nurse confirms initial placement of a blindly inserted small bore NG feeding tube by:
a. x-ray
b. air insufflation
c. observing patient for coughing
d. pH measurement of gastric aspirate
A
A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse administers:
a. 20% intralipids
b. 5% dextrose solution
c. 5% Ringer's lactate solution
d. 0.45%
B
A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carfully assesses the patient for:
a. hyperkalemia
b. hypoglycemia
c. hypercalcemia
d. hypophosphatemia
D
Which of the following statements best described the etiology of obesity:
a. obesity primarily results from a genetic predisposition
b. psychosocial factors can override the effects of genetics in the etiology of obesity
c. Obesity is the result of comple
C
The obesity classification that is most often associated with cardiovascular health problems is:
a. primary obesity
b. secondary obesity
c. gynoid fat distribution
d. android fat distribution
D
Health risks associated with obesity include (select all that apply)
a. colorectal cancer
b. rheumatoid arthritis
c. polycystic ovary disease
d. nonalcoholic steatohepatitis
e. systemic lupus erythematosus
A, C, D
The best nutritional therapy plan for a person who is obese is:
a. the Zone diet
b. the Atkins diet
c. Sugar busters
d. foods from the basic food groups
D
This bariatric surgical procedure involves creating a stoma and gastric pouch that is reversible and no malabsorption occurs. What surgical procedure is this?
a. vertical gastric banding
b. biliopacreatic diversion
c. roux-en-y gastric bypass
d. adjustabl
D
A morbidly obese patient has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient
a. may have severe diarrhea early in the postoperative period
b. will not be allowed to ambulate for 1 or 2 day
D
Which of the following criteria are needed for a diagnosis of metabolic syndrome (select all that apply)
a. hypertension
b. elevated triglycerides
c. elevated plasma glucose
d. increased waist circumference
e. decreased low density lipoproteins
A,B,C,D
M.J. calls to tell the nurse that her elderly mother, who is 85 years of age, has been nauseated all day and has vomited twice. Before the nurse hangs up and telephones the health care provider to communicate your assessment data, the nurse should instruc
B
The nurse explains to the patient with Vincent's infection that treatment will include:
a. smallpox vaccinations
b. viscous lidocaine rinses
c. amphotericin B suspension
d. topical application of antibiotics
D
The nurse is involved in health promotion related to oral cancer. Teaching young adults about behaviors that put them at risk for oral cancer includes:
a. discouraging use of chewing gum
b. avoiding use of perfumed lip gloss
c. avoiding use of smokeless t
C
The nurse explains to the patient with gastroesophageal reflux disease that this disorder:
a. results in acid erosion and ulceration of the esophagus caused by frequent vomiting
b. will require surgical wrapping or repair of the pyloric sphincter to contr
D
A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of:
a. an intolerance to the f
C
The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will include information concerning the importance of (select all that apply)
a. only taking aspirin with milk or bread products
b. avoiding taking aspirin
B,C
The pernicious anemia that may accompany gastritis is due to which of the following?
a. chronic autoimmune destruction of cobalamin stores in the body
b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss
c. a lack of
C
The nurse is teaching the patient and family about possible causative factors for peptic ulcers. The nurse explains that ulcer formation is:
a. caused by a stressful lifestyle and other acid producing factors such as h.pylori
b. inherited within families
D
An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about
a. cancer support groups, alopecia, and stomatitis
b, avitaminosis, ostomy care, and community resources
c. prosthetic devices, ski
D
Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patient specifically about foods they ingested containing
a.
B
Which of the following patients is it most important for the nurse to refer to the dietitian for a complete nutritional assessment?
1.A 38-year-old diabetic patient who is undergoing laser eye surgery
2.A 55-year-old with a history of alcoholism who is ho
Answer: 2
Rationale: An individual who is at nutritional risk should have a full nutritional assessment. The individual at greatest risk is the individual with chronic alcoholism and a fractured femur. Drugs such as corticosteroids place the individual at
When assessing the patient's nutritional status, the nurse asks which drugs the patient takes primarily because
1.foods alter the absorption or bioavailability of every drug.
2.if the patient skips a meal, medications may not be taken.
