M.J. calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to
a. administer antiemetic drugs and observe skin turgor.
b. give he
b. give her mother sips of water and elevate the head of her bed to prevent aspiration.
The nurse explains to the patient with Vincent's infection that treatment will include
a. tetanus vaccinations.
b. viscous lidocaine rinses.
c. amphotericin B suspension.
d. topical application of antibiotics.
d. topical application of antibiotics.
The nurse 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 tobacco.
d. discouraging drinking of carbonated beverage
c. avoiding use of smokeless tobacco.
Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)?
a. "The best time to take an as-needed antacid is 1 to 3 hours after meals."
b. "A glass of warm milk at bedtime will decrease yo
a. "The best time to take an as-needed antacid is 1 to 3 hours after meals.
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 fe
c. leakage of fluids into the mediastinum.
The pernicious anemia that may accompany gastritis is due to
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 intrinsic factor norma
c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa.
The nurse is teaching the patient and family that peptic ulcers are
a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori.
b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhoo
d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.
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. nutrition supplements, ostomy care, and support groups.
c. prosthetic device
d. wound and skin care, nutrition, drugs, and community resources.
The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply)
a. limiting alcohol intake to one serving per day.
b. only taking aspirin with milk or
c. avoiding taking aspirin and drugs containing aspirin.
d. only taking drugs prescribed by the health care provider.
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 patients specifically about foods they ingested containing
a.
b. meat and milk.
The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to
a. increase fluid intake.
b. administer an antibiotic.
c. administer an antimotility drug.
d. quarantine the patient to prevent spread of the virus.
a. increase fluid intake.
A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain (select all that apply)?
a. Gastroenteritis
b. Ectopic pregnancy
c. Gastrointestinal
a. Gastroenteritis
b. Ectopic pregnancy
c. Gastrointestinal bleeding
d. Irritable bowel syndrome
e. Inflammatory bowel disease
Assessment findings suggestive of peritonitis include (select all that apply)
a. rebound tenderness.
b. a soft, distended abdomen.
c. dull, intermittent abdominal pain.
d. shallow respirations with bradypnea.
e. observing that the patient is lying still.
a. rebound tenderness.
e. observing that the patient is lying still.
In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease
a. frequently results in toxic megacolon.
b. causes fewer nutritional deficiencies t
c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy.
The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply)
a. persistent abdominal pain.
b. marked abdominal dist
a. persistent abdominal pain.
b. marked abdominal distention.
A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that
a. chemotherapy will begin after the patient recovers from the surgery.
b. both chemotherapy and radiation can be used a
c. follow-up colonoscopies will be needed to ensure that the cancer does not recur.
The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states
a. "I should only have to change the pouch every 4 to 7 days."
b. "The drainage in the pouch will look like my normal stools."
c. "I may not need
a. "I should only have to change the pouch every 4 to 7 days.
In contrast to diverticulitis, the patient with diverticulosis
a. has rectal bleeding.
b. often has no symptoms.
c. has localized cramping pain.
d. frequently develops peritonitis.
b. often has no symptoms.
A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is
a. applying a truss to the hernia site.
b. allowing the patient to stand to void.
c. supporting the incision during coughing.
d. ap
d. applying a scrotal support with an ice bag.
The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu
a. scrambled eggs and sausage.
b. buckwheat pancakes with syrup.
c. oatmeal, skim milk, and orange juice.
d. yogurt, strawberr
a. scrambled eggs and sausage.
What should a patient be taught after a hemorrhoidectomy?
a. Take mineral oil before bedtime.
b. Eat a low-fiber diet to rest the colon.
c. Administer oil-retention enema to empty the colon.
d. Use prescribed pain medication before a bowel movement.
d. Use prescribed pain medication before a bowel movement.
A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that
a. pruritus is a common problem with jaundice in this phase.
b. the patient is most likely to transmit the disease during this phase.
c. gas
a. pruritus is a common problem with jaundice in this phase.
A patient with acute hepatitis B is being discharged in 2 days. The discharge teaching plan should include instructions to
a. avoid alcohol for the first 3 weeks.
b. use a condom during sexual intercourse.
c. have family members get an injection of immuno
b. use a condom during sexual intercourse.
A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include
a. having genetic testing done.
b. recommending a heart-healthy diet.
c. the necessity to reduce weigh
b. recommending a heart-healthy diet.
The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that
a. a lack of clotting factors promotes the collection of blood in the abdominal cavity.
b. portal hypertension and hypoalbuminemia
b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
In planning care for a patient with metastatic liver cancer, the nurse should include interventions that
a. focus primarily on symptomatic and comfort measures.
b. reassure the patient that chemotherapy offers a good prognosis.
c. promote the patient's co
a. focus primarily on symptomatic and comfort measures.
Nursing management of the patient with acute pancreatitis includes (select all that apply)
a. checking for signs of hypocalcemia.
b. providing a diet low in carbohydrates.
c. giving insulin based on a sliding scale.
d. observing stools for signs of steato
a. checking for signs of hypocalcemia.
e. monitoring for infection, particularly respiratory tract infection.
A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple
c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.
The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that
a. shock-wave therapy should be tried initially.
b. once gallstones are removed, they tend not to recur.
c. the disorder can be successf
d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic.
Teaching in relation to home management after a laparoscopic cholecystectomy should include
a. keeping the bandages on the puncture sites for 48 hours.
b. reporting any bile-colored drainage or pus from any incision.
c. using over-the-counter antiemetics
b. reporting any bile-colored drainage or pus from any incision.
What physiologically occurs with vomiting?
a. The acid-base imbalance most commonly associated with persistent vomiting is metabolic acidosis caused by loss of bicarbonate.
b. Stimulation of the vomiting center by the chemoreceptor trigger zone (CTZ) is c
d. The parasympathetic nervous system causes increased salivation and gastric mobility as well as relaxation of the lower esophageal sphincter. The acid-base imbalance that occurs with vomiting is metabolic alkalosis from the loss of hydrochloric (HCl) ac
Which laboratory findings should the nurse expect in the patient with persistent vomiting?
a. ? pH, ? sodium, ? hematocrit
b. ? pH, ? chloride, ? hematocrit
c. ? pH, ? potassium, ? hematocrit
d. ? pH, ? potassium, ? hematocrit
c. The loss of gastric HCl acid causes metabolic alkalosis and an increase in pH; loss of potassium, sodium, and chloride; and loss of fluid, which increases the hematocrit.