3.some drugs increa
Answer: 3
Rationale: Certain drugs (such as folic acid, riboflavin, and fat-soluble vitamins) may increase nutrient requirements. Some medications can be taken with food; other medications must be taken without food. Food may alter the absorption or bioav
The health care provider orders a 10% fat emulsion solution to be administered to a critically ill patient who is currently receiving peripheral parenteral nutrition. Which of the following assessment findings would alert the nurse to a systemic problem r
Answer: 1
Rationale: Patients receiving lipids are at extreme risk for infection because fat emulsions at room temperature are a medium for microorganism growth. Catheter-related infections can occur in patients receiving parenteral nutrition; local or sy
An important factor associated with both short-term and long-term weight-loss success is
1. higher initial body mass index.
2. simultaneous smoking cessation.
3. fewer dieting attempts in the past year.
4. a strong desire to improve appearance.
Answer: 4
Rationale: Motivation to lose weight is essential for a favorable and successful outcome.
Following discharge instructions for a patient who has had bariatric surgery for treatment of obesity, the nurse determines that additional teaching is needed when the patient says,
1. "I shouldn't eat concentrated sweets."
2. "I can eat small, frequent m
Answer: 3
Rationale: Discharge teaching for a patient after bariatric surgery may include six small meals/day, diet high in protein and low in fat and carbohydrates, avoidance of ingestion of solids with fluids, avoidance of large amounts of fluids at one
The nurse determines that teaching regarding a weight-loss program has been effective when the patient says,
1. "I will keep a diary of daily weights to chart my weight loss."
2. "I plan to lose 4 pounds a week until I have lost my goal of 60 pounds."
3.
Answer: 4
Rationale: Behavior-modification programs deemphasize the diet and focus on how and when to eat; support groups offer support and information on dieting tips. Patients should set a weight loss goal of 1 to 2 pounds per week. Weight should be che
27-year-old woman comes into the clinic with fatigue.
She has lost 10 pounds in the past 2 months.
She is a graduate student working on her dissertation.
History of Crohn's disease
Claims she is unable to watch her diet because she "doesn't have time to t
1. Fluids, electrolytes, fat
2. She should begin a high-fat, high-protein diet.
3. Provide her with a list of foods that she should try to eat.
21-year-old woman comes into her physician's office for her routine check-up.
She states that she has switched to a vegetarian diet because she is concerned with cruelty to animals.
She eats mainly fast food and salads from her college cafeteria.
She cons
1. Iron deficiency
2. Beans, legumes, soy products
3. The USDA website
75-year-old woman is scheduled to have exploratory surgery tomorrow for a bowel obstruction.
History of type 2 diabetes
Orders call for a PICC insertion because the physician anticipates a need for resting her GI tract.
Her son is here for the surgery, an
1. She will be fed through the PICC only until she is able to eat 60% of her calories orally. Then she will be back to eating "normally."
2. Her blood glucose should be monitored closely. A slight increase in blood glucose is to be expected at the outset
84-year-old man is being discharged from the hospital.
He was admitted with complications from esophageal cancer.
PEG tube has been placed to allow tube feedings.
He lives with his wife, who is 82 years old.
Has no other family in town
1.What risks are as
1. Aspiration, ensuring proper use of formula
2. Proper tube care
3. His weight and hydration status
45-year-old woman is hospitalized for shortness of breath and respiratory distress.
Physical examination findings
Blood pressure 150/72
Heart rate 104
Respiratory rate 30
Temperature 98.3� F
SaO2 88%
Height 5'5"
Weight 320 pounds
History of hypertension,
1. Teach her the negative effects of obesity.
2. Pain in joints, high cholesterol, sleep apnea
3. Drug therapy for weight reduction, such as Alli, or bariatric surgery
4. Support groups or individual therapy sessions
5. Postanesthesia problems due to her
A patient with persistent vomiting of 3 days' duration is seen at the urgent care center because of increasing weakness. Intravenous therapy with lactated Ringer's solution is started, and arterial blood gases (ABGs) are ordered. Which of the following AB
Answer: 3
Rationale: Vomiting is a cause of metabolic alkalosis; the arterial blood gases indicate partially compensated metabolic alkalosis. The pH is greater than 7.45 (alkalosis); the HCO3- is above 26 mEq/L (metabolic); and the PaCO2 is less than 35 m
After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective?
1."I can have a glass of low-fat milk at bedtime."
2."I w
Answer: 3
Rationale: Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patient
When teaching a patient with a history of upper GI bleeding to check the stools for blood, the nurse informs the patient that
1.if vomiting of bright red blood occurs, stools will not be black and sticky.
2.blood is never obvious in stools and must be det
Answer: 4
Rationale: Melena (black, tarry stools) indicates slow bleeding from an upper gastrointestinal source. The longer the passage of blood through the intestines, the darker the stool color, because of the breakdown of hemoglobin and the release of
Diagnostic testing is planned for a patient with a suspected peptic ulcer. The nurse explains to the patient that the most reliable test for determining the presence and location of an ulcer is a(n)
1.endoscopy.
2.gastric analysis.
3.barium swallow.
4.ser
Answer: 1
Rationale: Endoscopy is the primary tool for diagnosing the source of upper gastrointestinal bleeding.
A young woman calls a triage hotline complaining of severe nausea for the past 6 hours.
She denies any emesis, but is unable to obtain any relief from her nausea.
She states her temperature is "a little higher than normal" at 99.5o F.
She has had no recen
1. Dietary history (and if anyone else has nausea), history of nausea, and discussion of possible pregnancy
2. Breathing exercises and peppermint tea
3. No, unless her vomiting is unremitting or includes blood.
20-year-old man complains of loss of appetite and occasional lower sternal chest pain 30 to 60 minutes after meals.
He claims symptoms began about 6 months ago.
He has a history of asthma.
States he has needed inhaler "more than usual"
Does not know what
1. Respiratory history
2. Avoid acids foods, alcohol, and caffeine.
3. Discuss with him that if untreated, GERD can lead to esophagitis and Barrett's esophagus.
4. Esophagitis, Barrett's esophagus, respiratory problems, and dental erosion
40-year-old woman was previously admitted to the hospital for exacerbation of Cr0hn's disease.
After beginning high-dose IV corticosteroid treatment for Crohn's disease, she develops massive upper GI bleeding.
Bright red blood hematemesis and melena
She i
1. Peptic ulcer
2. Closely monitor I & O and vital signs.
3. Avoid acidic foods, caffeine, and alcohol.
4. Nutritional changes, need for taking only prescription medications, how to avoid future incidences, avoiding smoking, importance of monitoring for b
76-year-old man complains of feeling like food is "stuck" in his esophagus.
Also complains of experiencing epigastric pain while eating
History of smoking 1 pack per day for 40 years and hypertension
EGD and biopsy samples taken reveal esophageal cancer.
1. He will have an NG tube immediately after surgery, and then he will need to maintain an upright position for at least 2 hours after eating.
2. He may need a permanent feeding gastrostomy.
3. Any changes in eating habits should be discussed, along with
When assessing a patient's abdomen, it would be most appropriate to
A) a. Auscultate the abdomen before palpation.
B) b. Palpate the abdomen before auscultation.
C) c. Percuss the abdomen before auscultation.
D) d. Perform deep palpation before light palp
A
When preparing a patient for a capsule endoscopy study, the nurse should
A) a. Ensure the patient understands the required bowel preparation.
B) b. Have the patient return to the procedure room for removal of the capsule.
C) c. Teach the patient to mainta
A
Inspection of an elderly patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. The most likely etiology for this abnormal assessment finding is
A) a. Herpesvirus.
B) b. Candida albicans.
C) c. Vitamin deficiency.
D) d.
B
The nurse would recognize that the liver performs which of the following functions (select all that apply)?
A) a. Bile storage
B) b. Detoxification
C) c. Red blood cell (RBC) destruction
D) d. Protein metabolism
E) e. Steroid metabolism
B,C,D,E
The health care team is assessing a patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which of the following laboratory values are the best diagnostic indicators of acute pancreatitis?
A) a. Gastric
C
The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, the nurse will palpate the patient's
A) a. Left lower quadrant.
B) b. Left upper quadrant.
C) c. Right lower quadr
D
The nurse is reviewing the laboratory test results for a 71-year-old patient with metastatic lung cancer. The patient was admitted with a diagnosis of malnutrition. Serum albumin level is 4.0 g/dl and prealbumin is 10 mg/dl. The nurse should draw which of
D
The nurse is caring for a patient admitted to the hospital for asthma who weighs 186 lb (84.5 kg). During dietary counseling, the patient asks the nurse how much protein he should ingest each day. How many grams of protein does the nurse recommend should
C
The nurse is providing care for a 23-year-old woman who is a strict vegetarian. To prevent the consequences of iron deficiency, the nurse should recommend
A) a. Brown rice and kidney beans.