A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will first be included in interprofessional care?
a. Oral administration of broth and tea
b. IV replacement of fluid and e
b. The patient with severe or persistent vomiting requires IV replacement of fluids and electrolytes until able to tolerate oral intake to prevent serious dehydration and electrolyte imbalances. Oral fluids are not given until vomiting has been relieved a
A patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer which fluid first?
a. Water
b. Hot tea
c. Gatorade
d. Warm broth
a. Water is the fluid of choice for rehydration by mouth. Very hot or cold liquids are not usually well tolerated. Although broth and Gatorade have been used for the patient with severe vomiting, these substances are high in sodium and should be administe
Ondansetron (Zofran) is prescribed for a patient with cancer chemotherapy-induced vomiting. What should the nurse understand about this drug?
a. It is a derivative of cannabis and has a potential for abuse.
b. It has a strong antihistamine effect that pro
d. Ondansetron (Zofran) is one of several serotonin
antagonists that act both centrally and peripherally to reduce vomiting: centrally on the vomiting center in the brainstem and peripherally by promoting gastric emptying. Dronabinol (Marinol) is an orall
Older patients may have cardiac or renal insufficiency and may be more susceptible to problems from vomiting and antiemetic drug side effects. What nursing intervention is most important to implement with these patients?
a. Keep the patient flat in bed to
c. Implementing safety precautions (placement close to the nurses' station, call bell in reach, hourly visual checks, use of sitters) is the priority. The patient would not be kept in a flat position because of the potential for aspiration of vomitus. Kee
What are characteristics of gingivitis?
a. Formation of abscesses with loosening of teeth
b. Caused by upper respiratory tract viral infection
c. Shallow, painful vesicular ulcerations of lips and mouth
d. Infectious ulcers of mouth and lips as a result o
a. When gingivitis is untreated, abscesses form and teeth are loosened with periodontitis. Herpes simplex is a viral infection related to the upper respiratory system and has shallow, painful vesicular ulcerations of lips and mouth. Aphthous stomatitis ha
Which infection or inflammation is found related to systemic disease and cancer chemotherapy?
a. Parotitis
b. Stomatitis
c. Oral candidiasis
d. Vincent's infection
b. Stomatitis is inflammation of the mouth related to systemic diseases and cancer chemotherapy medications. There is excessive salivation, halitosis, and a sore mouth. Parotitis is a Staphylococcus infection that may occur with prolonged NPO status and r
A patient is scheduled for biopsy of a painful tongue ulcer. Based on knowledge of risk factors for oral cancer, what should the nurse specifically ask the patient about during a history?
a. Excessive exposure to sunlight
b. Recurrent herpes simplex infec
b. Stomatitis is inflammation of the mouth related to systemic diseases and cancer chemotherapy medications. There is excessive salivation, halitosis, and a sore mouth. Parotitis is a Staphylococcus infection that may occur with prolonged NPO status and r
When caring for a patient following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurse's primary concern?
a. Relief of pain
b. Patent airway
c. Positive body image
d. Tube feed
b. Because surgical treatment of oral cancers involves extensive excision, a tracheostomy is usually performed with the radical dissections. The first goal of care is that the patient will have a patent airway. The other goals are appropriate but of lesse
A patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. During the patient's early postoperative course, what does the nurse anticipate that the patient may need?
a. Oral nutritional supplements
b. Drug t
b. Measures to assess and treat withdrawal from alcohol should be implemented with patients who have heavy use of alcohol because alcohol withdrawal can be life threatening. Tobacco withdrawal may also be uncomfortable for the patient. Nutritional needs m
The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods or beverages that decrease LES pressure. What should be included in this list (select all that apply)?
a. Alcohol
b. Root beer
c. Chocolate
d. Citrus fruits
a, c, e, f. Alcohol, chocolate, fatty foods, and cola sodas (caffeine) as well as peppermint and spearmint will decrease lower esophageal sphincter (LES) pressure. Root beer and herbal tea do not have caffeine. Citrus fruits will not affect LES pressure.
How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms?
a. Drink 10 to 12 ounces of water with each meal.
b. Space six small meals a day between breakfast and bedtime.
c. Sleep with the head of the bed elevated on 4- to 6-
c. The use of blocks to elevate the head of the bed facilitates gastric emptying by gravity and is strongly recommended to prevent nighttime reflux. Liquids should be taken between meals to prevent gastric distention with meals. Small meals should be eate
A patient with esophageal cancer is scheduled for a partial esophagectomy. Which nursing intervention is likely to be of highest priority preoperatively?
a. Practice turning and deep breathing.
b. Brush the teeth and mouth well each day.
c. Teach about po
d. Eating a high-calorie, high-protein diet, perhaps in liquid form, is the highest priority preoperatively. Because of dysphagia, the patient frequently has poor nutritional status because of the inability to ingest adequate amounts of food before surger
Following a patient's esophagogastrostomy for cancer of the esophagus, what is most important for the nurse to do?
a. Report any bloody drainage from the NG tube.
b. Maintain the patient in semi-Fowler's or Fowler's position.
c. Monitor for abdominal dist
b. Following esophageal surgery, the patient should be positioned in semi-Fowler's or Fowler's position to prevent reflux and aspiration of gastric sections. NG drainage is expected to be bloody for 8 to 12 hours postoperatively. Abdominal distention is n
Which esophageal disorder is described as a precancerous lesion and is associated with GERD?
a. Achalasia
b. Barrett's esophagus
c. Esophageal strictures
d. Esophageal diverticula
b. Barrett's esophagus is an esophageal metaplasia primarily related to gastroesophageal reflux disease (GERD). Achalasia is a rare chronic disorder with delayed emptying of the lower esophagus and is associated with squamous cell cancer. Esophageal stric
What is an accurate description of eosinophilic esophagitis?
a. Adenocarcinoma or squamous cell tumors of the esophagus
b. Dilated veins in the esophagus caused by portal hypertension
c. Inflammation of the esophagus from irritants or acidic gastric reflu
d. Eosinophilic esophagitis is swelling of the esophagus caused by infiltration of eosinophils in response to food triggers or environmental allergens. Esophageal cancer is usually caused by adenocarcinoma, with the remainder being squamous cell tumors. E
Which type of gastritis is most likely to occur in a college student who has an isolated drinking binge?
a. Acute gastritis
b. Chronic gastritis
c. Helicobacter pylori gastritis
d. Autoimmune metaplastic atrophic gastritis
a. Acute gastritis is most likely to occur with an isolated drinking binge. Chronic gastritis is usually caused by Helicobacter pylori or viral and fungal infections. Autoimmune gastritis is an inherited condition.
Nursing management of the patient with chronic gastritis includes teaching the patient to
a. take antacids before meals to decrease stomach acidity.
b. maintain a nonirritating diet with six small meals a day.
c. eliminate alcohol and caffeine from the di
b. A nonirritating diet with six small meals a day is recommended to help control the symptoms of gastritis. Antacids are often used for control of symptoms but have the best neutralizing effect if taken after meals. Alcohol and caffeine should be elimina
Duodenal and gastric ulcers have similar as well as differentiating features. What are characteristics unique to duodenal ulcers (select all that apply)?
a. Pain is relieved with eating food.
b. They have a high recurrence rate.
c. Increased gastric acid
a, c, d, f. Duodenal ulcers have increased HCl acid gastric secretion, which causes the burning and cramping in the midepigastric area; the pain is relieved with food; and 90% to 95% of patients have H. pylori infection. The other options occur with both
Which patient is at highest risk of having a gastric ulcer?
a. 55-yr-old female smoker with nausea and vomiting
b. 45-yr-old female admitted for illicit drug detoxification
c. 27-yr-old male who is being divorced and has back pain
d. 37-yr-old male smoker
a. The 55-yr-old female smoker experiencing nausea and vomiting is more likely to have a gastric ulcer. The other patients are not in the highest-risk age range or do not have enough risk factors. Although lower socioeconomic status, smoking, and drug use
Corticosteroid medications are associated with the development of peptic ulcers because of which probable pathophysiologic mechanism?
a. The enzyme urease is produced.
b. Secretion of hydrochloric acid is increased.
c. The rate of mucous cell renewal is d
c. Corticosteroids decrease the rate of mucous cell renewal. H. pylori produces the enzyme urease. Alcohol ingestion increases the secretion of HCl acid. Aspirin and NSAIDs inhibit the synthesis of mucus and prostaglandins.
Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers?
a. Acid back diffusion into the mucosa
b. The release of histamine from GI cells
c. Ammonia formation in the mucosal wall
d. Breakdown of the gastric mucosal
a. The ultimate damage to the tissues of the stomach and duodenum, precipitating ulceration, is acid back diffusion into the mucosa. The gastric mucosal barrier is protective of the mucosa but without the acid environment and damage, ulceration does not o
What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease?
a. Maintain a bland, soft, low-residue diet.
b. Use alcohol and caffeine in moderation and always with food.
c. Eat as normally as possible, eliminating foods t
c. There is no specific diet used for the treatment of peptic ulcers, and patients are encouraged to eat as normally as possible, eliminating foods that cause discomfort or pain. Eating six meals a day prevents the stomach from being totally empty and is
What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation?
a. Stop spillage of GI contents into the peritoneal cavity.
b. Remove excess fluids and undigested food from the stomach.
c. Feed the patient the nutrients m
d. NG intubation is used with acute exacerbation of peptic ulcer disease (PUD) to remove the stimulation for hydrochloric acid (HCl) and pepsin secretion by keeping the stomach empty. Stopping the spillage of GI contents into the peritoneal cavity is used
Which statements are characteristic of the uses of antacids for peptic ulcer disease (select all that apply)?
a. Used in patients with verified H. pylori
b. Patients frequently noncompliant with use
c. Neutralize hydrochloric acid in the stomach
d. Cover
b, c, f. Antacids need a high dose and frequency, which may lead to noncompliance; they neutralize HCl in the stomach that prevents the conversion of pepsinogen to pepsin; and may stimulate the release of gastrin in PUD patients. Amoxicillin/clarithromyci
Which medications are used to decrease gastric or hydrochloric acid secretion (select all that apply)?
a. Famotidine (Pepcid)
b. Sucralfate (Carafate)
c. Omeprazole (Prilosec)
d. Misoprostol (Cytotec)
e. Bethanechol (Urecholine)
a, c, d. Famotidine (Pepcid) reduces HCl secretion by blocking histamine and omeprazole (Prilosec) decreases gastric acid secretion by blocking adenosine triphosphatase (ATPase) enzyme. Misoprostol (Cytotec) has antisecretory effects. Sucralfate (Carafate
The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement?
a. "I should stop all my medications if I develop any side effects."
b. "I should continue my treatment regimen as long
c. Increased vagal stimulation from emotional stress causes hypersecretion of HCl, and stress reduction is an important part of the patient's management of peptic ulcers, especially duodenal ulcers. If side effects to medications develop, the patient shou
A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report?
a. Vomiting of bright-red blood
b. Projectile vomiting of undigested food
c
c. Perforation of an ulcer causes sudden, severe abdominal pain that becomes generalized and may be referred to the back, accompanied by a rigid, boardlike abdomen, shallow respirations, and a weak rapid heart rate. Vomiting of blood indicates hemorrhage
A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the priority action by the nurse?
a. Check the patency of the NG
a. If symptoms of gastric outlet obstruction, such as nausea, vomiting, and stomach distention, occur while the patient is on NPO status or has an NG tube, the patency of the NG tube should first be assessed. A recumbent position should not be used in a p
When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse take first?
a. Irrigate the patient's NG tube.
b. Notify the health ca
d. Abdominal pain that causes the knees to be drawn up and shallow, grunting respirations in a patient with peptic ulcer disease are characteristic of perforation and the nurse should assess the patient's vital signs and abdomen before notifying the HCP.
Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by
a. distention of the smaller stomach by too much food and fluid intake.
b. hyperglycemia caused b
d. Because there is no sphincter control of food taken into the stomach following a Billroth II procedure, concentrated food and fluid move rapidly into the small intestine, creating a hypertonic environment that pulls fluid from the bowel wall into the l
Which statement by a patient with dumping syndrome should lead the nurse to determine that further dietary teaching is needed?
a. "I should eat bread and jam with every meal."
b. "I should avoid drinking fluids with my meals."
c. "I should eat smaller mea
a. Dietary control of dumping syndrome includes small, frequent meals with low carbohydrate content and elimination of fluids with meals. The patient should also lie down for 30 to 60 minutes after meals. These measures help to delay stomach emptying, pre
While caring for a patient following a subtotal gastrectomy with a gastroduodenostomy anastomosis, the nurse determines that the NG tube is obstructed. Which action should the nurse take first?
a. Replace the tube with a new one.
b. Irrigate the tube unti
d. If the patient's NG tube becomes obstructed following a gastrectomy with an intestinal anastomosis, gastric secretions may put a strain on the sutured anastomosis and cause serious complications. Be sure that the suction is working and because of the d
A patient with cancer of the stomach at the lesser curvature undergoes a total gastrectomy with an esophagojejunostomy. Postoperatively, what should the nurse teach the patient to expect? a. Rapid healing of the surgical wound
b. Lifelong administration o
b. A total gastrectomy removes the parietal cells responsible for secreting intrinsic factor necessary for absorption of cobalamin. Lifelong IM administration of cobalamin is necessary to prevent the development of pernicious anemia. Wound healing is usua
What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have?
a. Melena
b. Occult blood
c. Coffee-ground emesis
d. Profuse bright-red hematemesis
a. Melena is black, tarry stools from slow bleeding from an upper GI source when blood passes through the GI tract and is digested. Occult blood is the presence of guaiac-positive stools or gastric aspirate. Coffee-ground emesis is blood that has been in
A patient is admitted to the emergency department with profuse bright-red hematemesis. During the initial care of the patient, what is the nurse's first priority?
a. Establish two IV sites with large-gauge catheters.
b. Perform a focused nursing assessmen
b. Although all of the interventions may be indicated when a patient has upper GI bleeding, the first nursing priority with bright-red (arterial) blood is to perform a focused assessment of the patient's condition, with emphasis on BP, pulse, and peripher
A patient with upper GI bleeding and melena is treated with several drugs. Which drug should the nurse recognize as a priority to administer before, during, and potentially after endoscopy?
a. Oral nizatidine (Axid)
b. Epinephrine injection
c. Vasopressin
d. IV esomeprazole (Nexium) is a proton pump inhibitor (PPI) that is used to decrease acid secretion and prevent interference with clotting as a bolus before endoscopy and then a continuous infusion. Nizatidine is a histamine (H2)-receptor blocker that de
What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes?
a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind should be a
b. All over-the-counter (OTC) drugs should be avoided because their contents may include drugs that are contraindicated because of the irritating effects on the gastric mucosa. Patients are taught to test suspicious vomitus or stools for occult blood, but
The nurse evaluates that management of the patient with upper GI bleeding is effective when assessment and laboratory findings reveal which result?
a. Hematocrit (Hct) of 35%
b. Urinary output of 20 mL/hr
c. Urine specific gravity of 1.030
d. Decreasing b
d. The patient's blood urea nitrogen (BUN) is usually elevated with a significant hemorrhage because blood proteins are subjected to bacterial breakdown in the GI tract. With control of bleeding, the BUN will return to normal. During the early stage of bl
A large number of children at a public school have suddenly developed profuse diarrhea and bloody stools. The school nurse suspects food poisoning related to food from the school cafeteria and requests analysis and culture of which food?
a. Milk
b. Ground
b. Food poisoning caused by Escherichia coli O147:H7 is characterized by profuse diarrhea, abdominal cramping, and bloody stools and is most often associated with undercooked, contaminated ground beef or poultry. Salmonella contamination most often occurs
The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea makes which statement?