B) b. Cauliflower and egg substitutes.
C) c. Soybeans and hot bre
C
A patient who has dysphagia as a consequence of a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the following interventions should the nurse integrate into this patient's care?
A) a. Flush the tube with
B
Which of the following methods should be used to confirm the placement of a patient's newly-inserted nasogastric (NG) feeding tube?
A) a. X-ray
B) b. Aspiration
C) c. Air auscultation
D) d. Measurement of external length
A
The nurse recognizes that the majority of patients' caloric needs should come from which of the following sources?
A) a. Fats
B) b. Proteins
C) c. Polysaccharides
D) d. Monosaccharides
C
A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral nutrition (PN). Which of the following principles should guide the nurse's administration of the patient's nutrition?
A) a. Administration of PN require
B
Which of the following assessments should the nurse prioritize in the care of a patient who has recently begun receiving parenteral nutrition (PN)?
A) a. Skin integrity and bowel sounds
B) b. Electrolyte levels and daily weights
C) c. Auscultation of the
B
During the initial postoperative period following bariatric surgery, the nurse recognizes the importance of monitoring obese patients for respiratory insufficiency based on knowledge that
A) a. The body stores anesthetics in adipose tissue.
B) b. Intubati
A
The nurse is caring for a patient who is 5'6" tall and weighs 186 lb. The nurse has discussed reasonable weight loss goals and a low-calorie diet with the patient. Which of these statements made by the patient indicates a need for further teaching?
A) a.
A
The nurse is caring for a 45-year-old woman with a herniated lumbar disk and obesity. The patient realizes that weight loss is necessary to lessen back strain. The patient is 5'6" tall and weighs 186 lb (84.5 kg) with a body mass index (BMI) of 28 kg/m2.
B
In developing an effective weight reduction plan for an overweight patient who states a willingness to try to lose weight, it is most important for the nurse to first assess which of the following factors?
A) a. The length of time the patient has been obe
C
In developing a weight reduction program with a 45-year-old patient who weighs 186 lb, the nurse encourages the patient to set a weight loss goal of how many pounds in 4 weeks?
A) a. 1-2
B) b. 3-5
C) c. 4-8
D) d. 5-10
C
The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient says
A) a. "I plan to lose 4 lb a week until I have lost the 60-pound goal."
B) b. "I wi
B
A community health nurse is conducting an initial assessment of a new patient. Which of the following assessments would the nurse include when screening the patient for metabolic syndrome (select all that apply)?
A) a. Blood pressure
B) b. Resting heart r
A,D,E
Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when which of the following is noted?
A) a. Decreased blood pressure
B) b. Absence of muscle tremors
C) c. Relief of
C
The patient receiving chemotherapy rings the call bell and reports an onset of nausea. The nurse should prepare a prn dose of which of the following medications?
A) a. Morphine sulfate
B) b. Zolpidem (Ambien)
C) c. Ondansetron (Zofran)
D) d. Dexamethasone
C
The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 ml PO. The nurse would evaluate its effectiveness by questioning the patie
B
When administered a dose of metoclopramide (Reglan), a patient complains of nausea. The nurse would teach the patient to report which of the following potential adverse effects?
A) a. Tremors
B) b. Constipation
C) c. Double vision
D) d. Numbness in the fi
A
After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, the nurse explains that which of the following may be experienced as a common temporary adverse effect of the medication?
A) a. Drowsiness
B) b. Reduced hearing
A
The nurse is caring for a patient treated with intravenous fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, the nurse understands that which of the following food choices would be most appropriate?
A) a. Ice t
B
The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved?
A) a. Nausea
B) b. Belching
C) c. Epigastric pain
D) d. Difficulty swallowing
C
A patient reports having dry mouth and asks for some liquid to drink. The nurse reasons that this symptom can most likely be attributed to a common adverse effect of which of the following medications?
A) a. Digoxin (Lanoxin)
B) b. Cefotetan (Cefotan)
C)
D
A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following action
A
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis?
A) a. "You'll need to drink at least two to thre
B