a. "I can use A&D ointment or Vaseline jelly around the anal area to protect my skin."
b. "Gatorade is a good liquid to drink because
c. Antiperistaltic agents, such as loperamide (Imodium) and paregoric, should not be used in infectious diarrhea because of the potential of prolonging exposure to the infectious agent. Demulcent agents may be used to coat and protect mucous membranes in
What is the most important thing the nurse should do when caring for a patient who has contracted Clostridium difficile?
a. Clean the entire room with ammonia.
b. Feed the patient yogurt with probiotics.
c. Wear gloves and wash hands with soap and water.
c. Wearing gloves will avoid hand contamination, and washing hands with soap and water will remove more Clostridium difficile spores than alcohol-based hand cleaners and ammonia-based disinfectants. The entire room will have to be disinfected with a 10% s
In instituting a bowel training program for a patient with fecal incontinence, what should the nurse plan to do first?
a. Teach the patient to use a perianal pouch.
b. Insert a rectal suppository at the same time every morning.
c. Place the patient on a b
d. The first intervention to establish bowel regularity includes promoting bowel evacuation at a regular time each day, preferably by placing the patient on the bedpan, using a bedside commode, or walking the patient to the bathroom. To take advantage of
A nurse is doing a nursing assessment on a patient with chronic constipation. What data obtained during the interview may be a factor contributing to the constipation?
a. Taking methylcellulose (Citrucel) daily
b. High dietary fiber with high fluid intake
d. Ignoring the urge to defecate causes the muscles and mucosa in the rectal area to become insensitive to the presence of feces and drying of the stool occurs. The urge to defecate is decreased and stool becomes more difficult to expel. Taking a bulk-for
The nurse should teach the patient with chronic constipation that which food has the highest dietary fiber?
a. Peach
b. Popcorn
c. Dried beans
d. Shredded wheat
c. Of the foods listed, dried beans contain the highest amount of dietary fiber and are an excellent source of soluble fiber. Bran and berries also have large amounts of fiber. (See Table 42-7.)
Which method is preferred for immediate treatment of an acute episode of constipation?
a. An enema
b. Increased fluid
c. Stool softeners
d. Bulk-forming medication
a. Enemas are fast acting and beneficial in the immediate treatment of acute constipation but should be limited in their use. Increased fluids can help to decrease the incidence of constipation. Stool softeners have a prolonged action, taking up to 72 hou
8. When considering the following causes of acute abdomen, the nurse should know that surgery would be indicated
for (select all that apply)?
a. pancreatitis
b. acute ischemic bowel
c. foreign body perforation
d. ruptured ectopic pregnancy
e. pelvic infla
b, c, d, f. An immediate surgical consult is needed for acute ischemic bowel, foreign body perforation, ruptured ectopic pregnancy, or ruptured abdominal aneurysm. A diagnostic laparoscopy or a laparotomy may be done to repair a ruptured abdominal aneurys
A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction, IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four hours after admission, t
c. An adequately functioning nasogastric (NG) tube should prevent nausea and vomiting because stomach contents are continuously being removed. The first intervention in this case is to check the amount and character of the recent drainage and check the tu
A postoperative patient has a nursing diagnosis of pain related to effects of medication and decreased GI motility as evidenced by abdominal pain and distention and inability to pass flatus. Which nursing intervention is most appropriate for this patient?
a. The abdominal pain and distention that occur from the decreased motility of the bowel should be treated with increased ambulation and frequent position changes to increase peristalsis. If the pain is severe, cholinergic drugs, rectal tubes, or applicat
A 22-yr-old patient calls the outpatient clinic complaining of nausea and vomiting and right lower abdominal pain. What should the nurse advise the patient to do?
a. Use a heating pad to relax the muscles at the site of the pain.
b. Drink at least 2 quart
d. The patient is having symptoms of an acute abdomen and should be evaluated immediately by an HCP at a hospital able to perform surgery if needed. The patient's age, location of pain, and other symptoms are characteristic of appendicitis. Heat applicati
When caring for a patient with irritable bowel syndrome (IBS), what is most important for the nurse to do?
a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed.
b. Develop a trusting relationship with the patient to provide
b. Because there is no definitive treatment for irritable bowel syndrome (IBS), patients become frustrated and discouraged with uncontrolled symptoms. It is important to develop a trusting relationship that will support the patient as different treatments
A patient with a gunshot wound to the abdomen complains of increasing abdominal pain several hours after surgery to repair the bowel. What action should the nurse take first?
a. Notify the HCP.
b. Assess the patient's vital signs.
c. Position the patient
b. It is likely that the patient could be developing peritonitis, which could be life threatening, and assessment of vital signs for hypovolemic shock should be done to report to the HCP. If an IV line is not in place, it should be inserted and pain may b
The patient has persistent and continuous pain at McBurney's point. The nursing assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing interventions for this pa
b. The patient's manifestations are characteristic of appendicitis. After laboratory test and CT scan confirmation, the patient will have surgery. Laxatives are not used. The 6 hours of fluids and antibiotics preoperatively would be used if the appendix w
The patient has peritonitis, which is a major complication of ruptured appendix. What treatment should the nurse plan to include?
a. Peritoneal lavage
b. Peritoneal dialysis
c. IV fluid replacement
d. Increased oral fluid intake
c. IV fluid replacement along with antibiotics, NG suction, analgesics, and potential surgery would be expected. Peritoneal lavage may be used to determine abdominal trauma. Peritoneal dialysis would not be performed. Oral fluids would be avoided with per
A 20-year old patient with a history of Crohn's disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn's disease (select all that apply)?
a. Weight loss
b. Rectal bleeding
c. Abdominal pain
d. Toxic megacolon
e. Has
a, c, e, f. Crohn's disease may have severe weight loss, crampy abdominal pain, and segmented distribution through the entire wall of the bowel. Rectal bleeding and toxic megacolon are more often seen with ulcerative colitis.
What laboratory findings are expected in ulcerative colitis as a result of diarrhea and vomiting?
a. Increased albumin
b. Elevated white blood cells (WBCs)
c. Decreased serum Na+, K+, Mg+, Cl-, and HCO3-
d. Decreased hemoglobin (Hgb) and hematocrit (Hct)
c. In the patient with ulcerative colitis, decreased serum Na+, K+, Mg+, Cl?, and HCO3? are a result of diarrhea and vomiting. Hypoalbuminemia may be present. Elevated WBC counts occur with toxic megacolon. Decreased hemoglobin (Hgb) and hematocrit (Hct)
What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease?
a. Celiac disease and gallstones
b. Peptic ulcer disease and uveitis
c. Conjunctivitis and colonic dilation
d. Erythema nodosum and osteoporosis
d. Ulcerative colitis and Crohn's disease have many of the same extraintestinal symptoms, including erythema nodosum and osteoporosis, as well as gallstones, uveitis, and conjunctivitis. Celiac disease, peptic ulcer disease, and colonic dilation are not e
For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the
bowel (select all that apply)?
a. NPO
b. IV fluids
c. Bed rest
d. Sedatives
e. Nasogastric suction
f. Parenteral nutrition
a, b, e, f. With an acute exacerbation of inflammatory bowel disease (IBD), to rest the bowel the patient will be NPO, receive IV fluids and parenteral nutrition, and have nasogastric suction. Sedatives may be used to alleviate stress. Enteral nutrition w
The medications prescribed for the patient with IBD include cobalamin and iron injections. What is the rationale for using these drugs?
a. Alleviate stress
b. Combat infection
c. Correct malnutrition
d. Improve quality of life
c. Cobalamin and iron injections will help to correct malnutrition. Correcting malnutrition will also indirectly help to improve quality of life and fight infections.
The patient is receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease?
a. Corticosteroids
b. 6-Mercaptopurine
c. Antidiarrheal agents
d. Sulfasalazine (Azulfidine)
c. Antidiarrheal agents only relieve symptoms. Corticosteroids, 6-mercaptopurine, and sulfasalazine (Azulfidine) are used to treat and control inflammation with various diseases and maintain IBD remission.
A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On initial postoperative assessment of the patient, what should the nurse expect to find?
a. A rectal tube set to low continuous
b. The initial procedure for a total proctocolectomy with ileal pouch and anal anastomosis includes a colectomy, rectal mucosectomy, ileal reservoir construction, ileoanal anastomosis, and a temporary ileostomy. A loop ileostomy is the most common tempora
A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively?
a. Measure the ileostomy output to determine the status of the patien
a. Initial output from a newly formed ileostomy may be as high as 1500 to 2000 mL daily, and intake and output must be accurately monitored for fluid and electrolyte imbalance. Ileostomy bags may have to be emptied every 3 to 4 hours, but the appliance sh
A patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis?
a. Pa
a. Signs of malnutrition include pallor from anemia, hair loss, bleeding, cracked gingivae, and muscle weakness, which support a nursing diagnosis that identifies impaired nutrition. Diarrhea may contribute to malnutrition but is not a defining characteri
A health care provider just told a patient that she has a volvulus. When the patient asks the nurse what this is, what is the best description for the nurse to give her?
a. Bowel folding in on itself
b. Twisting of bowel on itself
c. Emboli of arterial su
b. Volvulus is the bowel twisting on itself. The bowel folding in on itself is intussusception. Emboli of arterial blood supply to the bowel is vascular obstruction. Protrusion of bowel in a weak or abnormal opening is a hernia.
The patient comes to the emergency department (ED) with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is
d. Intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration are characteristics of proximal small intestinal obstruction. Large bowel obstruction is characterized by constipation, low-grade abdominal pain, and abdominal distention.
An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to
a. offer ice chips to suck PRN.
b. provide mouth care frequently.
c. irrigate the tube with normal saline every 8 hours.
d. keep the patient supin
b. Mouth care should be done frequently for the patient with a small intestinal obstruction who has an NG tube because of vomiting, fecal taste and odor, and mouth breathing. No ice chips are allowed when a patient is NPO because of a bowel obstruction. T
During a routine screening colonoscopy on a 56-yr-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse?
a. "It is
c. Although all polyps are abnormal growths, the most common type of polyp (hyperplastic) is non-neoplastic, as are inflammatory, lipomas, and juvenile polyps. However, adenomatous polyps are characterized by neoplastic changes in the epithelium, and abou
When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about
a. dietary intake.
b. sports involvement.
c. environmental exposure to carcinogens.
d. long-term use of nonsteroidal antiinflamma
a. A diet high in red meat and low in fruit and vegetable intake is associated with development of colorectal cancer (CRC), as are alcohol intake and smoking. Family and personal history of CRC also increases the risk. Other environmental agents are not k
When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect the patient to have?
a. An abdominal dressing
b. An abdominal wound and drains
c. A temporary colostomy and drains
d. A perineal wound, d
d. With an abdominal perineal-resection (APR), an abdominal incision is made, and the proximal sigmoid colon is brought through the abdominal wall and formed into a permanent colostomy. The patient is repositioned, a perineal incision is made, and the dis
The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching?
a. The pouch can be worn for up to 2 weeks before changing it.
b. Decrease the amount of fluid intake to decrease the amount of drainage.
c.
d. The ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4 to 7 days unless there is a leak. Be
On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find?
a. Hyperactive, high-pitched bowel sounds
b. A brick-red, puffy stoma that oozes blood
c. A purplish stoma, shiny and moist with mucus
d. A sm
b. A normal new colostomy stoma should appear rose to brick-red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. Bowel sounds afte
The RN coordinating the care for a patient who is 2 days postoperative following an anterior-posterior resection (APR) with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)?
a. Irrigate the colostomy
d, e. The licensed practical nurse (LPN) can monitor and record observations related to the drainage and can measure and record the amount. The LPN could also monitor the skin around the stoma for breakdown. LPNs can irrigate a colostomy in a stable patie
A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best nursing intervention for this patient?
a. Have the patient's sexual partner reassure the patient that he is still desirable.
b. Reas
d. Sexual dysfunction may result from an APR, but the nurse should discuss with the patient that different nerve pathways affect erection, ejaculation, and orgasm and that a dysfunction of one does not mean total sexual dysfunction and also that an altera
In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient?
a. Semiliquid stools with increased fluid requirements
b. Liquid stools in a pouch and increased fluid requirements
d. The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileostomy has liquid to semili
The nurse plans teaching for the patient with a colostomy, but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient?
a. Encourage the patient to s
a. Encouraging the patient to share concerns and ask questions will help the patient to begin to adapt to living with the colostomy. The other options do not support the patient and do not portray the nurse's focus on helping the patient or treating the p
What should the nurse teach the patient with diverticulosis to do?
a. Use antibiotics routinely to prevent future inflammation.
b. Have an annual colonoscopy to detect malignant changes in the lesions.
c. Maintain a high-fiber diet and encourage fluid int
c. Formation of diverticuli is common when decreased bulk of stool, combined with a more narrowed lumen in the sigmoid colon, causes high intraluminal pressures that result in saccular dilation or outpouching of the mucosa through the muscle of the intest
An 82-yr-old man is admitted with an acute attack of diverticulitis. What is most important for the nurse to include in his care?
a. Monitor for signs of peritonitis.
b. Treat with daily medicated enemas.
c. Prepare for surgery to resect the involved colo
a. Diverticulitis can erode the bowel wall and perforate into the peritoneum. Abscesses may form to wall off the area of perforation, but complete perforation with peritonitis may occur. Systemic antibiotic therapy is often used, but medicated enemas woul
The patient calls the clinic and describes a bump at the site of a previous incision that disappears when he lies down. The nurse suspects that this is which type of hernia (select all that apply)?
a. Ventral
b. Inguinal
c. Femoral
d. Reducible
e. Incarce
a, d. The ventral or incisional hernia is due to a weakness of the abdominal wall at the site of a previous incision. It is reducible because it returns to the abdominal cavity. Inguinal hernias are at the weak area of the abdominal wall, where the sperma
The patient asks the nurse why she needs to have surgery for a femoral, strangulated hernia. What is the best explanation the nurse can give the patient?
a. "The surgery will relieve your constipation."
b. "The abnormal hernia must be replaced into the ab
c. A strangulated femoral hernia obstructs intestinal flow and blood supply, thus requiring emergency surgery. The other options are incorrect.
What is a nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy?
a. Applying heat to the inguinal area
b. Elevating the scrotum with a scrotal support
c. Applying a truss to support the operative site
d. Encouraging
b. Scrotal edema is a common and painful complication after an inguinal hernia repair and can be relieved in part by elevation of the scrotum with a scrotal support and application of ice. Heat would increase the edema and the discomfort and a truss is us
How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics
b. Avoidance of milk and milk products
c. Supplementation with pancreatic enzymes
d. Avoidance of gluten found in wheat, barley, oats, and rye
b. The most common type of malabsorption syndrome is lactose intolerance, and it is managed by restricting the intake of milk and milk products. Antibiotics are used in cases of bacterial infections that cause malabsorption, pancreatic enzyme supplementat
A patient is diagnosed with celiac disease following a workup for iron-deficiency anemia and decreased bone density. The nurse identifies that additional teaching about disease management is needed when the patient makes which statement?
a. "I should ask
c. The autoimmune process associated with celiac disease continues as long as the body is exposed to gluten, regardless of the symptoms it produces, and a lifelong gluten-free diet is necessary. The other statements regarding celiac disease are all true.
Which patient is most likely to be diagnosed with short bowel syndrome?
a. History of ulcerative colitis
b. Extensive resection of the ileum
c. Diagnosis of irritable bowel syndrome
d. Colectomy performed for cancer of the bowel
b. Short bowel syndrome results from extensive resection of portions of the small bowel and would occur if a patient had an extensive resection of the ileum. The other conditions primarily affect the large intestine and result in fewer and less severe sym
The patient asks the nurse to explain what the HCP meant when he said the patient had an anorectal abscess. Which description should the nurse use to explain this to the patient?
a. Ulcer in anal wall
b. Collection of perianal pus
c. Sacrococcygeal hairy
b. An anorectal abscess is a collection of perianal pus. An ulcer in the anal wall is an anal fissure. Sacrococcygeal hairy tract describes a pilonidal sinus. A tunnel leading from the anus or rectum is an anorectal fistula.
A 60-yr-old African American patient is afraid she may have anal cancer. What assessment finding puts her at high risk for anal cancer?
a. Alcohol use
b. Only one sexual partner
c. Human papillomavirus (HPV)
d. Use of a condom with sexual intercourse
c. Human papillomavirus (HPV) is associated with about 80% of anal cancer cases. Other risk factors include smoking, receptive anal sex, women with cervical or vulvar cancer or precancerous lesions, immunosuppression, and HIV infection. The other options
Following a hemorrhoidectomy, what should the nurse advise the patient to do?
a. Use daily laxatives to facilitate bowel emptying.
b. Use ice packs to the perineum to prevent swelling.
c. Avoid having a bowel movement for several days until healing occurs
d. Warm sitz baths provide comfort, healing, and cleansing of the area following all anorectal surgery and may be done three or four times a day for 1 to 2 weeks. Stool softeners and bulking agents help form a soft bulky stool that is easier to pass, but
The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing, and what serum bilirubin results would be expected?
a. Hemolytic jaundice with normal conjugated bilirubin
b. Posthepatic icterus with
c. Gallstones cause obstructive or posticteric jaundice and may elevate both conjugated and unconjugated bilirubin.
The patient experienced a blood transfusion reaction. What is the best explanation the nurse can give to the patient to explain the cause of the hemolytic jaundice that occurred?
a. Results from liver's altered ability from hepatocellular disease
b. Due t
d. Hemolytic jaundice from a blood transfusion reaction is from increased breakdown of RBCs producing increased unconjugated bilirubin in the blood. Hepatocellular jaundice results from damaged hepatocytes leaking bilirubin. Hemolytic jaundice occurs with
The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?
a. Hepatitis B (HBV)
b. Hepatitis C (HCV)
c. Hepatitis D (HDV
d. Hepatitis E virus (HEV) is associated with poor sanitation and contaminated water in developing countries.
Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?
a. Hepatitis A (HAV)
b. Hepatitis B (HBV
b. Hepatitis B virus (HBV) is a DNA virus that is transmitted via infectious blood and body products and is required for hepatitis D virus (HDV) replication, and chronic HBV along with chronic hepatitis C virus (HCV) accounts for 80% of hepatocellular can
Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination?
a. Anti-HBc IgG
b. Surface antigen HB
c. Immunization to HBV after vaccination is identified with the hepatitis B surface antibody (anti-HBs). Anti- HBc IgG indicates previous or ongoing HBV infection. Surface antigen HBsAg is present in acute and chronic infection. Core antigen anti-HBc IgM
The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best rationale for the nurse to explain the test to the patient?
a. Indicates ongoing infection with HBV
b. Indicates co-infection with HBV and HDV
c. Indicates pre
d. HBV DNA quantitation is the best indicator of viral replication and effectiveness of therapy for chronic HBV. HBsAg is present in acute or chronic infection. HBeAg indicates high infectivity and can also be used to determine clinical management of pati
Although HAV antigens are not tested in the blood, they stimulate specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies. Which antibody indicates there is acute HAV infection?
a. Anti-HBc IgG
b. Anti-HBc IgM
c. Anti-HAV IgG
d. Anti-HAV IgM
d. Anti-HAV immunoglobulin M (IgM) indicates acute HAV infection. Anti-HBc immunoglobulin G (IgG) indicates previous or ongoing infection with HBV. Anti-HBc IgM indicates acute HBV infection. Anti-HAV IgG indicates previous infection with HAV.
What test will be done before prescribing treatment for the patient with positive testing for HCV?
a. Anti-HCV
b. HCV genotyping
c. FibroSure (FibroTest)
d. HCV RNA quantitation
b. HCV genotyping is done to determine HCV drug choice, duration, and response to drug therapy. Anti-HCV and HCV RNA quantitation are tests completed to diagnose HCV. FibroSure (FibroTest) is used to assess the extent of hepatic fibrosis.
What causes the systemic effects of viral hepatitis?
a. Toxins produced by the infected liver
b. Impaired portal circulation from fibrosis
c. Cholestasis from chemical hepatotoxicity
d. Complement system activation by antigen-antibody complexes
d. The systemic manifestations of rash, angioedema, arthritis, fever, and malaise in viral hepatitis are caused by the activation of the complement system by circulating immune complexes. Liver manifestations include jaundice from hepatic cell damage and
During the incubation period of viral hepatitis, what should the nurse expect the patient to report?
a. Dark urine and easy fatigability
b. No symptoms except diagnostic results
c. Anorexia and right upper quadrant discomfort
d. Constipation or diarrhea w
b. During the incubation period, there are no symptoms, but serologic and enzyme markers of the disease are present. Earliest symptoms may include anorexia and discomfort in the upper right quadrant of the abdomen. Pruritus, dark urine, and light-colored
The occurrence of acute liver failure is most common in which situation?
a. An individual with hepatitis A
b. An individual with hepatitis C
c. Antihypertensive medication use
d. Use of acetaminophen with alcohol abuse
d. The most common cause of acute liver failure is drugs, usually acetaminophen in combination with alcohol. HBV is the second most common cause. HAV is a less common cause.
Following a needle stick, what is used as prophylaxis against HBV? a. Interferon
b. HBV vaccine
c. Hepatitis B immune globulin (HBIG)
d. Hepatitis B immune globulin (HBIG) and HBV vaccine
d. HBV vaccine and hepatitis B immune globulin (HBIG) are used together prophylactically after a needle stick. Interferon is used to treat chronic HBV.
The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?
a. "No immunization is available for hepatitis A, nor are you likely to get the disease.
b. Individuals who have been exposed to hepatitis A through household contact or foodborne outbreaks should be given IgG within 1 to 2 weeks of exposure to prevent or modify the illness. Hepatitis A vaccine is used to provide preexposure immunity to the v
A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?
a. "Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon."
b. "There are no
c. Nucleoside and nucleotide analogs (e.g., lamivudine) and pegylated interferon are used to treat chronic hepatitis B. No specific drugs are effective in treating acute viral hepatitis, although supportive drugs, such as antiemetics, sedatives, or antipr
The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement?
a. "I should avoid alcohol completely for at least as a year."
b. "I must avoid all physical contact with my family until the jaundice is gone."
c.
b. The patient with hepatitis B is infectious for 4 to 6 months, and precautions to prevent transmission through percutaneous and sexual contact should be maintained until tests for Hbs Ag or anti-HBc IgM are negative. Close contact does not have to be av
What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis?
a. Providing adequate nutritional intake
b. Promoting strict bed rest during the icteric phase
c. Providing pain relief without using liver-m
a. Adequate nutrition is especially important in promoting regeneration of liver cells, but the anorexia of viral hepatitis is often severe, requiring creative and innovative nursing interventions. Strict bed rest is not usually required, and the patient
When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis?
a. Does not manifest hepatomegaly or jaundice
b. Experiences less liver inflammation and damage
c. Immunosuppressive agents are indicated in hepatitis associated with immune disorders to decrease liver damage caused by autoantibodies. Autoimmune hepatitis is similar to viral hepatitis in presenting signs and symptoms and may become chronic and lead
The patient has been newly diagnosed with Wilson's disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect?
a. Pruritus
b. Acute kidney injury
c. Corneal Fleischer rings
d. Elevated serum iron leve
c. Corneal Fleischer rings, brownish red rings in the cornea near the limbus, are the hallmark of Wilson's disease. Pruritus (not seen with Wilson's disease) is commonly seen with jaundice or primary biliary cirrhosis. Renal failure associated with hepato
The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient?
a. Cirrhosis
b. Acute liver fai
d. The majority of patients with primary sclerosing cholangitis (PSC) also have ulcerative colitis. The manifestations are otherwise similar to cirrhosis, and PSC may lead to cirrhosis, liver failure, and liver cancer.
The patient is an older woman with cirrhosis who also has anemia. What pathophysiologic changes may contribute to this patient's anemia (select all that apply)?
a. Vitamin B deficiencies
b. Stretching of liver capsule
c. Vascular congestion of spleen
d. D
a, c, d. The anemia of cirrhosis is related to overactivity of the enlarged spleen that removes blood cells from circulation. Vitamin B deficiencies from altered intake and metabolism of nutrients and decreased prothrombin production can increase bleeding
A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)?
a. Weight loss
b. Diabetes management
c. Ulcerative colitis dietary changes
d. Dietary
a, b, d. There is no treatment for nonalcoholic fatty liver disease (NAFLD) except to control the other diseases that are frequently diagnosed in these individuals. These measures include weight loss for obesity, control of blood glucose for diabetes, con
Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices?
a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction
b. Loss of the small bile ducts and cholestasis and cirrhosis
c. Esophageal varices occur when collateral channels of circulation develop inelastic fragile veins as a result of portal hypertension. Portal hypertension is from scarring and nodular changes in the liver leading to compression of the veins and sinusoids
Which conditions contribute to the formation of abdominal ascites? a. Esophageal varices contribute to 80% of variceal hemorrhages
b. Increased colloidal oncotic pressure caused by decreased albumin production
c. Hypoaldosteronism causes increased sodium
d. Blood flow through the portal system is obstructed and causes portal hypertension that increases the blood pressure in the portal venous system. Decreased albumin production leads to decreased serum colloidal oncotic pressure that contributes to ascite
What laboratory test results should the nurse expect to find in a patient with cirrhosis?
a. Serum albumin: 7.0 g/dL (70 g/L)
b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L)
c. Serum cholesterol: 260 mg/dL (6.7 mmol/L)
d. Aspartate aminotransferase (AST): 6.0
b. Serum bilirubin, both direct and indirect, would be expected to be increased in cirrhosis. Serum albumin and cholesterol are decreased and liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), are initially elevate
Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help to improve nutrient intake?
a. Oral hygiene before meals and snacks
b. Provide all foods the patient likes to eat
c. Improve oral intake by feeding the pa
a. Oral hygiene may improve the patient's taste sensation. Food preferences are important, but some foods may be restricted if the patient is on a low-sodium or low-fat diet. The patient will feel more independent with self-feeding and will be more likely
The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)?
a. GI bleeding
b. hypokalemia
c. renal function
d. body image disturbances
e. increased clotting tendencies
b, c. With diuretic therapy, fluid and electrolyte balance must be monitored; serum levels of sodium, potassium, chloride, and bicarbonate must be monitored, especially hypokalemia. Renal function must be monitored with blood urea nitrogen and serum creat
What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy?
a. Manifests asterixis
b. Becomes unconscious
c. Has increasing oliguria
d. Impaired computational skills
d. Early signs (grade 1) of this neurologic condition include impaired computational skills, short attention span, personality change, decreased short-term memory, mild confusion, depression, and incoordination. Loss of consciousness (grade 4) is usually
To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patie
c. Ammonia must be reduced to treat hepatic encephalopathy. The laxative, lactulose, decreases ammonia by trapping the ammonia and eliminating it in the feces. A ?-adrenergic blocker will be used to decrease portal venous pressure and decrease variceal bl
The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?
a. Turn the patient every 3 hours.
b. Encourage increasing ambulation.
c. Assist the patient to the bathroom.
d. Prevent constipation to reduce ammon
c. The patient may not be oriented or able to walk to the bathroom alone because of hyperreflexia, asterixis, or decreased motor coordination. Turning should be done every 2 hours to prevent skin breakdown. Activity is limited to decrease ammonia as a by-
A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia and inadequate food intake. What would be an appropriate midday snack for the patient?
a. Peanut butter and salt-free cracke
b. The patient with advanced, complicated cirrhosis requires a high-calorie, high-carbohydrate diet with moderate to low fat. Patients with cirrhosis are at risk for edema and ascites, and their sodium intake may be limited. The tomato sandwich with salt-
The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?
a. Alcohol intake is now okay.
b. HBIG will be required to prevent rejection.
c. Elevate the head 30 degrees to improve ven
d. Monitoring for viral, fungal, and bacterial infection after the liver transplant is essential, as only fever may be present with an infection. Alcohol will not be any better for the patient after the transplant than it was before the transplant. HBIG i
During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?
a. Prepare the patient for immediate portal shunting surgery.
b. Perform guaiac testing on all stools to detect occult blood.
c. Ma
c. Bleeding esophageal varices are a medical emergency. During an episode of bleeding, management of the airway and prevention of aspiration of blood are critical factors. Portal shunting surgery may be performed for esophageal varices but not during an a
A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a splenorenal shunt. As a result of this procedure, what should the nurse expect the patient to experience?
a. An improved survival rate
b. Decreased serum am
d. By shunting fluid sequestered in the portal vein into the venous system, pressure on esophageal veins is decreased and more volume is returned to the circulation, improving cardiac output and renal perfusion. However, because ammonia is diverted past t
In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse advise the patient?
a. A daily exercise regimen is important to increase the blood flow through the liver.
b. Cirrhosis can be reversed if
c. Abstinence from alcohol is very important in alcoholic cirrhosis and may result in improvement if started when liver damage is limited. Although further liver damage may be reduced by rest and nutrition, most changes in the liver cannot be reversed. Ex
A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?
a. Chemotherapy is highly successful in the treatment of liver cancer.
b. The patient will undergo surgery to remove the involved
c. Because the prognosis for cancer of the liver is poor and treatment is largely palliative, supportive nursing care is appropriate. The patient exhibits clinical manifestations of liver failure, as seen in any patient with advanced liver failure. Whethe
A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?
a. "If you are interested in a transplant, you really should talk to your doctor about it."
b. "Liver transplants are indicated on
d. Liver transplantation is indicated for patients with cirrhosis as well as for many adults and children with other irreversible liver diseases. Liver transplantation is contraindicated with severe extrahepatic disease, cancers, ongoing drug or alcohol u
Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis?
a. Tetany
b. Pseudocyst
c. Pleural effusion
d. Pancreatic abscess
d. A pancreatic abscess, usually from an infected pseudocyst, is a collection of pus that must be drained to prevent infection of adjacent organs and sepsis. Tetany from hypocalcemia is treated with IV calcium gluconate (10%). Although pseudocysts usually
When assessing a patient with acute pancreatitis, the nurse would expect to find
a. hyperactive bowel sounds.
b. hypertension and tachycardia.
c. a temperature greater than 102� F (38.9� C).
d. severe left upper quadrant (LUQ) or midepigastric pain.
d. The predominant symptom of acute pancreatitis is
severe, deep abdominal pain that is usually located in the left upper quadrant (LUQ) but may be in the midepigastrium. Bowel sounds are decreased or absent, the patient is hypotensive and may manifest sy
Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis?
a. Increased serum calcium
b. Increased serum amylase
c. Increased urinary amylase
d. Decreased serum glucose
b. Although serum lipase levels and urinary amylase levels are increased, an increased serum amylase level is the criterion most commonly used to diagnose acute pancreatitis in the first 24 to 72 hours. Serum calcium levels are decreased and serum glucose
What treatment measure is used in the management of the patient with acute pancreatitis?
a. Surgery to remove the inflamed pancreas
b. Pancreatic enzyme supplements administered with meals
c. Nasogastric (NG) suction to prevent gastric contents from enter
c. Pancreatic rest and suppression of secretions are promoted by preventing any gastric contents from entering the duodenum, which would stimulate pancreatic activity. Surgery is not indicated for acute pancreatitis but may be used to drain abscesses or c
A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care?
a. Provide diversi
c. Positions that flex the trunk and draw the knees up to the abdomen help to relieve the pain of acute pancreatitis and positioning the patient on the side with the head elevated decreases abdominal tension. Diversional techniques are not as helpful as p
The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement?
a. "I should observe for fat in my stools."
b. "I must not use alcohol to prevent future attacks of pancreatitis."
c. "I shou
c. Sodium restriction is not indicated for patients recovering from acute pancreatitis, but fat is restricted. The stools should be observed for steatorrhea, indicating that fat digestion is impaired. Alcohol is a primary cause of pancreatitis and should
What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis?
a. The need to abstain from alcohol
b. Experience acute abdominal pain
c. Malabsorption and diabetes mellitus
d. Require a high-carbohydrate, high-
c. Chronic damage to the pancreas causes a deficiency of digestive enzymes and insulin resulting in malabsorption and diabetes mellitus. Abstinence from alcohol is necessary in both types of pancreatitis, as is a high-carbohydrate, high-protein, and low-f
The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)?
a. Avoid nicotine.
b. Eat bland foods.
c. Observe stools for steatorrhea.
d. Eat high-fat, lo
a, b, c. Measures to prevent attacks of pancreatitis are those that decrease the stimulation of the pancreas. Lower fat intake and foods that are less stimulating and irritating (bland) should be encouraged. High carbohydrates are less stimulating. Avoid
What is a risk factor associated with cancer of the pancreas?
a. Alcohol intake
b. Cigarette smoking
c. Exposure to asbestos
d. Increased dietary intake of spoiled milk products
b. Major risk factors for pancreatic cancer are cigarette smoking, chronic pancreatitis, diabetes, age, family history of pancreatic cancer, high-fat diet, and exposure to benzidine. Pancreatic cancer is not directly associated with alcohol intake, as pan
In a radical pancreaticoduodenectomy (Whipple procedure) for treatment of cancer of the pancreas, what anatomic structure is completely resected that will affect the patient's nutritional status?
a. Stomach
b. Pancreas
c. Common bile duct
d. Duodenum adjo
d. In a Whipple procedure the head of the pancreas, the duodenum which is adjacent to the pancreas, distal segment of the common bile duct, and the distal portion of the stomach are removed. The duodenum is responsible for the breakdown of food in the sma
Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all
that apply).
a. Obesity
b. Age over 40
c. Multiparous female
d. History of excessive alcohol intake
e. Family history of gallbladder disease
a, b, c, e, f. Incidence of cholelithiasis is higher in women, multiparous women, persons over 40 years of age, and those with family history and obesity. Postmenopausal women taking estrogen replacement therapy and younger women on oral contraceptives ha
Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this
condition (select all that apply)?
a. Fasting
b. Hypothyroidism
c. Parenteral nutrition
d. Prolonged immobility
e. Streptococcus pneumonia
a, c, d. Acalculous cholecystitis is associated with prolonged immobility, fasting, prolonged parenteral nutrition, and diabetes mellitus. Hypothyroidism, Streptococcus pneumoniae, and absence of bile in the intestine are unrelated to this condition.
A patient with an obstruction of the common bile duct has clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this clinical manifestation?
a. Water soluble (conjugated) bilirubin in the blood excreted into
b. Absence of bilirubin and bile salts in the intestine lead to clay-colored stools and steatorrhea. Soluble bilirubin in the blood excreted into the urine leads to dark urine. Contraction of the inflamed gallbladder leads to pain with fatty food intake.
The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?
a. It is noninvasive and is a very reliable method of detecting gallstones.
b. It is the only t
a. Ultrasonography is accurate in detecting gallstones and is a noninvasive procedure. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) may also be used when the patient is allergic to contrast medium. An IV cholangiogram
What treatment for acute cholecystitis will prevent further stimulation of the gallbladder?
a. NPO with NG suction
b. Incisional cholecystectomy
c. Administration of antiemetics
d. Administration of anticholinergics
a. NPO and nasogastric (NG) suction prevent gallbladder stimulation from food or fluids moving into the duodenum. Laparoscopic cholecystectomy is used more often than incisional cholecystectomy, but both remove the gallbladder, not its stimulation. Admini
Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?
a. Return to work in 2 to 3 weeks
b. Be hospitalized for 3 to 5 days postoperatively
c. Have a T-tube placed in the common bile duct to provide bile dra
d. The laparoscopic cholecystectomy requires one to four small abdominal incisions to visualize and remove the gallbladder, and the patient has small dressings placed over these incisions. The patient with an incisional cholecystectomy is usually hospital
A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse?
a. "A low-fat diet will prevent the development of further gallstones and should
c. After removal of the gallbladder, bile drains directly from the liver into the duodenum and a low-fat diet is recommended until adjustment to this change occurs. Most patients tolerate a regular diet with moderate fat intake but should avoid excessive
What must the nurse do to care for a T-tube in a patient following a cholecystectomy?
a. Keep the tube supported and free of kinks.
b. Attach the tube to low, continuous suction.
c. Clamp the tube when ambulating the patient.
d. Irrigate the tube with 10-
a. The T-tube drains bile from the common bile duct until swelling from trauma has subsided, and bile can freely enter the duodenum. The tube is placed to gravity drainage and should be kept open and free from kinks to prevent bile from backing up into th
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